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Radial Club Hand

Radial Club Hand. Correction of Deformity. Centralization Radialization Distraction Distal Ulnar Osteotomy Problems: High recurrence rate Growth arrest distal ulna. New Method: Ulnarization (Paley 1998). Modification of Buck Gramko method

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Radial Club Hand

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  1. Radial Club Hand

  2. Correction of Deformity • Centralization • Radialization • Distraction • Distal Ulnar Osteotomy Problems: • High recurrence rate • Growth arrest distal ulna

  3. New Method: Ulnarization (Paley 1998) • Modification of Buck Gramko method • Buck Gramko: called this radialization since makes ulna into a radius • Paley: called this ulnarization since moves carpus to the ulnar side of the ulnar head

  4. Ulnarization of the Carpuswith Tendon Transfer of FCU

  5. RCH: Poor Grip Strength • Due to lack of fulcrum • Forearm shortening affects muscle length curve (Blick’s) • Excessive palmar flexion pull: dorsi flexion of hand increases grip strength

  6. Ulnarization • Converts head of ulna into a fulcrum due to radial pull of muscles fulcrum Muscle pull

  7. Flexor Carpi Ulnaris Transfer • FCU is the major deforming flexor force • Transfer to dorsum converts it to a correction force • This helps improve finger flexion ROM and strength

  8. Lengthening • Improves muscle tension (Blick’s curve) • Improves grip strength

  9. Paley (1998) Name describes direction of carpal translocation Volar approach Visualize all the N-V structures Transfer FCU tendon Extensile for elbow contracture release Buck-Gramko (1979) Name describes change of ulna to a radius Dorsal approach Cannot visualize N-V structures Transfer FCR* *FCR usually absent Ulnarization vs Radialization

  10. 8 year followup

  11. 7 yr. followup radiographs

  12. Ulnarization: Results • 15 patients; 21 hands • Followup 1-7 years • Recurrence: 0 • Growth arrest: 0

  13. Ulnarization: Complications • 2 skin necrosis treated by debridement and secondary closure

  14. Wrist Dorsiflexion PASSIVE preop -15° postop +36° ACTIVE postop 9°(10-20°)

  15. Preop: 79mm (40-175mm) Postop: 102mm (58-188mm) No Growth Inhibition

  16. Conclusion • safe • no recurrences • no growth arrest • low complication rate • improves grip strength • active dorsiflexion • improves activities of daily living • improves cosmesis

  17. Lengthening of the Forearm for Radial Clubhand

  18. Strategy Dependent on age at presentation Age 610 years Two lengthenings

  19. Before age 10 years • 1st lengthening 4-6 cm • After age 10 years • 2nd lengthening 6-8 cm

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