A 15-yr-old with distraction osteogenesis
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A 15-year-old, right-hand dominant female patient presented to with a history of left-sided type 3 radial longitudinal deficiency. She was initially treated in infancy at an outside hospital with centralization and pollicization procedures. Subsequent to her initial surgeries, she developed worsening of her limb-length discrepancy and bowing of her forearm secondary to damage to her distal ulnar physis during centralization.

Physical examination of her left upper extremity on presentation was notable for elbow range of motion from 0° to 110° flexion. She exhibited complete absence of forearm pronation and supination, 10° arc of motion in wrist flexion and extension, and 30° radial deviation without any ulnar deviation.

Given continued deformity with dissatisfaction in both functional and aesthetic results after her prior procedures, as well as lack of remaining growth, the patient was referred to the Limb Lengthening & Complex Reconstruction Service for continued care. Radiographs of the patient’s left forearm performed on the day of the clinic visit demonstrated complete absence of the distal radius with associated hypoplasia of the proximal radius and post-pollicization changes in the hand with a hypoplastic carpus.

Preoperative templating was performed to identify center of rotation of angulation and locations for osteotomy. A proximal and distal location was identified for optimal correction of angular deformity. This allowed for distraction osteogenesis at two sites with the potential to increase the rate of distraction, given the patient’s young age.

Correction of deformity proceeded with application of a three-ring Ilizarov frame. A half ring was placed in the proximal ulna stabilized with a wire and two dorsal half pins. This was perpendicular to the proximal ulnar segment in both planes. Two hinges at the apex of the proximal deformity were placed along the convexity of the deformity to allow for maximal correction of angular deformity.

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