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CASE REPORT Table of Contents   
Year : 2006  |  Volume : 40  |  Issue : 4  |  Page : 267-268
Radial club hand - A case report


Department of Orthopedics, Rajindra Hospital, Patiala, India

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How to cite this article:
Walia J, Singh R, Sareen S, Walia AK. Radial club hand - A case report. Indian J Orthop 2006;40:267-8

How to cite this URL:
Walia J, Singh R, Sareen S, Walia AK. Radial club hand - A case report. Indian J Orthop [serial online] 2006 [cited 2020 Jan 17];40:267-8. Available from: http://www.ijoonline.com/text.asp?2006/40/4/267/34511

   Introduction Top


Radial club hand is a deficiency along the preaxial or radial side of upper extremity. Petit[[1] in 1733, described the first case of radial club hand in an autopsy of neonate with bilateral club hands and absent radii. Since then, this congenital anamoly has continued to puzzle the hand surgeons.


   Case Report Top


A 10 years old female presented with deformity of hand which consist of radial deviation of hand towards radial side of fore arm. The deformity of hand included the absence of thumb along with short and mal-developed four fingers. This deformity had been present since birth of child and had progressed since then to the present status.

On examination, forearm was found to markedly atrophied as compared to opposite normal limb and had single forearm bone. The length of forearm was found to be shortened as compared to opposite side. The deformity was provisionally diagnosed as radial club hand. Movements of elbow flexion and extension were limited at extremes. All distal movements including rotatory movements of forearm, wrist and fine finger movements were not possible. Only bit flickering movements at fingers were possible. The thumb had not developed at all.

Child had associated congenital heart defect in the form of dextrocardia. Other congenital anomalies were ruled out by proper thorough investigations. X-Ray showed complete absence of radius with lateral bowing of ulna.

Soft tissue release of contracted structures along with JESS fixator was applied to the limb. After removal of stitches, distraction was started and continued till maximum of correction had achieved. Daily full rotation on deviated side and half rotation on convex side of deformity was given.

After 2 months, fixator was removed, wrist arthrodesis along with centralization of ulna was done and POP cast was given. More then 90% correction had achieved with the procedure at the end with any shortening [Figure - 1], [Figure - 2].


   Discussion Top


Radial club hand referred to radial ray deficiencies including all malformation with longitudinal failure of formation of parts along the preaxial border of upper extremity, deficient or absent thenar muscles, shortened or absent thumb and shortened or absent radius.

The incidence of radial club hand is estimated to 1 :100,000 live births, with right sided involvement more common and boys are more often affected than girls. The cause of radiual club hand is unknown and the deformities are believed to occur sporadically due to defect occurring in embryo development during 4th to 7th week in-utero.

The currently accepted and most useful classification of congenital radial dysplasia is by Heikel[2] (1988) in which four types are described

Type I : Short distal radius

Type II : Hypoplastic radius

Type III : Partial absence of radius Type IV : Total absence of radius.

Variable degrees of thumb deficiencies are frequently associated with all patterns.

Clinically, the deformity is usually noticed at birth. The neonate presents with a short forearm deviated radially with tight radial side soft tissue structures. The thumb may be deficient to varying degrees. The fingers are stiff and elbow movements may also be retracted. Various associated anomalies of cardiovascular, hematopoietic, gastro-intestinal and musculo-skeletal system may also present.

Initial therapy consists of passive stretching of taut radial structures after birth till 6 - 8 weeks. Serial corrective plaster casts are applied at 1-2 weeks interval for 6 months till adequate passive correction is achieved.

Surgical therapy is performed around the age of one year in these children.

Options of surgical treatment are

  • Centralization of hand[3], ulnar and radial Z-plasty incisions[4] Centralization of Hand and Tendon transfers[5] and
  • Pollicization for reconstruction of thumb with radial club[6]


However in resistant cases and those presenting with delay, better attempts at stretching the soft tissue with distracter techniques using illizarov or mini external fixator e.g. as described by Kessler[7], had also added to options for surgeons.

 
   References Top

1.Petit JL. Remarques sur un enfant nouveau-ne, don't les bras etaient difformes. IN: Memories de l'academie Royale des Sciences. Paris Imprimerie Royale, 1733, p17.  Back to cited text no. 1    
2.Heikel HVA. Aplasia and hypoplasia of the radius. Acta Orthop Scand 1988; 39 (Suppl) : 1.  Back to cited text no. 2    
3.Manske PR, MCCarroll HR Jr. Swanson K. Centralisation of the radial club hand: an ulnar surgical approach. J Hand Surg 1981 ; 6 : 423.  Back to cited text no. 3    
4.Watson HK, Beebe RD, Cruz NI. A centralization procedure for rdial club hand. J Hand Surg 1984 ; 9 A : 541.  Back to cited text no. 4    
5.Bayne LG, Klug MS. Long term review of the surgical treatment of radial deficiencies. J Hand Surg 1987; 12 : 169.  Back to cited text no. 5    
6.Buck-Gramcko D. Pollicization of the index finger: method and results in aplasia and hypoplasia of the thumb. J Bone Joint Surg 1971 ; 53A : 1605.  Back to cited text no. 6    
7.Kessler I. Centralisation of the radial club hand by gradual distraction. J Hand Surg 1989; 14 (B) : 37.   Back to cited text no. 7    

Top
Correspondence Address:
JPS Walia
Department of Orthopedics, Rajindra Hospital, Patiala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.34511

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    Figures

  [Figure - 1], [Figure - 2]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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