title: The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency.
abstract: OBJECTIVE
  To assess recurrence and complications in children with radial longitudinal deficiency treated with or without external fixator soft tissue distraction prior to centralization.
  
  
  METHODS
  Thirteen upper extremities treated with centralization alone were compared with 13 treated with ring fixator distraction followed by centralization. Resting wrist position between the 2 groups was compared before surgery, approximately 2 years after surgery (midterm), and at final follow-up, which was at a mean of 10 years for the centralization-alone group and 6 years for the distraction group. Radiographs were reviewed for hand-forearm angle, hand-forearm position, volar carpal subluxation, ulnar length, and physeal integrity.
  
  
  RESULTS
  The clinical resting wrist position was improved significantly after surgery and at final follow-up in both groups, but recurrence was worse at final follow-up in the distraction group patients. Radiographically, in the centralization alone group, the hand-forearm angle improved from 53° before surgery to 13° at midterm but worsened to 27° at final follow-up. In the distraction group, the hand-forearm angle improved from 53° before surgery to 21° at midterm but worsened to 36° at final follow-up. The hand-forearm position improved between preoperative and final assessment in both groups, but at final follow-up, the centralization-alone group had a significantly better position. Volar subluxation was 4 mm improved in the centralization alone group and 2 mm worse in the distraction group at final follow-up.
  
  
  CONCLUSIONS
  Centralization, with or without distraction with an external fixator, resulted in improved alignment of the wrist. Distraction facilitated centralization, but it did not prevent deformity recurrence and was associated with a worse final radial deviation and volar subluxation position compared with wrists treated with centralization alone.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO.
authors.forename: M Claire
authors.initials: MC
authors.lastname: Manske
authors.affiliation: Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO.
authors.forename: Lindley B
authors.initials: LB
authors.lastname: Wall
authors.affiliation: Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Steffen
authors.affiliation: Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO. Electronic address: goldfarbc@wudosis.wustl.edu.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
mesh_terms: D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D006228:Hand Deformities, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011884:Radius / Q000002:abnormalities*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000002:abnormalities*
keywords: Radial deficiency; centralization; distraction; fixator; recurrence