Congenital radius deficiency: Radiographic outcome and survivorship analysis

The experience with congenital radius deficiency, or radial hemimelia, at t he Shriners' Hospital for Children, Los Angeles Unit, was reviewed. A cohor t of 29 limbs in 23 patients was identified with an average follow-up perio d of 50 months. Radiographic parameters were assessed using the hand-forear m angle, hand-forearm position, and ulnar bow. We compared radialization to modified centralization, assessed the efficacy of ulnar osteotomy, and ass essed the effect of age, preoperative deformity, ulnar osteotomy, and Bayne 's type on the final result. Revisions were noted and a survivorship analys is performed. The cohort had statistically significant correction of hand-f orearm angle and hand-forearm position. Radialization was similar to modifi ed centralization in the final outcome. Ulnar osteotomy was an efficacious way to correct ulnar deformity. Age, preoperative deformity, performance of an ulnar osteotomy, and Bayne's type did not affect the final wrist positi on. Survivorship analysis was performed using revision as the end point, wi th a survivorship rate at 5 years of 67%. Significant risk factors for revi sion included radial or positive hand-forearm angle and young age at the ti me of the index procedure. There was a suggestion that small postoperative hand-forearm position, or radial translation, increased the risk of revisio n. Preoperative deformity, performance of an ulnar osteotomy, and Bayne's t ype did not affect the risk of revision. These data offer support for the h ypothesis that a more ulnar translation and an ulnar angulation of the wris t is a means of reducing the radial lever arm and thus the incidence of def ormity recurrence and need for revision. (J Hand Surg 1999;24A:1132-1144. C opyright (C) 1999 by the American Society for Surgery of the Hand.)