Radial Club Hand: Straightening the Wrist and Lengthening the Forearm

Radial club hand (radial longitudinal deficiency) is a birth condition in which the radius – the forearm bone on the thumb side – is short, underdeveloped or absent. Without its support the hand bends sharply towards the thumb side, the forearm is short, and the thumb itself is often small or missing.

Types

The condition ranges from a slightly short radius with a mildly tilted wrist to complete absence of the radius with a severely deviated hand. Surgeons grade it (commonly using the Bayne classification) to guide treatment. The thumb is graded separately, since thumb reconstruction is often the biggest functional gain.

Check the whole child first

Radial club hand can be linked with conditions affecting the heart, blood, kidneys or spine (for example Holt–Oram syndrome, TAR syndrome, Fanconi anaemia and VACTERL association). Before any surgery, children need a general examination, blood counts, heart echo, kidney ultrasound and spine X-ray where indicated, coordinated with the paediatrician.

Treatment through childhood

1. Infancy: gentle stretching and splinting to keep the soft tissues as supple as possible
2. Soft-tissue distraction: a small external fixator gradually stretches the tight soft tissues on the thumb side over a few weeks, bringing the hand towards the end of the ulna without forceful surgery
3. Centralisation or radialisation: the hand is stabilised over the ulna in a straighter position, with tendon balancing
4. Thumb reconstruction: if the thumb is absent or unusable, the index finger can be repositioned as a thumb (pollicisation), usually in early childhood
5. Forearm lengthening: the ulna can be lengthened gradually later in childhood or adolescence if the forearm is very short

When not to straighten the wrist

If the elbow is stiff and cannot bend, the bent wrist may be what allows the child to bring the hand to the mouth. Straightening it could take that ability away. Each plan is built around what the child can and cannot do.

Possible complications

Recurrence of the wrist deviation (common, which is why splinting continues), injury to the ulnar growth plate, stiffness, pin-site problems and the need for further procedures as the child grows.

Long-term follow-up

Radial club hand is managed over many years, with planned procedures at the right ages and regular follow-up until growth ends. Hand therapy is part of every stage.