Treatment of Madelung's deformity

Treatment of Madelung's deformity is still controversial. We reviewed retrospectively 19 patients with Madelung's deformity (two bilateral, 21 cases) who underwent surgery to the radius and ulna to improve range of motion, decrease pain and improve appearance of the wrist. Nineteen patients underwent 21 distal radial osteotomy procedures using three different techniques: subtraction, addition or dome osteotomy. Ulnar shortening and redirection of the distal ulna was performed in 12 cases; a long oblique osteotomy was used in 10 of these cases. The Sauvé-Kapandji technique was performed in five cases, an ulnar distal epiphysiodesis in two cases and a combination of osteotomy and epiphysiodesis in one case. The aim was to reduce the distal radial slope and to restore the orientation and congruity of the distal radio-ulnar joint and to improve its function. Pain was reduced as a result of the procedure: more than 75% of the cases had no or intermittent pain at the review. Pronation improved from 63° to 68° (P=0.467, not significant) and supination improved from 48° to 72° on average (P=0.034, significant). Grip strength increased from 11 to 18 kgf (P=0.013, significant). Madelung's deformity is not always a benign condition and it responds well to corrective osteotomies.