BACKGROUND: Preoperative soft-tissue distraction for congenital radial deficiency is well described, but indications are unclear and long-term outcomes are lacking. METHODS: This study evaluated one surgeon's 16-year experience with preoperative soft-tissue distraction using uniplanar devices. Eight extremities in seven consecutive patients (average age, 2.5 years) with type 4 radial deficiency and severe wrist deformity were distracted before centralization (seven extremities) or radialization (one extremity). RESULTS: In the short term, average hand-forearm angle improved by 89 degrees and average hand-forearm position improved by 31 mm. In the long-term, wrist deformity recurred commensurate with the degree of initial deformity. Fortuitously, one infant experienced unintended epiphyseal distraction that lengthened the ulna by 15 mm before radialization. One patient required recentralization; two developed minor pin-track infections. Multiple distractor readjustments were necessary early in the series. CONCLUSIONS: Preoperative soft-tissue distraction for radial deficiency is indicated in late-presenting or neglected patients or cases with severe, irreducible wrist angulation and displacement. Dramatic correction is possible using uniplanar distractors. Although minor complications are common, they diminish with experience. Using this technique, the surgeon avoids skeletal shortening and undue strain on the nerves and vessels at the time of centralization or radialization.
BACKGROUND: Preoperative soft-tissue distraction for congenital radial deficiency is well described, but indications are unclear and long-term outcomes are lacking. METHODS: This study evaluated one surgeon's 16-year experience with preoperative soft-tissue distraction using uniplanar devices. Eight extremities in seven consecutive patients (average age, 2.5 years) with type 4 radial deficiency and severe wrist deformity were distracted before centralization (seven extremities) or radialization (one extremity). RESULTS: In the short term, average hand-forearm angle improved by 89 degrees and average hand-forearm position improved by 31 mm. In the long-term, wrist deformity recurred commensurate with the degree of initial deformity. Fortuitously, one infant experienced unintended epiphyseal distraction that lengthened the ulna by 15 mm before radialization. One patient required recentralization; two developed minor pin-track infections. Multiple distractor readjustments were necessary early in the series. CONCLUSIONS: Preoperative soft-tissue distraction for radial deficiency is indicated in late-presenting or neglected patients or cases with severe, irreducible wrist angulation and displacement. Dramatic correction is possible using uniplanar distractors. Although minor complications are common, they diminish with experience. Using this technique, the surgeon avoids skeletal shortening and undue strain on the nerves and vessels at the time of centralization or radialization.
Authors: George R F Murphy; Malcolm P O Logan; Gill Smith; Branavan Sivakumar; Paul Smith Journal: J Bone Joint Surg Am Date: 2017-12-20 Impact factor: 5.284