We treat a variety of deformities and limb length discrepancies of the upper limb. Our Center also has extensive experience in congenital hand surgery. The conditions that we have treated include radial club hand, ulnar dysplasia, radiohumeral synostosis, syndactyly, growth arrest with shortening and/or deformity of the radius, ulna, and humerus, congenital pseudarthrosis of the forearm, and elbow stiffness and contractures.
Radial club hand
With this condition, the radius bone is partially or completely missing. Because of this, the hand and wrist, which normally sit on the end of the radius, are displaced to the side of the ulna. Instead of trying to centralize the hand on the end of the ulna all at once, we combine open surgery to lengthen some of the tight soft tissues with gradual correction using an external fixator to progressively stretch the tight nerves, blood vessels, and tendons while centralizing the hand. We think this is a much more successful and safe procedure. Even with successful centralization, the deformity often recurs because of failure to transfer a tendon to maintain the correction. We perform the tendon transfer at the same time. Because many children with radial club hand are born without a thumb, we perform an additional operation to create a thumb from the index finger. This is called pollicization. The results of this approach have been very satisfactory. We perform this surgery when the patient is as young as 1 year, shortly after completing the centralization. Because the forearm in these patients remains very short, we lengthen the forearm for the first time when the patient is between the ages of 6 and 8 years and for the second time when the patient is between the ages of 12 and 14 years.
We have developed a new method for the treatment of syndactyly (webbing of the fingers). This involves pulling the fingers apart, using an external fixator. This grows new soft tissues between the fingers, making surgical separation of one or more fingers safer and reducing the need for skin grafting.
This deformity of the wrist is very complex and requires a combination of lengthening and special bone and soft tissue surgery of the wrist using a procedure called hemi-epiphyseal elevation and distal transport of the lunate bone. With this approach, both the functional and aesthetic results are very satisfactory.
This condition is most commonly due to damage of the growth plate of the humerus from infection, bone cyst, or fracture. The humerus on one side can be 5 to 17 cm shorter than the humerus on the other side. In most cases, the arm length discrepancy can be corrected in one lengthening. Associated deformities of the elbow or shoulder can also be corrected at the same time.
Growth arrest of the ulna or radius with shortening and/or deformity
Damage of the growth plate of the radius or ulna due to trauma, infection, or multiple osteochondromas can lead to deformity of the forearm, elbow, and wrist. The best way to treat this and to prevent further deformity from developing is to lengthen and correct the deformity of the ulna and/or radius.