The treatment of radial club hand: Absent radius, aplasia of the radius, hypoplasia of the radius, radial paraxial hemimelia

Abstract

1. 1. A series of forty-one children with radial club hand deformity is described. In twenty-two this was bilateral. 2. 2. The importance of early splintage to prevent soft tissue contracture is stressed. A simple ratchet type of splint, which has proved effective, is described. Splintage is only required at night. 3. 3. Operation by centralisation of the carpus over the ulna has proved satisfactory in correcting the deformity and producing wrist stability. A limited range of wrist movement is still possible and so far there does not appear to have been any detrimental effect on the growth of the lower ulnar epiphysis. A satisfactory correction can be maintained by a soft tissue periosteal flap. 4. 4. While the expected improvement in appearance has been achieved the loss of function which had been anticipated has not materialised. 5. 5. Surgical correction of the wrist deformity should not be contemplated unless there is active flexion of the elbow to about ninety degrees. In many cases where the elbow is stiff in extension at birth there is a tendency to gradual loosening of the elbow during the first year or two. Where this does not occur a posterior release of the elbow capsule (as carried out in arthrogryphosis) can be successful. 6. 6. Pollicisation of the index finger should be seriously considered. The result will depend to a considerable extent on the structure and function of the index finger. 7. 7. In order to get the best possible functional result early operation should be considered.