Langenskiöld Procedure for Madelung’s Deformity: Case Series of Late Sequelae

Abstract

Background: Although many authors advise to postpone surgical intervention until skeletal maturity is reached, the Langenskiöld procedure-entailing physiolysis and the release of Vickers' ligament-is a known procedure in case of Madelung's deformity in children. Although advised in textbooks and recent reviews, the results and late sequelae of this procedure have been poorly documented. The aim of this study is to portray the late effects of this procedure for three patients and emphasize a very careful patient selection. Methods: A retrospective study was performed of the medical records of three patients who underwent a Langenskiöld procedure with release of Vickers' ligament for Madelung's deformity of the wrist. They were recalled for function evaluation and their results are presented in the current study. Results: We report the long term results of three patients (five wrists) who underwent a Langenskiöld procedure with release of Vickers' ligament in detail. Mean follow-up was twelve years (range: 11 -14 years). In all of the operated wrists severe pain recurred due to destruction of the distal radio-ulnar joint. Further salvaging surgeries were necessary, some with highly dissatisfying results. Conclusions: Based on our experience we advise not to perform this procedure until further studies have proven its effectiveness and clear indications. Other techniques are available for later correction of Madelung's deformity, with similar results on pain relief, wrist function and cosmetics. However, we will advocate conservative treatment until skeletal maturity is reached.

Madelung deformitesi

“…Bu işlem genelikle Langenskiold prosüdürü olarak anılan fizyoliz ile birlikte uygulanır. [23] El bilek volarinde fleksör karpi radyalis önemli iyileşmeler sağlamaktadır. Bu düzeltmeler ters açık kama ve kubbe osteotomilerdir.…”

Madelung's Deformity of the Wrist—Current Concepts and Future Directions

“…Historically, the most favored operative solution is a "Vickers" ligament release combined with a physiolysis, often referred to as the Langenskiö ld procedure. 15 During this operation, the "Vickers" ligament is released from its proximal attachment to the radial metaphysis. Physeal bars or bony bridges are resected and the physis is interposed with fat.…”