Radial Club Hand

1. Radial Club Hand Dr Gaurav Jain Consultant Paediatric Orthopaedic Surgeon , Indore 9111464959 https://www.drgauravjain.com

2. What is Radial Club Hand? • Rare congenital condition, meaning your baby was born with it, and can affect one or both arms. • Two bones in your baby’s forearm: • ulna, on outer side and • radius, on inner side. • It occurs when radius does not form properly. • This causes wrist to bend toward thumb side of forearm. • Affects soft tissues and flesh of forearm. • Arrangement of muscles and nerves may be unbalanced, and some muscles and nerves may be missing.

3. What are the symptoms of radial longitudinal deficiency? • Mild form, condition will probably not cause problems with development or hand movement. • Severe form, may have problems moving hand, fingers, and elbow. Entire arm will be shorter, with a curved forearm and stiff elbow and fingers, may also have a small or missing thumb. • Types of radial longitudinal deficiency • Type1 move hand normally. Usually do not need surgery unless it is necessary to correct an underdeveloped thumb. • Type 2 wrist bends inward, and ulna bows out. Children with this type often have an underdeveloped thumb. • Type 3 missing most of radius bone. wrist bends inward more severely and hand has limited support. ulna is bowed. Most children with this type of radial longitudinal deficiency have an underdeveloped or missing thumb. • Type 4 most common and most severe form of radial longitudinal deficiency. Children with this type are missing radius bone and have significant shortness in forearm. may also have limited range of motion elbow. Most children with type 4 have an underdeveloped or missing thumb, and may have differences in fingers as well. Many children adapt by using pinky finger to pick up toys and or objects.

4. What causes radial longitudinal deficiency? • Usually occurs by chance, although for some people it can also run in family. • Doctors and scientists do not know why some children are born with this condition. • several Theories, including compression of uterus and blood vessel injury. • Associated with several congenital syndromes, affecting heart, digestive system, and kidneys. • Also been linked to some chromosomal abnormalities, including Down syndrome and Trisomy 18 and 13.

5. How we care for radial longitudinal deficiency at Ortho-Care? • Nonoperative • passive stretching • target tight radial-sided structures • observation • indicated if absent elbow motion or biceps deficiency • hand deformity allows for extra reach to mouth in presence of a stiff elbow

6. Operative • hand centralization • indications • good elbow motion and biceps function intact • done at 6-12 months of age • followed by tendon transfers • contraindications • older patient with good function • patients with elbow extension contracture who rely on radial deviation • proximate terminal condition

7. technique • involves resection of varying amount of carpus, shortening of ECU, and, if needed, an angular osteotomy of ulna (be sure to spare ulnar distal physis) • may do as two stage procedure in combination with a distraction external fixator • if thumb deformity n combine with thumb reconstruction at 18 months of age