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External Fixators: Reduction and Final Wrist Position

- See:
      - Over Distraction of Wrist Joint
      - Palmar Tilt Reduction
      - Radial Inclination Reduction

- Wrist Position:
      - wrist is placed in neutral to slight extension w/ care taken not to over distraction the hand;
      - over distraction is related to delayed union & finger stiffness;
             - in order to avoid finger stiffness, use least distraction force necessary to maintain skeletal length in synergy w/ wrist extension to relax finger extensor tendons;
             - note that patients who have delayed external fixation (ie cases that are initially treated with casting), may be prone to excessive post op pain due to the forces necessary to bring the fracture out to length;
      - position of wrist flexion (resultant MP extension) will promote clawing
      - excessive distraction will also promote clawing of the hand;
      - attempt to position the wrist in extension, because it relaxes tension on finger extensor tendons, & prevents contractures of MP joint extension