Functional Outcome of Distal end Radius Fracture Treated by Ligamentotaxis by External Fixator with or without K Wire Augmentation

Jump To References Section

Authors

  • Brijbhushan S. Mahajan
     Assistant Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra,patildr.vishal@yahoo.in ,IN
  • Vishal Patil
     Assistant Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra
  • Yogesh Rathod
     PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra ,IN
  • Ameya Kulkarni
     PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra ,IN
  • Nimesh Nebhani
     PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra ,IN
  • Bhalchandra Prabhakar Bhalerao
     PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra ,IN

DOI:

https://doi.org/10.18311/mvpjms/2018/v5i2/18361

Keywords:

Disabilities of the Arm, Shoulder and Hand (DASH) Score, Ligamentotaxis, Radius Fracture
Orthopaedics

Abstract

Background: One of the most common injuries encountered in orthopedic practice are Distal Radius fractures. This comprises of 8%−15% of all fractures in adults. The reason for comminuted DER fractures is high-energy trauma in young and low-energytrauma in elderly. They present as shear and impacted fractures involving the articular surface of the distal radius with displacement of the fragments. External fixation for distal radius fracture relies on the principle of Ligamentotaxisin which, a distraction force applied to the carpus aligns the fragments by means of intact ligaments. The length and alignment of fracture fragment is guided by pull and counter pull which are otherwise difficult to control. Objective: To study functional outcome of distal end radius fracture treated by ligamentotaxis with evaluation of functional results according to Disabilities of the Arm, Shoulder and Hand (DASH) score system. Material and Methods: We included 30 patients (Male 24 and Female 6) treated for distal end radius fracture during a period from 2015 to 2017. Patients were evaluated clinically by subjective assessment using DASH Scoring system. Result: After functional evaluation of patients according to the scheduled follow up with mean DASH Score of 76.08 at 1st month, 62.92 at 3rd month and 42.60 at 6th month, and was found to be Highly Significant (p<0.001) among all the compared groups. Conclusion: We concluded that external fixation and ligamentotaxis applied to complex distal radius fractures, when added with augmented K-wire fixation can provide direct augmentation of fracture stability and a good wrist function.

Downloads

Published

2019-04-17

Issue

Volume 5, Issue 2, July - December 2018

Section

Original Research Article

 

References

Pogue DJ, Vegas SF, Patterson RM, Peterson PD, Jenkins DK, Sweo TD, et al. Effects of distal radius malunion on wrist joint mechanics, J Hand Surg Am. 1990; 15:721–27. https://doi.org/10.1016/0363-5023(90)90143-F.

Lozano-Calderon SA, Doornberg J, Ring D. Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation, J. Bone Joint Surg. Am. 2006; 88:1486–93. https://doi.org/10.2106/00004623-20060700000009, https://doi.org/10.2106/JBJS.E.00930. PMid:16818974.

Mehta JA, Bain GI, Heptinstall RJ. Anatomical reduction of intra-articular fractures of the distal radius: An arthroscopically-assisted approach, J Bone Joint Surg Br. 2000 Jan; 82(1):79-86. https:// doi.org/10.1302/0301-620X.82B1.10101, https://doi.org/10.1302/0301-620X.82B1.0820079. PMid: 10697319.

Melone CP Jr. Distal radius fractures: patterns of articular fragmentation, Orthop Clin North Am. 1993 Apr; 24(2):239-53. PMid: 8479722.

Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius, J Bone Joint Surg Am. 2004 Aug; 86-A(8):1646-52. https://doi.org/10.2106/00004623200408000-00007. PMid: 15292411.

Rogachefsky RA, Lipson SR, Applegate B, Ouellette EA, Savenor AM, McAuliffe JA. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation, J Bone Joint Surg Am. 2001 Apr; 83-A(4):50919. https://doi.org/10.2106/00004623-200104000-00005. PMid: 11315779.

Ruch DS, Weiland AJ, Wolfe SW, Geissler WB, Cohen MS, Jupiter JB. Current concepts in the treatment of distal radial fractures, Instr Course Lect. 2004; 53:389-401. PMid: 15116629.

Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: changes in treatment over the past two decades, Instr Course Lect. 2003; 52:185-95. https://doi.org/10.2106/00004623-200303000-00026.

Simic PM., Weiland AJ. Fractures of the distal aspect of the Radius: Changes in Treatment Over the past two decades, J Bone Joint Surg Am. 2003; 85-A: 552-564. https://doi.org/10.2106/00004623-200303000-00026.

Fernando Deigo L, Jesse, Library of Congress, Fractures of Distal Radius: A Practical Approach to Management, 2nd edition.

Neal C. Chen, Jupiter JB. Current concepts review: Management of distal radial fractures, J Bone Joint Surg Am. 2007; 89:2051-62. https://doi.org/10.2106/00004623200709000-00025, https://doi.org/10.2106/JBJS.G.00020. PMid: 17768207.

Cui Z, Pan J, Yu B, Zhang K, Xiong X. Internal versus external fixation for unstable distal radius fractures: An up-to-date meta-analysis, Int Orthop. 2011; 35(9):133341. https://doi.org/10.1007/s00264-011-1300-0. PMid: 21698429, PMCid: PMC3167461.

Cole JM, Obletz BE. Comminuted fractures of the distal end of the radius treated by skeletal transfixion in plaster cast: An end-result study of thirty-three cases, J Bone Joint Surg Am 1966; 48:931-45. https://doi.org/10.2106/00004623196648050-00011.

Standring S. Gray's Anatomy – The Anatomical Basis of Clinical Practice. 41st ed.: Amsterdam Elsevier Churchill Livingstone Publication; 2015.

Kaempfee FA, Walker KM. External fixation for distal radius fractures: Effect of distraction on outcome, Clin Orthop Related Res. 2000; 380:220-25. https://doi.org/10.1097/00003086-200011000-00030.

Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity, J Hand Ther. 2001; 14(2):128-46. https://doi.org/10.1016/S0894-1130(01)80043-0.

Beaton DE, Davis AM, Hudak P, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: What do we know about it now? British Journal of Hand Therapy. 2001; 6(4):109-18. https://doi.org/10.1177/175899830100600401.

Horesh et al. The surgical treatment of severe comminuted fractures with the small AO external fixation device, Clin. Orthop. 1991; 263:147–53. PMid: 1993369.

Jakim I, Pieterse HS, Sweet MBE. External fixation for intra articular fracture of distal radius, JBJS. (Br) 1991; 73:302. https://doi.org/10.1302/0301-620X.73B2.2005161.

Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC. A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J. Hand Surg Am. 2005 Nov;30(6):1185-99. Review. PubMed PMID:16344176.

Anvekar MA, Nimbargi SS, Srinath SR, Nelivigi AS. Treatment of intra-articular fracture of distal radius with static external fixators ligamentotaxis: A prospective study, JEMDS. 2013; 2(32):6026-38. https://doi.org/10.14260/jemds/1093.

Jakim I, Pieterse HS, Sweet MB. External fixation for intraarticular fractures of the distal radius. J. Bone Joint Surg Br 1991; 73(2):302-6.

Boparai RPS, Boparai RS, Kapilar R, et al. Role of ligamentotaxis in management of comminuted intra/juxta articular fractures. IJO 2006; 40(3):185- 187.