A modified centralization procedure for radial club hand caused by partial or total absence of the radius is presented. This technique differs from the methods presently used in that no carpal bones are resected. Adequate release of the wrist from the fibrotic radial anlage is provided through two Z-plasty incisions to allow the hand to move easily to the new position. Stabilization is then obtained with a Kirschner wire placed via the lunate and capitate into the long finger metacarpal and then directed in a retrograde fashion into the ulna. A total of 12 centralization procedures with the above technique have shown very good results. Long-term follow-up results demonstrate remodeling of the ulna, which becomes broad in its distal end, resembling a radius.