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Deviated wrist: radial and ulnar clubhand

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Mano zamba radial o deficiencia radial

In the radial club hand (radial deficiency), the lateral side of forearm and hand (side of the radius and thumb) does not form properly. As the bone in this part (radius) is shorter, the wrist deviates outward. Furthermore, the forearm is half the normal length and the thumb is usually affected (see section hypoplastic thumb) (Figure 5).


Figure 5. Radial clubhand. The hand is skewed, the forearm is very short and there is no thumb.


The degree of involvement varies. According to radiography, we set different groups in the classification of Bayne (Fig 6).


Figure 6. Radiograph of a radial clubhand. There is only one small part of the radius (Bayne type III), so that the hand is deflected.

Radial deficiency is the classic example of a patient requiring medical-genetic assessment, as it is associated in approximately 30% of cases with syndromes. Most common are: blood (Fanconi Anemia, TAR), heart (Holt-Oram) and VACTERL, and in 30% to malformations of the spine (5). A spine radiograph is performed by protocol, along with a renal ultrasound and an echocardiogram to rule out these syndromes; but we may need other studies.

The usual treatment for this condition is called "centralization of the carpus", because the hand is centered on the ulna, in order to bring it into line with the forearm. The surgery is performed at around the first year of life. The problem with this treatment is the tendency to wrist redeviation and limited mobility (Figure 7).


Figure 7. Several years after centralization. Although improved hand position is clear, the wrist deviated.

Dr Soldado uses microsurgical techniques for better results: less wrist redeviation and more mobility. After treating the deviation of the wrist, we have to reconstruct the thumb (see section Thumb hypoplasia). As we approach adolescence, we can extend the forearm.

Ulnar clubhand o ulnar deficiency

In ulnar deficiency or ulnar clubhand, the inner side (side of the ulna and little finger) does not form properly. The bone in this part (ulna) is shorter and the wrist is deflected forward. Fingers on the inner side are also missing(Figure 8 and 9). The main problem is that the thumb is often malformed (70%, see pular hypoplasia) and fingers often have existing syndactylies (30%, View syndactyly). The most important thing to improve the function of these hands is to reconstruct the thumb (about one year of age) and then the syndactylies.


Figure 8. Discreet ulnar deficiency, where only the little finger is missing. The remaining structures and function are normal.



Figure 9. Ulnar clubhand. The forearm is shorter, the wrist is flexed and fingers with syndactyly.

Unlike the radial clubhand, this malformation is not associated with syndromes, but it may be associated with other malformations (spine and lower extremity). It is advisable to examine the lower extremities and perform an X-ray of the spine.

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