Soft-Tissue Distraction With a Ring External Fixator Before Centralization for Radial Longitudinal Deficiency

Radial Deficiency

“…RLD is rarely an isolated finding and is associated with several congenital syndromes (Tables 1 and 2) (Goldfarb et al 2006a;de Graaff and Kozin 2009). Isolated radial deficiency is estimated to comprise only 8-30 % of the cases (Goldfarb et al 2006b;Koskimies et al 2011).…”

“…Isolated radial deficiency is estimated to comprise only 8-30 % of the cases (Goldfarb et al 2006b;Koskimies et al 2011). The frequency of associated anomalies increases with the severity of RLD (Goldfarb et al 2006a). Associated anomalies are seen in 40 % of patients with unilateral involvement and 77 % of patients with bilateral involvement (Lin and Perloff 1985;Goldfarb et al 2006a;Koskimies et al 2011); (Goldberg and Bartoshesky 1985).…”

“…The frequency of associated anomalies increases with the severity of RLD (Goldfarb et al 2006a). Associated anomalies are seen in 40 % of patients with unilateral involvement and 77 % of patients with bilateral involvement (Lin and Perloff 1985;Goldfarb et al 2006a;Koskimies et al 2011); (Goldberg and Bartoshesky 1985). Because greater than 70 % of the cases are associated with some other anomalies, signs of RLD should lead the practitioner to search for problems in other organ systems.…”

“…These modifications help to decrease the force required to reduce the carpus. Currently, centralization techniques are preceded by soft tissue distraction with or without soft tissue release (see below) to decrease operative time and allow for easier wrist rebalancing (Goldfarb et al 2006a Surgery may be performed through a variety of incisions, including either a straight line radialbased incision, s-shaped radial incision, radial incisions with z-plasty closure, transverse dorsal wrist incision, bilobed flap, or dorsal transposition flap (Buck-Gramcko 1985; Evans et al 1995;Pilz et al 1998;Upton 2006;VanHeest and Grierson 2007). These later flap designs try to take advantage of redundant tissue over the ulnar head which can be brought to the radial (skin-deficient) side of the carpus following centralization.…”

“…The Pediatric Upper Extremity DOI 10.1007/978-1-4614-8758-6_11-1 # Springer Science Business Media New York (outside the USA) 2014 carpus distal to the ulna (Goldfarb et al 2006a). Kessler was the first to use preoperative soft tissue distraction to position the hand in a more favorable position prior to centralization (Kessler 1989).…”