الفهرس 
Embryology of limb developmentOnly 14 pages are availabe for public view
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Abstract
( Introduction) Radial club hand is a deformity in which the hand is bent at the wrist and deviated towards the thumb .The deformity is classified by Bayne and Klug into four groups. Type I: Short distal radius. Elbow and proximal radius are normal but distal radial physis is deficient and radius is shortened.The thumb may show variable degree of hypoplasia. Type II: Hypoplastic radius . The wrist is unstable and radially deviated . Type III : Partial absence of the radius and Type IV: Total absence of the radius and this is the most common type.
(methods)We reviewed literature from 2012 to 2016 as regard the diagnosis and the new advances in the treatment of radial club hand, including: indications , techniques , results and possible complications. (results)The natural history of RLD is generally a worsening of the Deformity with stiffness in radial deviation, palmar subluxation of The carpus, and aggravation of the ulnar bowing.Surgical correction is always
required in type III and IV.
The results depend not only on the technique applied, but also on the severity of the malformation. This is true especially in regard to muscles and tendons, be cause they have to maintain the new muscle balance. Therefore, the results range from recurrence with limited range of active motion and epiphyseal damage to a fully straightened forearm - hand axis with 10◦–20◦active ulnar deviation and a considerable broadening of the supporting distal end of the ulna.
Geck et al.listed the possible causes of radial deviation recurrence: inadequate intraoperative correction,failure to release the radial side soft tissues, remature removal of the ulnar pin, and inability to balance the radialforces.
Some of the less good results can be improve d by secondary procedures: osteotomy of the ulna to correct the inclination of the distal articular surface or straighten the bowing, lengthening of the ulna with deformity correction by con tinuous distraction, extensor tenolysis and tendon transposition, especially together with ulnon-carpal arthrodesis which makes all wrist muscles free for finger movements.
(conclusion)This study and similar studies - confirm the fact that RCH is still one of the unsolved problems. Distraction is now a well known modality utilized worldwide.
Our recommendations:
Preliminary soft tissue distraction for RLD proved effective for treatment especially for age group like this studied in our series; late presenting and older age children. Distraction facilitated subsequent radialization with tensionless alignme nt of the carpus on top of the ulna.This protocol has minimal complications. Further comparative study should be conducted including the results of this protocol, and those young infants presenting early in life with supple deformity and managed early with primary centralization or radialization without distraction.