Surgical Treatment (RCH)

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• Surgical Treatment of RCH Types 0–I–II
Type 0 RCH, which represents the radial-deviated hand with a normal-length radius, is caused by a deficiency in the radial wrist extensors and flexors {Mo, 2004 #236;James, 2004 #237}. Not all cases with type 0, type I, or type II RCH need surgical correction. Splinting and stretching alone are frequently used to treat these patients. When patients have a significant radial deviation of the hand at rest, however, surgery can be indicated {Wall, 2013 #44;Mo, 2004 #236}. Mo and Manske have described correction of RCH type 0 with tendon transfers and soft tissue rebalancing {Mo, 2004 #236}. The procedure is partially based on the radialization procedure of BuckGramcko {Buck-Gramcko, 1985 #392}. The ECU is divided leaving a distal stump attached to the fifth metacarpal. It is then transferred into the dorsal wrist capsule at the level of the third metacarpal to help improve any existing extension deficit. The extensor carpi radialis tendons (if present) are transferred to the distal stump of the extensor carpi ulnaris (ECU) to transfer the force of the abnormal forearm muscles to the ulnar side of the wrist, resulting less radial deviation. While long-term results were lacking in Mo’s study, early postoperative
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Matsuno, in a small series of four patients, described a technique using external distractors placed on both the ulna and the radius in an attempt to correct both radial height and wrist position. Unfortunately, results were poor and require extended treatment, with absorption of regenerate bone occurring after distraction attempts. If one chooses to utilize this technique, patients and parents should be aware that delayed consolidation or malunion of the radius can occur and that three or more lengthening procedures may be required to gain and maintain appropriate length {Matsuno, 2006

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