congenital radial club hand: results of centralization in 10 cases

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 <0.05). stability of the wrist was acceptable in the latest follow up in all patients. we recommend that correction of congenital radial club hand by centralization should be performed in three stages. the first is preoperative splinting and corrective casting, the second centralization of the ulna and correction of angular deformity, and the third which may be longer than previous stages is postoperative splinting and bracing. this stage of treatment should be continued till skeletal maturity.