CONGENITAL ABSENCE OF THE RADIUS

With Review of Literature and Report of Three Cases.

¹ The Orthopaedic Service of the Children's Memorial Hospital, Chicago.

(1) Congenital absence of the radius is by no means a rare condition, there being at least 250 cases recorded in medical literature up to 1923. These cases are reviewed and tabulated, together with three cases here reported.

(2) The principal pathlogy of the radial defect comprises: total or partial absence of the radius, either unilateral or bilateral; the hypertrophied and curved ulna on the affected side; congenital club-hand, usually radio-palmar in type; absence of the thumb, together with its metacarpal bone; general atrophy of the affected extremity; and the limitation of joint movements.

(3) The radial defect usually is associated with other concomitant anomalies elsewhere in the body.

(4) There are many theories proposed to explain the etiology of this deformity. Of these, Gegenbaur's archipterygeal theory and Dareste's amniotic theory have the largest number of followers. The present writer believes what the essential cause of the defect is due to some disturbing factor which arises during the first few weeks of fetal life, either due to the inherent defect in cell vitality or to some inflammatory or irritative process (Virchow's phlogistic diathesis).

(5) Diagnosis of the condition is usually not difficult, but the ultimate verification must rest in radiographic findings. Prognosis is always grave, as the degree of anomalies may be so extensive as to make life impossible, or at least the power of resistance so weak as to make the patient succumb to some intercurrent infection. The operative measures merely correct the deformed hand, but the affected extremity always remains weak.

(6) The various methods of operative procedure have been devised and these are reviewed briefly. The Ryerson method of ulnar graft, as adopted in one of our cases, is also mentioned.

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