title: Soft-tissue distraction with a ring external fixator before centralization for radial longitudinal deficiency.
abstract: OBJECTIVE
  To review the techniques and evaluate the use of soft-tissue distraction with a ringed fixator for radial longitudinal deficiency (RLD) before centralization.
  
  
  METHODS
  Eight extremities in 6 patients with severe RLD were treated with ring fixator distraction followed by centralization. A clinical examination was performed and radiographic data were obtained prospectively and at an average follow-up period of 17 months. The techniques and the early objective (range of motion, position) and radiographic outcome were evaluated.
  
  
  RESULTS
  The preoperative ring fixator accomplished an average of 16 mm of distraction and allowed the centralization procedure to be performed effectively and without tension. Clinical alignment was improved markedly. The hand-forearm angle improved from 72 degrees radial to 8 degrees ulnar after surgery. The volar carpal subluxation improved by an average of 6 mm.
  
  
  CONCLUSIONS
  Precentralization ring fixator distraction allows the performance of a tensionless centralization procedure with good early radiographic and clinical outcome in patients severely affected with RLD.
  
  
  METHODS
  Therapeutic, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. goldfarbc@wustl.edu
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Murtha
authors.forename: J Eric
authors.initials: JE
authors.lastname: Gordon
authors.forename: Paul R
authors.initials: PR
authors.lastname: Manske
mesh_terms: D000293:Adolescent; D002348:Carpal Bones / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004480:Ectromelia / Q000000981:diagnostic imaging / Q000601:surgery*; D016267:External Fixators; D005260:Female; D006228:Hand Deformities, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011300:Preoperative Care; D011859:Radiography; D011884:Radius / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014955:Wrist Joint / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery