Rotational alignment must be considered during application of the distractor or external fixator.
They are uniplanar devices. Once applied, rotation of the fracture fragments cannot be adjusted significantly. Thus, the pins should be placed so that when they are in the same plane, malrotation is corrected, and the fracture is reduced.
Note: Remember that tensioning the unilateral distractor typically produces fracture angulation. Adjust the pin clamps appropriately to prevent this.