The following illustrations of the different reduction techniques provide examples that can be used or modified as necessary. Unless the fracture is older and consolidated, the surgeon usually begins with less invasive reduction techniques, and if they do not succeed, progresses to techniques which require more fracture exposure. With other fractures, open reduction may be necessary. Percutaneous reduction aids (pointed reduction forceps, Schanz screws or ball-spike pusher) may allow reduction without opening the fracture. Sometimes only mild traction and rotational adjustment are required. Reduction is usually more challenging with proximal and distal fractures as well as with delayed treatment. This should be done before reaming and nail insertion. Even after guide-wire insertion, further correction of alignment may be needed to avoid deformity. Length, angulation, and rotation are all important to restore. ![]() The fracture must be reduced to allow guide-wire placement, during reaming, and during nail insertion. Reduction is an essential part of intramedullary nailing. associated with extended deep vein thrombosis prophylaxis following hip fracture surgery. Dynamic (oval) rather than static (round) holes may be used when the fracture pattern prevents shortening. To ensure adequate fixation of acute tibial fractures, use of locking screws both proximally and distally is advisable. These have been called “dynamic locking” screw holes (see illustrations). Some locking screw holes are designed with an oval shape so that a screw at one end of the oval will allow some fracture impaction, but still control rotation as well as limit shortening to the length of the oval. Length-stable locking is often called “static” locking. This is usually not necessary if distraction is avoided, but may be considered when a fracture fixed with length-stable locking is healing slowly. Delayed removal of locking screws (“dynamization”) was often advised. When locking nails were first introduced, their potential for impaired healing was recognized. European Journal of Vascular and Endovascular Surgery (2014). However, locking prevents impaction of distracted fractures, and interferes with their healing. DVT occurs mainly in the lower extremities and, to a lesser extent, in the upper extremities. Locked nails permit stable fixation which controls length, rotation, and alignment of proximal and distal fractures. Background Emerging evidence suggests aspirin may be an effective venous thromboembolism (VTE) prophylaxis for orthopaedic trauma patients, with fewer bleeding complications. Deep vein thrombosis (DVT) is the formation or presence of a thrombus in the deep veins. ![]() Modern IM nails permit placement of locking screws through bone and nail, to improve fixation both proximally and distally.
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