Harbuzniak I. The effectiveness of combined treatment for the children with congenital club hand and anomaly of the hand

Object: congenital radial and ulna club hand with anomaly of the hand. The aim: increase the functional results of the treatment of the children with congenital radial and ulna club hand to do the combination surgery of the forearm and the hand. Methods: physical examining, radiological, ultrasound investigation, electromyography, statistics. Established that the congenital radial and ulna club hand combinations with anomaly of the hand up to 100%. Update a new study that the functional treatment results increase up to 21,42 % in children with congenital radial and ulna club hand who had the surgical treatment of the forearm, and increase up to 47,65 % in children who had the combination surgery of the forearm and the hand. At first we explored the specificity of the soft-tissue conditions of the upper extremity using ultrasound investigation. The identification of the fibrocartilaginous anlage using the ultrasound investigation amounts to 82,35 % of the sensivity and 100 % of the specifity. The new treatment-and-diagnostic strategy of children with congenital club hand and anomaly of the hand depends on: the type of club hand, anomaly of the hand, the conditions of the forearms soft-tissue, the functional disturbance. This strategy consists of the combination surgery of the forearm and the hand. It allows to decrease the total angel of the deformity up to 77.84° in congenital radial clubhand and up to 37.1° in congenital ulna clubhand, and improve the functional treatment results in 2.2 times. Update a new study that the soft-tissue conditions of the upper extremity in congenital club hand affects at the treatment results. The soft-tissue distraction before centralization decrease the size of the ulna resection, prevent the osteoepiphysiolysis of the distal ulna. The muscular imbalance correction and the resection of the fibrocartilaginous anlage decrease the recurrence of the hands luxation up to 26 %. The specificity of the vessels anatomy and fibrocartilaginous anlage which were verification with ultrasound investigation helps to plane the surgical treatment, decrease the vessels damage and increase the effectiveness of surgical treatment. The new method of the surgical treatment of the radiohumeral synostosis (patent of Ukraine № 88423) allows to rotation of the forearm, the formation of the ulnahumeral articulation, get the active movements and improve on the functional of the upper extremity. The new treatment-and-diagnostic strategy of children with congenital club hand and anomaly of the hand allows choosing the type of surgical treatment according of the functional disturbance, anomaly of the hand, and improve on the functional of the upper extremity. The results of this research were introduced into clinical work of SI "Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine", Medical Academy of Postgraduation education of Kharkiv of Ministry of health service of Ukraine, the Head children's hospital of Lviv; the Head children's hospital of Odessa of Ministry of health service of Ukraine.Traumatology and Orthopedics.