Surgical management of radial club hand:
Centralization of the carpus on the distal ulna (preferred method). There are numerous modifications that have been described to obtain the best correction of the wrist on the ulna. Descriptions of this surgery are beyond the scope of this book.
Radialization is a surgical technique that involves over correction of the carpus on the ulna combined with a tendon transfer to rebalance the wrist. Head of ulna is brought to the carpal bones and secured with K-wire in ulnar deviation.
Ulnar bowing is commonly seen with radial club hand. If ulnar bow in greater than 30 degrees this will require a corrective osteotomy. Surgical correction to straighten the bone.
Additional staged procedures are commonly performed with radial club hand.
Ulnar lengthening procedures are commonly necessary in the future for the children with radial club hand.
Case Example of surgical correction for radial club hand:
Sair had the surgical procedure:
Centralization of his ulna for his left arm.
You can see the remarkable difference post op when comparing to his right side.
Sair was fitted with a wrist splint placing left wrist in a more neutral position correcting the radial deviation and slight extension after his cast was removed.
The goal was for Sair to return to the therapy clinic for splint adjustments to improve his wrist position to a more neutral position and to increase extension as he heals and develops.
Sair really enjoyed his therapy play time and getting his custom splint.
It is obvious from this photo that Sair will have improved function of his left arm after surgery.
Sair’s parents are planning on bringing their son back to the mission hospital for surgery for his right radial club hand.