Management of Juxta/Intra Articular Comminuted Distal End Radius Fracture by Ligamentotaxis with External Fixator – Early Results

Abstract

Aim: The aim of our study is to assess the functional, clinical, and radiological outcome of juxtra/intraarticular comminuted distal end radius fracture treated by ligamentotaxis using external fixator. Study Design: A Retrospective Study. Introduction: Distal end radius fracture accounts for 17.5% of total upper limb fractures. The comminuted juxtra/intraarticular fracture is more common in elderly females due to osteoporosis. Management of these fractures is a challenging task for a surgeon as far as functional and cosmetic results are concerned. It is also controversial as there are various treatment options available like a plaster cast, k-wire, external fixator, and open reduction internal fixation with locking plate. Material and Methodology: We did a retrospective analysis of 36 cases fulfilling inclusion criteria of juxta/intra articular comminuted distal end radius fracture, operated by ligamentotaxis using external fixator at G.K. General hospital, Bhuj, Gujarat from July 2018 to August 2019. The clinical, radiological, and functional outcomes were evaluated at 6,10,14 weeks and 6months postoperatively by using Mayo wrist score. Results: There were 22 females and 14 males with a mean age of 48 years and mean follow up of 7.2 months in our study. The average hospital stay was two days. The average time of fracture union was 7.3 weeks. The average Mayo score at the time of final follow-up was 78. Excellent to good results were seen in 85% of cases, and fair to poor results are seen in 15% of cases. Two patients had pin track infection which was treated by regular dressing and one had loosening of shanz pin which required removal. Conclusion: Ligamentotaxis with external fixator in juxta- and/or intra-articular comminuted distal end radius fracture is an effective method of treatment providing good radiological, clinical and functional outcome. It is simple, cost effective, short duration procedure preserving fracture biology and best suited for comminuted distal end radius fracture where other methods are contraindicated.