Abstract
Recurrent deformity from centralization and radialization led to the development in 1999 of a new technique by the author called ulnarization. This method is performed through a volar approach in a vascular and physeal sparing fashion. It biomechanically balances the muscle forces on the wrist by dorsally transferring the flexor carpi ulnaris (FCU) from a deforming to a corrective force. The previous problems of a prominent bump from the ulnar head and ulnar deviation instability were solved by acutely shortening the diaphysis and by temporarily fixing the station of the carpus to the ulnar head at the level of the scaphoid. This is the first report of this modified Paley ulnarization method, which the author considers a significant improvement over his original procedure.
Highlights
Radial club hand (RCH) treatment has been given to patients by centralization of the carpus on the end of the ulna [1,2,3,4,5,6,7,8,9,10,11]
In 2008, Paley et al reported on 21 hands in 14 consecutive patients who underwent ulnarization between 2000 and 2006 [19]
The hand-to-forearm angle improved from an average of 53° of radial deviation to 22° of ulnar deviation
Summary
Radial club hand (RCH) treatment has been given to patients by centralization of the carpus on the end of the ulna [1,2,3,4,5,6,7,8,9,10,11]. In 1985, Buck-Gramcko [11,12,13] described an alternative to centralization, which he termed radialization. He used a dorsal incision to dissect the hand free of the carpal bones and translocated the hand to the ulnar side of the ulnar head. He transferred and shortened the extensor and flexor carpi radialis (FCR) tendons respectively to the ulnar side to weaken the forces of radial deviation and strengthen the ulnar motors. The rate of partial growth arrest of the distal ulna (11% of cases) secondary to avascular necrosis of the growth plate and the rate of recurrence (7.5% of cases) were much lower than with centralization [13]
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