Current Concepts in Radial Club Hand

Abstract

Radial club hand is a complex congenital abnormality of the radial or pre-axial border of the upper extremity. It has a wide range of phenotypes from hypoplasia of the thumb to complete absence of the radius and the first ray. Centralization with tendon transfer is a popular method for maintaining the correct position of radial club hand. On the other hand, various corrections were devised, e.g. radialization after distraction to emphasize the fact that the head of the ulna is positioned under the radial carpal bones and is no longer placed in a slot in the center of the carpus, microvascular epiphysis transfer, gradual correction using Ilizarov method, for Bayne Type III or Type IV. We should pay attention to the recurrence of radial deformity or circulatory impairment with the tension. Lunate excision or ulnar shortening can be selected for tension-free correction. Radialization can be indicated for avoiding the recurrence of radial flexion. However, we should pay attention of the radial protrusion of the ulnar head. For avoiding the recurrence of radial deformity or circulatory impairment, gradual correction using Ilizarov external fixation can be indicated, especially in the cases with severe radial deviation or with short forearm. In the mild cases, Bayne Type I or Type II, radius lengthening is accompanied by a soft-tissue distraction or release at the ulnar carpal joint with keeping wrist and forearm motion without producing growth plate damage.

Keywords: Centralization; Radial club hand; Radialization; Radius lengthening.

Fig. (1)

Bilobed flap on the dorsal wrist is designed.

Fig. (2)

Thick tissue is removed at the radial side for reducing the tension of radial and volar flexion of the wrist with taking care to avoid damage to the superficial branches of the radial nerve.

Fig. (3)

Tissue around the ulnar head is excised and the proximal end of the carpus after extensor retinaculum is cut and extensor carpi ulnaris tendon was retracted to radial side.

Fig. (4)

We make sure that the proximal end of the carpus can be on the ulnar head.

Fig. (5)

A K-wire is inserted from the metacarpal to the ulna to fix the bones. Bilobed flap is moved to ulnar side and closed with interrupted sutures.

Fig. (6)

Zigzag incision was made along the radial side of the wrist.

Fig. (7)

Care was taken to avoid damage to the sensory branches of the radial nerve. The thick fasciae around the brachioradialis and radial wrist extensors were released for improving the range of wrist motion.

Fig. (8)

The radius was fixed with an external fixator for bone lengthening after the radial zigzag incision was extended proximally to expose the distal radius.

Fig. (9)

The skin was then closed with interrupted sutures and Z-plasty was applied on the radial side of the wrist.