Radialization With Ulnar Cuff Osteotomy: A Technique for Deformity Correction in Radial Longitudinal Deficiency

Various procedures described for deformity correction in radial longitudinal deficiency (RLD) have encountered problems of stiffness, instability, and inadequate correction. Many surgical modifications of these procedures have still resulted in deformity recurrence, shortening, and damage to the epiphysis. To align the hand with the forearm, the deforming forces from both soft tissues and skeletal growth should be addressed without damaging the ulnar epiphysis or the carpus. To achieve this, we propose a metaphyseal ulnar cuff osteotomy during radialization. After soft tissue release, the overlap of carpus to ulna is shortened at the metaphysis in the form of a subperiosteal cuff along with additional tendon balancing. This procedure has helped us in correcting the deformity without damaging the epiphysis or the carpus and has maintained correction through the initial critical growth period of the child.