Open AccessLigamentotaxis for Barton's and Paediatric Distal Radial Fractures
Author(s) -
Palaniappan Lakshmanan,
Murali Krishna Sayana,
Balaji Purushothaman,
J. L. Sher
Publication year - 2009
Publication title -
journal of orthopaedic surgery
Language(s) - English
Resource type - Journals
eISSN - 2309-4990
pISSN - 1022-5536
DOI - 10.1177/230949900901700107
Subject(s) - medicine , wrist , traumatology , dorsum , radial fractures , orthopedic surgery , displacement (psychology) , specialty , wrist injury , physical therapy , surgery , orthodontics , anatomy , family medicine , psychology , psychotherapist
Purpose. To establish a consensus regarding immobilisation of the wrist following reduction of Barton's and paediatric distal radial fractures.Methods. Questionnaires were distributed to orthopaedic surgeons at the European Federation of National Associations of Orthopaedics and Traumatology meeting in Lisbon in 2005. Questions included the surgeon's country of practice, hospital, professional grade, years of experience, sub-specialty, and preferred position of wrist immobilisation after (1) a volar Barton's fracture, (2) a dorsal Barton's fracture, (3) a paediatric Salter-Harris type-II injury to the distal radius with volar displacement, and (4) the same injury but with dorsal displacement.Results. Of 148 questionnaires distributed, 118 were returned. The specialist-to-trainee ratio was 45:73. In volar Barton's fractures, only 20% (29% specialists and 15% trainees) would immobilise the wrist in palmar flexion, as per recommendations. In dorsal Barton's fractures, only 25% (33% specialists and 21% trainees) would immobilise the wrist in dorsiflexion, as per recommendation. In paediatric Salter Harris type-II injury to the distal radius with volar displacement, 87% (100% specialists and 79% trainees) would immobilise the wrist in dorsiflexion or in a neutral position, as per recommendation. In the same injury but with dorsal displacement, 84% (89% specialists and 81% trainees) would immobilise the wrist in palmar flexion or in a neutral position, as per recommendation. In all 4 types of fractures, 26% to 30% of respondents would immobilise the wrist in a neutral position.Conclusion. Most respondents deviate from the recommended immobilisation positions in treating Barton's fractures. Understanding of the anatomy or biomechanics of ligamentotaxis are crucial for conservative treatments.