A prospective study of functional evaluation of distal radius fracture by external fixator using the principle of ligamentotaxis
Keywords:Distal radius fracturs, External fixation, Ligamentotaxis, Intra-articular fractures, Distal end radius
Background: Preservation of the articular congruity is the principal prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 years of documented clinical experience. The main aim of the study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation using the principle of ligamentotaxis.
Methods: In a prospective controlled study, 30 cases of distal end radius fractures with intra articular extension were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis. Mean age of the patients was 40.2 years, external fixator was applied for a mean duration of 6 weeks.
Results: In this study there were 8 patients with excellent results comprising 27%, 14 patients with good results comprising 47%, 7 patients with fair results comprising 23%, 1 patient with poor results comprising 3%.
Conclusions: In a prospective investigation, static external fixators were applied to 30 intra-articular fractures of the distal end of the radius. Fixator was kept up for a total of six weeks. The results were 8 excellent, 14 good, 7 fair, and 1 poor. Only one complication, pin loosening (10%), occurred. This series concludes that ligamentotaxis by external fixation consistently produces a good result in the management of intra-articular distal end of radius fractures in younger age groups (50 years).
Cooney III WP, Linscheid RL, Dobyns JH. External Pin Fixation for Unstable Colles’ Fractures. J Bone Joint Surg. 1979;61:840-5.
Wolfe SW, Pike L, Slade III JF. Augmentation of Distal Radius Fracture Fixation with Coralline Hydroxyapatite Bone Graft Substitute. J Hand Surg. 1999;24:816-27.
Orbay JL, Fernandez DL. Volar Fixation for Dorsally Displaced Fractures of the Distal Radius: A Preliminary Report. J Hand Surg. 2002;27:205-5.
Musgrave DS, Idler RS. Volar Fixation of Dorsally Displaced Distal Radius Fractures Using the 2.4-mm Locking Compression Plates. J Hand Surg. 2005;30:743-9.
Karnezis IA, Fragkiadakis EG. Association between Objective Clinical Variables and Patient-Rated Disability of the Wrist. J Bone Joint Surg. 2002;84:967-70.
Anzarut A, Johnson JA, Rowe BH. Radiologic and Patient-Reported Functional Outcomes in an Elderly Cohort with Conservatively Treated Distal Radius Fractures. J Hand Surg. 2002;29:1121-7.
McQueen MM. Redisplaced Unstable Fractures of the Distal Radius: A Randomised, Prospective Study of Bridging versus Non-Bridging External Fixation. J Bone Joint Surg. 1998;80:665-9.
Huang T, Huang C, Yu J. Operative Treatment of Intra-Articular Distal Radius Fractures Using the Small AO External Fixation Device. J Chinese Med Asso. 2005;68:474-8.
Fernandez LD, Jupiter BJ. Fractures of the Distal Radius A Practical Approach to Management. Springer Science + Business Media, LLC, New York, USA. 2002;
De la Torre M, Moreno N, Luis R. Surgery of Distal Radius Fractures: Assessment of Results. Revista de Ortopedia y Traumatología. 2006;50:366-71.
Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly. J Bone Joint Surg. 2009;91:1868-73.
Sakuma M, Endo N, Oinuma T, Miyasaka D, Oguma Y, Imao K et al. Incidence of Osteoporotic Fractures in Sado, Japan in 2010. J Bone Mineral Metabol. 2014;32:200-5.
Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T. Changing Incidence of Hip, Distal Radius, and Proximal Humerus Fractures in Tottori Prefecture, Japan. Bone, 1999;24:265-70.
Vishwanath C, Harish K, Gunnaiah KG, Ravoof A. Surgical outcome of distal end radius fractures by ligamentotaxis. J Orthop Allied Sci. 2017;5:68-73.
Sivaprakash SU, Reddy RM. Functional outcome of comminuted intra-articular distal radius fractures managed by Ligamentotaxis. Int J Orthopaed Sci. 2019;5(1):75-9.
Kamal Y, Khan HA, Farooq M, Gani N, Lone AUH, Shah AB, et al. Functional outcome of distal radius fractures managed by Barzullah working classification. Arch Trauma Res. 2015;4(1):e20056.
Maruthi CV, Shivanna. Management of fracture of distal radius by external fixator using the principle of ligamentotaxis a prospective study. Indian J Orthopaed Surg. 2015;2(1):19-26.
Frykman G. Fracture of the distal radius including sequelae-shoulder hand syndrome disturbance in distal radio or joint and impairment of nerve function: a clinical and impairment of nerve function: a clinical and experimental study. Act Ortho Scand. 1967;108:27-31.
Anderson R, O’Neil G. Comminuted fractures of distal end of the radius. Surg Gyn Obstet. 1944;78:434-42.
Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg. 1951;33A:895-907.
Jonsson U. External fixation for re-dislocated Colles’ fractures. Acta Orthop Scand. 1983;54(06):878-83.
Schuind F, Cooney WP III, Burny F, An KN. Small external fixation device for the hand and wrist. Clin Orthop Relat Res. 1993;(293):77-82.
Clyburn TA. Dynamic external fixation for comminuted intraarticular fractures of the distal end of the radius. J Bone Joint Surg Am. 1987;69(02):248-54.
Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO Group, 2nd ed. Berlin: Springer-Verlag. 1979.
Jenkins NH, Jones DG, Johnson SR, Mintowt-Czyz WJ. External fixation of Colles’ fractures. An anatomical study. J Bone Joint Surg Br. 1987;69(02):207-11.
Grewal R, Perey B, Wilmink M, Stothers K. A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation. J Hand Surg Am. 2005;30(04):764-72.
Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury. 2000;31(02):75-9.