Radial Club Hand

About Radial Club Hand

Radial Club Hand is a rare congenital condition where the radius bone in the forearm is short or absent, leaving the wrist deviated towards the thumb side and the hand visibly turned. Causes are considered genetic and developmental, with multifactorial influences during early limb formation. The condition can affect one or both forearms and may be associated with cardiac, kidney, or blood disorders we screen for.

Severity is graded into four types based on how much radius is present, with type 1 the mildest and type 4 the most severe and most common. Children typically present with a short, bowed forearm, a thumb that is small or absent, and limited wrist movement. Function depends heavily on whether the child has good elbow flexion through an intact biceps, which we test carefully during congenital hand deformity surgery planning.

Initial assessment at Kayakriti includes forearm radiographs around the age of one year, a careful review of elbow flexion and biceps function, and evaluation of thumb development. Type 1 deformity is often managed with stretching exercises, splinting, and selective radial bone osteotomy with a fixator for lengthening. Types 2 to 4 usually need a centralisation or radialisation procedure to stabilise the wrist over the ulna.

Around two years of age, if the thumb is absent or severely underdeveloped, index pollicization is performed to convert the index finger into a functional thumb. This is a complex microsurgical operation that transforms pinch and grip. Wrist deformity correction is typically done at one year of age, with the radially deviated hand brought central or ulnar over the ulna. Lifelong follow-up tracks function.

What to expect

• Forearm X-rays and full systemic screening at around one year.
• Careful assessment of biceps function before any surgical decision.
• Stretching and splinting first in mild type 1 deformities.
• Centralisation or radialisation for moderate to severe types 2-4.
• Index pollicization considered around age 2 if the thumb is absent.

Recovery

• Splinting typically continues for several weeks after centralisation.
• Therapy starts early to maintain finger and elbow movement.
• Pollicization usually allows useful pinch within 3-6 months.
• Long-term follow-up tracks growth and any need for revision surgery.