External fixation for distal radius fractures: adverse effects of excess distraction

External fixation is accepted treatment for some distal radius fractures. Ligamentotaxis is the basis for the technique, and failure to recognize its limitations can lead to excess distraction. This paper discusses potential complications of excess distraction as well as its effect on outcome. Supplemental fixation techniques and multiplanar ligamentotaxis are advocated to improve outcome when external fixation is used.