{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T23:24:10Z","timestamp":1787095450787,"version":"build-2736575974"},"reference-count":50,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Plast Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Radial longitudinal deficiency (RLD) is the most common congenital longitudinal deficiency of the upper limb. Established principles of reconstruction dictate a staged approach to address the primary components of the deformity: radial wrist deviation and\/or thumb deficiency. Severe RLD remains one of the most challenging conditions to manage, and no technique has yet achieved reliably durable correction. The goals of surgery are to create a stable carpal platform, achieve tension-free correction of soft tissue contractures, and restore a functional pinch mechanism. Surgical options for wrist stabilization may include soft tissue rearrangement and tendon transfer, centralization, free fibula flap, and radialization\/ulnarization. Recently, adjunctive techniques such as soft tissue distraction and ulnar cuff osteotomy have been employed to facilitate correction and may benefit ulnar growth. Special considerations are described for thumb hypoplasia and limb length discrepancy. Outcomes are generally favorable for functional use, although long-term objective results remain suboptimal relative to normal function, and recurrence of angular deformity remains a significant challenge, underscoring the need for continued research. In this chapter, we outline the etiology, classification, surgical management, and outcomes of RLD.<\/jats:p>","DOI":"10.1055\/a-2880-1135","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:16:57Z","timestamp":1783124217000},"page":"229-236","source":"Crossref","is-referenced-by-count":0,"title":["Radial Longitudinal Deficiency"],"prefix":"10.1055","volume":"40","author":[{"given":"Kala T.","family":"Pham","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, United States"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian J.","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, United States"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arren E.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, United States"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce R.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.jhsa.2017.04.012","article-title":"Radial longitudinal deficiency: recent developments, controversies, and an evidence-based guide to treatment","volume":"42","author":"D L Colen","year":"2017","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5435\/00124635-200701000-00005","article-title":"Radial longitudinal deficiency","volume":"15","author":"S D Maschke","year":"2007","journal-title":"J Am Acad Orthop Surg"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1016\/j.jhsa.2009.09.002","article-title":"Congenital longitudinal deficiency","volume":"34","author":"M S Bednar","year":"2009","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1053\/jhsu.1999.1145","article-title":"The spectrum of radial longitudinal deficiency: a modified classification","volume":"24","author":"M A James","year":"1999","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/1753193418762959","article-title":"Experimental evidence that preaxial polydactyly and forearm radial deficiencies may share a common developmental origin","volume":"44","author":"W L Lam","year":"2019","journal-title":"J Hand Surg Eur Vol"},{"key":"ref6","first-page":"1573871","article-title":"Zone of polarizing activity regulatory sequence mutations\/duplications with preaxial polydactyly and longitudinal preaxial ray deficiency in the phenotype: a review of human cases, animal models, and insights regarding the pathogenesis","volume":"2018","author":"M M Al-Qattan","year":"2018","journal-title":"BioMed Res Int"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"264","DOI":"10.2174\/1389202916666150528000412","article-title":"Role of genetic factors in the pathogenesis of radial deficiencies in humans","volume":"16","author":"A Elmakky","year":"2015","journal-title":"Curr Genomics"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1002\/ajmg.a.62033","article-title":"Prevalence and risk factors of radial ray deficiencies: a population-based case-control study","volume":"185","author":"J Syv\u00e4nen","year":"2021","journal-title":"Am J Med Genet A"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/ajmg.a.35707","article-title":"Characteristics and associated anomalies in radial ray deficiencies in Finland\u2013a population-based study","volume":"161A","author":"N Pakkasj\u00e4rvi","year":"2013","journal-title":"Am J Med Genet A"},{"issue":"20","key":"ref10","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.2106\/JBJS.20.00281","article-title":"Association of radial longitudinal deficiency and thumb hypoplasia: an update using the CoULD Registry","volume":"102","author":"M Forman","year":"2020","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jhsa.2019.12.004","article-title":"Radial longitudinal deficiency: severity differences between U.S. and Japanese cohorts","volume":"45","author":"S J Halverson","year":"2020","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1038\/gim.2012.120","article-title":"Complex genetics of radial ray deficiencies: screening of a cohort of 54 patients","volume":"15","author":"S Vergult","year":"2013","journal-title":"Genet Med"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"422.e1","DOI":"10.1016\/j.jhsa.2020.10.005","article-title":"Defining features of hand anomalies in severe thumb hypoplasia: a classification modification","volume":"46","author":"P S Chang","year":"2021","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.jhsa.2006.05.012","article-title":"Radial longitudinal deficiency: the incidence of associated medical and musculoskeletal conditions","volume":"31","author":"C A Goldfarb","year":"2006","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1097\/01.prs.0000279474.20167.a8","article-title":"Preoperative soft-tissue distraction for radial longitudinal deficiency: an analysis of indications and outcomes","volume":"120","author":"A H Taghinia","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/PRS.0b013e318290fca5","article-title":"Management of congenital radial longitudinal deficiency: controversies and current concepts","volume":"132","author":"L B Wall","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/BPO.0000000000001606","article-title":"Randomized Trial comparing preliminary results of radialization and centralization procedures in Bayne types 3 and 4 radial longitudinal deficiency","volume":"40","author":"S Mittal","year":"2020","journal-title":"J Pediatr Orthop"},{"issue":"24","key":"ref18","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.2106\/JBJS.17.00164","article-title":"Correction of \u201cWrist\u201d deformity in radial dysplasia: a systematic review and meta-analysis","volume":"99","author":"G RF Murphy","year":"2017","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"72.e1","DOI":"10.1016\/j.jhsa.2025.03.027","article-title":"Impact of surgical timing on functional outcomes in radial club hand: a retrospective study of Bayne-Klug type IIIb\/IV cases","volume":"51","author":"\u0130B \u00d6z\u00e7elik","year":"2026","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"241.e1","DOI":"10.1016\/j.jhsa.2020.07.018","article-title":"Treatment of radial longitudinal deficiency: an international survey","volume":"46","author":"L B Wall","year":"2021","journal-title":"J Hand Surg Am"},{"issue":"09","key":"ref21","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jhsa.2013.03.019","article-title":"Classification of congenital anomalies of the hand and upper limb: development and assessment of a new system","volume":"38","author":"M A Tonkin","year":"2013","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/1753193411413070","article-title":"Comparison of surgical treatment and nonoperative management for radial longitudinal deficiency","volume":"37","author":"P P Kotwal","year":"2012","journal-title":"J Hand Surg Eur Vol"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"293.e1","DOI":"10.1016\/j.jhsa.2017.11.012","article-title":"Radialization with ulnar cuff osteotomy: a technique for deformity correction in radial longitudinal deficiency","volume":"43","author":"A K Bhat","year":"2018","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref24","doi-asserted-by":"crossref","first-page":"738.e1","DOI":"10.1016\/j.jhsa.2022.01.025","article-title":"Long-term follow-up of ulnar growth in radial dysplasia treated by a combination of distraction and radialization","volume":"48","author":"R Mehta","year":"2023","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/01.bpo.0000152907.31293.00","article-title":"Pre-centralization soft tissue distraction for Bayne type IV congenital radial deficiency in children","volume":"25","author":"S Sabharwal","year":"2005","journal-title":"J Pediatr Orthop"},{"issue":"11","key":"ref26","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1016\/j.jhsa.2012.08.029","article-title":"Radiographic early to midterm results of distraction osteogenesis in radial longitudinal deficiency","volume":"37","author":"S Farr","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"09","key":"ref27","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/j.jhsa.2007.07.024","article-title":"Distraction lengthening of the ulna in children with radial longitudinal deficiency","volume":"32","author":"B M Peterson","year":"2007","journal-title":"J Hand Surg Am"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/j.jhsa.2006.01.017","article-title":"Radius lengthening for the treatment of Bayne and Klug type II and type III radial longitudinal deficiency","volume":"31","author":"T Matsuno","year":"2006","journal-title":"J Hand Surg Am"},{"issue":"12","key":"ref29","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1016\/j.bjps.2014.08.048","article-title":"Bone lengthening of the radius with temporary external fixation of the wrist for mild radial club hand","volume":"67","author":"T Takagi","year":"2014","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.jhsa.2015.01.004","article-title":"Soft tissue release and bilobed flap for severe radial longitudinal deficiency","volume":"40","author":"C Vuillermin","year":"2015","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.jhsa.2006.03.019","article-title":"Soft-tissue distraction with a ring external fixator before centralization for radial longitudinal deficiency","volume":"31","author":"C A Goldfarb","year":"2006","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.otsr.2015.02.009","article-title":"Treatment of severe radial club hand by distraction using an articulated mini-rail fixator and transfixing pins","volume":"101","author":"C Romana","year":"2015","journal-title":"Orthop Traumatol Surg Res"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.jhsa.2014.01.015","article-title":"The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency","volume":"39","author":"M C Manske","year":"2014","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1053\/jhsu.2000.6460","article-title":"The recurrence of deformity after surgical centralization for radial clubhand","volume":"25","author":"E Damore","year":"2000","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref35","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/BPO.0000000000000807","article-title":"Ulna growth patterns after soft tissue release with bilobed flap in radial longitudinal deficiency","volume":"38","author":"C Vuillermin","year":"2018","journal-title":"J Pediatr Orthop"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.jhsa.2006.03.016","article-title":"Ulnar growth patterns in radial longitudinal deficiency","volume":"31","author":"A M Sestero","year":"2006","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1053\/jhsu.2002.30078","article-title":"Functional outcome after centralization for radius dysplasia","volume":"27","author":"C A Goldfarb","year":"2002","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.jhsa.2007.02.026","article-title":"Dorsal rotation flap for centralization in radial longitudinal deficiency","volume":"32","author":"A VanHeest","year":"2007","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.jhsa.2004.06.010","article-title":"Surgical treatment of type 0 radial longitudinal deficiency","volume":"29","author":"J H Mo","year":"2004","journal-title":"J Hand Surg Am"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/S0363-5023(85)80013-7","article-title":"Radialization as a new treatment for radial club hand","volume":"10","author":"D Buck-Gramcko","year":"1985","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1177\/1753193418788935","article-title":"Outcomes of radialization for radial longitudinal deficiency: 20 limbs with minimum 5-year follow-up","volume":"44","author":"A K Bhat","year":"2019","journal-title":"J Hand Surg Eur Vol"},{"issue":"11","key":"ref42","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1177\/17531934231185024","article-title":"Outcomes of radialization with ulnar cuff osteotomy for radial longitudinal deficiency: a medium-term follow-up study","volume":"48","author":"A K Bhat","year":"2023","journal-title":"J Hand Surg Eur Vol"},{"issue":"10","key":"ref43","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/j.jhsa.2012.07.018","article-title":"Recurrence of radial bowing after soft tissue distraction and subsequent radialization for radial longitudinal deficiency","volume":"37","author":"C Dana","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref44","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1177\/1753193420961008","article-title":"Challenging the dogma: a straight wrist should be the goal in radial dysplasia","volume":"46","author":"M Ezaki","year":"2021","journal-title":"J Hand Surg Eur Vol"},{"issue":"03","key":"ref45","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/17531934221146893","article-title":"The unsolved problem of radial longitudinal dysplasia: how can we reliably prevent recurrence, preserve growth and optimize function?","volume":"48","author":"C A van Nieuwenhoven","year":"2023","journal-title":"J Hand Surg Eur Vol"},{"issue":"06","key":"ref46","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/S0363-5023(09)91063-2","article-title":"Long-term functional results after pollicization for the congenitally deficient thumb","volume":"17","author":"P R Manske","year":"1992","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref47","doi-asserted-by":"crossref","first-page":"328e","DOI":"10.1097\/PRS.0000000000000395","article-title":"Management of congenital radial longitudinal deficiency: controversies and current concepts\u2013an important correction of the donor site","volume":"134","author":"S K Vilkki","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref48","doi-asserted-by":"crossref","first-page":"70.e1","DOI":"10.1016\/j.jhsa.2019.03.001","article-title":"The modified Vilkki procedure: vascularized metatarsophalangeal joint transfer to reconstruct a full-length radius in type III radial hypoplasia","volume":"45","author":"S K Nayar","year":"2020","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref49","doi-asserted-by":"crossref","first-page":"157e","DOI":"10.1097\/PRS.0000000000000836","article-title":"Vascularized proximal fibular epiphyseal transfer for Bayne and Klug type III radial longitudinal deficiency in children","volume":"135","author":"J Yang","year":"2015","journal-title":"Plast Reconstr Surg"},{"key":"ref50","first-page":"237","article-title":"Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction","volume":"87","author":"M Innocenti","year":"2005","journal-title":"J Bone Joint Surg Am"}],"container-title":["Seminars in Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2880-1135.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T22:34:38Z","timestamp":1787092478000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2880-1135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":50,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,8,18]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2880-1135","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1535-2188","1536-0067"],"issn-type":[{"value":"1535-2188","type":"print"},{"value":"1536-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}