Distal Radius Frx: Palmar Tilt Reduction
- See: Palmar Tilt
- 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.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Tuesday, December 11, 2012 2:52 pm