Short term outcome of a two-staged approach for untreated radial longitudinal deficiency in children over two years of age.

BACKGROUND

Centralization of the hand over distal ulna remains the cornerstone of management for congenital radial longitudinal deficiency (CRLD). However, centralization alone presents several technical challenges. Gradual soft tissue distraction prior to centralization is usually helpful in tackling these issues. The currentstudy observed the short term outcomes of a two-staged procedure where wrist was gradually distracted with an external fixator before performing centralization.

METHODS

Retrospective analysis of 20 hands (14 patients) with Heikel type 3-4 CRLD managed by two-staged approach between year 2020 and 2024 was done. In first stage, gradual distraction of the wrist was performed with an external fixator. Once sufficient distraction was achieved, centralization of wrist over distal ulna was done as second stage without doing any tendon transfer across the wrist. Clinical hand-forearm angle (HFA) and radiological ulna-metacarpal angle (UMA) before and after treatment were compared to assess the amount of correction.

RESULTS

Mean age of children was 33.1 months; mean follow-up after centralisation was 26 months (range 18-48 months). Radial deviation was corrected from 74.3° to 12.6° (correction 61.7°, p < 0.001) and volar flexion from 66.4° to 12.0° (correction 54.5°, p < 0.001). Radiological UMA correction was 64.0° (AP, p < 0.001) and 45.5° (lateral, p < 0.001). Complications included pin-tract infection (2 hands), physeal widening (1 hand), K-wire breakage (1 hand) and finger contractures (5 hands). All were managed conservatively without compromising the final outcome.

CONCLUSIONS

A two-staged approach of gradual distraction and centralisation achieves satisfactory preliminary short term deformity correction in children with severe RLD presenting after two years. Prior distraction simplifies centralisation and obviates aggressive releases.