Reduction techniques in distal radius fractures.

External skeletal fixation is an important minimal invasive procedure in the management of fractures at the distal end of the radius. Attention to detail is important not only in the recognition of indications and function of the external fixator but also in its specific application. To improve anatomical restoration (e.g. palmar tilt) multi-planar ligamentotaxis is recommended. The demonstrated dynamic fixator is easy to apply and the double ball joint facilitates reduction after mounting by multi-planar ligamentotaxis. This transarticular unilateral external fixation system permits restoration of anatomy with the wrist in neutral or extension, thereby allowing full flexion of the metacarpophalangeal joints, with fingers and wrist extensor tendons relatively relaxed. Multi-planar ligamentotaxis, combined with a limited approach for supplementary procedures (fixation of articular fragments and/or bone grafting) and with early wrist motion, offers an encouraging treatment option in the management of unstable distal radial fractures by providing better anatomical restoration, especially of the palmar tilt and reduces the risk of wrist and finger stiffness.