An approach to the management of radial longitudinal deficiency

This paper describes an approach to the management of radial longitudinal deficiency. Early treatment includes manipulation and splintage prior to realignment of the carpus on the forearm. Twelve patients are presented in which a comparison is made between centralisation and radialisation surgical techniques. Preoperative distraction allowed radialisation without excision of a part of the carpus in five out of six patients. In contrast, centralisation with carpal excision was necessary in 5 out of 6 patients not treated by preoperative distraction. It remains to be seen whether radialisation is a superior procedure to centralisation in the longer term. However, radialisation in theory allows greater protection for the distal ulnar physis, maintains maximal length, and allows optimal wrist motion. Late treatment of radial longitudinal deficiency includes techniques of bone lengthening and correction of radial deviation deformity. Three cases are presented in which the Ilizarov technique was used to lengthen the forearm and to correct deformity. The complications of forearm lengthening are high but these techniques do allow significant correction of deformity.