Wrist centralization using the dorsal rotation flap in radial longitudinal deficiency

Although the role of wrist centralization has been controversial, the surgeon must knowledgeably make surgical decisions for patients with radial longitudinal deficiency, understanding the advantages and disadvantages of centralization techniques. The goals of surgical intervention for correction of radial longitudinal deficiency are to correct the radial deviation deformity of the wrist by centralizing the carpus on the distal end of the ulna, concomitant with balancing the soft tissue structures at the wrist maintaining finger and wrist motion. Wrist centralization is indicated in children with complete absence of the radius with elbow range of motion of greater than 90 degrees, and stable medical condition. This article presents the technique of wrist centralization surgery using a dorsal rotation flap. The wrist capsule is released from the radial side of the ulna, and the carpus is relocated over the distal end of the ulna, with a longitudinal pin placed through the ulna, across the carpus, and between or down the middle ray metacarpal. If the ulna has greater than 30 degrees angulation, a concomitant ulnar osteotomy is performed. Complications can include recurrence, pin problems, stiff digits, and diminished long-term ulnar growth. Long-term splint wear may be necessary to decrease the risk of recurrence. At the present time, an optimal single surgical technique for intervention for this complex congenital deformity has not yet been described.