Radial clubhand with congenital absence of elbow flexors treated by pedicled latissimus dorsi bipolar transfer: report of one case

Abstract

Radial longitudinal deficiency, congenital radial dysplasia, and radial clubhand all refer to the same condition, which can range from a simple thumb hypoplasia to a complete absence of the radius. 3 Bayne L.G. Klug M.S. Long-term review of the surgical treatment of radial deficiencies. J Hand Surg Am. 1987; 12: 169-179 Abstract Full Text PDF PubMed Scopus (173) Google Scholar , 12 Goldfarb C.A. Manske P.R. Busa R. Mills J. Carter P. Ezaki M. Upper-extremity phocomelia reexamined: a longitudinal dysplasia. J Bone Joint Surg Am. 2005; 87: 2639-2648https://doi.org/10.2106/JBJS.D.02011 Crossref PubMed Scopus (60) Google Scholar , 16 Maschke S.D. Seitz W. Lawton J. Radial longitudinal deficiency. J Am Acad Orthop Surg. 2007; 15: 41-52 PubMed Google Scholar Congenital absence of the biceps and brachialis muscles can be associated with this pathologic process, 21 Riordan D.C. Congenital absence of the radius. J Bone Joint Surg Am. 1955; 37 (discussion, 1139-40): 1129-1139 PubMed Google Scholar leading to a congenital inability to flex the elbow. Various surgical treatments for radial clubhand have been described since 1893 by Sayre. 23 Sayre R. A contribution to the study of club hand. Trans Am Orthop Assn. 1893; 6: 208-216 Google Scholar They include wrist centralization and radialization to improve wrist and hand function, which may be combined with index pollicization in the setting of a hypoplastic thumb. It is accepted that in radial clubhand, no correction should be performed to the wrist if elbow flexion is significantly limited. Indeed, by correcting the orientation of the wrist without restoring active elbow flexion in a child who has no elbow flexors, the hand would be moved farther from the body and mouth, which would compound functional impairment. In most cases, this contraindication involves a restriction in the passive motion of the humeroulnar joint, not the congenital absence of the brachialis and biceps muscles. Congenital inability to flex the elbow has been infrequently described and is usually treated by triceps transfer, 11 Ethans K.D. Leahey J.L. Congenital bilateral absence of the elbow flexors. Am J Phys Med Rehabil. 2001; 80: 759-761 Crossref PubMed Scopus (5) Google Scholar , 18 Menelaus M.B. Radial club hand with absence of the biceps muscle treated by centralisation of the ulna and triceps transfer. Report of two cases. J Bone Joint Surg Br. 1976; 58: 488-491 PubMed Google Scholar leading to the loss of active elbow extension. Bipolar pedicled latissimus dorsi transfers have been described to restore the flexion in the sequelae of brachial plexus palsy or after major arm trauma. 6 Cambon-Binder A. Belkheyar Z. Durand S. Rantissi M. Oberlin C. Elbow flexion restoration using pedicled latissimus dorsi transfer in seven cases. Chir Main. 2012; 31: 324-330https://doi.org/10.1016/j.main.2012.10.169 Crossref PubMed Scopus (24) Google Scholar , 19 Moneim M.S. Omer G.E. Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption. J Hand Surg Am. 1986; 11: 135-139 Abstract Full Text PDF PubMed Scopus (49) Google Scholar , 22 Rivet D. Boileau R. Saiveau M. Baudet J. Restoration of elbow flexion using the latissimus dorsi musculo-cutaneous flap. Ann Chir Main. 1989; 8: 110-123 Crossref PubMed Scopus (6) Google Scholar , 30 Zancolli E. Mitre H. Latissimus dorsi transfer to restore elbow flexion. An appraisal of eight cases. J Bone Joint Surg Am. 1973; 55: 1265-1275 PubMed Google Scholar We report the case of a 9-year-old patient with radial clubhand and congenital absence of elbow flexors who underwent bipolar latissimus dorsi transfer to restore active elbow flexion.