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.
Highlights
Radial club hand or radial ray deficiency is a complex congenital abnormality of the radial or pre-axial border of the upper extremity
Centralization with tendon transfer is a popular method for maintaining the correct position of radial club 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
Summary
Radial club hand or radial ray deficiency is a complex congenital abnormality of the radial or pre-axial border of the upper extremity. The first authentic case of congenital absence of the radius was recorded in 1733 by Petit [2]. Who described a case of newly-born male infant with bilateral club hand due to total absence of the radius [3]. Kato [4] pointed out that Gruber was the first author to make a review of the literature, and referred to 14 cases in 1865. Detailed references of all the cases published up until 1923 are included in a 1924 publication by Kato [3]. In this exhaustive review of the literature, Kato had found 250 cases rounded up to the year 1923, and three cases reported in. Kato's work should perhaps be considered as the first attempt at a comprehensive study of the anatomy, pathology, incidence, clinical presentation, diagnosis, and prognosis of radial dysplasia [1] Skerik and Flatt [4] published an outstanding study on the anatomic variations associated with radial ray deficiency and emphasized the importance of the soft-tissue abnormalities as well as the surgical and functional implications [1]
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