Pre-operative distraction lengthening for radial longitudinal deficiency

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Congenital Limb Malformations

Background:

• Total radial aplasia is a congenital condition characterized by the absence or underdevelopment of the radius bone.
• Management often involves surgical intervention to improve hand and wrist function.
• Traditional surgical approaches may involve complex procedures with potential risks.

Purpose of the Study:

• To evaluate the efficacy of pre-operative distraction using the Kessler device for carpal re-alignment in patients with total radial aplasia.
• To compare the outcomes of radialization with and without pre-operative distraction.

Main Methods:

• A review of patients treated for total radial aplasia.
• Comparison of surgical outcomes between a group treated with pre-operative distraction (Kessler device) and a group treated without distraction.
• Assessment of carpal re-alignment, radial angulation, and radial translation.

Main Results:

• Five out of six limbs treated with pre-operative distraction achieved carpal re-alignment.
• Only one out of six limbs treated without distraction achieved carpal re-alignment.
• The distraction group showed an average improvement of 38 degrees in radial angulation, compared to 19 degrees in the non-distraction group.
• Average radial translation improvement was 16 mm and 17 mm for the non-distraction and distraction groups, respectively.

Conclusions:

• Pre-operative distraction with the Kessler device is an effective method for re-aligning the carpus in total radial aplasia.
• This technique allows for successful hand re-alignment without the need for skeletal resection or excessive tension on neurovascular structures.
• Pre-operative distraction offers a promising, less invasive approach to managing radial aplasia.