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Over Distraction of Distal Radius Frx

- Discussion:
     - distraction (or ligamentotaxis) is used to facilitate reduction of distal radius frx;
     - overdistraction will cause increased mid & proximal carpal joint space widening & resistance to  passive flexion of finger tips to distal palm;
             - look for over distraction when proximal & mid carpal row joint spaces are widened;
             - 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;
     - most sensitive indicator is to attempt to flex index finger passively to the distal palmar crease;
             - w/ further distraction, there will be increase in MP joint extension;
             - clinically the fingers may appear to be clawed w/ MP extension;
             - excessive traction produces intrinsic minus position of hand that is in fact an extrinsic extensor  plus position of the finger MP joints;
     - RSD may be the most obvious result of overdistraction;
             - if there is any indication of RSD, then tension on the fixator must be released

The Effect of Increasing Distraction on Digital Motion After External Fixation of the Wrist.

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