Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases.

Abstract

Purpose: Radial club hand is a congenital malformation characterized by varying degrees of radial deviation and radial bone hypoplasia or absence. However, the optimal timing for corrective surgery remains a subject of debate. This study aimed to assess the impact of the timing of radial club surgery on functional outcomes.

Methods: Eligibility for inclusion was limited to patients exhibiting type IIIb or type IV deformities according to the Bayne and Klug classification, who began hand therapy and splinting postnatally, and underwent all surgical interventions before 10 months of age. Regular assessments were conducted for a minimum of 2 years, and up to 6 years after intervention. Data, including demographics, surgical interventions, post-intervention ranges of motion, and complications, were collected retrospectively.

Results: All 22 patients (34 hands) included in this study underwent surgical intervention before age 10 months. Our results demonstrated a mean preoperative hand-forearm angulation of 86.8° (range, 20°-150°) and a mean postoperative hand-forearm angulation of 3.8° (range, 0°-20°). The final range of motion showed a mean flexion of 84.3° (range, 70°-90°) in 30 hands, mean extension of 65.7° (range, 60°-70°) in 28 hands, mean ulnar deviation of 35.6° (range, 30°-40°) in 25 hands, and mean radial deviation of 17.4° (range, 15°-20°) in 27 hands. Skin necrosis occurred in 3 cases (9%).

Conclusions: A comprehensive management approach immediately after birth, integrating exercises, splinting, and surgical correction before age 10 months is effective and safe.

Type of study/level of evidence: Prognostic IV.