Correction of forearm deformities in congenital ulnar club hand: one-bone forearm

To describe our experience in the correction of congenital ulnar club hand, using the one-bone forearm procedure.

Fifteen cases of congenital ulnar club hand treated at Gaslini Children's Hospital of Genoa, Italy, from 1996 to 2008 were evaluated retrospectively. The one-bone forearm procedure was proposed for all 9 cases of type 2 (following the Bayne classification) and then performed in 8 patients with an average age of 5.5 years (range, 3-12 y). At surgery, the patients presented paradoxical hyperextension of the elbow (up to 45° of extension).

Average follow-up was 5.3 years (range, 1 to 13 y). Union of the osteotomy was obtained in all cases. In 7 cases, union occurred in an average of 65 days (range, 45-90 d); in 1 case (surgery at 12 y of age), union was delayed, with recovery 5.5 months after surgery and no need for further surgical procedures. All treated cases showed improvement of forearm function and of grasping ability of the hand (generally tridactyl). In addition, the paradoxical hyperextension movement that was present before surgery disappeared in all patients. Long-term radiographic follow-up showed in all cases the formation of a structure that was morphologically similar to that of the previously resected radial head.

The one-bone forearm procedure improves malformed forearm functions, thus increasing the possibility of carrying out daily life activities. The creation of the one-bone forearm should be preceded by the release of the distal ulnar anlage, which maintains fixed wrist deformity; this procedure should be performed within the first year of life.