205 results on '"radial club hand"'
Search Results
2. Progressive Bone Distraction Lengthening in the Treatment of Congenital Malformations of the Upper Limb
- Author
-
Paracuollo, Mario, Novelli, Chiara, Proserpio, Giulietta, Young, Keit, Pajardi, Giorgio, and Pajardi, Giorgio, editor
- Published
- 2023
- Full Text
- View/download PDF
3. Radial Club Hand: Microvascular Reconstruction
- Author
-
Vilkki, Simo K. and Pajardi, Giorgio, editor
- Published
- 2023
- Full Text
- View/download PDF
4. Congenital hypoplastic thumbs treated by staged nonvascularized MTP joint transfer for absent MCP joints and abductor digiti minimi tendon transfer for opposition: a case series study
- Author
-
Ramin Zargarbashi, Behnam Panjavi, and Mohammadreza Bozorgmanesh
- Subjects
Hypoplastic thumb ,MTP ,Metatarsophalangeal joint transfer ,Radial club hand ,Congenital ,Hand ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background We developed a 2-stage, MTP (metatarsophalangeal) joint- plus ADM (abductor digiti minimi) tendon-transfer, procedure for treatment of hypoplastic thumb. This method is intended to achieve both structural and functional goals of reconstruction. Structurally, it preserves a five-digit hand with minimal donor site complications. Functionally, it provides a functioning opposable thumb. Case presentation The case series included 7 patients with type IV hypoplastic thumb. At the first stage non-vascularized joint (not bone) was transplanted. In the second stage abductor digiti minimi tendon was transferred. Patients were followed for a median 5-yr period (range: 37–79 months). Functional outcome was assessed using a modified Percival assessment tool. Participants aged 17 to 36 months at the time of surgery with (2 male, 4 female). All patients were able to grasp large and small objects after the procedure. The thumb tip could actively move to touch the tips of index (2 patients) middle, ring, and little fingers (all patients) in an ulnar ward sequence and vice versa. All patients attained the ability to do lateral, palmar, and tripod pinch. As for donor site complications, none of the patients were found to have difficulty walking or keeping their balance. Conclusions An alternative surgical procedure was developed to reconstruct a hypoplastic thumb. We obtained a good functional and cosmetic outcome with few donor site complications. Future studies will be needed to determine the long-term outcomes, to refine the selection criteria and to examine the necessity of additional procedure at the older ages.
- Published
- 2023
- Full Text
- View/download PDF
5. Evaluation of the ulna lengthening by distraction osteogenesis in congenital radial deficiency.
- Author
-
Górecki, Michał, Redman, Marcin, Romanowski, Leszek, and Czarnecki, Piotr
- Subjects
- *
BONE lengthening (Orthopedics) , *RADIAL bone , *AGE distribution , *SURGERY , *PATIENTS , *ULNA , *TREATMENT effectiveness , *COMPARATIVE studies , *RESEARCH funding , *ADVERSE health care events , *HAND abnormalities , *EVALUATION - Abstract
Purpose: Publications evaluating the results of the ulna lengthening in congenital radial deficiency are based only on small groups of subjects which yield statistical studies of low scientific value. The aim was to examine the effectiveness of ulna lengthening in radial longitudinal deficiency and determine the number and quality of complications based on one of the most numerous study groups described in the literature. Methods: The material consists of a study group with 31 upper limbs of unmatured patients diagnosed with type III and IV radial longitudinal deficiency. The study group was evaluated based on the parameters known from the literature. The difficulties during elongation were classified according to Paley's classification. Results: The study group contained patients with a mean age of 9 years, and the number of boys and girls was comparable. Ulna length significantly increased after elongation compared to the initial bone length. The patient's age didn't affect the ulna lengthening, and the amount of elongation didn't significantly affect the total stabilization period. However, the total stabilization time increased with increasing patient age. Difficulties affected more than half of the cases. Conclusions: Ulna elongation in congenital radial deficiency results in significant lengthening of the ulna, and thus the entire forearm, compared to the initial bone length. This technique has a high percentage of difficulty, so its use should be considered after cautious discussion with the parents and patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. Congenital hypoplastic thumbs treated by staged nonvascularized MTP joint transfer for absent MCP joints and abductor digiti minimi tendon transfer for opposition: a case series study.
- Author
-
Zargarbashi, Ramin, Panjavi, Behnam, and Bozorgmanesh, Mohammadreza
- Subjects
- *
THUMB , *TENDONS , *OPERATIVE surgery , *METATARSOPHALANGEAL joint , *HYPOPLASTIC left heart syndrome , *FINGERS , *BONE grafting - Abstract
Background: We developed a 2-stage, MTP (metatarsophalangeal) joint- plus ADM (abductor digiti minimi) tendon-transfer, procedure for treatment of hypoplastic thumb. This method is intended to achieve both structural and functional goals of reconstruction. Structurally, it preserves a five-digit hand with minimal donor site complications. Functionally, it provides a functioning opposable thumb. Case presentation: The case series included 7 patients with type IV hypoplastic thumb. At the first stage non-vascularized joint (not bone) was transplanted. In the second stage abductor digiti minimi tendon was transferred. Patients were followed for a median 5-yr period (range: 37–79 months). Functional outcome was assessed using a modified Percival assessment tool. Participants aged 17 to 36 months at the time of surgery with (2 male, 4 female). All patients were able to grasp large and small objects after the procedure. The thumb tip could actively move to touch the tips of index (2 patients) middle, ring, and little fingers (all patients) in an ulnar ward sequence and vice versa. All patients attained the ability to do lateral, palmar, and tripod pinch. As for donor site complications, none of the patients were found to have difficulty walking or keeping their balance. Conclusions: An alternative surgical procedure was developed to reconstruct a hypoplastic thumb. We obtained a good functional and cosmetic outcome with few donor site complications. Future studies will be needed to determine the long-term outcomes, to refine the selection criteria and to examine the necessity of additional procedure at the older ages. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. The unsolved problem of radial longitudinal dysplasia: how can we reliably prevent recurrence, preserve growth and optimize function?
- Author
-
van Nieuwenhoven, Christianne A., Mann, Max, and Hülsemann, Wiebke
- Subjects
DYSPLASIA ,PATIENTS' attitudes ,SKELETAL maturity ,FOREARM ,WRIST ,FUNCTIONAL status - Abstract
Congenital radial longitudinal dysplasia remains an 'unsolved problem' in hand surgery. The challenges presented by the skeletal deficiency of the distal radius and soft tissue dysplasia of the severe radial longitudinal deficiency have been addressed by a number of techniques that aim to stabilize the position of the hand relative to the forearm and optimize forearm growth and hand function. Analysis of hand function and position in these children is difficult because of the abnormal 'wrist' mechanics, and the published results of the techniques used to date often lack a standardized approach and importantly the perception of function from the patient's perspective. The existing data is reviewed and compared with the results of cohorts from two major congenital upper limb centres. Soft tissue distraction prior to radialization or centralization may offer benefit in ulnar growth and forearm length but there is a need for further research into the long-term functional outcomes of the various techniques available to determine the optimal choice for these children. Level of evidence: V [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
8. An unusual phenotype of radial longitudinal deficiency (radial hemimelia) presenting in a young adult male
- Author
-
Meltem Özdemir, MD, Rasime P. Kavak, MD, Mehmet Akdağ, MD, and Selda Güven, MD
- Subjects
Radial longitudinal deficiency ,Radius deficiency, Radius dysplasia ,Radial club hand ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Radial longitudinal deficiency is a rare skeletal anomaly characterized by a defect in the development of structures that form the radial half of the forearm. The disorder is associated with a large spectrum of preaxial abnormalities. It is shown that the thumb and preaxial carpal bones are almost always hypoplastic or absent in almost all types of radial longitudinal deficiency. Congenital dislocation of the dysplastic radial head may accompany this rare deformity. Herein, we present a 20-year-old male patient with radial longitudinal deficiency who had a markedly hypoplastic radius but had a thumb and carpal bones with normal size, shape, and joint relations. Further, the right radial longitudinal deficiency of our patient was unusually accompanied by left congenital radial head dislocation. Our case shows that, although rare, radial longitudinal deficiency can present without any carpal and thumb abnormalities. And the current case also shows that a contralateral sided congenital radial head dislocation may accompany radial longitudinal deficiency.
- Published
- 2020
- Full Text
- View/download PDF
9. Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?
- Author
-
Deszczynski, Jaroslaw M., Albrewczynski, Tomasz, Shannon, Claire, and Paley, Dror
- Subjects
WRIST abnormalities ,HAND surgery ,ULNA ,HAND abnormalities ,RADIAL deviation - Abstract
(1) Background: Patients treated with the two previous generations of ulnarization developed a bump related to the ulnar head becoming prominent on the radial side of the hand. To finally remedy this problem, a third generation of ulnarization was developed to keep the ulnar head contained. While still ulnar to the wrist center, the center of the wrist remains ulnar to the ulnar head, with the ulnar head articulating directly with the trapezoid and when present the trapezium. (2) Methods: Between 2019 and 2021, 22 radial club hands in 17 patients were surgically corrected with this modified version of ulnarization. (3) Results: In all 17 patients, the mean HFA (hand–forearm-angle) correction was 68.5° (range 12.2°–88.7°). The mean ulna growth was 1.3 cm per year (range 0.2–2 cm). There were no recurrent radial deviation deformities more than 15° of the HFA. (4) Conclusions: This new version of ulnarization may solve the problem of the ulna growing past the carpus creating a prominent ulnar bump. The results presented are preliminary but promising. Longer-term follow-up is needed to fully evaluate this procedure. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. Evaluation of the ulna lengthening by distraction osteogenesis in congenital radial deficiency
- Author
-
Górecki, Michał, Redman, Marcin, Romanowski, Leszek, and Czarnecki, Piotr
- Published
- 2022
- Full Text
- View/download PDF
11. Radial club hand treated with soft-tissue distraction and subsequent pin stabilization: mid- to long-term results.
- Author
-
Pfister, Georges, Le Hanneur, Malo, Bachy, Manon, and Fitoussi, Franck
- Subjects
DISTRACTION ,PERSONAL identification numbers ,ULNA ,WRIST ,REOPERATION - Abstract
Radial club hand deformities are commonly treated with arthrolysis to allow centralization of the ulna. In this retrospective cohort study of 31 hands in 28 patients, we aimed to assess the outcomes of correction using progressive distraction and subsequent percutaneous pinning of the wrist with a corrective ulnar osteotomy. Mean follow-up time was 7 years (range 2 to 20). The angulation of the hand–forearm complex was decreased after each step of the procedure. Mean correction of the angulation was 64°, and the residual total forearm–hand angulation was 12° after completion of the surgery. At the time of bony maturity (four patients), all wrists had fused. Fifty-eight reoperations were required in 31 wrists because of pin migration or breakage, and in addition 18 secondary osteotomies of the ulna were performed. From this study we conclude that distraction and pinning provide satisfactory and stable realignment of the wrist to correct the deformity, but this treatment has drawbacks regarding the high number of reoperations and the loss of wrist mobility. Level of evidence: IV [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
12. Multi-axial correction system in the treatment of radial club hand
- Author
-
Bhat, Suneel B., Kamath, Atul F., Sehgal, Kriti, Horn, B. David, and Hosalkar, Harish S.
- Subjects
Medicine & Public Health ,Traumatic Surgery ,Pediatrics ,Orthopedics ,MAC fixator ,Radial club hand ,Multi-axial correction system - Abstract
Radial club hand is a well-recognized congenital malformation characterized by hypoplasia of bone and soft tissue on the radial aspect of the forearm and hand. The modalities of treatment have traditionally varied from stretching casts with soft-tissue procedures to the use of multiple corrective osteotomies. These osteotomies can be stabilized by a variety of methods, including external fixators that allow the possibility of gradual distraction with neohistiogenesis. This current study outlines the usage of one such device (multi-axial correction system [MAC]) in the management of deformity associated with severe radial club hand.Three consecutive cases of unilateral or bilateral severe (Bayne type IV) congenital radial club hand were corrected using MAC fixation in the last 5 years. This is a retrospective review of all three cases. Data parameters included: patient demographics, presentation findings, degree of deformity, amount of correction/lengthening, length of procedure, length of treatment, and associated complications. The surgical technique is described in detail for the benefit of the readership.The three patients with severe congenital radial club hand had a total of four limb involvements that underwent correction using osteotomies and usage of the MAC device for external fixation. All three patients underwent successful correction of deformity with the restoration of alignment, lengthening of forearm for improvement of function, and stabilization of the wrist (mean duration, mean lengthening, mean time to consolidation). The MAC system was well tolerated in all patients and associated complications were limited.The MAC fixator seems to be a good alternative modality of stabilization and correction for severe congenital radial club hand deformities. Its usage is fairly simple and it provides the ease of application of a mono-lateral fixator with far superior three-dimensional control, like the circular external fixator. We recommend that clinicians should add this modality to their armamentarium for the deformity correction of severe radial club hand and others in general.
- Published
- 2009
13. Failure of Formation of Parts Transverse and Longitudinal
- Author
-
Lam, Wee, Smith, Gillian D., Trail, Ian A., editor, and Fleming, Andrew N.M., editor
- Published
- 2015
- Full Text
- View/download PDF
14. Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?
- Author
-
Jaroslaw M. Deszczynski, Tomasz Albrewczynski, Claire Shannon, and Dror Paley
- Subjects
radial club hand ,ulnarization ,radialization ,centralization ,radial aplasia ,radial longitudinal defect ,Pediatrics ,RJ1-570 - Abstract
(1) Background: Patients treated with the two previous generations of ulnarization developed a bump related to the ulnar head becoming prominent on the radial side of the hand. To finally remedy this problem, a third generation of ulnarization was developed to keep the ulnar head contained. While still ulnar to the wrist center, the center of the wrist remains ulnar to the ulnar head, with the ulnar head articulating directly with the trapezoid and when present the trapezium. (2) Methods: Between 2019 and 2021, 22 radial club hands in 17 patients were surgically corrected with this modified version of ulnarization. (3) Results: In all 17 patients, the mean HFA (hand–forearm-angle) correction was 68.5° (range 12.2°–88.7°). The mean ulna growth was 1.3 cm per year (range 0.2–2 cm). There were no recurrent radial deviation deformities more than 15° of the HFA. (4) Conclusions: This new version of ulnarization may solve the problem of the ulna growing past the carpus creating a prominent ulnar bump. The results presented are preliminary but promising. Longer-term follow-up is needed to fully evaluate this procedure.
- Published
- 2021
- Full Text
- View/download PDF
15. Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series.
- Author
-
Lahiji, Farivar A., Asgari, Farhang, Mirzaee, Fateme, Zafarani, Zohreh, and Aslani, Hamidreza
- Abstract
• Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. • Treatment of RCH should begin as soon as possible after birth. • Treatment of patients with RCH by primary traction and centralization and pollicization surgery, can greatly improve the deformity. • Early centralization and pollicization can significantly restore the range of motion and function in patients with RCH. Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. There were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ± 1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ± 2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. The mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ± 11 percent and 61 ± 12 percent. Three patients developed skin necrosis. Early centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
16. Prevalencia de mano zamba radial en Hospital Shriners-México y revisión de la literatura.
- Author
-
Fortis-Olmedo, I. O., Hernández-Álvarez, M. A., González-Cepeda, E., and Avalos-Arroyo, G.
- Abstract
Introduction: Radial club hand is characterized by radial deviation of the hand, as a result of hypoplasia or absence of the radius. Material and methods: A descriptive, retrospective, cross-sectional and observational study of active patients diagnosed with radial club hand at the Shriners-Mexico Hospital was carried out. Results: We studied 71 patients and 92 limbs, the prevalence was 0.08%, 64.7% were men and 35.3% women. We observed 22 patients with involvement of the right thoracic extremity, 28 left and 21 bilateral. It was found that 93% of the patients had an associated syndrome. The most common type of radial longitudinal dysplasia was type 1. 58 limbs did not have a thumb. The State of Mexico is the most affected and 91.6% had a guardian with maximum high school education. [ABSTRACT FROM AUTHOR]
- Published
- 2019
17. Vascularized second metatarsophalangeal joint transfer for radial deficiency – an update.
- Author
-
Vilkki, Simo K. and Paavilainen, Pasi
- Abstract
Vascularized second metatarsophalangeal joint transfer offers a possibility to reconstruct the radial support which is lacking in radial dysplasia. Our experience from 1987 to 2017 with 34 congenital radial club hand reconstructions have allowed a possibility for long-term evaluation of the method. Compared with conventional methods, second metatarsophalangeal joint transfer results in better wrist mobility and does not restrict typical ulnar growth. The balance of the wrist remains good until age 11. Thereafter, the growth of the vascularized bone graft transfer matches only partially the distal ulnar growth in adolescence, resulting in mild recurrence of radial deviation. A new option to create a two-bone forearm in selected Bayne-Klug Type III radial dysplasia cases will allow a relatively good pro-supination ability. Potentially, a proximal fibular epiphyseal transfer could be a future solution. Currently, a safe harvest of the proximal fibula at childhood remains controversial. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
18. Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency.
- Author
-
Khan H, Ul Ain N, Afridi K, Bhatti Z, Chishti U, Malik TS, and Cheema T
- Abstract
Introduction Loss of radius either due to trauma or infection results in a deformity resembling a congenital radial club hand. This deformity results in difficulty to perform hand functions and cosmetic appearance and is called acquired radial club hand. There are a few case reports for the treatment of this severe deformity, but there are no proper guidelines for the management of this disease. From our experience, we decided to provide treatment guidelines for acquired radial club hand. Objectives To evaluate the outcome of radial deformity treatment in acquired radial club hand injuries and develop a treatment algorithm. Patients and methods It is a case series study of 11 patients with acquired radial club hand. It was conducted at a tertiary care hospital in Pakistan, from year 2016 to 2022. Basic principles of management of infection and trauma were followed. For the treatment of radial deformity, different options were opted according to the type of deformity, following the principles of treatment of congenital radial club hand. The outcome was graded on functional activity, pain, and bony union. Results Out of 11 patients, 36.36% showed excellent results, 27.27% showed good results, 27.27% showed fair results, and 9.09% showed poor results. Results were excellent in all patients with avascularized bone graft and distraction lengthening, with or without the Darrach procedure. Of the patients in whom distraction lengthening was performed, one patient showed excellent results while the other patient achieved similar results after the Darrach procedure of ulnar shortening. In the case of one bone formation by radioulnar synostosis, the results were variable. Two of the patients showed good outcomes while the other two had fair outcomes. Results in the case of ulnar centralization were mixed with good, fair, and poor results in one patient each. After three months of follow-up, 87% of the patients showed fair to excellent results. Conclusion With our experience, we recommend an algorithm for the treatment of acquired radial club hand., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khan et al.)
- Published
- 2023
- Full Text
- View/download PDF
19. Long-Term Follow-Up of Ulnar Growth in Radial Dysplasia Treated by a Combination of Distraction and Radialization.
- Author
-
Mehta, Rujuta, Ghanghurde, Bipin Arun, Shah, Ishani Pinakin, and Thatte, Mukund
- Abstract
To study the long-term results of radial club hand, regarding ulna growth, radial angulation, and volar subluxation using a 2-stage treatment protocol. From 1998 to 2009, 39 radial club hands (32 patients) were treated with distraction, radialization, and a bilobed flap. Long-term follow-up was available in 13 patients (17 hands; average 12.6 years, range 9–16 years). All 17 hands were classified as Bayne and Klug grade 3 or 4. The average age at distraction was 12 months (SD 5.3). The average age at radialization was 14 months (SD 5.8). At final follow-up, the average ulna length on the involved side was 69.3% of the uninvolved contralateral side in the unilateral cases. In the 4 bilateral cases, the average ulna length was 62% of the ulna length of a cohort of normal children. The transverse diameter of the ulna in the posteroanterior view was 79%, and in the lateral view 99%, of the radius on the contralateral side in the unilateral cases. The average radial deviation improved from 82° to 8° and the average volar subluxation improved from 20° to 12°. However, in 4 hands recurrent volar subluxation and required revision surgery. This approach to treatment was associated with consistent results in the correction of the radial angulation, volar subluxation, and ulna growth in long-term follow-up. Volar subluxation may result in a requirement for revision. Therapeutic IV. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
20. Radial club hand treated with soft-tissue distraction and subsequent pin stabilization: mid- to long-term results
- Author
-
Georges Pfister, Malo Le Hanneur, Franck Fitoussi, and Manon Bachy
- Subjects
Wrist Joint ,Orthodontics ,business.industry ,Ulna ,Soft tissue ,Retrospective cohort study ,Wrist ,Osteotomy ,body regions ,Radius ,Percutaneous pinning ,Treatment Outcome ,medicine.anatomical_structure ,Radial club hand ,Distraction ,medicine ,Deformity ,Humans ,Surgery ,medicine.symptom ,business ,Hand Deformities, Congenital ,Retrospective Studies - Abstract
Radial club hand deformities are commonly treated with arthrolysis to allow centralization of the ulna. In this retrospective cohort study of 31 hands in 28 patients, we aimed to assess the outcomes of correction using progressive distraction and subsequent percutaneous pinning of the wrist with a corrective ulnar osteotomy. Mean follow-up time was 7 years (range 2 to 20). The angulation of the hand–forearm complex was decreased after each step of the procedure. Mean correction of the angulation was 64°, and the residual total forearm–hand angulation was 12° after completion of the surgery. At the time of bony maturity (four patients), all wrists had fused. Fifty-eight reoperations were required in 31 wrists because of pin migration or breakage, and in addition 18 secondary osteotomies of the ulna were performed. From this study we conclude that distraction and pinning provide satisfactory and stable realignment of the wrist to correct the deformity, but this treatment has drawbacks regarding the high number of reoperations and the loss of wrist mobility. Level of evidence: IV
- Published
- 2020
21. An unusual phenotype of radial longitudinal deficiency (radial hemimelia) presenting in a young adult male☆☆☆
- Author
-
Rasime Pelin Kavak, Meltem Özdemir, Mehmet Akdağ, and Selda Guven
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,musculoskeletal diseases ,lcsh:R895-920 ,Hypoplastic radius ,Thumb ,Congenital radial head dislocation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Forearm ,medicine ,Deformity ,Radius deficiency, Radius dysplasia ,Radiology, Nuclear Medicine and imaging ,Radial longitudinal deficiency ,business.industry ,Radial hemimelia ,Radial club hand ,Anatomy ,body regions ,Carpal bones ,medicine.anatomical_structure ,Young adult male ,Musculoskeletal ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Radial longitudinal deficiency is a rare skeletal anomaly characterized by a defect in the development of structures that form the radial half of the forearm. The disorder is associated with a large spectrum of preaxial abnormalities. It is shown that the thumb and preaxial carpal bones are almost always hypoplastic or absent in almost all types of radial longitudinal deficiency. Congenital dislocation of the dysplastic radial head may accompany this rare deformity. Herein, we present a 20-year-old male patient with radial longitudinal deficiency who had a markedly hypoplastic radius but had a thumb and carpal bones with normal size, shape, and joint relations. Further, the right radial longitudinal deficiency of our patient was unusually accompanied by left congenital radial head dislocation. Our case shows that, although rare, radial longitudinal deficiency can present without any carpal and thumb abnormalities. And the current case also shows that a contralateral sided congenital radial head dislocation may accompany radial longitudinal deficiency.
- Published
- 2020
22. Lengthening of the ulna by external fixation in children with congenital radial club hand
- Author
-
Sergey I. Golyana, Andrey V. Safonov, Natalia V. Avdeychik, and Denis Yu. Grankin
- Subjects
030222 orthopedics ,medicine.medical_specialty ,animal structures ,Osteosynthesis ,business.industry ,medicine.medical_treatment ,Ulna ,Osteotomy ,Surgery ,03 medical and health sciences ,External fixation ,0302 clinical medicine ,medicine.anatomical_structure ,Radial club hand ,Forearm ,Pediatrics, Perinatology and Child Health ,medicine ,Deformity ,Upper limb ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,medicine.symptom ,business - Abstract
Background. Congenital radial club hand is characterized by the radial deviation of the hand, the longitudinal underdevelopment of the forearm, and the dysfunction of the upper limb. The shortening of the ulna is observed in all types of congenital radial club hand. The average shortening of the ulna surgical treatment was 33.3% compared to the intact contralateral side. Aim. This study aimed to evaluate the results of ulna elongation by the method of external fixation, depending on the level of osteotomy, in patients with congenital radial club hand type IIIIV. Materials and methods. The treatment results of 36 patients with congenital radial club hand type IIIIV from 1998 to 2018 were analyzed. The average age of the patients was 7.4 years 3.5 years. The patients were divided into three groups, depending on the level of ulnar osteotomy. Shortening of the ulna, correction of the angle of deformity of the ulna, radial deviation of the hand, period of correction, elongation obtained, index of fixation and osteosynthesis, and associated complications were analyzed. Results. The observation period was an average of 5.8 years. Before surgical treatment, the ulna was 33.3% shorter, while after surgery, it was 16%. Before surgery, the angle of deformation was 20.5 14.8, while after surgery, it was 7.4 5.6; this gives an angle of deformity correction of 63.9%. The elongation of the ulna was 3.2 1.1 cm. In patients who underwent proximal osteotomy, the resulting elongation was 32% and 18.4% more, respectively, than in patients who underwent an osteotomy in the middle and distal sections of the ulna. In group 1, the correction period was 24.4% and 28.9% more than in groups 2 and 3, respectively. The index of fixation in group 1 was 53.6%, which was 45.7% less than in groups 1 and 3. Postoperative complications included a false joint (15%), inflammation (10%), and forearm deformities (7.5%). Conclusions. In patients with congenital radial club hand type IIIIV, the optimal part of an ulna osteotomy is the proximal section. With a hand deviation of more than 20, osteotomy is performed in the distal section with simultaneous correction of the deformity.
- Published
- 2020
23. Bone lengthening of the radius with temporary external fixation of the wrist for mild radial club hand—'Relapse with the elapse'
- Author
-
Takehiko Takagi, Atsuhito Seki, and Shinichiro Takayama
- Subjects
Male ,Wrist Joint ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Infant ,Radius ,Hand Deformities ,Wrist ,Bone Lengthening ,Surgery ,External fixation ,Treatment Outcome ,medicine.anatomical_structure ,Radial club hand ,Fracture Fixation ,Recurrence ,Child, Preschool ,medicine ,Humans ,Female ,business - Published
- 2020
24. The unsolved problem of radial longitudinal dysplasia: how can we reliably prevent recurrence, preserve growth and optimize function?
- Author
-
van Nieuwenhoven CA, Mann M, and Hülsemann W
- Subjects
- Child, Humans, Treatment Outcome, Radius surgery, Radius abnormalities, Forearm, Ulna surgery, Hand Deformities, Congenital surgery
- Abstract
Congenital radial longitudinal dysplasia remains an 'unsolved problem' in hand surgery. The challenges presented by the skeletal deficiency of the distal radius and soft tissue dysplasia of the severe radial longitudinal deficiency have been addressed by a number of techniques that aim to stabilize the position of the hand relative to the forearm and optimize forearm growth and hand function. Analysis of hand function and position in these children is difficult because of the abnormal 'wrist' mechanics, and the published results of the techniques used to date often lack a standardized approach and importantly the perception of function from the patient's perspective. The existing data is reviewed and compared with the results of cohorts from two major congenital upper limb centres. Soft tissue distraction prior to radialization or centralization may offer benefit in ulnar growth and forearm length but there is a need for further research into the long-term functional outcomes of the various techniques available to determine the optimal choice for these children. Level of evidence: V.
- Published
- 2023
- Full Text
- View/download PDF
25. A new incision in the correction of radial longitudinal deficiency: The double Y sliding flap approach.
- Author
-
Rosanda E, Parolo C, Lorenzano V, and Pajardi GE
- Subjects
- Humans, Retrospective Studies, Skin Transplantation methods, Surgical Flaps, Cicatrix, Plastic Surgery Procedures, Hand Deformities, Congenital surgery
- Abstract
One concern in the surgical treatment of radial longitudinal deficiency (RLD) is certainly the skin incision. Over the years many different types have been proposed and used. We propose a new skin incision technique: a double Y sliding flap with the main body along the dorsal wrist crease, followed by raising a proximal and a distal flap providing wide access to the dorsal surface of the wrist joint. After correction of the wrist deformity, skin triangles are resected on the radial and ulnar sides of the incision. Then the skin of the distal flap is slid radially and proximally, filling the defect left by the resected radial triangle, while the proximal flap is slid in the opposite direction, enabling transverse closure along the ulnar side of the incision. The final scar comprises a central body along the dorsal wrist crease, and a radial branch. The aim of this study was to analyze the clinical results of this new double Y sliding flap approach for the surgical treatment of type III and IV RLD. We retrospectively reviewed medical records of surgical correction of RLD using our new incision, between January 2016 and December 2018 in our department of hand surgery. Endpoints comprised correction of redundant skin, scar appearance, and complications. Twelve limbs in 9 patients treated with this double Y sliding flap approach were reviewed: correction of redundant skin was systematic, only 2 limbs showed postoperative complications (1 case of notable edema and 1 of delayed wound healing), and scar aspect was graded good in 11 of the 12 cases. The double Y sliding flap was safe, with minimal complications, adequate skin restoration, wide exposure of the wrist, and esthetically good scar. LEVEL OF EVIDENCE: IV., (Copyright © 2022 SFCM. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
26. CONGENITAL RADIAL CLUB HAND: RESULTS OF CENTRALIZATION IN 10 CASES
- Author
-
M. Farzan, S. M. J. Mortazavi, T. Baghdadi, and M. Zanoosi
- Subjects
Radial club hand ,centralization ,ulna ,Medicine (General) ,R5-920 - Abstract
Congenital radial club hand is an intercalary or terminal deficiency characterized by radial deviation of the hand, marked shortening of the forearm, and generalized underdevelopment of the extremity. We performed centralization of the ulna in 12 forearms of 10 patients with severe congenital radial club hands. The mean follow up was 42 months after operation (24 to 68 months). The mean age at the operation was 16.8 months (7 to 42 months). The mean angular deformity before operation was 100 degrees (75 to 135). The angular deformity was corrected in all patients initially, but in the latest follow up the mean residual angular deformity was 19.58 degrees (5 to 45). The mean correction of angular deformity was 79.57 degrees (55 to 120). Range of motion in the wrist increased significantly after operation in both flexion-extension range and radial-ulnar deviation range (P
- Published
- 2005
27. Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?
- Author
-
Claire Shannon, Tomasz Albrewczynski, Jaroslaw M. Deszczynski, and Dror Paley
- Subjects
radial club hand ,Ulnar head ,radialization ,Radial aplasia ,Wrist ,Pediatrics ,Article ,RJ1-570 ,03 medical and health sciences ,0302 clinical medicine ,Radial club hand ,centralization ,radial longitudinal defect ,Radial deviation ,Medicine ,030212 general & internal medicine ,Orthodontics ,030222 orthopedics ,business.industry ,Ulna ,medicine.disease ,Third generation ,ulnarization ,radial aplasia ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,business - Abstract
(1) Background: Patients treated with the two previous generations of ulnarization developed a bump related to the ulnar head becoming prominent on the radial side of the hand. To finally remedy this problem, a third generation of ulnarization was developed to keep the ulnar head contained. While still ulnar to the wrist center, the center of the wrist remains ulnar to the ulnar head, with the ulnar head articulating directly with the trapezoid and when present the trapezium. (2) Methods: Between 2019 and 2021, 22 radial club hands in 17 patients were surgically corrected with this modified version of ulnarization. (3) Results: In all 17 patients, the mean HFA (hand–forearm-angle) correction was 68.5° (range 12.2°–88.7°). The mean ulna growth was 1.3 cm per year (range 0.2–2 cm). There were no recurrent radial deviation deformities more than 15° of the HFA. (4) Conclusions: This new version of ulnarization may solve the problem of the ulna growing past the carpus creating a prominent ulnar bump. The results presented are preliminary but promising. Longer-term follow-up is needed to fully evaluate this procedure.
- Published
- 2021
28. Lengthening of radius in patients with congenital radial club hand, type II
- Author
-
Sergey I. Golyana, Natalia V. Avdeychik, Andrey V. Safonov, Ekaterina Anatolievna Zakharyan, and Denis Yu. Grankin
- Subjects
medicine.medical_treatment ,030230 surgery ,03 medical and health sciences ,External fixation ,0302 clinical medicine ,Radial club hand ,Forearm ,external fixation ,medicine ,Orthopedics and Sports Medicine ,Orthodontics ,030222 orthopedics ,business.industry ,Second metatarsal bone ,lcsh:RJ1-570 ,lcsh:Pediatrics ,Radius ,medicine.disease ,Hypoplasia ,Transplantation ,medicine.anatomical_structure ,lengthening ,microsurgical technique ,Pediatrics, Perinatology and Child Health ,Surgery ,Metatarsal bones ,business ,congenital radial club hand - Abstract
Background. Congenital radial club hand (CRCH) is characterized by longitudinal underdevelopment of the forearm and hand on the radial surface. Underdevelopment can range from hypoplasia to aplasia of the radius. More than 50 methods to correct the forearm deformities, depending on the degree of radius underdevelopment, have been proposed. Aim. We evaluated the results of CRCH treatment using microsurgical technique and external fixation. Methods. We analyzed 16 patients (age, 4.6 0.9 years) with CRCH type II, according to the classification of Bayne and Klug, treated between 1994 and 2017. The patients were divided into two groups: Group 1 were patients undergoing microsurgical autotransplants of the epimetaphyseal second metatarsal bone with growth plate to the position of the radius defect and group 2 were patients treated by lengthening of the radius with external fixation. We analyzed the types of deformities, size of the radius defects, and range of motion in upper limb joints before the stage of the lengthening. External fixation index and number of complications also were determined. The type and number of recurrent deformities and timing of their detection were analyzed. Results. The observation period ranged from 12 months to 10 years (average, 3.8 years). In group 1, good results were obtained in 62.5% of cases. After transplantation of the metatarsal bone growth plate, the work of the growth plate continued, characterized by increasing radius length in the later observation period. In group 2, good results were obtained in 50% of cases. Clinical and X-ray examinations showed recurrent hand deviation and radius shortening, which required repeated radius lengthening. Conclusion. Microsurgical transplantation of the second metatarsal bone with growth plate is accepted more in reconstruction of the radial bone in patients with CRCH type II due to creation of a growth zone in the distal part of the radius. Radius lengthening via external fixation is applicable while maintaining the distal epimetaphysis and normal transverse dimensions of the radial bone.
- Published
- 2019
29. Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series
- Author
-
Farivar Abdollahzadeh Lahiji, Fateme Mirzaee, Zafarani Zafarani, Farhang Asgari, and Hamidreza Aslani
- Subjects
Orthodontics ,Pollicization ,business.industry ,food and beverages ,Radial club hand ,Centralization ,Wrist ,Article ,Sagittal plane ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Coronal plane ,Metacarpal bone ,Third metacarpal bone ,Deformity ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,business ,Range of motion - Abstract
Highlights • Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. • Treatment of RCH should begin as soon as possible after birth. • Treatment of patients with RCH by primary traction and centralization and pollicization surgery, can greatly improve the deformity. • Early centralization and pollicization can significantly restore the range of motion and function in patients with RCH., Introduction Radial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. Methods There were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ± 1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ± 2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. Results The mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ± 11 percent and 61 ± 12 percent. Three patients developed skin necrosis. Conclusion Early centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH.
- Published
- 2019
30. The Paley ulnarization of the carpus with ulnar shortening osteotomy for treatment of radial club hand
- Author
-
Paley Dror
- Subjects
Radial club hand ,Ulnarization ,Radialization ,Centralization ,Congenital radius deficiency ,Orthopedic surgery ,RD701-811 - Abstract
Recurrent deformity from centralization and radialization led to the development in 1999 of a new technique by the author called ulnarization. This method is performed through a volar approach in a vascular and physeal sparing fashion. It biomechanically balances the muscle forces on the wrist by dorsally transferring the flexor carpi ulnaris (FCU) from a deforming to a corrective force. The previous problems of a prominent bump from the ulnar head and ulnar deviation instability were solved by acutely shortening the diaphysis and by temporarily fixing the station of the carpus to the ulnar head at the level of the scaphoid. This is the first report of this modified Paley ulnarization method, which the author considers a significant improvement over his original procedure.
- Published
- 2017
- Full Text
- View/download PDF
31. Histopathological, Ultrastructural, and Immunohistochemical Findings in Radial Longitudinal Deficiency: A Prospective, Observational Study.
- Author
-
Mittal, Samarth, Garg, Bhavuk, Mehta, Nishank, Kumar, Vijay, Karpe, Aashraya, Kakkar, Aanchal, Sharma, Mehar, Sarkar, Chitra, and Kotwal, Prakash
- Abstract
To report the histopathological, electron microscopic, and immunohistochemical findings of tissue samples obtained from patients with radial longitudinal deficiency (RLD) and investigate the contribution of abnormality in soft tissues as a secondary driver of deformity in RLD. Specimens from radial-sided muscles and tendons were obtained at the time of surgery (either radialization or centralization) from 14 patients with 16 limbs affected with Bayne type 3 and type 4 RLD. The specimens were evaluated using light microscopy, electron microscopy, and immunohistochemical examination. Among the 16 frozen muscle specimens, 6 (37%) showed normal muscle, while 10 (63%) showed the presence of atrophic fibers. The 6 cases with normal muscle showed no abnormality in fiber type distribution. Six patients showed predominance of type 1 muscle fibers. None of the specimens had myofibroblasts; 4 of 16 specimens had mast cells, and 9 of 16 specimens showed the presence of platelet derived growth factor–positive cells. Features of myofibroblasts (the presence of basal lamina, intercellular junctions, or pinocytic vesicles) were not identified in any specimen on electron microscopy. The histopathological, electron microscopic, and immunohistochemical findings, in particular the absence of myofibroblasts, in tissue samples obtained from patients with RLD, do not support the assumption of abnormality in soft tissues as a secondary driver of deformity in RLD. This study provides a preliminary insight into a possible role of soft tissues in the development of the deformity in RLD. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
32. Radial, renal and craniofacial anomalies: Baller-Gerold syndrome
- Author
-
Murthy Jyotsna, Babu Ramesh, and Ramanan Padmasani
- Subjects
Baller-Gerold syndrome ,craniosynostosis ,crossed ectopia ,ectopic kidneys ,microcephaly ,radial agenesis ,radial club hand ,reflux ,renal agenesis ,vesico ureteric reflux ,Surgery ,RD1-811 - Abstract
The Baller-Gerold syndrome is a rare syndrome with very few cases published in literature. Craniosynostosis and radial aplasia are striking features, easy to diagnose. However, there are many differential diagnoses. Often, the question raised is whether the Baller-Gerald syndrome is a distinct entity. We report a patient with findings of craniosynostosis and radial aplasia consistent with the diagnosis of the Baller-Gerold syndrome. Genotypic heterogeneity could possibly underlie the phenotypic variability exhibited by these cases.
- Published
- 2008
33. Radial, renal and craniofacial anomalies: Baller-Gerold syndrome
- Author
-
Jyotsna Murthy, Ramesh Babu, and padasani Venkat Ramanan
- Subjects
baller-gerold syndrome ,craniosynostosis ,crossed ectopia ,ectopic kidneys ,microcephaly ,radial agenesis ,radial club hand ,reflux ,renal agenesis ,vesico ureteric reflux ,Surgery ,RD1-811 - Abstract
the baller-gerold syndrome is a rare syndrome with very few cases published in literature. craniosynostosis and radial aplasia are striking features, easy to diagnose. however, there are many differential diagnoses. often, the question raised is whether the baller-gerald syndrome is a distinct entity. we report a patient with findings of craniosynostosis and radial aplasia consistent with the diagnosis of the baller-gerold syndrome. genotypic heterogeneity could possibly underlie the phenotypic variability exhibited by these cases.
- Published
- 2008
- Full Text
- View/download PDF
34. Forearm lengthening: management of elbow and wrist.
- Author
-
Launay, Franck and Pesenti, Sébastien
- Subjects
- *
FOREARM , *FOREARM abnormalities , *BONE lengthening (Orthopedics) , *HAND abnormalities , *EXOSTOSIS , *SURGERY , *THERAPEUTICS - Abstract
The risk and consequences of an elbow or a wrist contracture are lower during a forearm lengthening than during a lower limb lengthening. This kind of complication can mostly be avoided by an active and intensive regimen of physiotherapy. However, there are some challenges to deal with in treating the disorder multiple exostoses and the radial club hand, including the lack of consensus on the best treatment for multiple exostoses. However, it is important to realize that the evolution of multiple exostoses can lead to a radial head dislocation which will damage the pronation and the supination range of motion. As this motion can be poor even without a radial head dislocation as a result of the radius being longer than the ulna, an interesting technique can be to lengthen the ulna to limit this phenomenon. In radial club hand, the main problem is the deviation of the hand requiring a centralization. The best treatment for centralization of the hand is to do a progressive correction with an external fixator. Thereafter, it is possible to lengthen the forearm, but this indication is mainly cosmetic in the unilateral radial club hand. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
35. Brachial plexus block for perioperative analgesia in children with radial club hand: a retrospective audit.
- Author
-
Samra, Tanvir, Kaur, Ranvinder, and Choudhary, Lalita
- Subjects
- *
BRACHIAL plexus , *ANALGESICS , *BRACHIAL plexus block , *CARPAL bones , *PATIENT compliance , *ANATOMY - Abstract
Objectives: Brachial plexus block in combination with general anaesthesia is used for surgical correction of radial club hand. We carried out this retrospective study to assess the feasibility and efficacy of brachial plexus block in children with radial club hand. Intraoperative and postoperative analgesic requirements were the primary outcome measures analysed. Methodology: We conducted a retrospective audit and collected data on the intraoperative and postoperative analgesic requirements in 24 patients anaesthetised for orthopedic treatment of this congenital deformity in our children's hospital over a period of 5 years. Results: Transarterial axillary block was administered to 8 patients; nerve stimulator guided supraclavicular block was used in 4 patients; and 12 were administered anesthesia without administration of brachial plexus block. Intraoperative additional supplementation of intravenous opioid was required in 12.5%, 50% and 75% of patients administered axillary block, supraclavicular block and no block (only general anesthesia) respectively. The mean time interval for administration of first dose of analgesic in postoperative period was 4.5, 3.6 and 0.75 hours respectively. Permanent diaphragmatic paralysis was reported in one patient with supraclavicular block. No complication was reported in the group with axillary block. Conclusion: Supplementation of general anesthesia with transarterial axillary brachial plexus block provides adequate perioperative analgesia in children with radial club hand operated for centralisation of ulna. [ABSTRACT FROM AUTHOR]
- Published
- 2014
36. Recurrence rate of radial deviation following the centralization surgery of radial club hand
- Author
-
Morteza Balvardi, Farid Najd Mazhar, Alireza Mirzaei, Hooman Shariatzadeh, and Morteza Nakhaei Amroodi
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,Standard treatment ,Radial club hand ,Centralization ,Mean age ,General Medicine ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Forearm ,Recurrence ,Radial deviation ,Congenital Deformity ,Medicine ,Original Article ,030212 general & internal medicine ,Medical journal ,business - Abstract
Background: Congenital radial club hand (RCH), as a rare congenital deformity of the upper extremity, is characterized by a wide spectrum of malformations including radial deviation. Centralization surgery is the standard treatment for severe cases that have been associated with a high rate of recurrence. This study reports the long-term results and recurrence rate of radial deviation following the centralization surgery of RCH. Methods: The medical records of 13 congenital RCH patients (16 hands), who underwent centralization surgery, were reviewed retrospectively. Hand-forearm angle (HFA), hand-forearm position (HFP), and ulnar bow (UB) were used to assess forearm angles. Results: The mean age of the patients was 19.4±8.9 months, and their mean follow-up was 62.1±39.9 months. The mean HFA correction was 29.4°±23.9°, the mean HFA recurrence was 13.3°±13.7°, the mean correction of HFP was 13.4±7.3 mm, and the mean recurrence of HFP was 1.4±2.8 mm. The mean UB showed 7.6°±12.5° correction immediately after surgery and a further 3.6°±7.3° at the last follow-up (overall 11.2°±17.6°). A number of 12 out of 13 parents were completely satisfied with the results. Conclusion: According to our results, an acceptable long-term result is expected after the centralization surgery of RCH. However, the risk of the recurrent radial deviation is high and needs to be optimized in future investigations.
- Published
- 2018
37. VACTERL association
- Author
-
Sajad Ahmad Salati and Sari M Rabah
- Subjects
VACTERL association ,radial club hand ,Medicine - Abstract
VACTERL association is a useful acronym for a condition characterised by the sporadic, non-random association of specific birth defects of multiple organ systems.We present one such case which had congenital abnormalities of renal,skeletal and cardiac system.
- Published
- 2010
38. Hand function in children with radial longitudinal deficiency.
- Author
-
Ekblom, Anna Gerber, Dahlin, Lars B., Rosberg, Hans-Eric, Wiig, Monica, Werner, Michael, and Arner, Marianne
- Subjects
- *
PURE red cell aplasia , *DYSPLASIA , *CELL transformation , *CHILDREN'S health , *MUSCULOSKELETAL system diseases - Abstract
Background: In children with hypoplasia or aplasia of the radius (radial longitudinal deficiency) manual activity limitations may be caused by several factors; a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited range of motion in the fingers and impaired grip strength. The present study investigates the relation between these variables and activity and participation in children with radial dysplasia. Methods: Twenty children, age 4-17 years, with radial longitudinal dysplasia Bayne type II-IV were examined with focus on the International Classification of Functioning and Health, version for Children and Youth (ICF-CY) context. Body function/structure was evaluated by measures of range of motion, grip strength, sensibility and radiographic parameters. Activity was examined by Box and Block Test and Assisting Hand Assessment (AHA). Participation was assessed by Children's Hand-use Experience Questionnaire (CHEQ). Statistical correlations between assessments of body function/ structure and activity as well as participation were examined. Results: The mean total active motion of wrist (49.6°) and digits (447°) were less than norms. The mean hand forearm angle was 34° radially. Ulnar length ranged from 40 to 80% of age-related norms. Grip strength (mean 2.7 kg) and Box and Block Test (mean 33.8 blocks/minute) were considerably lower than for age-related norms. The mean score for the AHA was 55.9 and for CHEQ Grasp efficiency 69.3. The AHA had significant relationship with the total range of motion of digits (p = 0.042). Self-experienced time of performance (CHEQ Time) had significant relationship with total active motion of wrist (p = 0.043). Hand forearm angle did not show any significant relationship with Box and Block Test, AHA or CHEQ. Conclusion: In radial longitudinal deficiency total range of motion of digits and wrist may be of more cardinal importance to the child's activity and participation than the angulation of the wrist. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
39. Comparison of surgical treatment and nonoperative management for radial longitudinal deficiency.
- Author
-
Kotwal, P. P., Varshney, M. K., and Soral, A.
- Subjects
RADIOLOGICAL research ,HAND injuries ,FINGER injuries ,WRIST injuries ,WRIST surgery ,GRIP strength ,THERAPEUTICS - Abstract
We compared the radiological and functional outcomes in patients with radial longitudinal deficiency treated surgically with those managed nonoperatively and correlated the ease of performance of activities with radiological and functional parameters in the two groups. A retrospective analysis was done in 446 type 3 and 4 hands (modified Bayne classification) over 20 years comparing the subjective assessment, objective and functional scores in nonoperatively managed hands (Group 1; n = 137) to hands managed with centralization or radialization (Group 2; n = 309). The subjective, objective and functional measures were significantly better in Group 2. Improved alignment, finger and wrist range of motion and grip strength were related to improvement in functional score. Surgical treatment of radial longitudinal deficiency provides improvement in cosmesis, function and ease of performance of activities when compared with nonoperatively managed hands. [ABSTRACT FROM PUBLISHER]
- Published
- 2012
- Full Text
- View/download PDF
40. Strategic two-stage approach to radial club hand.
- Author
-
Fujiwara, Masao, Nakamura, Yoko, Nishimatsu, Hidekazu, and Fukamizu, Hidekazu
- 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. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
41. Multi-axial correction system in the treatment of radial club hand.
- Author
-
Bhat, Suneel, Kamath, Atul, Sehgal, Kriti, Horn, B., and Hosalkar, Harish
- Abstract
Radial club hand is a well-recognized congenital malformation characterized by hypoplasia of bone and soft tissue on the radial aspect of the forearm and hand. The modalities of treatment have traditionally varied from stretching casts with soft-tissue procedures to the use of multiple corrective osteotomies. These osteotomies can be stabilized by a variety of methods, including external fixators that allow the possibility of gradual distraction with neohistiogenesis. This current study outlines the usage of one such device (multi-axial correction system [MAC]) in the management of deformity associated with severe radial club hand. Three consecutive cases of unilateral or bilateral severe (Bayne type IV) congenital radial club hand were corrected using MAC fixation in the last 5 years. This is a retrospective review of all three cases. Data parameters included: patient demographics, presentation findings, degree of deformity, amount of correction/lengthening, length of procedure, length of treatment, and associated complications. The surgical technique is described in detail for the benefit of the readership. The three patients with severe congenital radial club hand had a total of four limb involvements that underwent correction using osteotomies and usage of the MAC device for external fixation. All three patients underwent successful correction of deformity with the restoration of alignment, lengthening of forearm for improvement of function, and stabilization of the wrist (mean duration, mean lengthening, mean time to consolidation). The MAC system was well tolerated in all patients and associated complications were limited. The MAC fixator seems to be a good alternative modality of stabilization and correction for severe congenital radial club hand deformities. Its usage is fairly simple and it provides the ease of application of a mono-lateral fixator with far superior three-dimensional control, like the circular external fixator. We recommend that clinicians should add this modality to their armamentarium for the deformity correction of severe radial club hand and others in general. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
42. Preliminary Soft Tissue Distraction Using External Fixator in Radial Club Hand.
- Author
-
KANOJIA, R. K., SHARMA, N., and KAPOOR, S. K.
- Subjects
SOFT tissue injuries ,FLEXOR tendons ,HAND injuries ,PHALANGES ,HUMAN abnormalities ,WOUNDS & injuries - Abstract
Preliminary soft tissue distraction using an external fixator before centralisation and tendon transfer of the flexor and extensor carpi ulnaris to the little finger metacarpal was used to treat Bayne’s type III and IV deformities in 18 hands of 14 patients with radial club hands. Treatment with external fixator was started at a mean age of 8 (range 3–30) months. In 16 of 18 hands, the surgical treatment was completed before 10 months of age. Adequate soft tissue stretching was achieved before centralisation using fractional distraction with the external fixator in the majority of hands. After an average follow-up period of 31 months, there were seven good, eight satisfactory and one unsatisfactory result. [ABSTRACT FROM PUBLISHER]
- Published
- 2008
- Full Text
- View/download PDF
43. Infraclavicular coracoid approach brachial plexus block for radial club hand repair.
- Author
-
PONDE, VRUSHALI, ATHANI, B., and THRUPPAL, SHREEDHAR
- Subjects
- *
BRACHIAL plexus diseases , *GENETIC disorders in children , *RADIAL nerve , *SPINAL nerve diseases , *PEDIATRIC anesthesia , *PEDIATRIC surgery - Abstract
Background: Radial club hand is a congenital deformity in which the radius is absent, the metacarpophylangeal and interphalayngeal joints are fused and muscles arising from the radius are absent. This can alter the motor response to peripheral nerve stimulation. The classical motor response to median nerve stimulation (contractions of the fingers) cannot be elicited, hence fine twitches in the hand, at the wrist or in the surgical area or pronation–supination at a current of 0.5 mA were taken as endpoints. The aim of this study was to assess the feasibility of achieving successful infraclavicular coracoid approach block in the intra- and postoperative periods when ideal responses to electrical nerve stimulation are absent because of congenital anomalies. Methods: Thirty-five patients aged 8 months to 2 years, weighing 7–12 kg were selected and the blocks were performed under light general anesthesia. Fentanyl 2 μg·kg−1was used as rescue analgesic in case of block failure. Postoperatively CHEOPS pain score was recorded at h1, h4 h6, h8, and h10 postoperatively. Tramadol 2 mg·kg−1 was given in case of inadequate pain relief (CHEOPS >4). Results: In no patient could we elicit the finger flexion response which is typical of median nerve stimulation. Intraoperatively, one out of 35 children (3.3%) showed reaction to pain. In the postoperative period two out of 35 (6%) children had high pain scores and were given tramadol. Analgesia lasted for 6.5 ± 1.50 h. Conclusions: Despite the limitation of absence of an ideal response to nerve stimulation in radial club hand, endpoints such as fine twitches in the hand, at the wrist or in the surgical area or pronation–supination were sufficient to achieve a successful block. This block gives satisfactory intra- and postoperative analgesia. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
44. Comparison of Instruments to Assess Hand Function in Children With Radius Deficiencies.
- Author
-
Buffart, Laurien M., Roebroeck, Marij E., Janssen, Wim G.M., Hoekstra, Anneke, Hovius, Steven E.R., and Stam, Henk J.
- Subjects
JUVENILE diseases ,OLD age ,DIAGNOSIS ,ARM - Abstract
Purpose: For treatment evaluation of children with radius deficiencies (RDs), standardized assessment of hand function in performing activities is required. Instruments to measure hand function have been developed for other diagnoses. The current study aimed to find additional evidence for validity, reliability, and usefulness of these instruments for children with RDs. Methods: In this study, 20 children with RDs (aged 4–12 years) participated; 16 were boys, and 13 children were unilaterally affected. Children were assessed using the Assisting Hand Assessment, the Unilateral Below Elbow Test, the Prosthetic Upper Extremity Functional Index, and ABILHAND-Kids. Construct and convergent validity of the instruments were studied focusing on predefined hypotheses and relationships with other instruments and the therapist’s global assessment. Test-retest reliability was assessed in 10 children by means of the intraclass correlation coefficients and the smallest detectable differences. Results: For children with RDs, the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index appeared to be the most valid function test and questionnaire according to the relationships found with type of RD, functional hand grips, and the therapist’s global assessment of hand function. Regarding test-retest reliability, intraclass correlation coefficients ranged from 0.82 to 0.91, and smallest detectable differences were acceptably small. Conclusions: The current results contribute to the evidence that the instruments, especially the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index, provide valid and reliable results in children with RDs. Type of study/level of evidence: Diagnostic I. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
45. Current Concepts in Radial Club Hand
- Author
-
Masahiko Watanabe, Takehiko Takagi, Atsuhito Seki, and Shinichiro Takayama
- Subjects
musculoskeletal diseases ,Wrist ,Thumb ,Article ,Radialization ,03 medical and health sciences ,0302 clinical medicine ,Radial club hand ,Forearm ,medicine ,Deformity ,030212 general & internal medicine ,Simulation ,Orthodontics ,030222 orthopedics ,business.industry ,Ulna ,Short forearm ,Centralization ,body regions ,Carpal bones ,medicine.anatomical_structure ,Radius lengthening ,medicine.symptom ,business - Abstract
Radial club hand is a complex congenital abnormality of the radial or pre-axial border of the upper extremity. It has a wide range of phenotypes from hypoplasia of the thumb to complete absence of the radius and the first ray. Centralization with tendon transfer is a popular method for maintaining the correct position of radial club hand. On the other hand, various corrections were devised,e.g. radialization after distraction to emphasize the fact that the head of the ulna is positioned under the radial carpal bones and is no longer placed in a slot in the center of the carpus, microvascular epiphysis transfer, gradual correction using Ilizarov method, for Bayne Type III or Type IV. We should pay attention to the recurrence of radial deformity or circulatory impairment with the tension. Lunate excision or ulnar shortening can be selected for tension-free correction. Radialization can be indicated for avoiding the recurrence of radial flexion. However, we should pay attention of the radial protrusion of the ulnar head. For avoiding the recurrence of radial deformity or circulatory impairment, gradual correction using Ilizarov external fixation can be indicated, especially in the cases with severe radial deviation or with short forearm. In the mild cases, Bayne Type I or Type II, radius lengthening is accompanied by a soft-tissue distraction or release at the ulnar carpal joint with keeping wrist and forearm motion without producing growth plate damage.
- Published
- 2017
46. Magnetically controlled growing rods in severe radial club hand congenital deformities
- Author
-
R. Vialle, M. Le Hanneur, Manon Bachy, F. Fitoussi, G. Pfister, and Raphaël Pietton
- Subjects
Male ,business.industry ,Magnetic Phenomena ,Rehabilitation ,Anatomy ,Prostheses and Implants ,Rod ,Radius ,Radial club hand ,Cadaver ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Growing rod ,business ,Hand Deformities, Congenital ,Aged - Published
- 2019
47. Radial club hand management with initial gradual distraction by Ilizarov
- Author
-
Faisal Mi'raj and Sammy Saleh Alhuraiby
- Subjects
Orthodontics ,Radial club hand ,Distraction ,Psychology - Published
- 2019
48. Outcome of Centralization and Ulnarization of the Carpus with Ulnar Shortening Osteotomy on Functioning in Children with Radial Club Hand
- Author
-
Sakti Prasad Das and G. Shankar Ganesh
- Subjects
medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,medicine.disease ,Cerebral palsy ,Muscle tone ,medicine.anatomical_structure ,Radial club hand ,Forearm ,International Classification of Functioning, Disability and Health ,Radiological weapon ,Orthopedic surgery ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Original Article ,business - Abstract
BACKGROUND: Radial club hand (RCH) is characterized by a wide array of hand and forearm anomalies. Various treatment approaches have been described depending upon the stages of RCH. The major drawback of these studies is that the effectiveness of these interventions was reported on clinical and radiological outcomes. With the increasing focus on patient-centered care nowadays, we wanted to identify the components associated with functioning and evaluate the effectiveness of two surgical procedures on functional outcomes using the International Classification of Functioning, Disability and Health (ICF)-based tools. MATERIALS AND METHODS: We identified 14 children from our records (nine boys, five girls) with a mean age of 5.6 years, classified as Bayne types III–IV and classified them into two groups; those who were operated by centralization (group 1) and ulnarization of the carpus with ulnar shortening osteotomy procedure (group 2). The outcomes were evaluated by the brief ICF core set for the child and youth with cerebral palsy up to the age of 5 and the brief ICF core set for hand conditions for a period of 1 year after surgery. RESULTS: The results showed that both the operative techniques showed improvement in the structure component (s730-structure of upper extremity). ICF categories of d445-hand and arm use, d530-toileting, and d880-engagement in play showed a change in frequencies of more than 40% after surgery and were maintained till follow-up. However, categories related to muscle power functions (b730), muscle tone (b735), fine hand use (d440), hand and arm use (d445) and engagement in play (d880) showed no significant improvement (p > 0.05). There were no differences between both the surgical procedures in improving the outcomes (p > 0.05). CONCLUSION: We conclude that surgical techniques may be more appropriate to improve the cosmetic or structural appearance of the upper extremity than functioning.
- Published
- 2019
49. Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report
- Author
-
Ricardo Nascimento, Ricardo Horta, Rui Pinto, Álvaro Silva, José Amarante, Ricardo São-Simão, M. Silva, Pedro Negrão, and Jorge Carvalho
- Subjects
musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Arthrodesis ,Elbow ,030230 surgery ,Wrist ,musculoskeletal system ,medicine.disease ,Osteotomy ,Surgery ,body regions ,03 medical and health sciences ,Pseudarthrosis ,0302 clinical medicine ,medicine.anatomical_structure ,Radial club hand ,Forearm ,medicine ,Deformity ,medicine.symptom ,business - Abstract
Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion-pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauve-Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation-supination was 58-0-48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score-Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593-597, 2016.
- Published
- 2016
50. Occurrence of radial club hand in children with different syndromes
- Author
-
Sergei Ivanovich Golyana, Anton Vladimirovich Govorov, Natalia Valerievna Avdeichik, and Andrey V. Safonov
- Subjects
Pediatrics ,medicine.medical_specialty ,vacterl syndrome ,VACTERL Syndrome ,media_common.quotation_subject ,holt-oram syndrome ,Radial club hand ,tar syndrome nagera syndrome ,medicine ,Orthopedics and Sports Medicine ,Girl ,media_common ,Holt–Oram syndrome ,Clinical pathology ,business.industry ,Ulna ,lcsh:RJ1-570 ,lcsh:Pediatrics ,Surgical correction ,medicine.disease ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Upper limb ,Surgery ,business ,congenital radial club hand - Abstract
Aim. Clinical analysis of congenital radial club hand as part of some genetic syndromes as well as the optimization of methods of non-surgical and surgical treatment of patients with this pathology. Material and Methods. From 2007 to 2014, we conducted a survey of 170 children with congenital radial club hand. Among them, 32 patients were diagnosed (18.8%) with different syndromes. We assessed the degree to which the radius was underdeveloped among this group of patients as well as the management features of patients according to various comorbidities. Results. The assessment identified Holt-Oram syndrome in 17 children (nine boys and eight girls; 53.1%) and TAR-syndrome in nine children (four boys and five girls; 28.1%). VACTERL syndrome was detected in four male patients (12.5%) and Nagera syndrome was observed in two children (one boy and one girl; 6.25%). Surgical treatment of radial club hand in patients with genetic syndromes is the same as that of the patients with isolated congenital radial club hand: a single- or two-stage correction of the hand relative to the ulna with subsequent reconstruction of the rays of the hand. The duration of treatment of such patients did not significantly differ compared to the patients with isolated congenital radial club hand. Conclusion. Congenital radial club hand, identified as part of genetic syndromes, requires a comprehensive examination to diagnose comorbidities, observation, and treatment by specialists to determine the optimal age for surgical correction of the existing strain of the upper limb.
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.