A treatise on orthopedic surgery . das in talipes due to absence of the tibia or fibula the hand maybe malformed also. Deficient formation of the radius with corresponding distor-tion is the most common. Of this 114 cases are recorded. In56 cases it was stated that the deformity was unilateral, in 46bilateral. In 44 cases the radius was absent; in 12 cases a partwas present; 60 per cent, of the patients were males.^ The most important form of club-hand is, then, that due toabsence or to defective formation of the radius. As in talipesvalgus due to absence of the fibula, the tibia is short and
A treatise on orthopedic surgery . das in talipes due to absence of the tibia or fibula the hand maybe malformed also. Deficient formation of the radius with corresponding distor-tion is the most common. Of this 114 cases are recorded. In56 cases it was stated that the deformity was unilateral, in 46bilateral. In 44 cases the radius was absent; in 12 cases a partwas present; 60 per cent, of the patients were males.^ The most important form of club-hand is, then, that due toabsence or to defective formation of the radius. As in talipesvalgus due to absence of the fibula, the tibia is short and oftenbent sharply forward, so in this form of club-hand the ulna isusually short and bent inward. The hand may be perfect information, but, as a rule, the thumb is absent or rudimentary,and other adjoining bones, together with the correspondingligaments and muscles, may be absent also^ (^ig- 338). The hand occupies practically a right-angled relation to theulna, and as this bone is usually bent inward as well, the direc- FiG. Congenital absence of radius and the bones of the thumb. (Weigel.) ^Antonelli, Zeits. f. Orth. Chir., 1905, Bd. xiv. ^ StofPel u. Stempel, Zeits. f. Orth. Chir., B. 23, H. 1 u. 2, 1909. DEFORMITIES OF TEE UPPER EXTREMITY. 513 Fig. 339. tion of the hand is often reversed and is parallel to the a rule, the hand is also somewhat bent forward, so that thedeformity might be described as radiopalmar (Fig. 339). Treatment.—In those forms ofclub-hand in which the structureis normal the deformity may beovercome, as a rule, by manipula-tion, and support by the plasterbandage or otherwise, as describedin the treatment of talipes. Mas-sage and muscle training are re-quired in the after-treatment. Ifthe deformity is complicated bydefective muscular developmentand limited joint motion massageand passive manipulation may berequired for years. Complete re-covery is unusual. In slighter cases of radial club-hand, due to defective develop-ment, it may be
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