Radial Club Hand Treated by Paley Ulnarization Generation 3: Is This the New Centralization?

Abstract

(1) Background: Patients treated with the two previous generations of ulnarization developed a bump related to the ulnar head becoming prominent on the radial side of the hand. To finally remedy this problem, a third generation of ulnarization was developed to keep the ulnar head contained. While still ulnar to the wrist center, the center of the wrist remains ulnar to the ulnar head, with the ulnar head articulating directly with the trapezoid and when present the trapezium. (2) Methods: Between 2019 and 2021, 22 radial club hands in 17 patients were surgically corrected with this modified version of ulnarization. (3) Results: In all 17 patients, the mean HFA (hand–forearm-angle) correction was 68.5° (range 12.2°–88.7°). The mean ulna growth was 1.3 cm per year (range 0.2–2 cm). There were no recurrent radial deviation deformities more than 15° of the HFA. (4) Conclusions: This new version of ulnarization may solve the problem of the ulna growing past the carpus creating a prominent ulnar bump. The results presented are preliminary but promising. Longer-term follow-up is needed to fully evaluate this procedure.

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

“…13 In 2019, Paley further modified the procedure by releasing the scapholunate ligaments, hinging the scaphoid bone, shortening the ulna, and bringing the ulnar head to the diastasis between the scaphoid and lunate. 8 Although the results were promising with regard to risk of recurrence and growth arrest, it is necessary to verify whether these results can be maintained with longer follow-up. In addition, results of active wrist motion were not reported.…”

“…5 The current surgical options mainly include centralization, radialization, Paley ulnarization, soft-tissue release with bilobed flap, and vascularized bone graft transfer including vascularized second metatarsophalangeal joint transfer and proximal fibular epiphyseal transfer. [6][7][8] Centralization has remained the mainstay for Bayne and Klug types 3 and 4 RCHs. 9 However, high radial deviation recurrence, growth arrest caused by physeal injury, and wrist stiffness have been reported.…”

Outcomes of radialization with ulnar cuff osteotomy for radial longitudinal deficiency: a medium-term follow-up study

“…Paley et al. (2021) described a relative length concept of ulnar shortening for the acute correction of radial club hand and also mentioned the importance of an osteotomy as part of their technique (Deszczynski et al., 2021).…”

The unsolved problem of radial longitudinal dysplasia: how can we reliably prevent recurrence, preserve growth and optimize function?

“…Paley (2017) proposed ‘ulnarization’ as another way to straighten the wrist, with transposition of the hand to the ulnar side of the ulna, however, this procedure includes a shortening osteotomy of the ulna, further reducing forearm length (Deszczynski et al., 2021; Paley, 2017).…”

“…The decreased soft tissue tethering lessens the longitudinal force of the carpus on the distal ulna and its physis, with a longer ulna reported to be up to 75% of the normal length. Paley (2017) proposed 'ulnarization' as another way to straighten the wrist, with transposition of the hand to the ulnar side of the ulna, however, this procedure includes a shortening osteotomy of the ulna, further reducing forearm length (Deszczynski et al, 2021;Paley, 2017).…”