Central Ray Deficiency: Subjective and Objective Outcome of Cleft Reconstruction

Purpose: To assess the long-term subjective and objective outcome of cleft reconstruction in patients with central ray deficiency. Methods: Twelve patients with 16 central ray deficiency hands were included. Each hand had been treated with cleft reconstruction using soft tissue and/or bony procedures. A surgeon and parent assessed the subjective outcome using a visual analog scale to compare preoperative and postoperative appearance. Objective outcome was assessed with a clinical examination for digital range of motion and with a radiographic examination for preoperative and postoperative divergence angles of the index finger and ring finger metacarpals and phalanges. Results: The surgeon's visual analog scale score significantly increased from 4 to 7. Nine parents were very satisfied, 4 were satisfied, and 3 were somewhat satisfied with hand appearance. A ring finger proximal interphalangeal joint flexion contracture averaging 31° was the most notable clinical finding. The metacarpal divergence angle significantly improved from 33° to 12°, and the phalangeal divergence angle significantly improved from 38° to 12°. Conclusions: Cleft reconstruction improves hand appearance in patients with central deficiency. A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up. Type of study/level of evidence: Therapeutic IV.