Role of ligamentotaxis in management of comminuted intra/juxta articular fractures

Abstract

Background : Comminuted intra/juxta-articular fractures are the most difficult one's to treat in orthopaedics as far as functional & cosmetic results are concerned. The basic aim of our study was to analyse the efficacy of distractors / external fixator in various forms using principle of ligamentotaxis to achieve a high degree of functional & cosmetic results in these fractures. Methods : This consecutive prospective study comprised of thirty cases of comminuted intra/juxta-articular fractures, varying from grade 0 to grade III B Gustilo & Anderson classification, treated by the principle of ligamentotaxis using distracter / ex fix in its various forms. Results : Average time of union varied from 3 weeks to 20 weeks depending upon the bone involved. Commonest complication was pin tract infection (13), while delayed union (3) and mal­union (one) was also observed. Good range of motion at the involved joint was observed in majority of the cases. As per modified clinical scoring system of Green and O'Brien (1978) excellent to good results were seen in 73.34% cases and fair to poor results in 26.66%. Conclusion : Thus we conclude that ligamentotaxis is an excellent method for the management of comminuted intra/juxta articular fractures. It not only obviates the need of ORIF and/or POP cast but also gives better functional results. It is very useful in compound comminuted fractures around joints where other methods are contraindicated.