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Closed reduction

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Applying external manipulation to fractures to restore the length, alignment, and rotation of the involved bone is called closed reduction. Adequate analgesia is critical for its success. The specific reduction maneuver to be used depends on the pattern and location of the fracture. However, in general, axial traction and reversal of the deforming force is used to impart ligamentotaxis.

By reducing displaced fractures, soft tissue complications, such as swelling, skin breakdown, and neurovascular compromise, can be minimized. Therefore, even fractures that will undergo an internal fixation procedure should have an attempted closed reduction.

Once the reduction maneuver is done, the fracture must be immobilized. Most fractures require three-point contact to maintain the reduction. The joint above and below the fracture are included in the splint or cast. The extremity must be sufficiently padded, especially at sites of bony prominences. The cast or splint must also allow for typical post-injury swelling. Patients often report a decrease in pain once the fracture is appropriately reduced and splinted.