Outcome of Centralization and Ulnarization of the Carpus with Ulnar Shortening Osteotomy on Functioning in Children with Radial Club Hand

摘要

Background Radial club hand (RCH) is characterized by a wide array of hand and forearm anomalies. Various treatment approaches have been described depending upon the stages of RCH. The major drawback of these studies is that the efectiveness of these interventions was reported on clinical and radiological outcomes. With the increasing focus on patientcentered care nowadays, we wanted to identify the components associated with functioning and evaluate the efectiveness of two surgical procedures on functional outcomes using the International Classifcation of Functioning, Disability and Health (ICF)-based tools. Materials and Methods We identifed 14 children from our records (nine boys, fve girls) with a mean age of 5.6?years, classifed as Bayne types III–IV and classifed them into two groups; those who were operated by centralization (group 1) and ulnarization of the carpus with ulnar shortening osteotomy procedure (group 2). The outcomes were evaluated by the brief ICF core set for the child and youth with cerebral palsy up to the age of 5 and the brief ICF core set for hand conditions for a period of 1?year after surgery. Results The results showed that both the operative techniques showed improvement in the structure component (s730-structure of upper extremity). ICF categories of d445-hand and arm use, d530-toileting, and d880-engagement in play showed a change in frequencies of more than 40% after surgery and were maintained till follow-up. However, categories related to muscle power functions (b730), muscle tone (b735), fne hand use (d440), hand and arm use (d445) and engagement in play (d880) showed no signifcant improvement (p0.05). There were no diferences between both the surgical procedures in improving the outcomes (p0.05). Conclusion We conclude that surgical techniques may be more appropriate to improve the cosmetic or structural appearance of the upper extremity than functioning.