DRGauravJain (2)

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Radial Club Hand

• Dr Gaurav Jain
• Consultant Paediatric Orthopaedic Surgeon ,
  Indore
• 9111464959
• https//www.drgauravjain.com

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What is Radial Club Hand?

• Rare congenital condition, meaning your baby was
  born with it, and can affect one or both arms.
• Two bones in your babys forearm
• ulna, on outer side and
• radius, on inner side.
• It occurs when radius does not form properly.
• This causes wrist to bend toward thumb side of
  forearm.
• Affects soft tissues and flesh of forearm.
• Arrangement of muscles and nerves may be
  unbalanced, and some muscles and nerves may be
  missing.

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What are the symptoms of radial longitudinal
deficiency?

• Mild form, condition will probably not cause
  problems with development or hand movement.
• Severe form, may have problems moving hand,
  fingers, and elbow. Entire arm will be shorter,
  with a curved forearm and stiff elbow and
  fingers, may also have a small or missing thumb.
• Types of radial longitudinal deficiency
• Type1 move hand normally. Usually do not need
  surgery unless it is necessary to correct an
  underdeveloped thumb.
• Type 2 wrist bends inward, and ulna bows out.
  Children with this type often have an
  underdeveloped thumb.
• Type 3 missing most of radius bone. wrist bends
  inward more severely and hand has limited
  support. ulna is bowed. Most children with this
  type of radial longitudinal deficiency have an
  underdeveloped or missing thumb.
• Type 4 most common and most severe form of radial
  longitudinal deficiency. Children with this type
  are missing radius bone and have significant
  shortness in forearm. may also have limited
  range of motion elbow. Most children with type 4
  have an underdeveloped or missing thumb, and may
  have differences in fingers as well. Many
  children adapt by using pinky finger to pick up
  toys and or objects.

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What causes radial longitudinal deficiency?

• Usually occurs by chance, although for some
  people it can also run in family.
• Doctors and scientists do not know why some
  children are born with this condition.
• several Theories, including compression of
  uterus and blood vessel injury.
• Associated with several congenital syndromes,
  affecting heart, digestive system, and kidneys.
• Also been linked to some chromosomal
  abnormalities, including Down syndrome and
  Trisomy 18 and 13.

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How we care for radial longitudinal deficiency at
Ortho-Care?

• Nonoperative
• passive stretching
• target tight radial-sided structures
• observation
• indicated if absent elbow motion or biceps
  deficiency
• hand deformity allows for extra reach to mouth in
  presence of a stiff elbow

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• Operative
• hand centralization
• indications
• good elbow motion and biceps function intact
• done at 6-12 months of age
• followed by tendon transfers
• contraindications
• older patient with good function
• patients with elbow extension contracture who
  rely on radial deviation
• proximate terminal condition

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• technique
• involves resection of varying amount of carpus,
  shortening of ECU, and, if needed, an angular
  osteotomy of ulna (be sure to spare ulnar distal
  physis)
• may do as two stage procedure in combination with
  a distraction external fixator
• if thumb deformity n combine with thumb
  reconstruction at 18 months of age

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