Evaluation of Ligamentotaxis in Management of Comminuted Intra-articular Fractures of Distal Radius Using Spanning Naseer–Awais (NA) External Fixator

Abstract

Abstract Background: Comminuted intra-articular distal ra-dius fractures are the most common amongst the frac-tures of the upper limb. There are various methods of management of comminuted intra-articular fractures of distal radius published in the orthopaedic literature, these are closed reduction and plaster cast application, closed reduction and percutaneous pin fixation, closed reduction percutaneous pin fixation with plaster cast application, ligamentotaxis with application of exter-nal fixation across the wrist joint and open reduction and internal fixation. Objective: Objectives of this study were to evaluate the ligamentotaxis for the treatment of comminuted intra-articular fractures of distal radius and compare the prescribed data for comparison with similar series in the orthopaedic literature. Methodology: During this study 30 skeletally mature patients with comminuted intra-articular fractures of distal radius attending outpatient department or ortho-paedic emergency of Lahore General Hospital, Lahore, with less than one week duration were admitted in the hospital. They were examined clinically. Radiographs were taken and diagnosis was confirmed. Patients with open fractures or with multiple injuries were excluded from the study. Patients were administered general anesthesia. Skin distal to the elbow was prepared with antiseptic iodine solution and draping was done. Clo-sed reduction of the fracture was done and N. A exter-nal fixator was applied across the wrist joint. Distrac-tion force was applied across the fracture site by elon-gation of threaded rod of external fixator. This distrac-tion force was maintained till union of the fracture according to the principle of ligamentotaxis. All the patients were examined in outpatient department at regular intervals. Data of this study was recorded for comparison of similar series in recent orthopaedic lite-rature. Results: There were no serious complications in our study. Six patients (20%) developed mild pin tract in-fections these were treated by oral antibiotic therapy. One patient (3.3%) developed aseptic loosening of external fixator after three weeks. In this patient exter-nal fixator was replaced by plaster cast. One patient (3.3%) lost the reduction in which revision of external fixation was carried out. After removal of external fixator / plaster cast, a supervised programme of phy-siotherapy was started for restoration of the wrist and hand functions. Twenty two (73.3%) patients required physiotherapy for 1 week, 5 (16.7%) required for 2 weeks and 3 patient (10%) did not require it at all. Conclusion: We conclude that ligamentotaxis is an excellent method for the management of comminuted intraarticular fractures of distal end of radius. It obvi-ates the need of plaster cast application or open reduc-tion and internal fixation of the fracture and result of this study are comparable with similar series published in the orthopaedic literature. Keywords: Ligmaentotaxis distal radius fracture.