Resetting a Broken Bone

What is involved in a closed and open fracture reduction

Resetting a broken brone involves placing the bone ends and fragments into their proper positions so that the bone can heal properly. This process is also called a fracture reduction.

Your healthcare provider may either perform a closed reduction (in which the skin is not cut) or an open reduction (in which an incision is made to reset the bone with pins, screws, and other appliances).

A fracture reduction requires a bone specialist known as an orthopedist who knows how to manipulate the broken ends into their original position and fix them securely into place.

This article walks you through the steps of what is involved in resetting a bone, both for closed reductions and open reductions.

Doctor and nurse treating boy's arm in hospital
ERproductions Ltd / Getty Images 

Resetting a Bone Fracture: Step-by-Step

Fracture reductions are typically performed in an emergency room. Less traumatic fractures may be treated at an urgent care clinic or even an orthopedist's office.

Here is what to expect if a fracture needs to be reduced.

Step 1: Diagnosis

The diagnosis of a bone fracture usually involves an X-ray. This helps characterize the nature of the fracture and identify any bone fragments or complications (such as a torn muscle or ruptured blood vessels) that may influence the treatment plan.

The fracture can either be closed (meaning the skin is intact) or open (meaning the skin is broken). Based on the findings, the orthopedist will decide if an open or closed reduction is needed as well as which fixation or immobilization devices are most appropriate.

Step 2: Selection of Anesthesia

Anesthesia is a medicine used to prevent pain during surgeries and other procedures. Depending on the severity of the break, this may involve:

In almost all situations where a fracture reduction is needed, some form of anesthesia will be needed.

Step 3: Sterilization

Sterilization of the skin is performed with alcohol, iodine, or some other type of sterilizing solution. This prevents bacteria from entering breaks in the skin which may not only lead to infection but also complications like septicemia (when an infection spreads into the bloodstream) and sepsis (the immune system's severe overreaction to an infection).

If there is an open fracture, the orthopedist will irrigate the wound with isotonic saline, a sterile salt-based solution used to remove contaminants, blood clots, and other impurities from the wound. The orthopedist will also debride the wound, meaning that all foreign and contaminated materials (including damaged tissue) are thoroughly extracted from the wound.

Step 4: Administration of Anesthesia

The most common form of anesthesia used for a closed fracture is a hematoma block. A hematoma block is done by injecting the anesthetic into the fracture hematoma (the pool of blood surrounding the broken bone). Delivering the drug in this way "bathes" the broken ends in the anesthetic, better ensuring sustained pain relief.

Regional or general anesthesia is most commonly used for open fractures. Regional anesthesia is injected close to a nerve, a bundle of nerves, or the spinal cord. General anesthesia is delivered by intravenous infusion (into a vein).

Step 5: Performing the Reduction

A fracture reduction involves manipulating the ends of the broken bone so that they are realigned into their original position. The approach differs for a closed and open reduction.

How to Reduce a Closed Fracture

For a closed reduction, the orthopedist will manipulate the bone ends in the following steps:

  1. Fracture distraction: This is where a broken bone is pulled out of its abnormal position.
  2. Increasing the deformity: This is when the broken bone is bent and moved.
  3. Decreasing the deformity: This is when the bone is released so that is in the correct, straightened position

What to Expect

During a closed reduction, you may feel pressure or a crunching sensation but usually not any significant pain.

How to Reduce an Open Fracture

For an open reduction, the surgeon will position the bone ends and fragment into the correct position using metal implants—such as plates, rods, or screws—to hold them together. This is referred to as internal fixation.

Internal fixation can be used to treat open fractures if the wound is clean, there is minimal skin or tissue damage, and the broken pieces of bone are well aligned.

If not, external fixation is used. This is when metal screws and rods project out of the skin so that they can be attached to an external stabilizing bar made of metal or carbon fiber. After healing, the external appliance is removed and the wounds are closed.

Step 6: Immobilization

Immobilizing the bone ensures that the broken ends are held firmly in place. After reducing an open or closed fracture, a splint or cast may be required. These are made of a variety of materials, the most common of which are plaster and fiberglass.

For severe open fractures, external fixation is the main source of immobilization. In some cases, traction may need to help ease the broken bone back into its correct position while reducing any weight-bearing stress on the limb.

Step 7: Post-Reduction X-Rays

Post-reduction X-rays are those taken after the fracture has been reduced. This ensures that the broken bones are correctly aligned. If they are not, further treatment may be needed, including surgery or repeat surgery.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Goh AXC, Yeo JW, Gao JF, et al. Comparative efficacy of anaesthetic methods for closed reduction of paediatric forearm fractures: a systematic review. Emerg Med J. 2022 Dec;39(12):888-96. doi:10.1136/emermed-2021-21210

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.