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QUESTION 1 OF 1

A newly born child was referred to you with deformity of the right upper limb(Figure 1). The paediatric team performed a through investigations on the child including genetic testing and no abnormality was detected. Your examination shows that shoulder is normal, elbow motions ranged from 90 flexion to 30 degrees short of full extension. The thumb is missing. X-ray shows complete absence of radius and bowed ulna.
The best strategic plan is:

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Figure 1.Clinical photo

QUESTION ID: 1299

1. Amputation as the outcome of reconstruction is unpredictable particularly with absent thumb
2. Bilobed skin flap to correct deformity as soon as possible
3. Centralisation of the ulna and free toe transfer age 9 month
4. Radialisation of the ulna age 9 month and pollicisation of the index finger at 18 month
5. Serial casting and bracing until she is 3 years old