Centralization of the hand and wrist in radial dysplasia aims to reposition and fix the ulna in the midline. It was one of the first operations described for radial dysplasia around 1890. The ulna head is shortened minimally and then transposed into a recess created by the removal of the lunate and/or the capitate bones. The ulna is secured in position with a k wire through the third metacarpal. Further reinforcement is provided by an ulnar capsulodesis.
Traditionally, the results of centralization have been suboptimal. The ulnar head epiphyseal growth plate can be damaged as it is repositioned resulting in further growth disturbance. As a result of bony fusion and a less favourable vector of pull of the wrist flexors, wrist mobility is less than for radialization procedures.
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