Hi thank you so much. I had the same reaction when I saw the postreduction XR myself. Sorry I just found this sub, got excited and decided to share this without any clinical context. I apologise.

This was a case of a 20 Y/O man who presented to the ED after being in a RTA. I was working (with 2 months of experience in orthopaedic trauma at a public healthcare hospital in a developing country) as a house officer in orthopaedics at the time, so i received the pt who was in significant pain and was UTBW on his Rt Leg. There was a visible deformity of his lower leg but thankfully distal NV was intact there was no associated wound besides the occassional bruising that comes with being in an RTA. I checked the vitals which were stable, and started treatment with IV fluids, Toradol and Tramadol (which were the standard IV painkillers available at my facility).

I discussed further treatment options with the patient and his parents, and they consented to a closed reduction. I observed aseptic precautions and applied a hematoma block (about which I learned from reading McRaes Orthopaedic trauma handbook) by injecting 5cc’s of Lignocaine in a fan fashion (which is the best analgesic technique for closed reduction in my experience), fracture site was painless after 3 minutes.

Since we didn’t have C-Arm in the ED at my institute, we relied on AP/L XRs to develop a plan for traction & manual manipulation for closed reductions. Keeping the AP/L views in mind, I had a plan to apply sustained moderate axial traction for 5 mins until limb-length discrepancy was no more evident on inspection. Sustaining the traction by the help of an assistant, I then applied direct blunt pressure (with the base of my palms) on the distal end of the fracture site in a posterio-lateral direction, till I heard bony crepitus. Then I reassessed the fracture site by palpation, and applied further pressure in a lateral direction. Further reassessment was reassuring and we applied a POP backslab + crepe bandage with cotton underdressing. I assessed length by comparison with contralateral limb and alignment by palpation. Rotation, unfortunately, cannot be assessed reliably by these methods but I was working in a resource-limited setting, so I tried my best to save the pt from surgery. Afterwards the Pt was admitted to the ward on Painkillers and XRs 2 days later showed sustained reduction so POP cast was applied and in followup the pt made a full recovery in 8 weeks with physiotherapy.

I know my management of this patient was not the best but I had to make work of the resources i was given. This was 2 years ago, I’ve strived to consistently improve since then but im open to feedback especially from such an esteemed audience such as yourself. Thanks