Reposition

Repositioning fractured bones is a procedure in which the displaced parts of broken bones are brought back into the correct anatomical position without the need for making an incision in the skin. This is typically achieved through manual manipulation or with the aid of medical instruments. The goal of repositioning is to ensure proper bone healing and restoration of normal functionality.

The advantages of fractured bones repositioning include:

• Short duration of the procedure and faster recovery – The advantage of repositioning is the rapid achievement of the correct position of the moving parts of the bones, which leads to a short duration of the procedure itself. This allows the process of bone healing and rehabilitation to begin as soon as possible, thereby reducing the total recovery time of the patient.
• Reduced impact on soft tissues due to the absence of incisions: Repositioning is performed carefully and precisely to minimize additional stress or damage to surrounding soft tissues such as muscles, ligaments, and nerves. This reduces the risk of complications and enhances the patient’s recovery.
• Decreased pressure on the skin and swelling: Repositioning helps reduce the pressure that could otherwise cause skin irritation or damage. It can also help reduce swelling, as the correct alignment of bones allows normal blood and lymph flow, which can accelerate the resorption of swelling and reduce discomfort.
• Preservation of bone healing potential: Repositioning ensures that the mobile bone fragments are correctly aligned and positioned anatomically, creating favorable conditions for bone healing. Proper bone healing is crucial for restoring strength and stability, contributing to a faster and more efficient recovery.
• Reduction of postoperative pain and swelling – Proper reposition allows the bones to be properly aligned and stabilized, which can reduce discomfort and pain after surgery. Reducing pain and swelling can improve patient comfort, facilitate rehabilitation, and speed up the healing process.
• Increased probability of returning to normal function- By bringing the moving bone parts into the correct position, the reposition helps restore normal functionality of the affected part of the body. This may include restoring normal movement, the ability to walk, or the use of extremities.
• Faster fracture healing: Repositioning enables proper bone alignment, which enhances the bones’ ability to heal together and form a solid union. This results in a faster fracture healing process and reduces the time required for complete recovery.
• Strengthening the bone after healing. Proper reposition allows the bones to heal properly. Properly healed bones tend to be firmer and more resistant to future injuries compared to bones that have not been adequately repositioned. This process of remodeling allows the bones to adapt to the load and stress exerted on them during normal activities.
• Low risk of infection: Proper repositioning helps reduce trauma to the surrounding tissues, minimizing the possibility of skin damage and exposure of the internal body to microorganisms. Additionally, proper alignment of bones facilitates postoperative care and hygiene, further reducing the risk of infection.

It is important to note that each fracture case is unique, and repositioning should be approached individually, considering the patient’s specific circumstances and the nature of the fracture.

Possible risks during bone repositioning

While closed bone repositioning is a relatively safe procedure, there can be certain risks and complications. Some potential complications include:

Improper bone healing: Despite the goal of repositioning to achieve proper bone alignment for optimal healing, sometimes bones may not heal correctly, or deformities may occur. This can lead to poor functional outcomes and the need for additional treatment. In some cases, re-fracture (a repeated fracture of the bone) can occur after closed repositioning. This typically happens if the bones are not adequately stabilized or if the patient prematurely stresses the injured area.

Soft tissue damage: Manipulation of bones during repositioning can cause damage to surrounding soft tissues, such as muscles, ligaments, or blood vessels. This can lead to mobility difficulties and prolonged recovery.

Neurovascular complications: The repositioning procedure can increase the risk of damaging nerve structures or blood vessels that pass near the site of the bone fracture. This can lead to neurological or vascular deficits.

Surgery may be required after bone repositioning in certain cases: if closed repositioning fails to achieve proper alignment, if there is bone instability, complex fractures involving soft tissue damage, or various complications including infections, incomplete fracture healing, presence of foreign bodies, or complications that require surgical intervention.

These complications, although possible, are not common, and most patients successfully recover from closed bone repositioning.

Procedure of bone repositioning:

The procedure of bone repositioning can vary depending on the type of fracture, its location, and other individual factors. The basic general steps involved in the procedure of bone repositioning are as follows:

1. Fracture evaluation: The doctor will first assess the severity and nature of the fracture through physical examination and medical imaging diagnostics, such as X-rays or CT scans.
2. Patient preparation: The patient will be prepared for the procedure, which may involve the use of local or general anesthesia, depending on the complexity of the fracture and the patient’s preferences.
3. Patient positioning: The patient will be properly positioned to allow the doctor access and checkup of the fractured bones.
4. Bone manipulation: The doctor will carefully manipulate the fractured parts of the bones to properly align them and place them in the correct anatomical position. This may include manual pulling, rotation or mild extension or flexion of fractured bone segments.
5. Support or fixation: After repositioning, the doctor may apply the appropriate method of support or fixation to maintain the correct position of the bones during the healing process. This may include the application of gypsum, orthosis, screws, plates, or external fixators.
6. Monitoring and verification: After placing the bones in the correct position, the doctor will perform the check again to confirm the correct alignment and stability of the bones. Additional X-rays can be used to confirm the correct position of the bones.

What to expect after the procedure?

After the bone repositioning, you can expect some level of pain and swelling in the area of the fracture. This is a normal response of the body to injury and the repositioning procedure. Your doctor will recommend appropriate analgesics and measures to reduce pain and swelling, such as applying ice, elevation of the extremities, and taking prescribed medications.

In most cases, immobilization is applied after repositioning to maintain the bones in the proper position and facilitate the healing process. This may involve the application of a cast, orthosis, or other means of fixation. Your doctor will schedule regular follow-up appointments to monitor the bone healing process and assess the progress of your recovery.

After a period of immobilization, physical therapy and rehabilitation may be required to restore the strength, mobility and functionality of the affected part of the body. The recovery time after bone reposition may vary depending on the type of fracture, the location of the injury and individual factors. It is important to follow the doctor’s instructions, adhere to a therapeutic plan and gradually return to normal activities to reduce the risk of complications or re-injury.

Self-help at home

Carefully follow the instructions given to you by your doctor regarding immobilization, medication, and other aspects of recovery.

In the first few days after repositioning, applying ice to the fracture area can help reduce swelling and relieve pain. Keep the ice wrapped in a towel on the broken area for 10-15 minutes several times a day. Elevation of the injured extremities helps to reduce swelling. Lie down or sit while supporting the injured area with a pillow or pad to keep it above heart level. It is important to avoid putting weight on or unnecessarily moving the injured part. Adhere to the recommended immobilization and activity restrictions to allow the bones to heal.

Maintain good hygiene of the injured area. Be careful not to wet or moisten the cast, if applied. If allowed, lightly wipe the plaster surface with a damp cloth to maintain cleanliness. Watch out for a healthy diet rich in nutrients to support the bone healing process. Also, drink enough water to stay hydrated, which is important for recovery.

Cast or splint care

• Keep the cast or splint dry, avoiding exposure to water, as it can damage the material or cause skin irritation underneath. If the cast does get wet, inform your doctor immediately.
• If you experience itching under the cast, do not insert any objects inside to scratch it, as it can cause irritation or abrasions. Instead, you can try lightly tapping or patting the cast to temporarily relieve the itching.
• Only qualified medical professionals should change or remove the cast or splint. If you notice that the cast is cracked, shifted, or causing discomfort, contact your doctor immediately.
• Follow your doctor’s instructions regarding the reduction of swelling and the use of painkillers. Applying ice, elevation of the extremities and regular intake of prescribed medications can help relieve swelling and discomfort.
• Do not put objects, dust, lotions or powders inside the cast or splint. This can cause skin irritation or lead to infection.
• Make sure that the skin under the cast remains clean and dry. If allowed, you can gently wipe the cast surface with a damp cloth to remove dirt and sweat.

When to call a doctor after repositioning?

1. If there is a sudden increase or unbearable pain in the fracture area after the reposition, you should contact your doctor. This could be a sign of complications or improper bone healing.
2. If swelling or redness increases or spreads beyond the fracture area, you should consult a doctor. This may indicate infection or other complications.
3. If you experience loss of sensation or mobility in the injured area after repositioning, you should immediately consult a doctor. This may indicate nerve or blood vessel damage.
4. If you notice that the skin around the fracture becomes blue, purple, or cold, this may indicate reduced blood flow. Talk to your doctor in these situations.
5. If you see that the cast or splint is shifting, cracking, breaking, or causing discomfort, you should contact your doctor immediately. This may require reassessment and possible replacement of the immobilization.
6. If you have any unusual symptoms such as fever, sweating, nausea, vomiting, or any other changes that appear concerning, you should consult your doctor for advice.

Bone reposition is a bone manipulation procedure to return fractured parts to the correct position. The goal of the reposition is to achieve proper healing of the bone and the restoration of normal function of the damaged area. The reposition can be performed in a variety of ways, including a closed reposition (manual bone restoration) or an open reposition (surgical placement of the bone).

Benefits of closed repositioning include reducing pain, swelling and pressure on soft tissues, preserving bone healing potential, faster fracture healing, increased likelihood of returning to normal function, reducing the risk of infection, and maintaining bone strength after healing. After repositioning, patients can expect a certain recovery period that includes immobilization, pain and swelling control, regular check-ups with a doctor, physical therapy, and adherence to rehabilitation instructions.

It is important to follow the doctor’s instructions, adhere to immobilization and activity restrictions, maintain hygiene of the injured area, consume a healthy diet, and contact the doctor if any unusual symptoms or complications occur.

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