External Fixation and Centralization Versus External Fixation and Ulnar Osteotomy: The Treatment of Radial Dysplasia Using the Resolved Total Angle of Deformity

Author(s): McCarthy JJ, Kozin SH, Tuohy C, Cheung E, Davidson R, and Noonan K

Source: J Pediatr Orthop 29(7):797-803, 2009.

Summary:

The treatment of the forearm in radial dysphasia remains difficult.  The purpose of this paper was to introduce a new radiographic measure of radial dysphasia and to assess two different cohorts treated by different methods to maintain forearm alignment.  One cohort was treated with preliminary external fixation and subsequent centralization.  The other cohort was treated with ulnar osteotomy with external fixation and over correcting of the bone to realign the forearm.  The authors also define the three dimensional deformity by the resolved total angle of deformity. 

Eleven children (14 limbs) underwent surgical correction.  Six children underwent correction of the angular deformity with preliminary external fixation followed by centralization.  Four of these patients had undergone previous centralization.  Five patients underwent ulnar osteotomy with external fixation to overcorrect the bony deformity and realign the forearm.  The mean age for the group that underwent preliminary distraction and centralization was 9 years.  The initial resolved total angulation was 112° for this group, which improved 38° following surgery.  However, there was a regression to 71° at follow-up indicating substantial recurrence.  The mean age for the group that underwent ulnar osteotomy and external fixation was 10 years.  The initial resolved total angulation was 88° for this group which improved 50° following surgery.  However, over time there was degradation to 95°. There was a variety of pin track infection in both groups.  There was one case of delayed consolidation.  Otherwise, all children tolerated the distraction and consolidation phase without problem.