I am sharing a few photographs from a patient with a particularly challenging form of radial longitudinal deficiency (RLD) because several important points are shown nicely.
There is such a dramatic difference between the surgically treated left side and the right side before surgery. There is a great deal of deformity on the right side and the left side looked just the same, before surgery. Now the left side has a much more typical appearance and is in a position to maximize function.
Surgery on left side was in three stages.
First, we applied the fixator which we use in several forearm/ wrist deformity as it allows the best correction and is also the safest in the protection of the ulna growth plate. The ulna is already short and we do not want to do anything that could shorten it further (ie, we don’t want to injury the growth plate). Without going too far on this, there are three things that could shorten the already short ulna. First, a growth plate injury means the bone won’t grow normally. Second, some described procedures shorten the bone as part of the plan- I don’t agree with these. And finally, there may be some degree of shortening when angulation of the ulna is corrected. We want to minimize this and can do so.
Second, we removed the fixator and performed the centralization procedure. I really like this procedure in the right patient, like this one.
Pollicization. This is my favorite procedure. We don’t always perform this surgery in patients with severe RLD, especially when they favor the ring and small finger (see below). But, even when the new finger does not make a perfect thumb, it can still be helpful for grasping larger objects (like a water bottle) and also for precision pinch (like holding a coin).
On the pre- surgical right side, the patient demonstrates ‘ulnar prehension’. That is, the patient is using the ring and little fingers for function, like writing. This indicates the severity of the RLD.