An Algorithm for Management of Radial Longitudinal Deficiency

Lack of specific guidelines in the literature renders management of radial longitudinal deficiency (RLD) exceedingly diverse. This diversity in treatment approaches can lead to variability in outcomes and pose a challenge in determining the most effective interventions for each individual case of RLD. Surgeons must carefully consider the unique characteristics and needs of each patient when developing a treatment plan for this complex condition. Around 40% of cases are linked to syndromes like Holt-Oram syndrome, thrombocytopenia absent radius (TAR) syndrome, Fanconi anaemia and VACTERL. Hand surgeons must be knowledgeable about these conditions, as they may be the first to identify these syndromes in children. Associated elbow stiffness can also be a crucial factor in treatment decision-making. Although this condition has been studied for more than 10 decades, the surgical treatment that is currently available is not completely successful in restoring 'normal' wrist function and appearance. Centralisation and radialisation procedures continue to be the cornerstones of surgical treatment. Many innovative approaches include altering the biomechanics of this condition with bony or soft tissue procedures and microvascular techniques. Understanding the proximal limb changes is crucial in the holistic management of this challenging malformation. This article presents a treatment algorithm based on literature evidence and our clinical experience. Level of Evidence: Level V (Therapeutic).