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J Hand Surg Am. 2014 May;39(5):895-901. doi: 10.1016/j.jhsa.2014.01.015. Epub 2014 Mar 1.

The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency.

Author information

1
Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO.
2
Shriners Hospital for Children and the Department of Orthopaedic Surgery, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO. Electronic address: goldfarbc@wudosis.wustl.edu.

Abstract

PURPOSE:

To assess recurrence and complications in children with radial longitudinal deficiency treated with or without external fixator soft tissue distraction prior to centralization.

METHODS:

Thirteen upper extremities treated with centralization alone were compared with 13 treated with ring fixator distraction followed by centralization. Resting wrist position between the 2 groups was compared before surgery, approximately 2 years after surgery (midterm), and at final follow-up, which was at a mean of 10 years for the centralization-alone group and 6 years for the distraction group. Radiographs were reviewed for hand-forearm angle, hand-forearm position, volar carpal subluxation, ulnar length, and physeal integrity.

RESULTS:

The clinical resting wrist position was improved significantly after surgery and at final follow-up in both groups, but recurrence was worse at final follow-up in the distraction group patients. Radiographically, in the centralization alone group, the hand-forearm angle improved from 53° before surgery to 13° at midterm but worsened to 27° at final follow-up. In the distraction group, the hand-forearm angle improved from 53° before surgery to 21° at midterm but worsened to 36° at final follow-up. The hand-forearm position improved between preoperative and final assessment in both groups, but at final follow-up, the centralization-alone group had a significantly better position. Volar subluxation was 4 mm improved in the centralization alone group and 2 mm worse in the distraction group at final follow-up.

CONCLUSIONS:

Centralization, with or without distraction with an external fixator, resulted in improved alignment of the wrist. Distraction facilitated centralization, but it did not prevent deformity recurrence and was associated with a worse final radial deviation and volar subluxation position compared with wrists treated with centralization alone.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic III.

KEYWORDS:

Radial deficiency; centralization; distraction; fixator; recurrence

PMID:
24594270
DOI:
10.1016/j.jhsa.2014.01.015
[Indexed for MEDLINE]
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