ABSTRACT: Radial clubhand is a condition that is cosmetically unappealing and functionally challenging to the patient. Management of this condition aims to achieve a straighter alignment of the hand on the forearm while maintaining a stable wrist without compromise of growth at the distal ulnar epiphysis. We have been using a 2-stage procedure to manage type 3 and 4 radial clubhand since 1993. Centralization is initially obtained by using the Ilizarov fixator in a hinged-distraction mode. Once this is achieved, the correction is secured at a second stage by pinning the carpus to the ulna. We describe in detail the technique of constructing the Ilizarov frame for this purpose.