Skills Lab Exercise 6 Direct and indirect fracture

Skills Lab Exercise 6 Direct and indirect fracture reduction

Objectives At the end of this exercise, participants should be able to: • Directly reduce fractures using different techniques • Toggling, levering, point forceps, use of bone plate • Perform indirect reduction using an intra-medullary pin

Material • Bone models with fractures (x 4) • • Transverse radius fracture (x 2) Long oblique tibial fracture Comminuted femur fracture Small osteotome Point reduction forceps Serrated forceps or Verbrugge clamps 4 mm intramedullary pin and Jacobs chuck

Preparation • Prepare all models in advance, use same models for all groups • Elastic bands glued / screwed to bone to simulate soft tissue contraction • Apply 3. 5 mm plate to one radius fracture model then remove from one side, to be used for ‘reduction using plate’ • Transverse radius fracture to show toggling • Long oblique tibia fracture to show use of pointed forceps • Comminuted femur to show use of IM pin (indirect reduction) • All participants attempt different techniques for reduction

Techniques for direct fracture reduction

Techniques for indirect reduction

Exercise • Participants perform exercises • Reduce transverse radius fracture • Toggling • Levering • Reduce generic bone transverse fracture with plate and forceps • Reduce long oblique tibial fracture using point reduction forceps • Align comminuted femur fracture using blunt IM pin

Summary / discussion Understand techniques for fracture reduction • Toggling • Levering • Use of bone plate • Point reduction forceps • Alignment of comminuted fracture using an IM pin