Updated: 10/4/2016

Ulnar Club Hand

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Introduction
  • A congenital upper extremity deformity characterized by
    • deficiency of the ulna and/or the ulnar sided carpal structures
    • unstable elbow and stable wrist or vice versa
      • elbow abnormalities more common than wrist abnormalities
  • Epidemiology
    • 5-10 times less common than radial club hand
  • Associated conditions
    • medical
      • not associated with systemic conditions like radial club hand
    • orthopaedic conditions
      • PFFD 
      • fibula deficiency 
      • scoliosis
      • phocomelia
      • multiple hand abnormalities
        • almost all patients have absent ulnar sided digits
Presentation
  • Symptoms
    • limited function
    • usually painless
  • Physical exam
    • shortened, bowed forearm
    • decrease in elbow function
    • loss of ulnar digits
Classification
 
Bayne Classification
Type 0  • Deficiencies of the carpus and/or hand only

Type 1  • Undersized ulna with both growth centers present

Type II  • Part of the ulna is missing (typically the distal ulna is absent)
Type III  • Absent ulna
Type IV  • Radiohumeral synostosis
There is a subtype of each classification that is based on the first webspace
 • A = Normal
 • B = Mild deficiency of the webspace
 • C = Moderate to severe deficiency of the webspace
 • D = Absent webspace
 
Treatment
  • Goals
    • treatment depends on multiple factors including
      • hand position, thumb function, elbow stability, syndactyly
      • thumb condition is most important factor to consider for treatment
  • Nonoperative
    • stretching and splinting
      • indications
        • used in early stages of treatment 
  • Operative
    • syndactyly release and digital rotation osteotomies
      • indications
        • done at 12-18 months of age
    • radial head resection and creation of a one-bone forearm  
      • indications
        • Stage II to provide stability at the expense of forearm motion
          • there is no good option for restoring elbow motion
        • corrective procedures should not be performed until the child is at least 6 months old
    • osteotomy of the synostosis
      • indications
        • may be required in Stage IV to obtain elbow motion
 

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