Amount of Distraction
We are unable to recommend for or against over-distraction of the wrist when using an external fixator.

Rationale
Two level II studies met the inclusion criteria. 86, 87 There was no statistically significant association between the amount of distraction and patient outcome using a non-validated instrument. However, the work group agreed that the important potential adverse effect of finger stiffness was not evaluated in these studies. It would not be ethical to conduct a prospective study to examine the effect of over-distraction. The work group hence have downgraded the recommendation to “inconclusive”.