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Radial Clubhand

Background

Radial clubhand is a deficiency along the preaxial or radial side of the extremity. Although considerable forearm and hand anomalies are the classic findings, proximal deficiencies also can occur throughout the arm and shoulder girdle. The elbow abnormalities can include deficiences of the olecranon, capitellum, coronoid fossa, and medial epicondyle.

In 1733, Petit first described radial clubhand in an autopsy of a neonate with bilateral clubhands and absent radii. Subsequent autopsy observations detailed the anomalous anatomy associated with radial clubhand and the associated malformations of other body systems.

Initial surgical treatment of radial clubhand involved an ulnar osteotomy to correct the bow, along with splitting of the distal ulna for insertion of the carpus. Reconstruction of the radius with a bone graft to support the carpus was reported in the 1920s, and nonvascularized epiphyseal transfer was reported in 1945. Results of these procedures were disappointing. They had multiple causes of failure, including disruption of the ulnar growth plate and subsequent increase in limb-length discrepancy, inadvertent ankylosis or arthrodesis of the wrist and loss of motion, and failure of the transplanted bone to grow, with eventual loss of radial support.

Centralization of the carpus on the distal ulna has emerged as the preferred surgical technique for correcting radial clubhand.
Pioneers in congenital hand surgery developed the basis for this procedure. Numerous modifications have been described to obtain or maintain correction of the wrist on the ulna.

Radialization is a technique that involves overcorrection of the carpus on the ulna combined with tendon transfer to further rebalance the wrist.

Despite over 250 years of investigation, current treatment regimens are still unable to restore normality: The limb remains short, and the wrist lacks full function.

This article summarizes the history of radial deficiencies, lists potential etiologies, highlights relevant pathoanatomy, discusses treatment regimens, reviews expected outcome, and details potential complications.

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