Introduction to Orthopedic Techniques
Orthopedic techniques are a medical technique used to diagnose and treat bone and joint injuries. "Li Shang Xu Duan Fang" proposed techniques such as stretching, applying force to the bone, and correcting. "Yi Zong Jin Jian" (1742) summarized and developed into eight techniques: touching, connecting, supporting, lifting, pressing, rubbing, pushing, and holding. Modern techniques have been summarized as: touching the heart, stretching and traction, rotating and flexing, lifting and pressing, swinging and touching, massage and manipulation, bone separation and compression, and rotation and resetting, which combine Chinese and Western medicine. In addition, there are techniques such as pulling, stretching, pinching, and shaking. See details below.
Brief History
Orthopedic techniques have a long history. About 3,000 years ago during the Zhou Dynasty, there were doctors specializing in the treatment of fractures. "Zhou Li Tian Guan" recorded the treatment of fractures by specialized doctors. During the Tang Dynasty, "Li Shang Xu Duan Fang" introduced techniques such as palpation, stretching, and correcting, which first applied the principles of leverage to the reduction of fractures and had a profound influence on future generations. In the Ming Dynasty, Xue Ji's "Zheng Gu Lei Yao" described 19 orthopedic techniques that were concise and practical. Wang Kentang's "Zheng Zhi Zhun Sheng" also recorded many orthopedic techniques. In particular, during the Qing Dynasty, "Yi Zong Jin Jian" summarized the previous experience of orthopedics and proposed eight techniques: touching, connecting, supporting, lifting, pushing, holding, pressing, and rubbing, known as the eight orthopedic techniques. After 1949, practitioners of Chinese medicine combined with Western medicine conducted scientific research on the eight orthopedic techniques, made improvements and innovations, and proposed new eight orthopedic techniques.
Techniques
The new eight orthopedic techniques are the basic methods for modern clinical orthopedics.
①Touching the heart: Use the fingertips to touch the local area of the fracture and feel it with the heart. The intensity of the technique gradually increases from light to heavy, from shallow to deep, and from far to near to understand the displacement of the fracture, whether there is separation or fragmentation. The doctor needs to establish a three-dimensional image of the displacement of the fracture in their mind. Although X-rays can clearly show the shape of the bones, X-ray films can only provide flat indications, while touching the heart can help understand the overall situation. Therefore, touching the heart is a guiding technique for the application of other techniques in diagnosis and treatment.
②Stretching and traction: This is the starting technique for reducing fractures. One or several people hold the proximal and distal ends of the fracture, initially applying traction to the limb in the original deformed position along the longitudinal axis of the limb, and then changing the direction of the limb according to the orthopedic steps to continuously pull and correct the shortening deformity of the limb and restore the length of the limb, creating conditions for the implementation of other orthopedic techniques.
③Rotating and flexing: The position of the fracture segment on the near side is not easy to change, and the distal segment can move freely since it is not continuous. Therefore, rotation, flexion, extension, and adduction methods are used to rotate or angularly displace the fracture ends for reduction.
④Lifting and pressing: This method is used to correct lateral displacement of the fracture. It was previously called "correcting by pressing". Lateral displacement of the fracture can be divided into anterior-posterior displacement and medial-lateral displacement. The former is corrected by lifting and pressing, and the latter is corrected by end-pushing. The doctor fixes the proximal end of the fracture with one hand and holds the distal end with the other hand, either lifting and pressing vertically or pushing horizontally.
⑤Swinging and touching: This method is used for transverse and serrated fractures, which can make the fracture surfaces closely contact each other and increase the stability of reduction. The assistant maintains traction while the doctor gently swings the distal end of the fracture left and right or up and down until the bone friction sound disappears. Touching is a method to make the fracture ends fit tightly. The doctor fixes the fracture with one hand and gently taps the distal end of the fracture with the other hand.
⑥Bone separation and compression: This technique is used to correct the displacement of fractures in adjacent bones. The doctor uses the thumbs and index, middle, and ring fingers of both hands to squeeze or compress the gap between the back of the hand and the fracture site, causing tension in the membrane between the bones, so that the fracture ends that are close to each other move apart. The proximal and distal fracture segments will then be relatively stable, and adjacent double fractures can be reduced together just like single fractures.
⑦Rotation and resetting: The resetting method is used to correct fractures in areas with thick muscles, especially when there is a large overlapping displacement that cannot be corrected by stretching and traction alone. The doctor presses the protruding end of the fracture with both thumbs aligned, while the other fingers of both hands surround the depressed end of the fracture, and then applies force to compress the protruding end, increasing the original angle of the fracture to 30-50 degrees. When the bone cortex of the fracture end is close, the doctor suddenly uses the surrounding four fingers to straighten the angle of the distant fracture end and perform reduction by reversing the angle. The rotating method is used to correct oblique fractures, spiral fractures, and fractures with soft tissue embedded. The doctor holds the proximal and distal fracture ends with both hands and rotates them in the opposite direction of the original displacement of the fracture, making the fracture ends relative to each other.
⑧Massage and manipulation: This technique is the specific application of tendon manipulation in the rehabilitation of fractures. Its purpose is to rehabilitate the damaged tendons and meridians around the fracture after the fracture is reduced. However, when using tendon manipulation, it should be gentle and only used as an auxiliary technique at the end of treatment.
Requirements
Orthopedic techniques require stability, accuracy, agility, even force, continuous movement, and appropriate strength. Avoid excessive force and violence. It is best to achieve satisfactory results in one reduction. Repeated reductions often aggravate local soft tissue damage, make swelling more severe, and make reduction more difficult, which may delay fracture healing or cause joint stiffness.
