Unstable articular fractures of the distal radius. Comparative techniques of ligamentotaxis.
Ligamentotaxis employing either pins and plaster or external fixators, frequently in conjunction with supplemental Kirschner wire internal fixation, has proved to be a reliable means of maintaining an accurate reduction of unstable articular fractures of the distal radius. Critical preoperative evaluation and surgical restoration of articular congruity along with attention to key technical details have resulted in a reproducible successful recovery. In our experience, the advantages of the pins and plaster technique are its relatively simple methodology, its comparatively low cost, and its high level of patient acceptance. The distinctive advantages of the external fixator are its superior mechanical efficiency, its capacity for fracture adjustment during the healing period, and the fact that it ensures unimpeded access to wounds. Nonetheless, regardless of the specific method chosen, this study clearly supports the contention that precision in patient selection and pin placement are the prerequisites for successful ligamentotaxis in the management of distal radius fractures.