The Journal of Bone and Joint Surgery, Vol 59, Issue 1 1-13, Copyright © 1977 by Journal of Bone and Joint Surgery, Inc
Radial club hand. A continuing study of sixty-eight patients with one hundred and seventeen club hands
DW Lamb
Based on a review of the embryology, genetics, and anatomy of radial club
hand, it is suggested that damage to the apical ectoderm on the anterior
aspect of a developing limb bud leads to the deformity. Study of the
families of thirty-five children with radial club hand suggested that the
condition is not genetically patterned. The anatomical findings and
associated congenital abnormalities in the cases known to be related to
thalidomide and in those in which thalidomide was not a factor were similar
except that the incidence of other skeletal deficiencies was higher in the
thalidomide group. Thirty-one of the 117 radial club-hand deformities (in
sixty-eight patients) under my personal supervision were treated by
centralization of the carpus on the ulna with satisfactory improvement of
the deformity. In three cases wrist deformity recurred mainly in a volar
direction, apparently the result of muscle imbalance. No significant
impairment of ulnar growth occurred and straightening of the wrist did not
affect function adversely. Pollicization of the index finger was done on
twenty-eight occasions. Although problems developed in the early cases,
these can be avoided using the methods described and the operation can
improve both function and appearance. A scheme of management is
recommended.
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