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Moncel, M.-H. et al. Fragmented reduction processes: Middle Palaeolithic technical behaviour in the Abri du Maras shelter, southeastern France.
The lithic industries also present a fragmented reduction system associated with a large range of mainly local raw materials.
The assemblage reflects a fragmented reduction sequence, with transport of large flakes and partially shaped tools to Attirampakkam, from 'quarry sites' located in proximity to raw material sources, followed by later stages in the on-site façonnage of handaxes, primarily on large flake blanks.
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This may result in impacted fragment reduction failure and nullifies the benefits of surgery.
Nevertheless, there is evidence from studies with large patient cohorts that fragment reduction, with anatomical Bohler's angle restoration, and subtalar joint congruity predict higher functional scores as well as a lower incidence of post-traumatic arthritis [1, 2].
Great care must be taken in accurate reduction of the "Tillaux" fragment; reduction can be obtained with minimally invasive manoeuvres performed with a smooth 3 mm wire used as a joystick and stabilised with 1.8 2.0 mm wire or with a cannulated screw.
In addition, obtaining both medial and anterior cortical buttress (anteromedial reduction) is the best option for pertrochanteric fragment reduction.
Closed reduction of capitellum and/or trochlear fractures rarely achieves and maintains fragment reduction, and requires a long period of immobilization.
The remodelling capacity is limited at the elbow and incapacitating limitation of joint range of motion often occurs due to sub-optimal fracture fragments reduction.
Considering the later risk of osteoarthritis, open reduction and volar plating may also be advantageous in the long term for more complex intra-articular fractures compared to external fixation, since the method allows specific fragment reduction.
Fiber-cerclage, applied in proximal humeral fractures stabilized by locking plates to further secure tuberosity fragments after reduction, is often used to minimize secondary fragment displacement (Nho et al. 2007, Voigt et al. 2007).
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