Challenging the dogma: a straight wrist should be the goal in radial dysplasia

For centuries, various techniques have been described to stabilize the carpus on the ulna in radial dysplasia to achieve a straight wrist, in the belief that it is better for function and cosmesis. Apart from ulnocarpal fusion, none had succeeded in preventing recurrence of radial deviation. Ulnocarpal fusion, however, carries the risk of shortening an already shortened forearm by damaging the epiphysis. Fingers are often stiff in radial dysplasia, and therefore a straight wrist may actually limit function. Formal assessment of the appearance in operated versus unoperated wrists remain inconclusive. This article challenges the dogma that a straight wrist should be the ideal goal in radial dysplasia. The optimum management of this condition remains debatable.