Orthopaedic Surgery
Radial Club Hand
Radial club hand is a longitudinal deficiency of a bone, the radius, in the forearm; this congenital difference occurs in 1 of 30,000 to 100,000 live births. It consists of an absent or incomplete radius, absent or incomplete thumb, deviation of the wrist toward the thumb's side (radial) and some degree of neuromuscular deficiency. Sometimes the problem may appear in both upper extremities. Many mechanisms have been implicated in cause of this difference, irradiation, environmental factors and nutrition among others have been studied but the real cause is still unknown. As other congenital differences radial club hand can be associated with other genetic syndromes such as VACTER, Holt-Oram Syndrome, TAR syndrome and Fanconi's anemia.
The child with this difference must undergo a thorough evaluation including heart, spine and kidneys, where other anomalies can be present. After these related problems have been ruled out or treated the hand surgeon will start treating the child with splints, casting and non-surgical manipulation to avoid or improve contractures.
Between 6 months and 1 year some patients with this problem will require a surgical procedure. This surgery is known as a "Centralization/radialization of carpus on ulnar epiphysis." With this surgery the hand specialist relocates the hand over the existing normal bone "the ulna" making the hand to be aligned with this normal bone. This procedure corrects the deformity and in some cases allows movement of the wrist. Usually the patient will be immobilized with a cast for four to 6 weeks after surgery. In some occasions this surgery must be accompanied by other procedures to further straighten the arm and to allow correct movement of the hand.
Generally the affected arm will be shorter than the normal one. When this difference is too severe the hand surgeon can perform a lengthening procedure around 6 and 8 years of age. The other important component of this difference is the absence or underdevelopment of the thumb. Hand surgeons can improve this problem with a procedure called "pollicization" this means to make the thumb out of the index finger. The thumb is the most important finger of the hand and because grasping is one of the most important functions humans have, the reconstruction of a thumb may provide a better function to the hand in selected cases. Usually the results of these procedures are advantageous; the decision to proceed with them depends on each individual case.
