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Correction of "Wrist" Deformity in Radial Dysplasia: A Systematic Review and Meta-Analysis.

Abstract Radial dysplasia affects 1 in 6,000 to 8,000 births, classically presenting with a shortened, bowed ulna and radially deviated hand. The optimal treatment remains unclear, with several opposing approaches advocated. This review aims to clarify the long-term outcomes of nonsurgical and surgical treatment of the "wrist" deformity.
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Mayor MeshTerms
Keywords
Journal Title the journal of bone and joint surgery. american volume
Publication Year Start




PMID- 29257019
OWN - NLM
STAT- MEDLINE
DCOM- 20171227
LR  - 20171227
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 99
IP  - 24
DP  - 2017 Dec 20
TI  - Correction of "Wrist" Deformity in Radial Dysplasia: A Systematic Review and
      Meta-Analysis.
PG  - 2120-2126
LID - 10.2106/JBJS.17.00164 [doi]
AB  - BACKGROUND: Radial dysplasia affects 1 in 6,000 to 8,000 births, classically
      presenting with a shortened, bowed ulna and radially deviated hand. The optimal
      treatment remains unclear, with several opposing approaches advocated. This
      review aims to clarify the long-term outcomes of nonsurgical and surgical
      treatment of the "wrist" deformity. METHODS: The Embase, MEDLINE, PubMed,
      Cochrane Central, ClinicalTrials.gov, and World Health Organization International
      Clinical Trials Registry Platform (ICTRP) databases were searched for published
      and unpublished studies reporting long-term outcomes of surgical or nonsurgical
      treatment of children with radial dysplasia. Results were not restricted by date 
      or language. Primary outcomes were hand-forearm angle, ulnar length, and "wrist" 
      active range of motion (ROM). Studies were assessed using the Grades of
      Recommendation, Assessment, Development and Evaluation (GRADE) criteria. Data for
      the change in hand-forearm angle were pooled using random-effects meta-analysis, 
      and mean differences and 95% confidence intervals were obtained. Primary outcome 
      data at last follow-up were pooled, and means and standard deviations were
      obtained. The PROSPERO registration of this study was CRD42016036665. RESULTS: Of
      104 studies identified, 12 were included in this review. Five were retrospective 
      cohort studies and 7 were case series. No randomized studies were found. Study
      quality was low or very low according to the GRADE criteria. The hand-forearm
      angle of nonsurgically treated patients worsened during childhood, from 66
      degrees to 84 degrees , whereas "wrist" active ROM, at 61 degrees , was better
      than that for most surgically treated patients. Ulnar length with nonsurgical
      treatment was predicted to be 64% of normal, but was not directly reported.
      Isolated soft-tissue release provided a modest reduction in hand-forearm angle
      compared with nonsurgical treatment. Soft-tissue distraction with centralization 
      or radialization achieved the best hand-forearm angle correction (16 degrees
      radial deviation). Radialization maintained better "wrist" active ROM (46 degrees
      ) and ulnar length than centralization. Microvascular second metatarsophalangeal 
      joint transfer yielded better reported "wrist" active ROM (83 degrees ) and good 
      ulnar length compared with other surgical techniques, but a slightly worse
      hand-forearm angle (28 degrees ). CONCLUSIONS: There was low-quality evidence
      that soft-tissue distraction plus centralization or radialization achieved the
      best correction of the hand-forearm angle for children with radial dysplasia.
      LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a
      complete description of levels of evidence.
FAU - Murphy, George R F
AU  - Murphy GRF
AD  - Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for
      Children, London, United Kingdom.
AD  - Randall Division of Cell and Molecular Biophysics, Guy's Campus, King's College
      London, London, United Kingdom.
FAU - Logan, Malcolm P O
AU  - Logan MPO
AD  - Randall Division of Cell and Molecular Biophysics, Guy's Campus, King's College
      London, London, United Kingdom.
FAU - Smith, Gill
AU  - Smith G
AD  - Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for
      Children, London, United Kingdom.
FAU - Sivakumar, Branavan
AU  - Sivakumar B
AD  - Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for
      Children, London, United Kingdom.
AD  - The Portland Hospital for Women and Children, London, United Kingdom.
FAU - Smith, Paul
AU  - Smith P
AD  - The Portland Hospital for Women and Children, London, United Kingdom.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - AIM
SB  - IM
MH  - Age Factors
MH  - Female
MH  - Hand Deformities, Congenital/*diagnostic imaging/*surgery
MH  - Humans
MH  - Male
MH  - Orthopedic Procedures/*methods
MH  - Radius/*abnormalities/diagnostic imaging
MH  - Reconstructive Surgical Procedures/*methods
MH  - Recovery of Function
MH  - Risk Assessment
MH  - Treatment Outcome
MH  - Wrist Joint/*abnormalities/diagnostic imaging
EDAT- 2017/12/20 06:00
MHDA- 2017/12/28 06:00
CRDT- 2017/12/20 06:00
PHST- 2017/12/20 06:00 [entrez]
PHST- 2017/12/20 06:00 [pubmed]
PHST- 2017/12/28 06:00 [medline]
AID - 10.2106/JBJS.17.00164 [doi]
AID - 00004623-201712200-00010 [pii]
PST - ppublish
SO  - J Bone Joint Surg Am. 2017 Dec 20;99(24):2120-2126. doi: 10.2106/JBJS.17.00164.