Preoperative soft-tissue distraction for radial longitudinal deficiency: an analysis of indications and outcomes.
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.
Taghinia
Amir H
AH
Boston, Mass. From the Division of Plastic Surgery, Children's Hospital and Harvard Medical School.
Al-Sheikh
Ayman A
AA
Upton
Joseph
J
D002648:Child; D002675:Child, Preschool; D005260:Female; D006228:Hand Deformities, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014953:Wrist / Q000601:surgery*