Preliminary experience with Ilizarov method in late reconstruction of radial hemimelia.

We report the outcome of ulnar lengthening with the Ilizarov technique in five adults with radial hemimelia and previous wrist centralization. The indications for ulnar lengthening in these patients were either a functional deficit due to the short ulna or poor appearance that caused the patient significant unhappiness. All patients had a successful lengthening of the ulna, with a gain in length from 4 to 13 cm; however, the procedures were prolonged (7 to 25 months), and all patients experienced complications. At the time of follow-up examination no patient had residual pain or paresthesias. In four of five patients, although ulnar lengthening resulted in somewhat stiffer digits, it improved function of the extremity as a whole. When asked if they would repeat the lengthening, knowing what they know now, all five replied that they would. The technical difficulties encountered in these cases suggest a cautious approach to ulnar lengthening. This is a long, arduous, painful process that requires a psychologically robust patient. If the ulna is very short preoperatively, lengthening can enhance the volume of space accessible to the hand and in that way improve function.