Staged Centralisation and Pollicisation for Radial Longitudinal Deficiency: A Case Series Emphasising Pre-pollicisation Index-Middle Finger Pinch Training.

Abstract

Background: Radial longitudinal deficiency (RLD) is a rare congenital malformation that severely impairs grasp and pinching due to radial ray and thumb hypoplasia or aplasia. Standard management typically involves early centralisation to align and stabilise the wrist, followed by pollicisation when the thumb cannot be reconstructed. However, little attention has been paid to pre-pollicisation-rehabilitation strategies that might facilitate the acquisition of postoperative pinch function. This study aimed to report early functional outcomes after staged reconstruction for severe RLD, highlighting a structured pre‑pollicisation programme that establishes index-middle finger pinch after wrist centralisation. Methods: We retrospectively reviewed four children (six hands) with RLD treated between 2022 and 2024 with staged reconstruction: (1) early orthotic management, (2) wrist centralisation at approximately 1 year of age and (3) pollicisation of the index finger at 2-3 years of age. All patients underwent a structured pre-pollicisation rehabilitation programme focussing on the development of index-middle finger pinch after centralisation. Outcomes at 6-18 months after pollicisation included grasp patterns and a tape measure-based pinch test. Results: All hands achieved cylindrical and spherical grasps, and four hands demonstrated early fine motor tasks, such as scissor use and pre-writing. The mean tape measure-pinch score was 3.5 points (range: 1-4) on a 5-point scale. One hand showed poorer function, corresponding to marked preoperative hypoplasia of the index donor finger. Wrist alignment and thumb opposition posture were maintained during the short-term follow-up period. Conclusions: Staged centralisation and pollicisation produced encouraging early functional outcomes in children with severe RLD. Pre-pollicisation-training to establish index-middle finger pinch after centralisation appeared to facilitate early acquisition of post-pollicisation-pinch and grasp, and may represent a simple, practical adjunct to standard surgical care. Level of Evidence: Level IV (Therapeutic).