Recurrence of Radial Bowing After Soft Tissue Distraction and Subsequent Radialization for Radial Longitudinal Deficiency

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 10; pp. 2082 - 2087
• Main Authors: Dana, Caroline, MD, Aurégan, Jean-Charles, MD, Salon, Arielle, MD, Guéro, Stéphane, MD, Glorion, Christophe, MD, Pannier, Stéphanie, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier
• Subjects: Biological and medical sciences; Child, Preschool; Diseases of the osteoarticular system; Female; Humans; Infant; Male; Medical sciences; Orthopedic Procedures; Orthopedics; Osteogenesis, Distraction; Postoperative Complications; Radial longitudinal deficiency; radialization; Radius - abnormalities; Radius - surgery; Recurrence; Retrospective Studies; soft tissue distraction; radialization; soft tissue distraction; Radial longitudinal deficiency; Relapse; Deficiency; Orthopedics; Distraction; Soft tissue
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2012.07.018

Purpose Centralization and radialization are the most widely reported surgical treatments for Bayne and Klug Type III and IV radial longitudinal deficiency. Prior soft tissue distraction has been introduced to improve reducibility of the deformity without skeletal resection. Satisfying long-term effects have been reported with centralization but are still unclear with radialization. Methods This is a retrospective study of 8 consecutive children with Bayne and Klug Type III or IV radial longitudinal deficiency treated with preliminary soft tissue distraction followed by radialization between 2003 and 2008. All children underwent the same surgical protocol. End points of the study were clinical appearance, the hand-forearm angle, and mean angular correction at last follow-up. Results The mean preoperative hand-forearm angle was 61° (26°–91°). The average duration of distraction was 1.9 month (1–3 mo). The initial postoperative angle averaged 12° (−14°–40°). There were 3 postoperative complications: 2 cases of pin loosening and 1 case of fracture of the base of the small finger metacarpal. Mean follow-up duration was 2.6 years (1–4 y). At last follow-up, 7 of the 8 patients had visible recurrence of the deformity, the hand-forearm angle had deteriorated to 44° (20°–69°), and the mean angular correction was 18° (−43°–59°). Conclusions Preoperative distraction allows a gradual realignment of the hand on the forearm without skeletal resection, but the recurrence rate after radialization is high. Tendon transfers and soft tissue tensioning were unable to maintain hand-forearm alignment following soft tissue distraction. Type of study/level of evidence Therapeutic IV.