Closed reduction

It is the alignment of fractured bone without visualization of the fracture line. Alignment of fractured fragments can be done without surgery. Occlusion of the teeth is used as a guiding factor. Fractures in the tooth bearing areas of the jaws are reduced satisfactorily by checking the final occlusion of the teeth.

Types of Closed Reduction

Reduction by manipulation

when the fractured fragments are adequately mobile without much overriding or impaction and the patient comes for treatment immediately after trauma (fresh fractures), then the digital or hand manipulation for reduction can be used. Specially designed instruments for grasping the fragments are available (Disimpaction forceps, bone holding forceps). It can be done under LA with sedation or under GA depending on the need of the patient.

Reduction by traction

Intraoral traction method

In intraoral traction method, prefabricated arch bars are attached to maxillary and mandibular dental arches by means of interdental wiring. Here, the fractured fragments are subjected to gradual elastic traction by placing the elastics, from upper to lower arch bars in a definite manner and direction depending on the fracture line.

Extraoral traction method.

In extraoral traction method, anchorage is taken usually from the intact skull of the patient and different types of head gears are used for various attachments, coming down over the face and connected to the arch bars by elastics and wires. Whenever the traction method is used, patient is encouraged to open and close the mouth slowly, so that the elastic traction starts functioning. Patient should be kept on analgesics for pain control, so that the elastic traction can be smooth. Once the proper occlusion is achieved, then the elastics are replaced by wires to carry out intermaxillary fixation or ligation (IML or IMF). It is also known as MMF (Maxillomandibular fixation). After the elastic traction is given, then the patient should be observed for a period of 12 to 24 hours. At the end of 48 hours, if satisfactory occlusion is not achieved, then open reduction is opted for.

Closed reduction Resources
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