Short-Term Clinico-Radiological Results of a Novel Technique of Casting for Radial Hemimelia with Ponseti-Like Principles.

Introduction: Radial hemimelia is a complex deformity with varying severity. Soft tissue stretching with plaster casts is recommended before definitive surgery of the wrist. There is no clear description of the casting method in literature. Applying plasters is challenging due to small working length of the forearm and absence of the thumb in most cases, leading to cast slippage. This original study describes Mehta technique of casting and stepwise reduction manoeuvres based on patho-mechanics of the dysplastic wrist as a novel method. Methods: We studied the effects of this novel technique on 30 patients with a total of 43 hands. Different parameters such as wrist flexion deformity, clinical and radiological hand forearm angle were compared pre- and post-casting treatment. Results: Successful reduction of ulno-carpal override and significant improvement in hand forearm angle was achieved. The hand forearm angle improved from 51.62° to 11.34° after completion of serial casting with a P value of less than 0.001, which was statistically significant. Conclusion: The novel casting technique is Out-patient based, retains the casts better due to a low cast index and reduces morbidity significantly particularly in syndromic children. This is the first of its kind study describing an original casting for Radial hemimelia, inspired by mechanics of Ponseti serial casting technique.