Preferably, an implant should help in reducing and stabilizing a fracture. Reduction can be secured through intervention in bone. The reduction secured by an anatomically shaped intramedullary nails is its good example. While the intra-medullary nail go across the fracture, reduction must happen in coronal and sagittal planes.
Some elongating can be obtained in multi-fragment shaft fractures after distal interconnecting by hammering the intra-medullary nail further distally. Though accurate planning is required with action. The tension in soft tissues is amplified which inclined to realign the fragments to their actual location. The push-pull technique is an effective and normally used technique for reducing and distracting a fracture like fracture of forearm. This technique is used with a laminar spreader and specific reduction tools.
The titanium bone plate is used in an anti-glide function as a simple and tender reduction procedure. Affixing a perfectly contoured titanium bone plate to one fragment of an angled metaphyseal fracture results in dislocating the opposite fragment and reducing it consequently. As the reduction takes place while retaining the durability, this technique puts right minor dislocations and angulations.
When an angled blade plate is inserted accurately in the epimetaphyseal segment of the bone, it will move the diaphyseal segment into anatomical alignment due to its shape,. At first, the blade of the titanium bone plate is inserted into the distal or adjoining fragment. After that by using the reduction forceps the shaft is reduced to the side-plate to hold the two simultaneously. With the help of the push-pull technique using the articulated tension device insertion, a good aligning ° is achieved, however, it is practically very challenging.
After the preparation of the blade seating canal, first the titanium bone plate is inserted into the sub-muscular tunnel by the side of the femoral shaft with its blade pointing sidewise. Then this plate is rotated through 180° which results in the blade fronting the bone. Next step of inserting the blade requires manipulation with the help of a joystick to align the blade canal to the blade. Length and axis are reinstated with linear traction
The lateral fragment of a distal radial fracture can be distracted and rotated just like the Hohmann technique with a K-wire inserted through the fracture line. Final stabilization is attained by introducing the K-wire into the cortex of the opposite side of the radius.
The technique of insertion of threaded K-wire or Schanz screws is mostly applied in articular fractures (distal radius, proximal humerus, acetabulum). This technique allows manipulation of bone fragment with or without a direct view. In the elbow fracture surgery Radial Head Prosthesis required to join the broken bone.
The external fixator can be used for indirect reduction, but tender elongating is tougher than with the distractor. Application of friction across a joint, soft tissues and ligaments on every side of the fracture area can help in attaining reduction (soft-tissue taxis, ligamentotaxis).
In reducing a multi-fragmentary particularly butterfly fragment fracture in the diaphysis, a temporary cerclage can be very useful. But this technique has the drawback of short term circumferential uncovering of the bone during the application of the wire, so only one wire Video AO20194n must be used.