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Distal Radius Frx: Palmar Tilt Reduction

- See: Palmar Tilt

- Discussion:
       - frx needs to be reduced prior to skin incisions & Ex Fix application;
       - longitudinal traction combined w/ thumb pressure and wrist flexion restores palmar tilt;
       - progressive wrist flexion will not restor palmar tilt until dorsal ligaments begin to tighten as wrist flexion limits are reached;
       - excessive forces can tear hinge & convert dorsally displaced Colle's type fracture to a palmarly displaced Smith's type fracture;
       - palmar translation of the distal fragment will further restore Palmar Tilt to the distal fragment;
               - (assumming there was no carpal ligamental injury);
       - using the external fixator, distal traction is followed by palmar translation to restore palmar tilt;
              - however, prior to applying of palmar translation, excessive distraction must be decreased because it may prevent the palmar translation force from restoring palmar tilt;
       - palmar translation creates a volar intercalated segmental collapse deformity of carpus as forces are transmitted to lunate & creates a rotatary force necessary to tilt lunate & distal radial frag palmarly;
       - although radial length & inclination are usually re-established & 
              maintained w/ traction, the palmar tilt of the radius is rarely restored to normal;
              - this may be due to fact that stout palmar radiocarpal ligaments reach maximum length before the z-shape dorsal ligaments, preventing latter from pulling dorsal aspect of the distal end of radius into its normal palmar inclination.

Intraarticular fractures of the distal radius: a cadaveric study to determine if ligamentotaxis restores radiopalmar tilt.

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