The recurrence of deformity after surgical centralization for radial clubhand

Fourteen children representing 19 cases of radial clubhand had centralization of the carpus on the distal ulna during an 18-year period. Age at the time of the initial surgery averaged 3.2 years (range, 0.7-8.1 years) and the follow-up periods averaged 6.5 years (range, 1.5-22.2 years). There were 16 type IV radial and 3 type III clubhands. Preoperative, postoperative, and follow-up x-rays were used to determine the initial deformity, amount of surgical correction, and degree of recurrence. The total angulation (the combination of the radial deviation of the hand and the ulna bow) was measured. The average preoperative angulation measured 83 degrees (range, 55 degrees to 110 degrees ). Centralization corrected the angulation an average of 58 degrees (range, 15 degrees to 95 degrees ) to an average immediate postoperative total angulation of 25 degrees (range, 5 degrees to 60 degrees ). At the final follow-up examination there was a loss of 38 degrees (range, 5 degrees to 105 degrees ) and the total angulation increased to an average of 63 degrees (range, 20 degrees to 120 degrees ). The difference between the preoperative, postoperative, and follow-up angles was statistically significant. There was a significant correlation between the preoperative angle and the final angle, the preoperative angle and the amount of correction, the amount of correction obtained at surgery and the recurrence of the deformity, and the age at time of initial surgery and the amount of recurrence.