Congenital radius deficiency: radiographic outcome and survivorship analysis

The experience with congenital radius deficiency, or radial hemimelia, at the Shriners' Hospital for Children, Los Angeles Unit, was reviewed. A cohort of 29 limbs in 23 patients was identified with an average follow-up period of 50 months. Radiographic parameters were assessed using the hand-forearm angle, hand-forearm position, and ulnar bow. We compared radialization to modified centralization, assessed the efficacy of ulnar osteotomy, and assessed the effect of age, preoperative deformity, ulnar osteotomy, and Bayne's type on the final result. Revisions were noted and a survivorship analysis performed. The cohort had statistically significant correction of hand-forearm angle and hand-forearm position. Radialization was similar to modified centralization in the final outcome. Ulnar osteotomy was an efficacious way to correct ulnar deformity. Age, preoperative deformity, performance of an ulnar osteotomy, and Bayne's type did not affect the final wrist position. Survivorship analysis was performed using revision as the end point, with a survivorship rate at 5 years of 67%. Significant risk factors for revision included radial or positive hand-forearm angle and young age at the time of the index procedure. There was a suggestion that small postoperative hand-forearm position, or radial translation, increased the risk of revision. Preoperative deformity, performance of an ulnar osteotomy, and Bayne's type did not affect the risk of revision. These data offer support for the hypothesis that a more ulnar translation and an ulnar angulation of the wrist is a means of reducing the radial lever arm and thus the incidence of deformity recurrence and need for revision.