1. Radiographs of the forearm are taken at the age of 1 year.
2. The child is assessed for suitability for surgical intervention at the age of 1 year.
3. The child is assessed for movements at the elbow joint and function of the biceps (elbow flexion)
- if the elbow joint is stiff and there is elbow flexion- then observation is advised with passive stretching of the radial side muscles.
- if elbow function is intact and biceps flexion is present- then a hand centralization procedure can be done.
4. Type 1 club hand- mild deformity- stretching exercises and radial bone osteotomy and fixator application (lengthening).
5. Type 2 to 4 club hand- moderate to severe deformity – centralization or planarization procedure.
6. At about 2 years of age the child, thumb is made with the index finger (index pollicization) if it is underdeveloped.