Comparative study on the functional outcome of ligamentotaxis in comminuted fractures of the distal end of radius and with that of conservative means of closed reduction and casting

Background: Comminuted fractures of lower end of radius most often bring out unsatisfactory outcome, if treated by conservative means of closed reduction and casting. This study was aimed to compare the results of ligamentotaxis in comminuted fractures of the distal end of radius and with that of closed manipulative reduction and plaster cast immobilization.Methods: Patients with comminuted fracture lower end of radius treated by ligamentotaxis or the conservative methods were included in the prospective study. Patients in group l treated by external fixator and in group 2 treated by conservative line of management. Postoperative check X-rays were taken. All the patients were evaluated on 3rd, 6th, 12th and 18th months after surgery. Functional results were assessed by Gartlands point score system and subjected to statistical analysis.Results: Total fifty patients were included in the study. Twenty five were treated by external fixator and the remaining was treated by conservative line of management. Patients underwent ligamentotaxis had 88% excellent results whereas 52% of patients on conservative care had similar results. When the conservative methods gave poor results for severely comminuted fractures, ligamentotaxis could bring out excellent re-orientation of fragments back to near normal alignment.Conclusions: Ligamentotaxis using a distracter is a better method to treat comminuted fractures of lower end of radius. Even though the initial reductions were excellent in a plaster cast, re-displacement rates are very high in a plaster cast. Fractures without intra articular extension always yielded far better results than intra articular fractures