International Journal of Orthopaedics Sciences
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International Journal of Orthopaedics Sciences

2019, Volume 5 Issue 1

Functional outcome of comminuted intra-articular distal radius fractures managed by Ligamentotaxis

Author(s): Dr. SU Sivaprakash and Dr. R Muralidhar Reddy
Abstract: Distal radius fracture is one of most common fractures seen in clinical practice. Comminuted intra articular fractures are usually associated with road traffic accidents, fall from height in young patients. In old age groups it is associated with severe osteoporosis due to trivial fall. All intra articular fractures need good reduction for better functional outcome. K-wire fixation with plaster application, open reduction and internal fixation with locking plate, external fixator application (Ligamentotaxis) are various described methods for treating this fractures. When there is severe commination k-wires and screws cannot perch age the small fragments and there is high chances of loss of reduction. Also when there is severe soft tissue swelling and in case of open fractures open reduction and internal fixation is not possible.
Materials and Methods: This is a prospective study conducted in our hospital from January 2017 to October 2018. Inclusion criteria include close and open comminuted intra-articular fractures of distalradius in skeletally mature patients. All patients treated by Ligamentotaxis (external fixator application). Exfix removal done after six weeks and started on physiotherapy. Every patient functional outcome assessed 4months after exfix removal using Mayo wrist scoring.
Results: Overall 30 patients of comminuted intra-articular distal radius fractures treated by Ligamentotaxis. Non dominant hand involved in 10 patients and dominant hand involved in 20 patients. All patients under went removal of exfix after 6 weeks of application. All patients subjected to vigorous physiotherapy after exfix removal for 3 weeks. Functional outcome of every patient measured using mayo wrist score 4 months after exfix removal. Overall together the average mayo wrist score of operated wrist was 82 with excellent results in 46.66% of cases, good results in 36.66% of cases and satisfactory results in 10%of cases, poor results in 6.66% cases with a very significant p-value of <0.0001 using paired t-test.
Conclusion: Ligamentotaxis is safe and effective method of treatment for comminuted intra articular distal radius fracture. Can be practiced by any orthopedic surgeon even in small hospitals. Best suited for open fracture, severe commination and soft tissue compromise
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