Radial opening wedge osteotomy in Madelung's deformity

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Pediatric Orthopedics

Background:

• Madelung's deformity presents with wrist pain, limited motion, and cosmetic concerns.
• Radiographic findings include decreased radioulnar angle and ulnar head subluxation.
• Generalized dyschondrosteosis may be associated with Madelung's deformity.

Purpose of the Study:

• To evaluate the efficacy of radiopalmar opening wedge osteotomy in treating Madelung's deformity.
• To assess improvements in pain, wrist function, and radiographic parameters.

Main Methods:

• Biplanar corrective opening wedge osteotomy of the radius with iliac crest graft.
• Surgical technique included optional ulnar recession, plate/Kirschner wire fixation, and external fixation.
• 11 female patients (12 wrists) with Madelung's deformity underwent the procedure.

Main Results:

• Satisfactory pain relief was achieved in all patients.
• Forearm length and bowed appearance improved, with improved radioulnar joint reduction.
• Radioulnar angle improved by 11 degrees; range of motion and grip strength were unchanged. Lunate subluxation showed minimal change.

Conclusions:

• Radiopalmar opening wedge osteotomy is an effective treatment for Madelung's deformity, significantly improving pain and cosmetic appearance.
• While radiographic alignment improves, functional outcomes like range of motion and grip strength remain unaffected.
• The procedure offers a viable surgical option for patients with Madelung's deformity, particularly those with associated dyschondrosteosis.