Reduction with Distraction

Abstract

Comminuted fractures, especially those involving joints, pose several problems. The first is the loss of intrinsic stability. Small comminuted fragments cannot by themselves be reduced and held in a stable state by compression. Secondly, a deforming force is still partially present in the form of the intact extremity proximal to the fracture. This force interacts with the elastic musculature that traverses the fracture zone and inserts on the distal fragment. Most residual displacements of fractures are a result of shortening, the weight of the extremity, and the pull of the elastic musculature surrounding the fractured extremity. Mechanical failures of the musculoskeletal system are usually either through bone or through ligament, and less frequently through both in the same location. In comminuted fractures there is usually some critical soft tissue, i. e., ligaments, capsule, or periosteum, that remains intact.