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    Radial Club Hand

    What is radial club hand/ radial dysplasia ?

    It is a rare congenital (by birth) problem in which the radius bone of the forearm did not form properly. This causes the affected hand to be bent inward toward the thumb-side of the forearm, often with limited movement.

    In addition to the curve of the wrist and forearm, child may have a missing or small thumb.

    How does radial club hand affect child ?

    Functional disablities depend upon the severity of radial dysplasia. In the most severe cases, the child may have very limited range of motion at the wrist because her radius is completely absent.  Some other problems that may cause limited function include:

    • an underdeveloped or absent thumb
    • curvature and/or shortened ulna
    • abnormal muscles in the forearm, wrist, and hand

    In mild cases, the radius is slightly smaller than the ulna with minimal wrist deviation. This generally does not cause problems in child’s development or hand function.

    How is radial club hand diagnosed ?

    It can be picked up on a routine prenatal ultrasound. After the baby is born, the deformity is apparent, and the diagnosis is usually confirmed through a physical exam and x-rays.

     Is radial club hand associated with other conditions ?

    It may be associated with anomalies of heart, kidneys, digestive system, blood cells disorders and musculoskeletal disorder.

    How radial club hand is treated ?

    Treatment usually begins during infancy by some combination of splinting, casting, stretching and range of motion (ROM) exercises. If the condition persists, surgery is usually needed.

    What are the symptoms of radial club hand ?

    • The affected arm is shorter, with curving of the forearm and stiffness of the wrist and fingers.
    • The thumb is either very small or missing.
    • The arrangement of muscles and nerves may be unbalanced.

    What do you want to achieve in radial club hand surgery ?

    The goals of treatment are to:

    • correct the radial deviation and balancing of the wrist
    • maintain wrist and finger mobility with maximum hand function
    • preserve forearm growth
    • improve appearance

    What are the nonsurgical methods to improve condition ? 

    During infancy, the goal of treatment is to allow child’s wrist to extend and her elbow to move into a normal position. More severe cases may require casting or splinting to gradually stretch the contracted soft tissues.

    Once passive motion is achieved, your baby will likely need to wear a night splint during infancy and periods of rapid growth. Even after surgery full range of movement exercises are extremely important.

    What are the surgical option for wrist in radial club hand ?

    • Centralization Surgery:
      • bones from child’s wrist are removed so that the hand sits straight on the end of the ulna, and the wrist position is maintained with a steel pin.
    • Radialization surgery:
      • hand is moved slight closer to ulnar border of the forearm and the tight muscles of the wrist are rearranged to balance hand at end of the ulna
      • a slight “overcorrection” is done to compensate for recurrence tendency.
    • Splinting:
      • usually needed following centralization or radialization procedures
      • splint may be used for a year or even more after surgery, until the ulna gradually broadens and becomes a more stable platform on which the wrist can balance.

    What are the surgical options for forearm and elbow in radial club hand ?

    • Osteotomy:  bones are cut and then rearranged forearm into a straighter position
    •  Release tight soft tissue structures at the back of the elbow that are causing the elbow to stiffen

     What are the surgical options for underdeveloped or absent thumb in radial club hand?

    • Surgical option maybe constructing a thumb from an existing index called Pollicization or by tendon transfers
    • Usually offered after other procedures completed or clubbed with them.

    What postoperative care is required after surgery ?

    Child may need to wear a cast for a few weeks. Physiotherapy and occupational therapy to improve function and reduce swelling and scarring.

    What is Long-term outlook of surgery ?

    The long-term outlook depends on the severity of deformity and any associated conditions. There is a tendency of radial club hand to recur, that time may need additional surgery as child grows.

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