Long Term Review of Radial Deficiencies
EDWARD H. COALE, JR., M.D., DAVID MOCHEL, M.D., ANDREW SATTEL, M.D., BARBARA KANIEWSKI, O.T.R AND JOHN C. COLWILL, M.D.
Radial deficiencies are a total or partial absence involving the radial or preaxial border of the upper extremity. The purpose of this study is to compare the long term outcomes of operative and non-operative treatment modalities in patients with radial club hand in regards to objective criteria, the ability to perform activities of daily living, and patient satisfaction.
Thirty-one patients with 51 radial deficiencies with an average follow-up of 18.2 years form the basis of this retrospective study. Nineteen patients were treated non-surgically while the remaining 12 had some form of surgical treatment including centralization and ulnar osteotomy or tendon transfers. We noted a complication rate of 22%. Total elbow motion averaged 53 degrees and 97 degrees in the non-operative and operative groups respectively. Total digit motion was 10% less in the operative group. Average grip stength was 1.6 pounds greater in the non-operative group while pinch strength was 3.0 pounds greater in the operative group.
Ninety-two percent of patients in the operative group were satisfied with both the appearance and function of their affected hands. In the non-operative group, 95% were pleased with their function while only 68% were satisfied with the appearance. Overall 88% of patients were employed, 95% drove, 93% were independent in self-care, and 22% were married.
Our results demonstrate that patients with radial deficiencies function and adapt well regardless of their treatment modality. Surgical treatment did not appear to improve function in our patients. The major advantage in surgical treatment for patients with radial deficiencies may be the higher level of satisfaction with the cosmetic appearance of the affected extremity.
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