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.
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).
We conclude that surgical techniques may be more appropriate to improve the cosmetic or structural appearance of the upper extremity than functioning.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Phatak, S. V. (2006). Radial club-hand: a case report. Indian Journal of Radiology and Imaging,16, 609–610.
Green, D., Hotchkiss, R., Pederson, W., & Wolfe, S. (2005). Green’s operative hand surgery (5th ed.). Philadelphia: Churchill Livingstone.
Shariatzadeh, H., Jafari, D., Taheri, H., & Mazhar, F. N. (2009). Recurrence rate after radial club hand surgery in long-term follow-up. Journal of Research in Medical Sciences,14(3), 179–186.
Bayne, L. G., & Klug, M. S. (1987). Long-term review of the surgical treatment of radial deficiencies. The Journal of Hand Surgery American Volume,12, 169–179.
James, M. A., McCarroll, H. R., Jr., & Manske, P. R. (1999). The spectrum of radial longitudinal deficiency: a modified classification. The Journal of Hand Surgery American Volume,24, 1145–1155.
Vilkki, S. K. (2008). Vascularized metatarsophalangeal joint transfer for radial hypoplasia. Seminars in Plastic Surgery,22(3), 195–212.
Sabharwal, S., Finuoli, A. L., & Ghobadi, F. (2005). Pre-centralization soft tissue distraction for Bayne type IV congenital radial deficiency in children. Journal of Pediatric Orthopedics,25, 377–381.
Lamb, D. W. (1977). Radial club hand: a continuing study of sixty-eight patients with one hundred and seventeen club hands. Journal of Bone and Joint Surgery American Volume,59(1), 1–13.
Buck-Gramcko, D. (1985). Radialization as a new treatment for radial club hand. The Journal of Hand Surgery American Volume,10, 964–968.
Manske, P. R., McCarroll, H. R., Jr., & Swanson, K. (1981). Centralization of the radial club hand: an ulnar surgical approach. The Journal of Hand Surgery American Volume,6, 423–433.
Horii, E., Nakamura, R., Nakao, E., Kato, H., & Yajima, H. (2000). Distraction lengthening of the forearm for congenital and developmental problems. The Journal of Hand Surgery British Volume,25, 15–21.
El-K, Mohamed. (2015). Centralization of radial club hand. Orthopedics and Rheumatolgy Open Access Journal,2(1), 555576. https://doi.org/10.19080/003OROAJ.2016.02.555576.
Paley, D. (2017). The Paley ulnarization of the carpus with ulnar shortening osteotomy for treatment of radial club hand. SICOT-Journal,3, 5. https://doi.org/10.1051/sicotj/2016040.
Saini, N., Patni, P., Gupta, S., Chaudhary, L., & Sharma, V. (2009). Management of radial clubhand with gradual distraction followed by centralization. Indian Journal of Orthopaedics,43(3), 292–300.
McCarthy, J. J., Kozin, S. H., Tuohy, C., Cheung, E., Davidson, R. S., & Noonan, K. (2009). External fixation and centralization versus external fixation and ulnar osteotomy: the treatment of radial dysplasia using the resolved total angle of deformity. Journal of Pediatric Orthopedics,29(7), 797–803.
Goldfarb, C. A., Klepps, S. J., Dailey, L. A., & Manske, P. R. (2002). Functional outcome after centralization for radius dysplasia. The Journal of Hand Surgery American Volume,27(1), 118–124.
Paley, D., Belthur, M., & Standard, S. (2008). Ulnarization for the treatment of radial clubhand, Presented at the American Academy of Orthopedic Surgeons. 75th Annual Meeting, San Francisco, CA.
Sestero, A. M., Van Heest, A., & Agel, J. (2006). Ulnar growth patterns in radial longitudinal deficiency. The Journal of Hand Surgery American Volume,31(6), 960–967.
Damore, E., Kozin, S. H., Thoder, J. J., & Porter, S. (2000). The recurrence of deformity after surgical centralization for radial club hand. The Journal of Hand Surgery American Volume,25(4), 745–751.
Dana, C., Auregan, J. C., Salon, A., Guero, S., Glorion, C., & Pannier, S. (2012). Recurrence of radial bowing after soft tissue distraction and subsequent radicalization for radial longitudinal deficiency. The Journal of Hand Surgery American Volume,37(10), 2082–2087.
DiLollo, A., & Favreau, C. (2009). Person-centred care and speech and language therapy. Seminars in Speech Language,31(2), 90–97.
Simeonsson, R. J. (2009). ICF-CY: a universal tool for documentation of disability. Journal of Policy and Practice in Intellectual Disabilities,6(2), 70–72.
World Health Organisation (WHO). (2001). International Classification of Functioning, Disability and Health: ICF. Geneva.
Kohler, F., Xu, J., Siva-Withmory, C., & Arockiam, J. (2011). Feasibility of using a checklist based on the ICF as an outcome measure in individuals following lower limb amputation. Prosthetics and Orthotics International,35, 294–301.
Kohler, F., Connolly, C., Sakaria, A., Stendara, K., Buhagiar, M., & Mojaddidi, M. (2013). Can the ICF be used as a rehabilitation outcome measure? A study looking at the inter- and intra-rater reliability of ICF categories derived from an ADL assessment tool. Journal of Rehabilitation Medicine,45(9), 881–887. https://doi.org/10.2340/16501977-1194.
Ekblom, A. G., Dahlin, L. B., Rosberg, H.-E., Wiig, M., Werner, M., & Arner, M. (2013). Hand function in children with radial longitudinal deficiency. BMC Musculoskeletal Disorders,14, 116. https://doi.org/10.1186/1471-2474-14-116.
Ekblom, A. G., Dahlin, L. B., Rosberg, H.-E., Wiig, M., Werner, M., & Arner, M. (2014). Hand function in adults with radial longitudinal deficiency. Journal of Bone and Joint Surgery American Volume,96(14), 1178–1184.
Kotwal, P. P., Varshney, M. K., & Soral, A. (2012). Comparison of surgical treatment and nonoperative management for radial longitudinal deficiency. The Journal of Hand Surgery American Volume,37(2), 161–169. https://doi.org/10.1177/1753193411413070. (Epub 2011 Jun 27).
Buffart, L. M., Roebroeck, M. E., Janssen, W. G., Hoekstra, A., Selles, R. W., Hovius, S. E., et al. (2008). Hand function and activity performance of children with longitudinal radial deficiency. Journal of Bone and Joint Surgery American Volume,90(11), 2408–2415. https://doi.org/10.2106/jbjs.f.00577.
Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Üstün, B., & Stucki, G. (2005). ICF linking rules: an update based on lessons learned. Journal of Rehabilitation Medicine,37, 212–218.
Murphy, G. R. F., Logan, M. P. O., Smith, G., Sivakumar, B., & Smith, P. (2017). Correction of “Wrist” deformity in radial dysplasia: a systematic review and meta-analysis. Journal of Bone and Joint Surgery American Volume,99(24), 2120–2126. https://doi.org/10.2106/JBJS.17.00164.
Wagner, L. V., & Davids, J. R. (2012). Assessment tools and classification systems used for the upper extremity in children with cerebral Palsy. Clinical Orthopaedics and Related Research,470(5), 1257–1271. https://doi.org/10.1007/s11999-011-2065-x.
Manske, P. R. (1996). Longitudinal failure of upper-limb formation Instructional course lectures, The American Academy of Orthopaedic Surgeons. Journal of Bone and Joint Surgery,78A, 1600–1623.
D’Arcangelo, M., Gupta, A., & Schecker, L. R. (2000). Radial club hand. In A. Gupta, S. P. Ray, & L. R. Schecker (Eds.), The growing hand. Diagnosis and management of the upper extremity in children (pp. 147–168). London: Mosby.
Nordstrand, L., Eliasson, A. C., & Holmefur, M. (2016). Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years. Developmental Medicine and Child Neurology,58(10), 1042–1048. https://doi.org/10.1111/dmcn.13106. (Epub 2016 Mar 27).
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Ethical Standard Statement
This study was approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all the primary caregivers before the surgical procedure.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Das, S.P., Ganesh, G.S. Outcome of Centralization and Ulnarization of the Carpus with Ulnar Shortening Osteotomy on Functioning in Children with Radial Club Hand. JOIO 54, 87–96 (2020). https://doi.org/10.1007/s43465-019-00019-z
- Congenital hand deformities
- Disabled children
- International Classification of Functioning, Disability, and Health
- Surgical procedures
- Treatment outcome