RADIAL CLUB HAND
DR SUDHAKARPRADHAN (GDMO/LECTURER)
DEFINITION
The normal hand connects with both bones of forearm. The radius and ulna at the wrist.In
radial club hand, A baby’s radius was not formed properly in the womb. Which in turn causes
the wrist to be in fixed bend position toward the thumb side of hand. There may be a
deformity or absence of thumb as well. The condition also called radial dysplasia which
means abnormal development of radius.
In most form radial club hand not only in the bone abnormal but the soft tissue and flesh of
forearm are also abnormal. The arrangement of muscle and nerve may be unbalanced Some
muscle and nerve may even absent.
In severe form entire arm will be shorter with marked curving of forearm Stiffness of elbow
and finger, thumb will be very small or absent.
Radial club hand is a birth defect .it develops early in pregnancy between 28 th day to 56th
days of gestation when the bone of arm and forearm are being formed the condition can not
be
treated
until
after
the
baby
is
born.
Radial club hand occurs 1 in 100000 live birth,more common in males than females.Ranges
from 4.7% to 6.1 % of all congenital anomalies.Bilateral in 38% to 50% cases.When
unilateral twice as frequent in right side.
EPIDEMIOLOGY
Primary insult is to the epical ectodermal ridge during critical limb development period
between 4th to 7th weeks
Mostly due to environmental factor.
1. Intra uterine compression.
2.Inflammatory process.
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3.Nutritional deficiency.
4.Infection.
5. Irradiation
6. Medication (especially thalidomide)
Several syndrome associated with radial dysplasia
a. Cardiovascular- Holt roam syndrome
b. Gastro intestinal- VATER syndrome.
c. Hematologic- Franconia anaemia and TAR syndrome.
CLASSIFICATION
Type N –Isolated thumb anomaly.
Type 0 –Deficiency of carpal bone.
Type i –short distal radius.
Type ii-Hypo plastic radius.
Type iii –partial absence of radius.
Type iv-complete absence of radius.
Type v-complete absence of radius and manifestation in proximal humerus.
TREATMENT
1.non operative management
2.Operative management
NON OPERATIVE MANAGEMENT
Immediately after birth the radial club hand often can be corrected passively and early casting
and splinting generally recommended.
Treatment should begin at birth and should consist of manipulation and serial casting into
corrected condition. should be done with a well padded long arm cast with arm gently placed
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into flexion and hand in maximally corrected position. serial casting to be done 2 week
interval.
SPLINTING
A light melded plastic short arm splint is applied along the radial side of forearm. And is
removed only for bathing until the infants begin to use the hand. Then the splint is worn only
during sleep.
SURGICAL TREATMENT
Surgical treatment is usually required to correct deviation of the wrist that persist despite non
surgical means of treatment.
1. LENGTHENING
This procedure is used prior to surgery to gently stretch the hand into a straighter position. A
customized frame (distractor) is surgically placed on the hand and fore arm so that pins go
through the ulna and hand .the pins in ulna and hand are then pushed apart gradually
(1mm/day)
2.CENTRALISATION
This procedure involves removing bones from the wrist so that hand sits straight on the end
of the ulna. It is stabilised by k-wire fixation. Then long arm cast given for 6 week.
3. RADIALISATION.
The hand of ulna is brought under the radial carpal bone and hand is fixed in ulnar deviation
with a k-wire.
-procedure includes release of tight radial soft tissue structure along with possible tendon
transfer from the radial to ulnar side of the wrist.
4.SPLINTING-This usually necessary following centralisation and radicalisation procedure.
5.POLICIZATION-For reconstruction of thumb with radial club hand..
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