ACCEPTABILITY CRITERIA FOR

REDUCTION IN FRACTURES
 Humeral Shaft Fractures
criteria for acceptable alignment include:
• < 20° anterior angulation
• < 30° varus/valgus angulation
• < 3 cm shortening
 Distal Radius
• In adults, the normal distal radial inclination
averages 220 on the AP view and 110 degrees of
volar tilt on the lateral projection.
• inclination  a goniometric measurement of the
angle between the distal radial articular surface
and a line perpendicular to the radial shaft on the
AP radiograph.
• Volar tilt is measured by a line across the distal
articular surface and a line perpendicular to the
radial shaft on the lateral view.
Radial inclination Volar Tilt
 Distal radial metaphyseal
• under 5 years of age Acceptable sagittal plane
angulation is from 100 - 350 degrees.
• under 10 years the degree of acceptable
angulation is from 100 – 250
• Over 10 years of age, acceptable alignment
from 50 - 200
 Diaphisis radius ulna

• Acceptable approximately 200 of angulation in

distal-third shaft fractures of the radius and
ulna, 150 at the midshaft level, and 100
degrees in the proximal third
• Accept 100% translation if shortening is less
than 1 cm. Although other authors
recommend accepting up to 450 of rotation,
we find this is
 Shaft Phalanx

• In children less than 10 years of age, 200 - 300

degrees may beacceptable.
• In children older than 10 years, 100 - 200
degrees of angulation is acceptable.
• Less angulation is acceptable in the coronal
plane.
• Malrotation is unacceptable
 Neck Metacarpal

• In general, 100 to 300of angulation greater

than the corresponding CMC joint motion is
acceptable.
 Distal Femoral Physeal Fractures
Acceptable reduction:
• Posterior angulation up to 200 will remodel in
kids < 10 yrs old,
• adolescent, however, will not remodle and will
not tolerate this degree of angulation;
no > 50 of varus-valgus angulation is acceptable;
 Femoral Neck Fractures
• Acceptable Reduction:
- poor reduction of femoral neck fractures interferes w/ blood supply to femoral head &
decreases apposition of bone between bone fragments;
- reduction should leave neck-shaft angle between 130-150 degrees;
- posterior comminution: have higher occurance of non-union;
valgus reduction:
- reduction should leave neck-shaft angle between 130-150 degrees;
- acceptable reduction may have up to 15 deg of valgus angulation;
- valgus reduction will increase bony stability, esp in pts w/ posterior comminution;
- excessive valgus ( > 1850 - Garden angle ) may increase rate of AVN (due to tethering of
lateral epiphyseal vessels);
- valgus position can be reduced by decreasing traction;
varus reduction:
- results in an increased non-union rate;
angulation: (anteversion)
- reduction should be between 0 - 15 degrees of anteversion;
- anterior or posterior angulation of > than 10 degrees should not be accepted,
particularly in
apex anterior angulation: (retroversion)
- internal rotation & adduction oppose fracture surfaces & correct apex anterior
angulation on lateral view;
- posterior angulation or retroversion can be corrected by posterior directed force
applied to anterior aspect of femoral shaft
 Tibial Fractures
acceptable reduction:
• more than 50% of cortical contact;
• less than 5-100 of varus / valgus angulation when
comparing tibial plateau to tibial plafond (some
will not accept more than 50 deg of varus);
• Less than 10-150 of anterior or posterior bowing
on lateral film;
• Less than 5 – 70 of internal or external rotation,
varus or valgus;
• No more than 10-15 mm of shortening;
ACCEPTABILITY CRITERIA FOR REDUCTION IN
PAEDIATRIC FRACTURES
UPPER LIMB FRACTURES
Proximal humerus:
• > 11 years of age : > 500 Contact < 200 angulation
• < 11 years of age : relatively greater displacement and
angulation can be accepted. Good to excellent long term
outcomes can be expected regardless of the # displacement.
Shaft humerus:
• Internal rotation: < 150
• Shortening: up to 1 to 2 cms.
• Displacement and angulation:
– < 5 years : Total displacement, Up to 700 angulation
– 5 to 12 years: 40 to 700 angulation
– > 12 years : 50 % contact , < 400 angulation
Supracondylar fracture humerus
• Anterior humeral line should be intact
• Baumann angle 70-78 0 or equal to the other
side
• Intact olecranon fossa
• Translation upto 30 %
• Rotations 20-300
• Varus/ valgus angulation not acceptable
Radius ulna
• < 9 years : 15 0 Angulation, 45 0 Malrotation,
Complete displacement, Straightening of radius
• 9-14 years: 10 0 Angulation, 30 0 malrotation,
Complete displacement, Some loss of radial bow
Fracture radial neck
• Younger children: 30-450
• Older Children: 150
 LOWER LIMB FRACTURES
Fracture neck femur :
• Only anatomical reduction is acceptable

Fracture shaft femur:

• 0-6 months of age: < 1.5 cm Of shortening, < 300 angulation
in varus valgus plane,< 300 angulation in AP plane
• 6 months -6 years: < 2 cms of shortening,< 15 0 angulation in
varus valgus plane,< 200 anterior angulation
• 6 – 10 years < 1.5 cm shortening, < 100 varus valgus
angulation, < 15 0 AP angulation
• > 10 years < 1 cm shortening,< 5 0 varus valgus angulation,<
10 0 AP angulation
Fracture – separation of distal physis of femur
• In Salter Harris type 1 and 2
• < 10 years < 200 anterior or posterior angulation
• > 10 years Only minimal AP angulation
• < 5 0 varus valgus angulation
• In Salter Harris type 3 and 4
• Anatomical reduction and ORIF
Fracture tibial tuberosity
• Only minimally displaced fractures with possible active
extension of knee to 00 can be acceptable. Rest require ORIF
Fracture Patella
• < 3 mm articular step off
• < 3 mm diastasis on xray
• Intact extensor mechanism
• Fracture of tibia and fibula
• A. Proximal metaphysis :
• Closed reduction to anatomic position or slight
varus is acceptable
• B. Diaphysis:
C. Distal tibial fractures
• Salter Harris type I & II
• (i) in patients with at least 2 years of growth
remaining: < 150 of posterior angulation,< 100 of
valgus angulation,00 of varus angulation
• (ii) in patients with less than 2 years of growth
remaining Angulation in all planes < 50
• Salter Harris type III & IV
• < 2 mm displacement