Treatments for Ulnar Club Hand in Children

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Exercises and splinting

During infancy, the first goal of treatment is to allow your child's wrist to extend and the elbow to move into a normal position. Your child's doctor will guide you in performing gentle but firm and frequently repeated passive stretching exercises for the wrist and elbow to help accomplish this goal.

   •   More severe cases may require casting or splinting to gradually stretch
       the contracted soft tissues.

       Once passive motion is achieved, your baby will likely need to wear a splint during the night throughout infancy
       and during periods of rapid growth.

   •   Even if your child needs surgery, keep in mind that the range of motion exercises are extremely important.

Any improvement in range of motion achieved through exercise will make subsequent surgery more
effective and perhaps less complex.

Surgical treatment

Surgical treatment is usually required to correct deviation of the wrist that persists after stretching and splinting. However, the decision to perform surgery is weighed against any other problems that your child may be experiencing due to associated medical conditions.

Sometimes, if your child cannot flex his elbow, a bent wrist and short forearm can be an advantage, enabling your child to do things like feed himself.

Surgery is divided into phases. Each problem is treated in separate surgical procedures that may take place over the course of months or years, depending on the problem.

The following is a general description of how the different parts of the arm and hand affected by radial club hand are surgically treated:

The wrist

There are a number of procedures your child's doctor may recommend:

Lengthening: This procedure is used prior to surgery to gently stretch your child's hand into a straighter position. Lengthening is recommended in infancy if it's difficult to stretch out the tight wrist. It is also used in adolescence when there is recurrent deformity or marked shortening of the forearm.

Centralization: This procedure involves removing bones from your child's wrist so that the hand sits straight on the end of the radius, which is sometimes placed in a slot within the wrist.

Radialization: This procedure involves moving your child's hand slightly closer to the radial border of

the forearm and reorganizing the tight muscles of the wrist so that the hand is balanced on the end of the radius.

Splinting: This is usually necessary following centralization or radialization procedures. At the time of surgery, surgeons will likely create an internal splint — a pin that is placed through your child's wrist and radius. This splint may remain in place for a year or even more after surgery, until the ulna gradually broadens and becomes a more stable platform on which the wrist may balance.

The forearm bones

Osteotomy: Your child's surgeon may want to straighten her forearm bones by cutting them into wedges, then rearranging them into a straighter position. These will be held in place by the same pin that holds the wrist.

Underdeveloped or absent thumb: Reconstructive surgery, either through a procedure known as pollicization or by tendon transfers, is usually performed after other procedures described above are completed.

Elbow: Surgery on the elbow is uncommon in ulnar club hand. However, in some cases, your child's doctor may want to perform an operation to release the tight soft tissue structures at the back of the elbow that are causing the elbow to stiffen.

What's my child's long-term outlook?

It depends on the severity of the deformity.

In mild cases, intermittent therapy throughout growth is required to maintain alignment and strength. These children will have minor limitations of motion, function and strength.

In the more severe cases, there will be marked limitation of motion, strength and function. In these situations, growth will also be limited in that forearm.

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