Closed Reduction (Fracture Reduction Without Incision)

Overview

Closed reduction is a non-surgical procedure that may be used to realign broken bone fragments through manual manipulation without an incision. It can be considered for certain fractures and dislocations when alignment can generally be restored without open surgery. The procedure often uses pain control such as local anesthesia, regional anesthesia, procedural sedation, or general anesthesia, followed by immobilization with a splint or cast. Key outcomes typically include improved alignment, reduced deformity, and support for healing, although follow-up imaging and monitoring can be important because alignment can sometimes shift after reduction.

Indications

This procedure may be considered when:

• •Displaced fractures where improved alignment may be achievable without open surgery (for example, certain distal radius, forearm, ankle, or finger fractures).
• •Acute joint dislocations where prompt reduction can generally reduce pain and may lower risk of soft-tissue or neurovascular compromise (for example, shoulder or finger dislocations).
• •Fractures with angulation, shortening, or rotational deformity that may be correctable with traction and manipulation.
• •Pediatric fractures where remodeling potential can often be higher and closed techniques may be preferred when stable alignment can be maintained.
• •Situations where swelling or soft-tissue condition can make immediate open surgery less suitable, and temporary closed reduction with splinting may be used as a bridge.
• •Fracture patterns that can generally be stabilized with casting/splinting after reduction and have acceptable risk of redisplacement with follow-up monitoring.

How It Works

The procedure typically involves several coordinated steps:

• •Pre-reduction evaluation can include assessment of skin integrity, swelling, open wounds, and baseline neurovascular status (distal pulses, capillary refill, sensation, and motor function).
• •Imaging (often orthogonal X-rays) may be used to define fracture geometry, displacement, and joint involvement; comparison views can sometimes be used.
• •Analgesia and anesthesia selection can be matched to expected pain and muscle spasm; procedural sedation or regional anesthesia may reduce guarding and facilitate controlled manipulation.
• •Traction can be applied along the long axis of the limb to restore length and reduce overlap of fragments; counter-traction can stabilize the proximal segment.
• •Corrective forces can then be applied to address angulation and translation; rotational alignment can be assessed clinically and corrected with controlled rotation.
• •For dislocations, reduction maneuvers can aim to reverse the mechanism of injury while minimizing torque on soft tissues; muscle relaxation from sedation/anesthesia can often improve success.
• •After repositioning, the limb can be held in the reduced position while a splint or cast is molded to maintain alignment; three-point molding principles may be used for certain fractures.
• •Post-reduction imaging can confirm restoration of alignment parameters (for example, angulation, displacement, joint congruity) and can identify interposed fragments or persistent subluxation.
• •Repeat neurovascular examination can detect complications such as nerve stretch injury or vascular compromise that may occur during injury or manipulation.
• •If alignment is unstable or unacceptable, additional attempts, alternative immobilization, or escalation to operative management (such as percutaneous pinning or open reduction) may be considered.
• •Follow-up imaging at intervals can monitor for loss of reduction, particularly during early swelling changes and cast settling.

Risks

As with any surgical procedure, potential risks include:

• •Loss of reduction (redisplacement) can occur after initial alignment, particularly with unstable fracture patterns or swelling changes under a cast or splint.
• •Neurovascular injury may occur from the original injury or during manipulation, including nerve traction neuropraxia or vascular compromise that can present with pain, pallor, paresthesia, weakness, or diminished pulses.
• •Compartment syndrome can rarely develop after fractures and reduction, typically presenting with escalating pain and tense swelling; it can be limb-threatening if unrecognized.
• •Skin complications can include pressure sores, blistering, or skin breakdown from splints/casts, especially with swelling or inadequate padding.
• •Joint stiffness and reduced range of motion can occur, often related to immobilization span and soft-tissue injury severity.
• •Malunion (healing in suboptimal alignment) can occur if alignment is not adequately restored or if reduction is lost during healing.
• •Nonunion or delayed union can occur in some fractures depending on blood supply, fracture pattern, and patient factors, even when reduction is initially adequate.
• •Sedation/anesthesia-related complications may include respiratory depression, aspiration risk, nausea, vomiting, allergic reactions, or hemodynamic changes, depending on the agents used and patient comorbidities.
• •Pain flare and swelling can occur after manipulation, and may require reassessment of immobilization fit and neurovascular status.

Recovery Expectations

Recovery follows a gradual progression:

• •Immediate (same day): Observation may span until sedation/anesthesia effects resolve; repeat neurovascular checks can generally occur before discharge from the care setting.
• •First 24–72 hours: Swelling can often peak; splinting rather than circumferential casting may be used initially, and reassessment can be needed if pain or tightness increases.
• •First 1–2 weeks: Follow-up evaluation and imaging can generally occur to confirm maintained alignment and adjust immobilization as swelling changes.
• •Weeks 3–6 (varies by bone and age): Immobilization may span several weeks; some fractures can transition from splint to cast or to a removable brace depending on stability and healing progress.
• •Weeks 6–12 (varies): Gradual return of motion can often begin after immobilization ends; stiffness can be common and may improve over time with guided rehabilitation.
• •Months 3–6: Strength and function can generally continue to improve; higher-demand activities may require a longer span depending on fracture type, healing, and symptoms.
• •Any time during recovery: New numbness, worsening pain, increasing swelling, or color/temperature change can indicate complications and may prompt urgent reassessment in clinical practice.

Alternatives

Depending on individual circumstances, alternatives may include:

• •Immobilization without reduction (casting or splinting) may be considered for non-displaced or acceptably aligned fractures.
• •Open reduction and internal fixation (ORIF) can be used when alignment cannot generally be restored or maintained with closed methods, or when joint congruity requires direct visualization.
• •Closed reduction with percutaneous pinning (CRPP) may be used when closed alignment is achievable but stability is limited with casting alone.
• •External fixation can be considered for certain unstable fractures, significant soft-tissue swelling, or polytrauma scenarios where staged management may be preferred.
• •Traction (temporary or definitive in selected cases) can be used to maintain length and alignment, particularly in specific fracture types or settings.
• •Arthroplasty or joint replacement can be considered in selected fractures (often in older adults) where fixation may be less reliable and functional restoration is prioritized.

Sources

• AAOS OrthoInfo - Fractures (Broken Bones)
• MedlinePlus (NIH) - Dislocations
• Cleveland Clinic - Broken Bone (Fracture)
• Johns Hopkins Medicine - Fractures