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

Purpose: To review the techniques and evaluate the use of soft-tissue distraction with a ringed fixator for radial longitudinal deficiency (RLD) before centralization. Methods: Eight extremities in 6 patients with severe RLD were treated with ring fixator distraction followed by centralization. A clinical examination was performed and radiographic data were obtained prospectively and at an average follow-up period of 17 months. The techniques and the early objective (range of motion, position) and radiographic outcome were evaluated. Results: The preoperative ring fixator accomplished an average of 16 mm of distraction and allowed the centralization procedure to be performed effectively and without tension. Clinical alignment was improved markedly. The hand-forearm angle improved from 72° radial to 8° ulnar after surgery. The volar carpal subluxation improved by an average of 6 mm. Conclusions: Precentralization ring fixator distraction allows the performance of a tensionless centralization procedure with good early radiographic and clinical outcome in patients severely affected with RLD. Type of study/level of evidence: Therapeutic, Level IV.