Surgical correction of Madelung’s deformity by combined corrective radioulnar osteotomy: 14 cases with four-year minimum follow-up

Abstract

Fourteen wrists in 11 girls, mean age 13.3 years (range 9-16) at surgery, were treated for Madelung's deformity. The presenting complaint was incapacitating pain. All were treated by radial closing wedge osteotomy and ulnar shortening osteotomy. The dorsal retinaculum was also surgically repaired in six cases. At a mean followup of 5.1 years (range 4-8.75), we observed improved range of motion in both flexion/extension and pronation/ supination and absence of pain during daily activity. Radiographically, positioning of the distal radial articular surface and lunate subsidence were improved. Union was obtained after all osteotomies without secondary procedures. Posterior displacement of the ulnar head persisted in two wrists. Combined radioulnar osteotomy restored the anatomy to as near normal as possible. This technique provides satisfactory and encouraging results and does not compromise the surgical future of the wrist. However, longer follow-up is required to assess recurrence or possible long-term degenerative consequences.Resumé Quatorze poignets chez 11 filles d'âge moyen 13,3 ans (9-16) à la chirurgie, ont été traités pour une déformation de Madelung. La douleur était la plainte principale. Tous les patients ont bénéficié d'une ostéotomie cunéiforme radiale de fermeture associée à un raccourcissement de l'ulna. Une plastie du retinaculum dorsal a été associée dans 6 cas. Au recul moyen de 5,1 ans (4-8,75), nous avons observé une amélioration des amplitudes articulaires aussi bien en flexion/extension qu'en pronation/supination avec absence de douleur lors des activités quotidiennes. Radiographiquement, l'orientation de la glène radiale ainsi que la subsidence du lunatum ont été améliorées. Toutes les ostéotomies ont consolidé en première intention dans des délais normaux. Un déplace-ment postérieur de la tête ulnaire persistait dans 2 cas. L'ostéotomie combinée radio-ulnaire permet de restaurer une anatomie le plus proche de la normale. Cette technique offre des resultants satisfaisants et encourageants et ne compromet pas le devenir chirurgical de ces poignets. Cependant, des études avec un plus long recul sont nécessaires afin de rechercher d'éventuelles récidives ou de possibles conséquences dégénératives à plus long terme.

Radiographic Criteria for Undergoing an Ulnar Shortening Osteotomy in Madelung Deformity

“…2,5,9,[14][15][16][17][18] Surgical treatment is typically reserved for adolescents with pain, functional limitations, and/or progressive deformity failing nonoperative treatment and should be tailored to each affected wrist. Radius dome osteotomy is a useful procedure to reliably correct the increased radial tilt present in almost all cases.…”

Madelung’s Deformity: Reverse Wedge Osteotomy of the Distal Radius Associate Ulnar Wedge Osteotomy: A Case Report

“…The treatment is surgical; several techniques have been described [9]. The cuneiform reversal osteotomy (OCR), which we have used, makes it possible to reorient the radial glenus by modifying as little as possible the overall length of the radius.…”

“…It relieves the pressure in this compartment while tightening the internal structure of the ligament [9]. The OCR associated with a subtraction osteotomy of the ulna seems to us easier technically because without maneuver of force, nor bone removal at a distance and allows significantly improve the patient's daily life.…”

Jaccoud's Arthropathy with Radial Shaft Deformity in a Patient with a History of Mild Carditis and Sydenham's Chorea

“…One important differential diagnosis that should be considered is Madelung' s deformity. This is a condition characterized by ulnar and dorsal curvature of the distal radius due to deficient growth of the volar and ulnar aspect of the distal radial physis, increased inclination of the distal radial joint surface, triangulation of the corpus with proximal and volar migration, and prominent dorsal subluxation of the ulnar head [20,21]. The deformity usually presents in late childhood or adolescence, is more common in females, and is usually bilateral [22].…”