How to Reset A Fracture - Realignment of Broken Bones

broken arm
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When you break your arm, leg or other bone, it will often need to be put back into the proper position. Doing so is called a "fracture reduction," but often it is referred to as "resetting a fracture."  Depending on the location of the fracture, the age of the patient, and a number of other factors, broken bones may need to be reset for proper healing.

Why Do Broken Bones Need to be Reset?

The bones are set in order to keep them in place while they are healing.

To get the broken ends of bones back into the original positions, your doctor will need to manipulate them in the bone setting procedure. Once they are back into position, they can be held in place while you heal. This can be done with a cast, brace, traction or external fixation. The ends of the bones will heal together as new bone grows back between the broken edges.

After a fracture, you may be taken to an emergency room and this procedure will be performed there. But if your fracture is less obvious or traumatic, you might instead go to an urgent care clinic or see your primary care physician and the diagnosis and procedure may be done there.

Steps for Setting a Broken Bone

  1. Diagnosis:
    The first step is to diagnose the injury, and see if it needs to be reset, or "reduced." Usually, this is done by obtaining x-rays of the injury, and determining if the fracture is out of place or not. You can expect a trip to the x-ray department.
  1. Anesthetic Selection:
    Broken bones hurt, and setting them is also going to be painful. In almost all situations where a fracture needs to be reduced, some anesthesia will be used. In some situations, the patient may need to be completely asleep for the procedure. But the most commonly used method is a type of local anesthesia called a "hematoma block." A hematoma block is performed by administering a local anesthetic to the area directly around the fracture.
  1. Sterilizing the Skin:
    If a hematoma block is selected as the anesthesia, the skin will be sterilized in with either alcohol, iodine, or another sterilization solution.  It is important to prevent infectious bacteria on the skin from getting to the area around the broken bone.  Infections of fractures can delay healing.
  2. Performing the Hematoma Block:
    Once the skin is properly sterilized, the hematoma block can be administered. The local anesthesia is injected from a syringe into the fracture hematoma. The hematoma is the collection of blood around the broken bone. Whenever a bone breaks, bleeding occurs at the site of the fracture. By injecting the local anesthetic into the hematoma, the ends of the broken bone are bathed in the local anesthetic. This provides excellent anesthesia to the area of the fracture.
  3. Performing the Reduction:
    After performing the hematoma block, much of the pain should be alleviated. At that point, the fracture can be reduced. Usually, this is performed by manipulating the ends of the broken bone so that they are in a better position. The patient may feel pressure, or feel a crunching sensation, but usually, there is not significant pain.
  1. Applying the Splint:
    After reducing the fracture, a splint can be applied to hold the fracture in the proper position.  Splints can be made of different materials, but common materials include plaster and fiberglass.
  2. Obtaining Post-Reduction X-Rays:
    Once the fracture has been reduced (or reset), an x-ray is obtained to ensure that broken bone is now in the proper position.  These x-rays can be used to determine if the fracture alignment is adequate or if further treatment is needed, even surgery, to realign the bone and hold it in position.

Source:

Fractures (Broken Bones), American Academy of Orthopaedic Surgeons, October, 2012.

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