Strategic two-stage approach to radial club hand

Abstract

In patients with radial club hand (RCH), there is absence of the radius and severe hypoplasia of the thumb, so both wrist stabilization and thumb reconstruction are essential. When wrist stabilization is performed, recurrence of angulation is a problem. When thumb reconstruction is done, preservation of at least one major dorsal vein is important to prevent necrosis of the reconstructed thumb. We executed a strategic approach to RCH, which aimed to prevent both recurrence of angulation and necrosis of the reconstructed thumb.

Keywords

Radial club hand - Centralization - Pollicization - Skin incision - Thumb reconstruction

• References

• 1 Manske PR, McCarroll Jr HR, Swanson K. Centralization of the radial club hand: an ulnar surgical approach. J Hand Surg 1981; 6A: 423-433
• 2 Watson HK, Beebe RD, Cruz NI. A centralization procedure for radial clubhand. J Hand Surg 1984; 9A: 541-547
• 3 Tonkin MA. Radial longitudinal deficiency (radial dysplasia, radial club hand). In Green ’s operative hand surgery . 1999. (eds) Green DP, Hotchkiss RN, Pederson WC. New York: Churchill Livingstone; 4th edn pp 344-558
• 4 Kleiman WB, Strickland JW. Thumb reconstruction. In Green’s operative hand surgery . 1999. (eds) Green DP, Hotchkiss RN, Pederson WC. New York: Churchill Livingstone; 4th edn, pp 2068-2170
• 5 Foucher G, Medina J, Lorea P, Pivato G. Principali-zation of pollicization of the index finger in congenital absence of the thumb. Tech Hand Up Extrem Surg 2005; 9: 96-104
• 6 Lister G. Reconstruction of the hypoplastic thumb. Clin Orthop Relat Res 1985; 195: 52-65
• 7 Bayne LG, Klug MS. Long-term review of the surgical treatment of radial deficiencies. J Hand Surg 1987; 12A: 169-179
• 8 Carroll RE. Pollicization. In Operative Hand Surgery . 1988. (ed.) Green DP. 2nd edn New York: Churchill Livingstone; pp 2263-2280
• 9 Buck-Gramcko D. Thumb reconstruction by digital transposition. Orthop Clin North Am 1977; 8: 329-342
• 10 Buck-Gramcko D. Radialization as a new treatment for radial club hand. J Hand Surg 1985; 10A: 964-968
• 11 James MA, Bednar M. Deformities of the wrist and forearm. In Green ’s Operative Hand Surgery . 2005. (eds) Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. Philadelphia: Elsevier; 5th edn, pp. 1469-1506
• 12 Kanojia RK, Sharma N, and Kapoor SK. Preliminary soft tissue distraction using external fixator in radial club hand. J Hand Surg Eur 2008; 33: 622-627
• 13 Evans DM, Gateley DR, Lewis JS. The use of a bilobed flap in the correction of radial club hand. J Hand Surg 1995; 20B: 333-337
• 14 Lamb DW. The treatment of radial club hand. Absent radius, aplasia of the radius, hypoplasia of the radius, radial paraxial hemimelia. Hand 1972; 4: 22-30
• 15 Kozin SH. Deformities of the thumb. In Green’s Operative Hand Surgery . 2005. (eds) Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. Philadelphia: Elsevier; 5th edn, pp 1445-1468
• 16 Bhat SB, Kamath AF, Sehgal K, Horn BD, and Hosalkar HS. Multi-axial correction system in the treatment of radial club hand. J Child Orthop 2009; [Epub ahead of print] Pub-Med PMID: 19730917