Ulnar Ray Deficiency: A New Classification and a Unique Case Report.

Area of Science:

• Congenital upper limb defects
• Pediatric orthopedics
• Developmental abnormalities

Background:

• Ulnar ray deficiency is a rare congenital anomaly affecting upper limb development.
• This condition can manifest in various forms, impacting hand and arm structure.
• Management strategies aim to improve function and aesthetics.

Observation:

• A unique case presented with bilateral upper limb anomalies: hand-on-flank deformity on one side and limb truncation on the contralateral side.
• The standard surgical approach for hand-on-flank deformity involves humerus osteotomy to reposition the hand anteriorly.
• The presence of contralateral limb truncation influenced the surgical decision-making process.

Findings:

• The senior author opted against performing a humerus osteotomy due to the contralateral limb truncation.
• Post-operative assessment revealed that the posterior hand position facilitated functional reach to the ano-genital area, pocket, and mouth.
• This suggests that the posterior hand position provided significant functional benefits in this specific complex case.

Implications:

• The findings challenge the conventional approach for hand-on-flank deformity when associated with contralateral limb truncation.
• Avoiding anterior repositioning of the hand may preserve or enhance functional capabilities in such complex congenital presentations.
• This case highlights the importance of individualized treatment strategies in pediatric orthopedic surgery for rare congenital anomalies.