Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Husnain Khan; Nur Ul Ain; Kamal Afridi; Zahid Bhatti; Umer Chishti; Tayyab S Malik; Tahseen Cheema

doi:10.7759/cureus.43154

Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency

Cureus. 2023 Aug 8;15(8):e43154. doi: 10.7759/cureus.43154. eCollection 2023 Aug.

Authors

Husnain Khan¹, Nur Ul Ain¹, Kamal Afridi², Zahid Bhatti³, Umer Chishti¹, Tayyab S Malik¹, Tahseen Cheema⁴

Affiliations

¹ Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, PAK.
² Plastic Surgery, Bolan Medical College, Quetta, PAK.
³ Plastic Surgery, Wahid Trust Hospital, Gujrat, PAK.
⁴ Orthopedic Surgery, National Orthopedic & General Hospital, Bahawalpur, PAK.

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.

Keywords: acquired radial club hand; malunion; orthopaedic hand surgery; osteomyelitis of radius; osteomyelitis treatment; radial club hand; radial deficiency; radius; trauma; upper limb.