We continue to favor a two- stage centralization procedure for RLD. In the first stage, we apply a circular fixator to allow a slow, painless stretching of the soft tissues. We know that in RLD, all of the radial (i.e., thumb) sided structures are abnormal and often tight. By using the fixator before surgery, we can stretch the soft tissues and allow a much easier and more effective 2ndstage, the formal centralization surgery.
In my experience, the problem with centralizing without using a fixator beforehand is that it can be difficult, if not impossible, to move than hand/ wrist onto the ulna bone. And even if possible, there will be tension and it may require removing some portion of the wrist bones. Both of these choices can affect the growth plate of the ulna (which will, in turn, limit the growth of an already short ulna).
The bottom line is that we believe the use of the fixator for a period of time before the centralization procedure is helpful in achieving the goals of surgery- wrist balancing. There is some early information (yet unpublished) supporting these thoughts and demonstrating an improved outcome. We are also in the process of analyzing our results.
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| Radial deficiency patient. The fixator is about to be removed on the right and the wrist centralized. Note the difference between the wrists (the left side has not yet been treated). |