Updated: 5/21/2021

Ulnar Club Hand

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  • summary
    • Ulnar Club Hand is a congenital upper extremity deformity characterized by a deficiency of the ulna and/or ulnar-sided carpal structures.
    • Diagnosis is made clinically.
    • Treatment can be nonoperative or operative depending on hand position, thumb function, elbow stability and presence of syndactyly.
  • Epidemiology
    • Incidence
      • 5-10 times less common than radial club hand
  • Etiology
    • 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 I
      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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