Radial longitudinal deficiency: long-term outcomes of radialization and vascularized metatarsophalangeal joint transfer

Abstract

Introduction: We studied long-term outcomes of radialization and free vascularized second metatarsophalangeal joint transfer for radial longitudinal deficiency using patient-reported and objective outcome measures. Methods: Patients aged ⩾10 years with Bayne and Klug type III or IV radial longitudinal deficiencies were identified from national referral centres. Patients treated by radialization (n = 15 limbs) and metatarsophalangeal joint transfer (n = 17 limbs) were assessed after a median follow-up of 13 years. Results: The respective scores after metatarsophalangeal joint transfer and radialization were: median Disabilities of Arm, Shoulder, and Hand scores 19 (95% CI: 7 to 25) and 19 (16 to 29); patient-rated wrist evaluation scores 11 (95% CI: 8 to 22) and 24 (95% CI: 10 to 38); and satisfaction with cosmesis 5 (95% CI: 3 to 6) and 8 (95% CI: 7 to 10). Median wrist active range of motion values were 90° (95% CI: 70 to 90) and 50° (95% CI: 30 to 60) and median wrist deviations were 20° (95% CI: 15 to 30) and 30° (95% CI: 15 to 60) after joint transfer and radialization, respectively. Secondary wrist procedures were more frequent in the joint transfer group. Conclusions: Both techniques yield good functional outcomes. Joint transfer produced a more consistent and larger range of active wrist extension–flexion but with poorer cosmetic results than radialization.