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Bone Lengthening of the Radius with Temporary External Wrist Fixation for Mild Radial Club Hand
Takehiko Takagi, MD, PhD; Shinichi Uchikawa, MD; Atsuhito Seki, MD, PhD; Shinichiro Takayama, MD, PhD
National Center for Child Health and Development, Tokyo, Japan

Introduction: The goals in the treatment of radial club hand are to correct the wrist deformity, to maintain the corrected position, to provide wrist-like mobility and to preserve the maximal forearm longitudinal growth capacity as well as to achieve an acceptable cosmetic result (Vilkki 1998). However, in fact, it is difficult to acquire alignment as well as mobility. We developed a new approach that tries to solve the problem of radial club hand by a combination of bone lengthening of the radius and temporary external fixation between ulna and metacarpals.
Materials and Methods: Five radial club hands have been treated with the new method, radius lengthening with external fixation to support the radial side. All hands were Bayne type I (short distal radius) or II (hypoplastic radius). The age of the patients at the time of operation was from 21 to 59 months (mean, 36.0 months). There were three male and two female patients. Two had TAR syndrome and useful thumbs were present. Pollicization has been done for absent thumb in two cases after wrist treatment. The follow-up period was from 25 to 55 months (mean, 38.4 months).
Results: Healing index of the radius was from 72.2 to 298.9 day/cm (mean, 176.8 day/cm). The radial/ulnar flexion was 80.0/-8.0 degrees before surgery and 29.0/15.0 degrees at the time of the final follow-up. All cases were able to hold and bring an object to mouth. Two cases were able to rotate a peg and three cases were not.
Conclusion: In the present series, all cases have shown ADL improvement with better range of motion despite poor healing index. Our novel method can be performed for the cases with mild (Bayne type I or II) radial club hand.


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