Soft tissue distraction for radial dysplasia entails applying an external Ilizarov-type fixator and distracting the radius for 2-3 months with concomitant expansion of soft tissues. It is being used increasingly for all grades of radial dysplasia prior to formal centralization or radialization. Typically daily lengthening is of the order of 0.75mm on the radial side of the frame. This can be achieved by parents or carers adjusting the frame at home. Wedge osteotomies can be used concurrently to straighten the radius. The frame is specifically designed for children being lightweight, and is both stable and radiolucent. At the end of lengthening and alignment of the wrist/forearm axis, a period of 2-3 weeks is allowed for reduction of oedema before the frame is removed.
During the period of distraction, flexion contractures of the digits may still need to be addressed by daily physiotherapy and digital splinting.
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