Surgical Treatment of Madelung Deformity in Pediatric Patients

Background Madelung deformity is a rare congenital wrist condition characterized by the premature growth arrest of the distal radial physis, leading to wrist deformity and functional limitations. This study aimed to assess the short-term functional and radiological outcomes in patients with Madelung deformity treated surgically at two Moroccan hospitals. Methods This retrospective descriptive study included five skeletally immature patients (seven wrists) who underwent surgical treatment for Madelung deformity between January 2014 and July 2024. Patients underwent distal radial dome osteotomy, often combined with ulnar shortening osteotomy and Vickers ligament release. Outcomes were assessed using the Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale for pain and satisfaction, range of motion measurements, and radiographic parameters. Results The median follow-up was 39.2 months. Postoperatively, improvements were observed in most range of motion parameters, except in flexion. The median PRWE score improved (11/100 to 4/100), and patients reported high satisfaction with aesthetic outcomes. Radiographic parameters showed substantial median corrections in ulnar tilt (-12°; -28° to -4°), lunate fossa angle (-13°; -24° to 1°), lunate subsidence (-6 mm; -15 mm to -3 mm), palmar displacement (-11 mm; -14 mm to -8 mm), and palmar tilt (-29°; -50° to -28°). Two wrists required reoperation due to complications or insufficient correction. Two siblings with Léri-Weill syndrome demonstrated contrasting outcomes based on the timing of intervention and initial deformity severity. Conclusion Combined radial and ulnar osteotomies improved pain, function, and radiographic parameters in adolescents with symptomatic Madelung deformity in the short to medium term. Early diagnosis and intervention may lead to better outcomes. Larger, prospective studies with longer follow-up are needed to establish optimal treatment algorithms and long-term outcomes.