title: Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right.
abstract: BACKGROUND
  Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome.
  
  
  OBJECTIVE
  To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs.
  
  
  METHODS
  A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2(nd) metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months.
  
  
  RESULTS
  Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion.
  
  
  CONCLUSIONS
  External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy.
authors.affiliation: Assistant professor, Department of Orthopaedics, Kamineni Institute of Medical Sciences , Narketpally, Nalgonda, India .
authors.forename: Vamshi Krishna
authors.initials: VK
authors.lastname: Chilakamary
authors.affiliation: Assistant Professor, Department of Orthopaedics, Nizam's Institute of Medical Sciences , Hyderabad, India .
authors.forename: Maheshwar
authors.initials: M
authors.lastname: Lakkireddy
authors.affiliation: Assistant Professor, Department of Orthopaedics, Nizam's Institute of Medical Sciences , Hyderabad, India .
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Koppolu
authors.affiliation: Professor and HOD, Department of Orthopaedics, Mediciti Institute of Medical Sciences , Hyderabad, India .
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Rapur
keywords: Finger stiffness; Ligamentotaxis; Percutaneous pinning