Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.

When you break an arm, leg, or any other bone of the body, that bone will often need to be put back into place so that it can heal properly. The process of resetting a bone is called a fracture reduction.

Fracture reduction requires a doctor to manipulate the broken ends of the bone into their original position and fix them in place with a cast, brace, traction, or external fixation. By doing so, new bone can grow back cleanly between the broken edges and better ensure that mobility and bone integrity are restored.

Fracture reductions are typically performed in an emergency room, however, less traumatic fractures may be treated at an urgent care clinic or physician's office.

This is what you can expect if a fracture needs to be reduced.

Diagnosis usually involves an X-ray to determine whether the fractured ends are out of place. The fracture can either be closed (meaning the skin is intact) or open (meaning the skin is broken). Based on the findings, the doctor will decide if the bone needs to be reduced (reset).

Anesthetic selection is important as it ensures the patient gets the appropriate relief based on the pain level and individual's medical status. In almost all situations where a fracture reduction is needed, some form of anesthesia will be used.

If the fracture is traumatic or complicated, the person may need a general anesthetic to be put completely asleep. But, more commonly, the doctor will opt for local anesthesia called a hematoma block, which delivers a local anesthetic directly to the area surrounding the fracture.

Sterilization of the skin is performed with alcohol, iodine, or some other type of sterilizing solution. This prevents bacteria from entering any breaks on the skin which may not only lead to infection but to complications such as septicemia.

Administration of the hematoma block is done by injecting the anesthesia from a syringe into the fracture hematoma (the collection of blood around the broken bone). Delivering the drug this way allows the broken ends of the bone to be bathed in the local anesthetic, better ensuring sustained pain relief. Hematoma blocks are not used for open fractures.

Performing the fracture reduction involves manipulating the ends of the broken bone so that they are realigned into their original position.

The patient may feel pressure or a crunching sensation but will usually not experience any significant pain.

Immobilizing the bone ensures the broken ends are held firmly in place. After reducing the fracture, a splint may be applied. While the splint can be made of a variety of materials, the most common types are plaster and fiberglass.

If the fracture is severe, it may require external fixation. This is a technique by which pins or screws are inserted into the bone and secured together to an external frame on the outside of the skin using a series of clamps and rods.

Post-reduction X-rays are performed to better ensure that the reduced fracture is correctly aligned. If not, further treatment options may be explored, including surgery.

Roberts JR & Roberts M. The procedural pause. Emergency News.

Bible JE, Mir HR. External fixation: Principles and applications. J Am Acad Orthop Surg. 2015;23(11):683-90. doi:10.5435/JAAOS-D-14-00281

Vinston, D. and Hoehn, C. Sedation-assisted Orthopedic Reduction in Emergency Medicine. Western J Emerg Med. 2013;14(7):47-54.

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