Fracture Reduction and Management
Decision Algorithm for Reduction Method
- The American College of Rheumatology recommends performing closed reduction for stable, non-displaced, or minimally displaced fractures where anatomic alignment can be achieved and maintained with casting or splinting 1
- Proceed directly to open reduction and internal fixation for displaced unstable fractures, particularly when closed reduction cannot achieve or maintain anatomic alignment 1
Immediate Post-Reduction Management
- Provide appropriate pain relief immediately and throughout the treatment period, as inadequate pain management leads to poor outcomes 1, 2
- Ensure proper immobilization technique appropriate to the fracture type and reduction method 1
Early Mobilization Protocol
- Begin finger motion immediately after casting or surgery for upper extremity fractures to prevent edema and stiffness 3, 2
- Introduce physical training and muscle strengthening early in the postfracture period 3, 2
Monitoring and Follow-Up
- Obtain follow-up imaging at regular intervals to ensure proper healing and detect any loss of reduction early 2
- Progress to aggressive mobilization once the fracture shows adequate healing on imaging 2
Critical Pitfalls to Avoid
- Avoid delayed mobilization: starting range-of-motion exercises late results in stiffness and suboptimal functional recovery 2
- Do not use high-pulse dosages of vitamin D for fracture patients, as these increase fall risk rather than prevent it 3
- Ensure close monitoring with imaging, as insufficient follow-up leads to missed complications 2
Secondary Fracture Prevention (Age ≥50)
- Systematically evaluate every patient aged 50 years and over for subsequent fracture risk after any fragility fracture 3
- Prescribe calcium 1000-1200 mg/day combined with vitamin D 800 IU/day, which reduces non-vertebral fractures by 15-20% and falls by 20% 3
- Initiate pharmacological treatment with alendronate or risedronate as first-line agents for patients at high risk of subsequent fractures 3