TYPE OF SURGERIES

Birth defects

Burns related deformities

Accidents/Trauma Injuries

Swellings on any part of the body

Nerve Disorders

Miscellaneous

Aesthetic

Orthopedic

Radial Clubbed Hand

  • Radial Clubbed Hand
  • Radial Clubbed Hand

Description of disability:

Radial club hand is a complex congenital anomaly involving failure of formation of structures on the paraxial border of the upper limb. This is an example of a longitudinal arrest of development. The deficiency involves the skeleton, muscles and tendons, nerves and vessels and other soft tissues of the entire upper limb to a greater or lesser extent. Radial dysplasia, also known as radial club hand or radial longitudinal deficiency, is a congenital difference occurring in a longitudinal direction resulting in radial deviation of the wrist and shortening of the forearm. It can occur in different ways, from a minor anomaly to complete absence of the radius, radial side of the carpal bones and thumb. Hyperplasia of the distal homeruns may be present as well and can lead to stiffness of the elbow. Radial deviation of the wrist is caused by lack of support to the corpus, radial deviation may be reinforced if forearm muscles are functioning poorly or have abnormal insertions. Although radial longitudinal deficiency is often bilateral, the extent of involvement is most often asymmetric.

When seen after birth the deviated hand is corrected in a splint to prevent further deviation. At 6months age ,the corrective surgery called radialization is done. During radialization the metacarpal of the index finger is pinned onto the ulna and radial wrist extensors are attached to the ulnar side of the wrist, causing overcorrection or ulnar deviation. This overcorrection is believed to make relapse of radial deviation less likely.

Treatment:

The surgery is done under general anesthesia.  The child stays in hospital for two days .The pins are removed after a month and exercises commenced.

When the radial club hand is associated with a hypo plastic thumb, pollicization (creation of thumb)is done at one year of age .

The index finger is freed from the middle finger and moved to the position of the thumb along with its tendons, nerves and blood vessels. Although the index pollicization results in a four finger hand, it is usually adequate aesthetically and functionally.

Post operative care: 

Rest, immobilization and elevation of the part with frequent follow-ups and splinting is the usual postoperative care. This is followed by physiotherapy.


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