Very Distal Radial Osteotomy For Madelung's Deformity

Abstract

Madelung's deformity results from arrested or slowed growth of the volar-palmar portion of the distal radial epiphysis. The deformity is characterized by increased volar and ulnar tilt of the articular surface of the radius and a bow of the distal radius in a palmar direction. When Madelung's deformity produces pain and interferes with function, correction of the deformity of the radius and secondary overgrowth of the ulna is desirable. Although osteotomy of the radius near the junction of the middle and distal thirds allows correction of the bow of the radius and limited correction of palmar tilt, it does not permit correction of ulnar tilt. We describe a very distal radial osteotomy that permits correction of the 3 deformities of the distal radius independently; correction of palmar tilt, ulnar tilt, and the bow of the radius are selected individually. The inherent flexibility makes the procedure technically challenging but allows for maximum independent correction of the components of Madelung's deformity. Early results indicate the procedure provides relief of pain and improved appearance with few complications.

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

“…Addition and subtraction wedge osteotomies; reverse wedge osteotomy; and segmental (double) radius osteotomy fixated with wires, plates, and external fixator and either associated or not to ulnar shortening have all been described. 1,2,16,17 Despite satisfactory results of most techniques, the concept of a radial lengthening and angulation osteotomy does allow the best possible correction of carpal subluxation and lunate stabilization.…”

Inverse Hemikallotasis zur Korrektur einer ausgeprägten Madelungschen Deformität

“…In der Literatur sind verschiedene Verfahren zur Korrektur der Madelungschen Deformität beschrieben. In der Regel erfolgt die Korrektur am distalen Radius entweder durch eine einzeitige "open wedge", eine "closing wedge" oder eine "dome osteotomy" [2][3][4][5][6][7]. Dabei müssen die Längenverhältnisse zwischen Elle und Speiche balanciert werden.…”

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

“…It occurs predominantly in females [10] and bilaterally [1] [19]. During the growth spurt the deformation gradually worsens until the physis has closed completely [15].…”

“…However, several surgical methods with varying results have been designed to correct the deformity. These can be grossly divided into three groups: 1) correction of the radius (the bowing and volar tilt of the articular surface) [20]- [22]; 2) correction of the ulna (the length and luxation of the ulnar head and the DRUJ) [23]- [25]; 3) combined correction of radius and ulna [14] [19] [25]- [28]. These techniques are generally applied at skeletal maturity.…”

“…Symptoms include wrist pain, fatigue during strenuous activities and a displeasing cosmetic aspect of the deformed wrist [7] [15] [18]. The range of motion (ROM) of the wrist and forearm is impaired [1] [11] [12] [19]. Pain usually subsides once skeletal maturity is reached, but may arise again due to incongruity of the distal radio-ulnar joint (DRUJ) [2] [12].…”