International Journal of Research in Orthopaedics

Ram CM et al. Int J Res Orthop. 2019 Mar;5(2):350-351

http://www.ijoro.org

Case Report

DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20190068

Ulnar dimelia: a rare case

C. Mathun Ram*, G. Chidambaranathan

Department of Orthopaedics, Nathan Super Speciality Hospital, Salem, Tamil Nadu, India

Received: 14 December 2018

Revised: 11 January 2019

Accepted: 12 January 2019

*Correspondence:

Dr. C. Mathun Ram,

E-mail: nathanorthocare@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Mirror hand deformity or ulnar dimelia is a congenital anomaly and several papers presented in various journals. We received a patient a child of four years old with deformity of right upper limb. The child had fixed elbow of 10 and many fingers. Fingers were symmetrical to the midline axis and X-ray showed double ulna facing each other and Inner/medial ulna is longer than the lateral one. This is a rare entity and not reported till now in any literatures.

Keywords: Ulna, Dimelia, Pair ulna

INTRODUCTION

Ulnar dimelia or mirror hand deformity is very rare and reported in few journals and various surgeries were performed on children or neglected.1 We wanted to give you to our four year old child a good, functional upper limb with usable hand. In this article we like to mention the rare malformation of one ulna longer than the other. a case report not reported globally.

CASE REPORT

We received a female child four years old with limited elbow movements with right upper limb deformities which is congenital, born to a non-consanguineous parents and the child was the first child in the family, delivered normally. On orthopaedic examination, shortening of the limb noticed, and FFD of 10 degrees and further flexion of 90* of elbow noticed. Radial deviation of hand, and all seven fingers arranged symmetrically. Shoulder ROM normal, forearm supination and pronation appeared normal, hand functions were normal like grasping an object, and lifting a small object. Left upper limb was totally normal roentgenogram showed two ulna facing each other and the inner ulna is longer than the outer one which is a rare variant not reported. All metacarpals in one plane seen in the xray.1

Figure 1: (A) Shown right upper limb with seven fingers; (B) X-ray right upper limb show two ulnar facing each other and the medial ulnar in longer.
Figure 1: (A) Shown right upper limb with seven fingers; (B) X-ray right upper limb show two ulnar facing each other and the medial ulnar in longer.

Reconstructive surgery was planned in stages and muscles training was given,

Stage 1: Wrist distraction of soft tissues.

Stage 2: To have full length of one flexor muscle, and radially placed ulna proximal end cut and removed, to get more elbow movements

Stage 3: All lateral fingers removed except medial five with skin flap, all remaining all digits radially shortened. Normal above elbow pop applied for 1-1/2 months and then physiotherapy passively started.

DISCUSSION

Mirror hand is a rare congenital deformity reported in literatures.2,3 Usually the ulna is doubled and face each other or follow each other and reported literatures showed both ulna showed equal length. But in our case it showed outer ulna is shorter by 7.8 mm- a rare case report. Several classifications given by Al-Qattan and Thunayan classification do not mention this type of variation 4. No other literature mention this type of variation.5,6

Considering the management though we have followed the previous procedures of Jafari did polizysation after exciton of three digits in 20 year patient, AVADIES on a seven year old patient, Afshar also did in six digit patient.7-9

We found excision of radial ulna proximal part gave good elbow flexion, extension, supination and pronation of forearms.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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