Congenital Differences-Radial Longitudinal Deficiency

Radial Longitudinal Deficiency

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The article discusses the treatment options for radial deficiency of the forearm also known as radial club hand. The most common procedure performed is soft tissue distraction followed by a wrist realignment procedure. A retrospective review of 446 patients found that surgical management had improvement in appearance and function. However, the evidence regarding treatment is limited to retrospective case series and there is a lack of a clearly superior procedure. All options have high rates of recurrence with considerable complication rates. The outcomes measured only relate to the presence of deviation and length of the forearm. The article suggests the need for a valid measure of outcome for this condition and a larger prospective multicenter cohort study. Complications need to be analyzed, and a randomized controlled trial comparing soft tissue distraction followed by centralization with vascularized second metatarsophalangeal joint transfer would be helpful. The article concludes that a procedure is needed that can correct and maintain the deformity with low complication rates. The authors favor soft tissue distraction followed by centralization procedure as it offers the most improvement with the lowest complication rate. However, a steeper learning curve and methods to limit complications are necessary for vascularized joint transfer, which may ultimately be the best procedure.

Keywords

radial deficiency

radial club hand

soft tissue distraction

wrist realignment

surgical management

recurrence rates

complication rates

outcomes measurement

prospective study

centralization procedure