Lengthening of the ulna by external fixation in children with congenital radial club hand
Background. Congenital radial club hand is characterized by the radial deviation of the hand, the longitudinal underdevelopment of the forearm, and the dysfunction of the upper limb. The shortening of the ulna is observed in all types of congenital radial club hand. The average shortening of the ulna surgical treatment was 33.3% compared to the intact contralateral side. Aim. This study aimed to evaluate the results of ulna elongation by the method of external fixation, depending on the level of osteotomy, in patients with congenital radial club hand type III-IV. Materials and methods. The treatment results of 36 patients with congenital radial club hand type III-IV from 1998 to 2018 were analyzed. The average age of the patients was 7.4 years ± 3.5 years. The patients were divided into three groups, depending on the level of ulnar osteotomy. Shortening of the ulna, correction of the angle of deformity of the ulna, radial deviation of the hand, period of correction, elongation obtained, index of fixation and osteosynthesis, and associated complications were analyzed. Results. The observation period was an average of 5.8 years. Before surgical treatment, the ulna was 33.3% shorter, while after surgery, it was 16%. Before surgery, the angle of deformation was 20.5° ± 14.8°, while after surgery, it was 7.4° ± 5.6°; this gives an angle of deformity correction of 63.9%. The elongation of the ulna was 3.2 ± 1.1 cm. In patients who underwent proximal osteotomy, the resulting elongation was 32% and 18.4% more, respectively, than in patients who underwent an osteotomy in the middle and distal sections of the ulna. In group 1, the correction period was 24.4% and 28.9% more than in groups 2 and 3, respectively. The index of fixation in group 1 was 53.6%, which was 45.7% less than in groups 1 and 3. Postoperative complications included a false joint (15%), inflammation (10%), and forearm deformities (7.5%). Conclusions. In patients with congenital radial club hand type III-IV, the optimal part of an ulna osteotomy is the proximal section. With a hand deviation of more than 20°, osteotomy is performed in the distal section with simultaneous correction of the deformity.