Correlation of wrist ligamentotaxis with carpal distraction: Implications for external fixation

Loebig, Thomas G.; Badía, Alejandro; Anderson, Donald D.; Baratz, Mark E.

doi:10.1016/s0363-5023(97)80048-2

Cited by 12 publications

(9 citation statements)

References 10 publications

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“…That said, it is possible to compare relative bone motions to a maximum of 3.3mm of distraction, which was the average for our subjects. At 3.3mm of distraction, Loebig et al6 found that lunocapitate distraction was 2.4 times as much as radiolunate distraction, which is consistent with our findings. Similarly, they measured 2.2 times more distraction at the radioscaphoid joint than the radiolunate joint, which is consistent with our findings6.…”

Section: Discussionsupporting

confidence: 93%

“…Bartosh and Saldana37 found an average of 3mm of overall wrist distraction in 19 cadaver wrists, regardless of the amount of load used. Loebig et al6 performed distractions on twelve cadaveric wrists using a standard servohydraulic mechanical testing device. They measured almost 2.5 times as much distraction at 80N of load than we did at 98 N(almost 8 mm vs. 3.3±3.1 mm).…”

Section: Discussionmentioning

confidence: 99%

“…Simple axial distraction studies have reported a large variability in the load-deformation behavior of individual wrists 6, and a subsequent investigation of 3-D carpal kinematics during wrist distraction has demonstrated that distraction alters carpal bone motion, specifically that it reduces radiocarpal motion during extension and increases radiocarpal motion during flexion 7.…”

Section: Introductionmentioning

confidence: 99%

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Conformational Changes in the Carpus During Finger Trap Distraction

Leventhal

Moore²,

Akelman³

et al. 2010

The Journal of Hand Surgery

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Introduction Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and mid-carpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the 3-D conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. Methods The dominant wrists of 14 healthy volunteers were scanned using computed tomography at rest and during application of 98N of distraction. Load was applied using finger traps and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone was calculated relative to the radius as well as the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal and carpal-metacarpal joints in the direction of loading using the radius, lunate, capitate and 3rd metacarpal. Results With loading, the distance between the radius and 3rd metacarpal increased an average of 3.3±3.1mm in the direction of loading. This separation was primarily located in the axial direction at the radiocarpal (1.0±1.0mm) and midcarpal (2.0±1.7mm) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98±0.7mm. Distraction between the radius and scaphoid (2.5±2.2mm) was 2.4 times greater than between the radius and lunate (1.0±1.0mm). Conclusions Carpal distraction has a significant effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conformational Changes in the Carpus During Finger Trap Distraction

Leventhal

Moore²,

Akelman³

et al. 2010

The Journal of Hand Surgery

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“…5). Our data support the findings of Loebig et al 4 Although the external fixator was locked with the wrist placed in the neutral position at 0 mm of distraction, an associated ulnar deviation was noticed during the radial-side wrist distraction caused by the application of the load on the second metacarpal distally. Our protocol was not designed to investigate the ulnar deviation; however, it seems that the progressive ulnar deviation of the wrist causes ulnar-side tendon relaxation between 0 and 4 mm of distraction.…”

Section: Discussionsupporting

confidence: 91%

The Effect of Increasing Distraction on Digital Motion After External Fixation of the Wrist

Papadonikolakis

Shen

Garrett

et al. 2005

The Journal of Hand Surgery

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“…In this wrist, a 7 mm distraction gap was utilised, based on evidence from the literature derived from external fixation distraction of the distal radial fracture which suggested that distraction of 3 mm fully tensions radiocarpal ligamentous structures [19]; that distraction of 5–8 mm is not associated with residual radiocarpal, intercarpal, or metacarpal stiffness [20]; and that greater than 8 mm distraction increases force to greater than 80 N through the carpus and thus may be excessive [21]. …”

Section: Discussionmentioning

confidence: 99%

Joint Preservation of the Wrist Using Articulated Distraction Arthroplasty: A Case Report of a Novel Technique

Fletcher

2015

Case Reports in Orthopedics

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Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative.

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Correlation of wrist ligamentotaxis with carpal distraction: Implications for external fixation

Cited by 12 publications

References 10 publications

Conformational Changes in the Carpus During Finger Trap Distraction

Conformational Changes in the Carpus During Finger Trap Distraction

The Effect of Increasing Distraction on Digital Motion After External Fixation of the Wrist

Joint Preservation of the Wrist Using Articulated Distraction Arthroplasty: A Case Report of a Novel Technique

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