Lunate Grafting Into the Radius for Lunate Fossa Reconstruction in Madelung Deformity

Oliveira, Ricardo Kaempf de; Delgado, Pedro J.; Ribak, Samuel; Bertelli, Jayme Augusto; Marques, Fabiano da Silva

doi:10.1016/j.jhsa.2018.01.014

Cited by 7 publications

(12 citation statements)

References 7 publications

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“…Those wrist anatomical changes induce clinical worsening of patients who report pain and functional impairment. 1,4 The ideal timing for the treatment of MD is also under debate in the literature. Vickers and Nielsen 5 were the first to stress that the best period for treating MD is during the early phase of the disease, when the patient still has open physes and with no degenerative signs.…”

Section: Discussionmentioning

confidence: 99%

“…The initial idea of a simple, obvious procedure with intra-articular osteotomy and bone grafting seems too much aggressive to an already diseased carpus, with a high probability of leading to joint stiffness and increased pain. 4 Therefore, we decided to use the dysplastic distal radius for joint reconstruction. An adequate lunate bone cover and support is obtained by means of an extraarticular osteotomy and radial epiphysis rotation.…”

Section: Discussionmentioning

confidence: 99%

“…Those anatomical changes may cause symptoms, including distal ulnar prominence, wrist pain, and motion loss, especially during childhood and adolescence. [1][2][3][4][5] There is a consensus that patients with mild deformities and fewer symptoms can be managed with conservative treatment. MD may be surgically corrected in cases of severe…”

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confidence: 99%

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Shelf Osteotomy for Madelung’s Deformity in Adults: A Novel Technique

Oliveira¹,

Brunelli

Aita

et al. 2021

J Wrist Surg

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Background Madelung's deformity (MD) comprises increased volar and ulnar tilt of the distal radius joint facet, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and a consequent distal ulnar prominence, along with wrist pain and loss of motion. Classic surgical techniques are problematic for adults, as they are specific for children and adolescents whose distal radial physis is still open. Description of Technique It is suggested a new treatment method for MD in skeletally mature patients: a distal radius osteotomy and joint realignment are performed through a volar approach to increase the support area of the lunate bone. The rotation and lengthening of the distal epiphysis of the radius generate support and cover to the lunate bone, with improvement of both radiocarpal and distal radioulnar joints. Patients and Methods We describe the technique in details and report the treatment of a 25-year-old female patient. Results Early clinical and radiographic outcomes are encouraging for the treatment of symptomatic patients. Conclusion There is a plethora on the literature about conflicting opinions on the best treatment options and surgical techniques are quite variable, although usually with good results. Besides, the technique here described is indicated during a specific stage of disease presentation, consisting of young adults without any wrist-degenerative changes. Having said that, it is possible to claim that MD treatment with shelf osteotomy is a concept change. Our main goal is to reconstruct the diseased segment and improve wrist stability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Shelf Osteotomy for Madelung’s Deformity in Adults: A Novel Technique

Oliveira¹,

Brunelli

Aita

et al. 2021

J Wrist Surg

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“…Otra posible indicación de la RM en casos de DM sería para evaluar el potencial de crecimiento de la fisis del radio distal, además de planificar una posible liberación, o para el diagnóstico de procesos degenerativos secundarios en caso de procedimientos quirúrgicos de rescate. [25][26][27] Tomografía computarizada La tomografía computarizada (TC) también es útil para la planificación quirúrgica, especialmente en casos de osteotomías del radio distal y ajustes de la ARCD. 28,29 Tratamiento Tratamiento no quirúrgico Se sabe poco sobre la historia natural de la DM.…”

Section: Imagen De Resonancia Magnéticaunclassified

Madelung Deformity: Diagnosis and Treatment Options

Oliveira

Ribak

Brunelli

et al. 2021

Revista Iberoamericana de Cirugía de la Mano

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Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment.The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology.When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability.We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD.

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“…Eine interessante Lösung empfahlen im Jahr 2018 Kaempf de Oliveira et al [18], die das Lunatum als Span in die distale Radiusgelenkfläche eingesetzt und damit die Gelenkverbindung für den Capitatumkopf unter Exstirpation des Os scaphoideum und Os triquetrum erhalten haben. Diese Methode käme bei unserer Patientin bei Verschlechterung der Schmerzsituation in Betracht.…”

Section: Kasuistikunclassified