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Closed Reduction

Closed reduction is a technique used for treating a broken bone in which the physician carefully manipulates the bone from the outside of the body. This method is used to correct bone position without making an incision to access the site of the fracture. Closed reductions can be used to treat not just fractures, but also dislocations.

Preparing for the Procedure
  1. The doctor will explain the procedure to you and your family.
  2. You will be positioned as appropriate so the doctor can have full access to the bone.
  3. If general anesthesia will be used, this will require more preparation, including a physical examination, blood tests, chest x-ray, and electrocardiogram (EKG). You will also have to fast for at least six to eight hours before the procedure or as recommended by the doctor.
In a closed reduction, the doctor will take an x-ray to visualize the bone and to determine the nature and position of the fracture. Pain medication and muscle relaxants will be given and then the orthopedic surgeon will carefully manipulate the bones to fit them back together. When the bones are aligned correctly, they are immobilized. Once a closed reduction is complete, x-ray is taken to confirm that the bones are properly placed.
After the closed reduction, the doctor will immobilize the bone using a cast, splint, or brace. A specific activity and rehabilitation program may be ordered in order to speed your recovery and maintain strength and range of motion.
  • To prevent your injured limb from swelling, rest it on pillows to elevate it above the level of your heart.
  • Keep the cast, splint or brace clean and dry.
  • Before walking on a “walking cast”, wait until it is completely dry.
  • Do not break off or cut any part of the cast.
  • You may be given crutches or a sling.
  • Follow your doctor's instructions for cast care.
A closed reduction is non-invasive treatment, which can speed healing time. Complications are rare, but may include:
  • Nerve damage.
  • Vascular injury.
  • Fat particles from the bone marrow or blood clots from veins that can dislodge and travel to the lungs.
  • Need for surgery if the bone does not heal properly.
  • Reaction to anesthesia.
Before the Procedure
  • The patient will be evaluated and diagnosed by the doctor before surgery is planned and the surgery will take place as soon as possible, depending on the patient’s readiness. This can be one to two days or within 24 hours.
  • It is recommended that you stay at a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.
After the Procedure
  • You should plan to remain in Thailand for at least one week through the duration of your treatment. This may vary from person to person, depending on your individual health and medical condition before the procedure as well as your age. Certain factors may require a longer stay in Thailand.
  • When you return for your follow-up appointment you will undergo a physical examination and you will receive documentation of your treatment history, a medical certificate, and a report detailing the closed reduction.
  • You may travel by car if it is a four-seater and it is recommended you sit in the passenger seat with the seat reclined. If you are traveling in a van, it is recommended you sit behind the driver and recline your seat.
  • Normally patients can travel home by air. Please discuss this with your doctor to confirm that you are healthy enough to fly before making flight arrangements. If you need a walking aid, such as a walker, crutches, or cane, be sure to let the airline know in advance if you will need a wheelchair at the airport and when you get off the airplane at your destination.
  • If you are traveling in First or Business class:
    • You can recline your seat normally, but support the affected limb to keep it from dangling and to maintain it in normal alignment. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation.
    • Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol.
    • If your doctor has recommended that you wear a brace or an arm sling, please keep it on for the duration of the flight, except when you recline your seat. You may take it off at that time. If you have an elastic bandage around the affected limb, you may loosen it slightly while in the air.
 
  • If you are traveling in Economy Class, be sure to select a seat in the exit row or a bulkhead seat.
  • You can recline your seat normally, but support the affected limb to keep it from dangling and to maintain it in normal alignment. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation. Please get up and move around at least every 30 minutes.
  • Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol.
  • If your doctor has recommended that you wear a brace or an arm sling, please keep it on for the duration of the flight. If you have an elastic bandage around the affected limb, you may loosen it slightly while in the air.
The success of a closed reduction depends on many factors. There are many factors that may result in an unsuccessful procedure such as the injury to nerves and/or blood vessels that may require an open surgery, the slowly healing bones, or the bone deformity.
 
What if this procedure is not performed?
Reductions are performed to restore normal position of bones and soft tissue after a fracture or dislocation. This promotes normal function after the fractured bone or dislocated joint and/or the supporting tissue heals. Attention is given to the nerves and blood vessels in the injured area as these can be damaged during the injury or during reduction. Treatment of the fracture or dislocation may involve treatment of damaged nerves and blood vessels as well. If you decide not to have this procedure, there may be associated risks to this decision. Please discuss it with your doctor.
 
Closed reduction is not always appropriate. Occasionally surgery is required for some fractures. The doctor can determine from x-rays whether or not surgery is necessary. If the surgeon is not sure, a closed reduction may be attempted first to see if the condition can be resolved.

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