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Distal Radius Frx: Use of Ligamentotaxis

- Discussion:
    - longitudinal traction restores skeletal length and improves fracture alignment,
    - radial styloid frx and scaphoid facet are usually amenable to reduction through ligamentotaxis or by manipulation and reduction with a large, pointed bone clamp;
    - residual incongruity usually involves the lunate facet of the distal end of the radius;

- Cautions:
    - excessive longitudinal traction may have the effect of increasing dorsal tilt as distal fragment pivots on taut dorsal soft tissue hinge;
    - most fixators use only longitudinal traction forces that are incapable of restoring palmar tilt;
    - dorsal capsule has no ability to maintain reduction by ligamentotaxis;
    - dorsal ligaments run obliquely and tend to stretch apart rather than exerting equivalent force to ditsal fragment from external fixator;

- Case Example:
    - radial styloid fragment of this distal radius fracture, did not reduced despite ample ligamentotaxis from an external fixator;
           - percutaneous pins were required to complete the reduction