Reduction techniques for osteosynthesis of intra-articular fractures

Abstract

The cornerstones for treatment of articular fractures are gentle handling of soft tissues and anatomical reconstruction of the articular surface with stable fixation, which enables a functional aftercare. By respecting these principles, satisfactory functional and radiological results with low complication rates can be achieved even for complex fracture patterns. Fracture complexity varies with the energy load during the trauma mechanism. The personality of the fracture must be recognized and totally understood by the operating trauma surgeon. The soft tissue situation in particular is of decisive importance. The definition of a fracture as a soft tissue injury that happens to have a broken bone in it is generally accepted and the local soft tissue status is seen as extremely significant. The success or failure of the treatment correlates with the correct interpretation of the overall situation. Meticulous planning is therefore an indispensable prerequisite for operative fracture treatment. Successful fracture management depends on individualized decision making with respect to optimal timing of the operative intervention, reconstruction strategy of the articular surface, choice of surgical approach, reduction maneuver technique and choice of implant. This strategy must be adapted to individual-specific fracture patterns and the patient’s general condition. The aim of this article is to provide an overview of the strategy and technique in management of articular fractures, with the main focus on reduction maneuver techniques.