THE ILIZAROV CORRECTION OF RADIAL HEMIMELIA

Abstract

This study assessed the role of Ilizarov technique, using soft tissue distraction, in correction of radial club hand deformities.

Five patients (6 deformities) with grade IV radial hemimelia (radial aplasia) were studied. There were three boys and two girls aged 2 to 8 years. One boy had bilateral involvement with TAR syndrome. One girl had bilateral involvement with VATER syndrome. One other boy had unilateral involvement with Holt Oram syndrome. The thumb was absent in three cases and hypoplastic in one case. The preoperative deformity measured 95 degrees (range 60–105 degrees). This was corrected using gradual soft tissue distraction with an Ilizarov fixator. Complete correction of the hand deformity was achieved over a period of 4–6 weeks. In two hands, rebalancing tendon transfers were performed in order to try and maintain correction. Following frame removal in both these patients, the deformity recurred despite splintage. Subsequently, four hands were treated with tendon transfers along with wrist stabilisation using intramedullary K-wires. The correction was maintained in all these cases.

It is concluded that the Ilizarov technique can be used to achieve complete correction of radial club hand deformity but that correction can only be maintained by intramedullary stabilisation. The technique is well tolerated by patients and is more physiological when compared to the conventional treatment with wrist centralisation.