Three-Stage Reconstruction Strategy for Severe Radial Longitudinal Deficiency at Beijing Jishuitan Hospital

[Diagnostic Dilemma]
🔬 Radial longitudinal deficiency is a rare upper extremity anomaly characterized by the absence of the radius.
🩸 This 5-year-old patient presented with an extreme radial deviation of 110 degrees and severe thumb hypoplasia.
👁️ Detailed preoperative radiographs and anatomical images are available in the comments, showing the forearm supported solely by the ulna.
💡 Immediate bony reconstruction in this scenario carries a catastrophic risk of neurovascular traction injury.

[Surgical Nuances]
👨⚕️ The hand surgery team at Beijing Jishuitan Hospital formulated a three-stage step-by-step reconstruction plan.
⚙️ As demonstrated in the attached video, the first phase utilized an external fixator for gradual soft tissue distraction.
⏱️ Over 11 weeks of controlled traction, the deformed wrist was safely distracted to a near-neutral position.
🦴 The second phase involved ulnar centralization to establish a stable biomechanical fulcrum for the carpal bones.

[Clinical Pearls]
🖐️ To address the functional deficit in the third phase, the team decisively performed index finger pollicization.
🔪 Rather than preserving a non-functional five-digit appearance, the index finger was transposed with its intact neurovascular bundle to reconstruct a functional thumb.
📊 This strategic anatomical trade-off successfully restored the core pinch and grasp biomechanics of the hand.

[Take-home Message]
📌 For older children with severe radial deviation, staged soft tissue distraction prior to bony centralization is the key to breaking the deadlock.
🏥 This approach achieves both anatomical alignment and independent functional recovery without compromising neurovascular safety.