When a bone is fractured, the bone fragments will get displaced or will lose their normal alignment.The loss of alignment of the bones if left alone can allow them to heal in the same position. This will have short term consequences such as loss of movement in the adjacent joints or damage to the joint surfaces due to abnormal pressure transmission. Various orthopedic procedures are available to repair the fracture and to realign the dislocated bone fragments. The fractured bones without any deformity can be realigned to their anatomical position by closed reduction procedure.

What is closed reduction and internal fixation?

Closed reduction and internal fixation (CRIF) is an orthopedic surgical procedure where the pieces of a broken bone are placed back into the right position indirectly without opening the fracture site per se and this position is held in place using wires, pins or metal plates. The procedure helps to manage bone fracture by realigning the bone fragments and stabilizing the fragments using internal fixation.

When is closed reduction and internal fixation recommended?

Your orthopedic surgeon may recommend CRIF for the following specific conditions.

• Fracture neck of femurInter trochanteric fracturea
• Fractures where the shaft of long bones (humerus, femur, and tibia) are involved, where treatment is done by intramedullary nails.
• Many children fractures

How do I prepare for this procedure?

A closed reduction is often performed as an emergency procedure. Your surgeon may enquire about:

• The time of your last meal
• Medicines and supplements that you take
• History of allergy
• Other medical conditions like diabetes, hypertension, etc.

You will also get instructions to arrange someone to ride you back home after the procedure.

The anesthesia team will examine you before the procedure.

What happens during the procedure?

Before the surgical procedure, you will be shifted to the operation room.

• Your anesthesiologist will administer the anesthesia or sedative medications through an intravenous line in your arm.
• You will be given an antibiotic along with anesthesia to decrease the risk of infection.
• Surgeon will manipulate the fracture by placing the bone in the right position by pushing or pulling the bone. This procedure is known as traction.
• Once the fragments are aligned in correct position, metal plates, screws, wires or pins are used to hold the fragments in place.
• A cast or splint may be used to give rest to the operated part post surgically

What are the post-procedure cares?

Soon after the procedure, you will be shifted to the recovery room where you will be monitored until the effect of anesthesia wears off. Once you are fully awake after the procedure, you will be given some medications for short-term pain after the surgery. You may also be taught how to use crutches.

If you do not have other injuries or problems, you will be able to go home the same day of the surgery or the next day. Before leaving, your surgeon will refer you to a physical therapist for rehabilitation therapy. The surgeon may give you some instructions for the post-procedure care at home. They may include:

• Take medicines to relieve pain and prevent infections.
• Give proper rest and keep the affected area in an elevated position to avoid swelling.
• Exercise as recommended by your physiotherapist to gain strength and complete range of motion.
• Visit the hospitals on the scheduled dates.

When the bone is healed, your surgeon may remove the pins, wires, and screws that are fixed during the procedure. Healing may need about 8 to 12 weeks depending upon the severity of the fracture. You may return to your normal activities as per the instructions of the surgeon and physical therapist.