Very distal radial osteotomy for Madelung's deformity

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.