“Less is More”-A Minimalistic Surgical Intervention to Correct the Right Upper Limb Deformity in an Isolated Right Radial Club Hand - A Case Report

Sep 29, 2026

Radial club hand is a rare congenital deformity of the radial forearm, which lacks a universal treatment protocol and requires individualized reconstruction based on severity and established surgical principles. A 12-year-old girl with an isolated, non-syndromic right radial club hand and flexion deformities at the wrist and elbow underwent a corrective wedge osteotomy with bilobed skin flaps, without wrist or musculotendinous unit intervention. A reasonable outcome was achieved in this complex anomaly using a minimalist approach.

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 172-176 “Less is More”-A Minimalistic Surgical Intervention to Correct the Right Upper Limb Deformity in an Isolated Right Radial Club Hand: A Case Report Sunil Kumar Rout1, Mainak Mallik2, Abhijit Kumar3, Mandira Saha Mallik4 Learning Point of the Article: In radial club hands, due to the lack of a standard treatment protocol, based on the established principles of reconstructive surgery and the surgical techniques described by different authors, a tailored approach has to be adopted as per the severity of the case, to restore the form and function, even with a minimalistic wedge osteotomy alone. Abstract Introduction: Radial club hand is a rare congenital condition (1 in 100,000) involving varying deformities on the radial side of the forearm, ranging from thumb underdevelopment to absence of the radius and related structures. It can be isolated or part of syndromes, such as thrombocytopenia-absentradius, Holt-Oram, or vertebral, anal, cardiac, tracheo-esophageal, renal, limb, and is bilateral in 50–72% ofcases. Case Report: A 12-year-old right-handed girl presented with an isolated, non-syndromic right radial club hand and flexion deformity at the wrist and elbow, without functional impairment. Her pathology did not fit existing Bayne and Klug or Heikel classifications, as her proximal radius was absent but the distal epiphysis and wrist were developed. A corrective wedge osteotomy with bilobed skin flaps was performed torealign the forearm. No intervention was made atthewrist or musculotendinous units, resulting inan acceptable outcome. Conclusion: Reasonable outcome could be obtained in a rare case of complex congenital anomaly like radial club hand following a minimalist approach ofwedge osteotomy alone to correct the forearm deformity. Keywords: Radial club hand, osteotomy, bilobed flap, case report. Introduction Radial club hand is a rare congenital anomaly (1 in 100,000 births) involving varying degrees of radial-side forearm malformations, from thumb hypoplasia to complete absence of the radius and first ray, often accompanied by underdevelopment of adjacent muscles, tendons, ligaments, nerves, and vessels. It may occur in isolation or in association with syndromes, such as thrombocytopenia-absent radius, Holt-Oram, and vertebral, anal, cardiac, tracheo-esophageal, renal, limb. The condition is bilateral in 50–72% of cases and linked to disruptions in sonic hedgehog gene pathways that influence the apical ectodermal ridge, essential for limb development [1]. The earliest known report is credited to Jean-Louis Petit in 1733 [2]. Treatment strategiesvary, ranging from conservative observation to surgical procedures aimed at centralizing the carpus over the ulna, often combinedwith corrective casting [3, 4]. | Author’s Photo Gallery | | | | | | --- | --- | --- | --- | --- | |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6496](https://doi.org/10.13107/jocr.2025.v15.i12.6496) | Dr. Sunil Kumar Rout Dr. Mainak Mallik Dr. Abhijit Kumar Dr. Mandira Saha Mallik

1Department of Plastic and Reconstructive Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India,
2Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India, 3Department of Anaesthesiology, All India Institute of Medical Sciences, Kalyani, West Bengal, India, 4Department of Radiation Oncology, All India Institute of Medical Sciences, Kalyani, West Bengal, India.
Address of Correspondence:
Dr. Mainak Mallik,
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India. (Former Associate Professor, Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India). 550/4, P.K. Guha

FAQs

What makes radial club hand challenging to treat?

Radial club hand has no standard treatment protocol, so management is individualized based on deformity severity and reconstructive principles described in the literature.

How was the deformity managed in this case report?

The patient underwent a corrective wedge osteotomy using bilobed skin flaps to realign the forearm, with no additional intervention at the wrist or musculotendinous units.

What outcome was reported after the minimalist surgical approach?

The authors reported an acceptable, reasonable outcome after wedge osteotomy alone, despite the anomaly being complex and rare.

Sep 29, 2026

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