Role of ligamentotaxis in Unstable Distal Radius Fractures

INTRODUCTION: Fractures of the distal radius are among the most common fractures seen in an emergency department The classic fracture described by SIR ABRAHAM COLLES in 1814 – low energy, extra articular, osteoporotic distal radius fracture – often does well with closed reduction and cast immobilization. High velocity injuries have resulted in severely comminuted and unstable fractures with intra articular components treatment has become increasingly difficult. Many unstable distal radial fractures are treated by closed reduction and casting with even small degrees of mal alignment adversely affects functional outcome has stimulated interest in external fixation and ligamentotaxis. External fixation for distal radius fracture relies on the principle of Ligamentotaxis in which, a distraction force applied to the carpus aligns the fragments by means of intact ligaments. Distraction assisted reduction and maintenance of distal radius fracture is a widely used and reliable treatment method. If the principles of ligamentotaxis are applied rationally the factors that cause instability are identified clinically and managed surgically, a satisfactory outcome can be expected. AIM: The aim is to study the functional outcome of unstable distal radius fractures managed by ligamentotaxis with external fixation. MATERIALS AND METHODS: This study was conducted in Government Royapettah Hospital for 2007 – 2009. Patients with unstable distal radius fractures were selected and treated with external fixator based on the principle of ligamentotaxis. Most of the cases resulted from high velocity injuries and fall on outstretched hand. The cases presented with swelling, pain of the wrist and painful movements. All the patients were evaluated with X rays of the wrist postero – anterior view and lateral view. The patients for whom external fixation and ligamentotaxis was planned were temporarily given below elbow plaster splint to relieve pain and limb elevated for edema to subside. Injection tetanus toxoid was given to all the patients. Most of the patients were operated on the day of admission in the emergency operation theater and few cases were delayed due to the medical conditions and in cases of gross edema to subside. All the patients were given per-operative antibiotics. RESULTS: The results of this study were analyzed using the patient evaluation and subjective rating scheme. This system was introduced by Gartland & Werley in 1951 and modified by Sarmiento. This is a functional demerit system and allow for comparison of results among several studies and also different methods of fixation. Bony union was achieved in all patients. DRUJ pain occurred in 2 patients and DRUJ instability in 3 patients. At the end of 3 months patient were evaluated using the Gartland & Werley’s system. CONCLUSION: Fractures of the distal radius though common and appear simple, affect the function of the wrist considerably. It is the commonest fracture seen in the outpatient department and most are treated with plaster immobilization. Most of these fractures are unstable resulting in loss of reduction and hence malunion, altered wrist kinematics, poor range of motion and early arthritis. The external fixation and ligamentotaxis proved to be a very useful method for treating unstable distal radius fracture. Though an effective method, it is not a panacea for all the injuries as different patterns of injuries emerge due to increased accidents and high velocity injuries. Our study equalled previous studies on external fixation for unstable distal radius fractures in results, showing simplicity and superiority of ligamentotaxis with external fixation for the management of these fractures Thus the distal radius fracture is no longer a simple fracture to treat by cast alone and more aggressive treatment is needed to restore the articular congruity and functional outcome