Closed reduction vs Open Reduction

What is an open reduction?

When a broken bone cannot be properly realigned through a simple method, open reduction becomes necessary. Open reduction involves orthopedic surgery, where the surgeon makes an incision near the fracture site to visualize and reposition bone fragments for proper healing.

Internal fixation refers to the use of medical devices like plates and screws, which are used to hold the bones in place. This method is essential for displaced fractures, where the bone fragments are significantly out of place. Open reduction surgery is crucial in preventing complications like avascular necrosis and ensuring the fractured bone returns to its normal anatomical position.

Board-certified orthopedic surgeons often perform this procedure, especially when closed reduction and internal fixation cannot achieve the desired results. Using pain medicine and advanced techniques ensures that the bone heals correctly, avoiding issues with soft tissue and promoting optimal bone healing.

What is a closed reduction?

When a bone breaks, closed reduction offers an effective solution for realignment without surgery. In this non-surgical procedure, an orthopedic specialist carefully manipulates the broken bone externally to align the fragments properly and ensure the fracture heals correctly.

Pain medication, local anesthetic, or general anesthesia are frequently used to relieve discomfort and keep blood pressure constant. This approach is beneficial for fractures when soft tissues and blood flow remain intact, allowing the healing process to occur naturally without needing internal fixation devices.

Closed reductions are a less intrusive alternative to open reduction and internal fixation (ORIF), making them suitable for various fractures in everyday life.

Closed Reduction vs Open Reduction

Choosing between open and closed reduction is critical for successful fracture care. Understanding the processes, benefits, risks, and specific conditions each therapy addresses substantially impacts patient outcomes and recovery.

Procedure

Open reduction and internal fixation (ORIF) involves surgically exposing the fracture site to align bone pieces correctly. This procedure often requires an incision to access the broken bones directly, followed by the use of metal pins, plates, or screws to maintain proper alignment. Local anesthesia or general anesthesia is administered to manage pain during the surgery.

On the other hand, closed reduction is a non-surgical technique that involves manipulating the broken bone externally to obtain the proper position. This procedure is less invasive and usually involves using a splint or cast to support the bone without making an incision.

Both techniques strive to restore the broken bone's strength and function, however the choice is determined by the nature and degree of the fracture.

Benefits

The advantages of open reduction include accurate alignment of the bone pieces, which is critical for complex fractures. This approach can dramatically reduce the likelihood of poor healing and problems like nonunion or malunion. Open reduction is beneficial for open fractures in which the bone has penetrated the skin and fractures involving several fragments.

In contrast, closed reduction is less intrusive and time-consuming. It lowers the chance of infection and relieves the pain associated with surgery. This approach is appropriate for minor fractures that may be treated without exposing the bone, allowing for a faster return to normal activities.

Risks and complications

Both open and closed reductions pose dangers and consequences. Open reduction necessitates surgical treatment, which carries risks such as infection, increased pain, and swelling around the incision site. Metal pins or K wires might cause issues if they becomes diseased or loosened.

While less invasive, closed reduction may not always achieve perfect alignment, especially in complex fractures, leading to potential issues in the healing process. Improperly set bones can result in chronic pain, deformity, or the need for subsequent surgeries. The patient's overall health, the severity of the injury, and the precise fracture features are all important considerations when deciding on the optimal method.

Conditions treated

Open reduction is usually used for serious fractures with many bone pieces or when the bone has broken through the skin. It is also desirable when internal fixation is required to keep the bone aligned while healing. Complex pelvic and spine fractures, as well as some forms of wrist or ankle fractures, are frequently treated by open reduction.

Closed reduction is appropriate for less severe fractures in which the bone fragments can be moved externally to align properly. It is commonly used to treat uncomplicated forearm, lower leg, and clavicle fractures. Both procedures attempt to restore function and strength; however, the choice is made based on the fracture's complexity and location.

Importance of learning the difference

Understanding the differences between open and closed reduction is vital in optimizing patient care and treatment outcomes. Here are key reasons why this knowledge is crucial:

• Accurate diagnosis and treatment: Properly distinguishing between open and closed reduction ensures that patients receive the most appropriate fracture reduction procedure, whether it's a broken bone needing internal fixation or a simpler injury that can heal properly without surgery.
• Minimizing risks: Knowing when to opt for surgery versus non-surgical methods helps in reducing the risk of complications such as infection, improper healing, and chronic pain.
• Efficient use of resources: Recognizing the time-consuming nature of open reduction and the quicker, less invasive approach of closed reduction allows for better resource allocation and patient scheduling.
• Patient education: Educating patients about the specifics of their procedure, including using K wires or internal fixation devices, helps manage their expectations and ensure compliance with post-procedure care.
• Enhanced healing: Choosing the correct method for fracture reduction can significantly impact how well and quickly the bone heals, directly affecting the patient's recovery and ability to return to everyday activities.
• Pain management: Understanding the pain implications of each method allows for better pre- and post-procedure pain management, improving overall patient comfort.
• Preventing long-term issues: Proper selection between open and closed reduction can prevent long-term issues, restoring strength and function more effectively.
• Tailored care plans: Knowledge of both procedures enables healthcare providers to create personalized care plans that consider the specific nature of the injury and the patient's overall health.
• Infection control: Awareness of the higher infection risk associated with surgical procedures can lead to more stringent infection control measures, particularly in open reduction cases.
• Professional competence: Mastery of these concepts enhances a healthcare professional's competence, making them more adept at handling a wide range of fracture scenarios efficiently and effectively.

Reduction choice considerations

Selecting the appropriate method for fracture reduction—whether open or closed reduction—depends on several factors:

• Fracture type and severity: Complex fractures with multiple bone fragments or significant displacement often require ORIF for precise alignment.
• Patient health: Overall health, age, and activity level influence the choice. Patients with conditions affecting bone healing might benefit from non-surgical options.
• Risk of complications: Closed reduction reduces the need for an incision, lowering the risk of infection and swelling, while surgical methods provide stability for severe fractures.
• Pain and recovery: Medicine to manage pain and inflammation is crucial, but the reduction method impacts overall recovery and rehabilitation.

Key takeaways

Healthcare practitioners must understand the differences between open reduction  and closed reduction. Open reduction, which involves surgical intervention and internal fixation, is most suited for difficult and displaced fractures since it provides exact alignment and stability. On the other hand, closed reduction is a less invasive approach better suited to minor fractures, lowering the risk of infection and promoting faster recovery.

These treatments should be chosen considering the fracture type, patient health, potential complications, and overall treatment goals to achieve optimal bone healing and effective restoration of strength and function.