[Madelung deformity: isolated ulnar wedge osteotomy]

Abstract

Objectives: Madelung deformity is defined as a partial closure of the medial half of the distal radial growth plate, with anatomical consequences (wrist deformity), and functional impairment (decrease range of motion, loss of grip strength, and wrist pain). We report a new surgical procedure including a shortening of the ulna combined with slight anterior flexion osteotomy aiming to correct the radio-ulnar dislocation and to improve the range of forearm rotation, without correcting the global deformity.

Methods: This was a retrospective study of four symptomatic wrists in three patients. The follow-up was 24 months. Patients were assessed clinically and radiologically pre and post operatively. The ulnar shaft was shortened and anteriorly flexed through a dorsal and ulnar approach and fixed with a fitted internal DCP plate. The aim of this osteotomy was to reduce the dislocated distal radio-ulnar joint.

Results: At 24 months follow-up, the function was considerably improved with a correction of the ulno-carpial conflict. The range of painfree forearm rotation improved. The post-operative views showed a correction of the dorsal dislocation of the ulnar head.

Conclusion: This technique seemed to be safe and demonstrated good results in these four wrists. It should be proposed in patients with Madelung deformity and assessed prospectively.