Management of Radial Club Hand

Abstract

Radial club hand is a deformity in which the hand is bent at the wrist and deviated towards the thumb. It arises usually sporadically and

rarely hereditary. It is relatively frequently in combinations with other

malformations. Radial club hand is a very complex malformations that

affects all tissues in the hand and forearm. Skeleton malformations occur not only in the radius but also in the whole arm. It is usually associated

with the absence or under developed thumb.

The deformity is classified by Bayne and Klug into four

groups. Type I: Short distal radius. Elbow and proximal radius are normal but distal radial physis is deficient and radius is shortened.

The thumb may show variable degree of hypoplasia. Type II: Hypoplastic

radius. The wrist is unstable and radially deviated. Type III : Partial

absence of the radius and Type IV: Total absence of the radius and this is

the most common type.

Treatment of mild radial dysplasia may be conservative. Surgery

is directed toward lengthening the radius or reconstructing a hypoplastic

thumb . The final result is often gratifying both cosmetically and

functionally.

Treatment of aplasia of the radius is challenging, and frequently

the end result is a " helper hand " that remains obviously deformed.

Surgical treatment of these problems is directed toward correcting the

gross angulation of the carpus on the forearm, stabilizing the hand and

wrist on the end of the ulna, and reconstructing the thumb when

indicated. The problem is complicated by the associated severe soft tissue

abnormalities and intrinsic stiffness in the finger joints.

At the end of this study; we recommend that preliminary soft tissue distraction prior to radialization of the ulna should be considered in treatment of radial club hand patients, especially in older age and late presenting children.