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