Central Ray Deficiency: Subjective and Objective Outcome of Cleft Reconstruction

Charles A. Goldfarb, Ben Chia, Paul R. Manske

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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.

Original languageEnglish
Pages (from-to)1579-1588
Number of pages10
JournalJournal of Hand Surgery
Issue number9
StatePublished - Nov 2008


  • Appearance
  • central deficiency
  • cleft hand
  • reconstruction
  • transposition


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