Initially, indirect reduction aims to obtain a fractured bone alignment before internal fixation or in combination with a fixation device. Bridge plating is generally carried out following the indirect reduction technique. The fundamental principle of indirect reduction is a distraction and is applied to the metaphyseal and diaphyseal bone.
A logical ground is provided by muscular covering surrounding the diaphysis of long bones because periosteal attachment of any single fragment and a controlled pull on the muscle is likely to align it in the preferred direction. An aligned pressure is applied by covering muscle under distraction on the shaft, relieving fragments into place. The same happens in the case of epiphyseal and metaphyseal bone. However, the distraction needed to align fragments is shifted less through muscular attachments as compared to capsular tissues, ligaments, and tendons. This situation is described as “ligamentotaxis” by Vidal. And this is also considered as part of conservative fracture management.
In the same way, indirect reduction at a fracture point is produced by traction applied by a limb’s traction table. Simultaneously, the reduction can be controlled better by using an implant or a large distractor to a single bone. The indirect reduction technique can be applied in combination with an external fixator or a distractor, or locking bone plate. A wide range of these fixators and plates are available from Orthopedic instruments manufacturers.
Points to be Considered for Implants
- First of all, the surgeon needs to study the fracture morphology for biological or bridge plating. Radial Head Prosthesis may be preferred for radial head fracture.
- Careful planning of reduction is required and selection of suitable plate keeping in mind the fracture’s anatomical location and nature.
- Proper care is needed while implanting the plate. For example, if an angled blade plate is to be applied, it must be placed sub muscularly. Then before reduction, it is to be inserted into the metaphyseal fragment. Then reduction is achieved by using a locking bone plate.
- Plate as a splint on the exterior of the bone is a common factor in all bridge plating, just like a nail which splints the bone from the bone’s interior.
- Recently, the application of splints in complex fractures has been acknowledged as a recommendable concept.
- The wave plate has good reasons for fracture treatment. E.g., less interference with blood supply avoids bone contact, alters the load to the tensile forces on the plate, and provides perfect bone grafting access at the fracture area.
- Practically, the bridge plate’s end is to be fixed firmly to the main fragments by using three to four screws. The strength of fixation to every main fragment must be balanced.
- In short fractures, recurring bending stresses are directed to the plate’s short segment or screw hole, resulting in fatigue.
- Long plate bridging a large fragmentation area with a short fixation on any end of the bone will go through a significant deformation force because bending stress per unit area is low that lessens the plate failure risk.