The Effect of Soft Tissue Distraction on Deformity Recurrence After Centralization for Radial Longitudinal Deficiency

Manske, M. Claire; Wall, Lindley B.; Steffen, Jennifer A.; Goldfarb, Charles A.

doi:10.1016/j.jhsa.2014.01.015

Cited by 20 publications

(17 citation statements)

References 19 publications

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“…Radialization maintained better “wrist” ROM (46°) and ulnar length (13.6 cm) than centralization (25° and 11.5 cm). Both yielded greater hand-forearm angle correction than in historical series of centralization without prior soft-tissue distraction 1 , 9 - 11 , 19 , 26 , which achieved a mean improvement of 34° to a final radial deviation of 28°, and similar ulnar length and “wrist” ROM.…”

Section: Resultsmentioning

confidence: 80%

Correction of “Wrist” Deformity in Radial Dysplasia

Murphy

Logan

Smith

et al. 2017

The Journal of Bone and Joint Surgery

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Background:Radial dysplasia affects 1 in 6,000 to 8,000 births, classically presenting with a shortened, bowed ulna and radially deviated hand. The optimal treatment remains unclear, with several opposing approaches advocated. This review aims to clarify the long-term outcomes of nonsurgical and surgical treatment of the “wrist” deformity.Methods:The Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (ICTRP) databases were searched for published and unpublished studies reporting long-term outcomes of surgical or nonsurgical treatment of children with radial dysplasia. Results were not restricted by date or language. Primary outcomes were hand-forearm angle, ulnar length, and “wrist” active range of motion (ROM). Studies were assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. Data for the change in hand-forearm angle were pooled using random-effects meta-analysis, and mean differences and 95% confidence intervals were obtained. Primary outcome data at last follow-up were pooled, and means and standard deviations were obtained. The PROSPERO registration of this study was CRD42016036665.Results:Of 104 studies identified, 12 were included in this review. Five were retrospective cohort studies and 7 were case series. No randomized studies were found. Study quality was low or very low according to the GRADE criteria. The hand-forearm angle of nonsurgically treated patients worsened during childhood, from 66° to 84°, whereas “wrist” active ROM, at 61°, was better than that for most surgically treated patients. Ulnar length with nonsurgical treatment was predicted to be 64% of normal, but was not directly reported. Isolated soft-tissue release provided a modest reduction in hand-forearm angle compared with nonsurgical treatment. Soft-tissue distraction with centralization or radialization achieved the best hand-forearm angle correction (16° radial deviation). Radialization maintained better “wrist” active ROM (46°) and ulnar length than centralization. Microvascular second metatarsophalangeal joint transfer yielded better reported “wrist” active ROM (83°) and good ulnar length compared with other surgical techniques, but a slightly worse hand-forearm angle (28°).Conclusions:There was low-quality evidence that soft-tissue distraction plus centralization or radialization achieved the best correction of the hand-forearm angle for children with radial dysplasia.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 80%

Correction of “Wrist” Deformity in Radial Dysplasia

Murphy

Logan

Smith

et al. 2017

The Journal of Bone and Joint Surgery

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“…Manske et al [ 24 ] in 2014 carried out a study to evaluate the effect of soft-tissue distraction on recurrence of deformity after centralization for radial longitudinal deficiency. Thirteen upper limbs treated with centralization alone were compared with 13 treated with external fixator distraction followed by centralization with 2–10 years follow up.…”

Section: Discussionmentioning

confidence: 99%

Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?

Deszczyński

Albrewczyński²,

Shannon³

et al. 2021

Children

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(1) Background: Patients treated with the two previous generations of ulnarization developed a bump related to the ulnar head becoming prominent on the radial side of the hand. To finally remedy this problem, a third generation of ulnarization was developed to keep the ulnar head contained. While still ulnar to the wrist center, the center of the wrist remains ulnar to the ulnar head, with the ulnar head articulating directly with the trapezoid and when present the trapezium. (2) Methods: Between 2019 and 2021, 22 radial club hands in 17 patients were surgically corrected with this modified version of ulnarization. (3) Results: In all 17 patients, the mean HFA (hand–forearm-angle) correction was 68.5° (range 12.2°–88.7°). The mean ulna growth was 1.3 cm per year (range 0.2–2 cm). There were no recurrent radial deviation deformities more than 15° of the HFA. (4) Conclusions: This new version of ulnarization may solve the problem of the ulna growing past the carpus creating a prominent ulnar bump. The results presented are preliminary but promising. Longer-term follow-up is needed to fully evaluate this procedure.

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“…They observed Centralization, with or without distraction with an external fixator, corrected alignment of the wrist. Distraction facilitated centralization, but it did not avoid deformity recurrence and was associated with a worse radial deviation and volar subluxation position compared with wrists treated with centralization alone [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series

Lahiji

Asgari

Mirzaee

et al. 2019

International Journal of Surgery Case Reports

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Highlights Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. Treatment of RCH should begin as soon as possible after birth. Treatment of patients with RCH by primary traction and centralization and pollicization surgery, can greatly improve the deformity. Early centralization and pollicization can significantly restore the range of motion and function in patients with RCH.

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The Effect of Soft Tissue Distraction on Deformity Recurrence After Centralization for Radial Longitudinal Deficiency

Cited by 20 publications

References 19 publications

Correction of “Wrist” Deformity in Radial Dysplasia

Correction of “Wrist” Deformity in Radial Dysplasia

Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?

Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series

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