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Radial longitudinal deficiency: long-term outcomes of radialization and vascularized metatarsophalangeal joint
Niko Kämppä1,2, Petra Grahn2, Pasi Paavilainen3
1Department of Hand Surgery, HUS Helsinki University Hospital, Hyvinkää Hospital, and University of Helsinki, Helsinki, Finland.
Introduction:
We studied long-term outcomes of radialization and free vascularized second metatarsophalangeal joint transfer for radial longitudinal deficiency using patient-reported and objective outcome measures.
Methods:
Patients aged ⩾10 years with Bayne and Klug type III or IV radial longitudinal deficiencies were identified from national referral centres. Patients treated by radialization (n = 15 limbs) and metatarsophalangeal joint transfer (n = 17 limbs) were assessed after a median follow-up of 13 years.
Results:
The respective scores after metatarsophalangeal joint transfer and radialization were: median Disabilities of Arm, Shoulder, and Hand scores 19 (95% CI: 7 to 25) and 19 (16 to 29); patient-rated wrist evaluation scores 11 (95% CI: 8 to 22) and 24 (95% CI: 10 to 38); and satisfaction with cosmesis 5 (95% CI: 3 to 6) and 8 (95% CI: 7 to 10). Median wrist active range of motion values were 90° (95% CI: 70 to 90) and 50° (95% CI: 30 to 60) and median wrist deviations were 20° (95% CI: 15 to 30) and 30° (95% CI: 15 to 60) after joint transfer and radialization, respectively. Secondary wrist procedures were more frequent in the joint transfer group.
Conclusions:
Both techniques yield good functional outcomes. Joint transfer produced a more consistent and larger range of active wrist extension-flexion but with poorer cosmetic results than radialization.
Level Of Evidence:
IV.
