Distal Ulnar Bifurcation Arthroplasty in the Treatment of Bayne and Klug Types 3 and 4 Radial Club Hands: Preliminary Outcomes.

BACKGROUND: The treatment of Bayne and Klug types 3 and 4 radial club hands (RCHs) remains challenging and controversial. In this study, the authors reported a new procedure called distal ulnar bifurcation arthroplasty and reviewed the preliminary results. METHODS: Between 2015 and 2019, 11 patients with 15 affected forearms having type 3 or 4 RCHs underwent distal ulnar bifurcation arthroplasty. The mean age was 55.5 months (range, 29 to 86 months). The surgical protocol consisted of (1) bifurcation of the distal ulna to accommodate the wrist with stable support; (2) pollicization to treat hypoplastic or absent thumb; and (3) in the case of significant bowed ulna, ulnar corrective osteotomy. In all patients, clinical and radiologic parameters including hand-forearm angle, hand-forearm position, ulnar length, wrist stability, and motion were recorded. RESULTS: The mean duration of follow-up was 42.2 months (range, 24 to 60 months). The average correction of hand-forearm angle was 80.2 degrees. The overall range of active wrist motion was approximately 87.5 degrees. Ulna growth per year was 6.7 mm (range, 5.2 to 9.2 mm). No major complications were recorded during follow-up. CONCLUSIONS: The distal ulnar bifurcation arthroplasty offers a technically feasible alternative for the treatment of type 3 or 4 RCH, which enables satisfactory appearance, provides stable support to the wrist, and maintains wrist function. Despite the promising preliminary results, longer follow-up is necessary to evaluate this procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.