Comparative study between percutaneous pinning and ligamentotaxis using external fixator in the management of distal end radius fracture in adults: a prospective study

Sridhar D. K., Raghavendra T. S., Jaipalsinh R. Mahida


Background: Fractures of distal end of radius are beginning at the proximal end of pronator quadratus and ending at the radio-carpal articulation. The final aim in the management of comminuted intra-articular fractures of distal radius is to restore normal function. Recognition of patterns that are inherently unstable and therefore necessitate additional forms of fixation to secure and maintain reduction and prevent late collapse is the key for successful management of the more complex fractures of distal radius. The aim is to study the functional outcome of surgical management of comminuted intra-articular fractures of distal end radius by comparing 2 different methods of surgical interventions.

Methods: In study of 30 cases treated in period from March 2008 to September 2009 at St. Martha’s Hospital by ligamentotaxis and percutaneous pinning, all patients with compound fractures, Frykman's IV, V, VI, VII and VIII, comminuted fractures and in fractures where reduction was lost following closed reduction and POP application were taken into consideration.

Results: The average age in males were 41.35 years and female were 35 years. 12 (40%) fractures were type VII, 6 (20%) were type VIII, 9 (30%) were type IV and 3 cases (10%) was type V. functional results in ligamentotaxis group (G1) 7 cases had excellent results (47%), in percutaneous pinning (G2), 3 cases had excellent result (20%). In ligamentotaxis group (G1) 3 had good results (20%), in percutaneous group (G2) 6 had good results (40%). In ligamentotaxis group (G1) 5 had poor results (33%), in percutaneous pinning group (G2) 6 had poor results (40%).

Conclusions: In comparative studies, external fixation with percutaneous pinning consistently achieves better anatomical results as compared to percutaneous pinning alone. In our study, also this technique has shown satisfactory result that lead to high rate of return to pre-injury status, high level of patient satisfaction and low rate of complications.


Distal end radius fracture, Ligamentotaxis, Percutaneous pinning, Frykman classification, Older criteria

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Agee JM. Distal radius fractures: Multiplanar ligamentotaxis. Hand Clin. 1983;9:577-85.

Cooney WP, Linscheid RL, Dobyns JH. External pins fixation for unstable Colles’ fractures. JBJS. 1979;61:840.

Cooney WP. Fractures of distal radius. Orthop Clin N Am. 1993;24(2):213.

Kaempfee FA, Walker KM. External fixation for distal radius fractures: Effect of distraction on outcome. Clin Orthop Related Res. 2000;380:220-5.

Geissler WB, Fernandez DL. Percutaneous and limited open reduction of the articular surface of distal radius. J Orthop Trauma. 1991;5:255.

Green DP. Pins and plaster treatment of comminuted fractures of distal end of radius. JBJS. 1975;57:304-10.

Rayhack JM. The history and evolution of percutaneous pinning of displaced distal radius fractures. Orthop Clin N Am. 1993;24(2):287-300.

Benoist LA, Freeland AE. Buttress pinning in the unstable distal radial fracture. J Hand Surg (Br). 1995;20(1):82-96.

Seitz Jr WH. External fixation of distal radius fractures. Orthop Clin N Am. 1993;24(2):255-63.

Jakim I, Pieterse HS, Sweet. External fixation of intraarticular fractures of the distal radius. J Bone Joint Surg (Br). 1991;73:302-6.

Knirk JL, Jupiter JB. Intraarticular fractures of distal radius in young adults. JBJS. 1986;68:647-59.

Bradway JK, Amadio PC, Cooney WP. Fracture of distal radius. JBJS. 1986;71:839-47.

Horesh Z, Volpin G, Hoerer D, Stein H. The surgical treatment of severe comminuted intraarticular fracture of distal radius with the small AO external fixation device. Clin Orthop Related Res. 1991;263:147-53.

Lipton H, Jupiter JB. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop Related Res. 1993;292:48-61.

Leibovic SJ, Geissler WB. Treatment of complex intraarticular distal radius fractures. Orthop Clin N Am. 1994;25(4):685-706.

Jupiter JB, Fernandez DL, Toh CL, Feilman T, Ring D. Operative treatment of volar intraarticular fractures of the distal radius, JBJS (Am). 1996;78(12):1817-28.