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. 2019 Nov;14(6):725-734.
doi: 10.1177/1558944718793179. Epub 2018 Aug 13.

Surgical Management of Madelung Deformity: A Systematic Review

Abbas Peymani  1   2 , Anna Rose Johnson  2 , Arriyan S Dowlatshahi  2 , Johannes G G Dobbe  1 , Samuel J Lin  2 , Joseph Upton  2 , Geert J Streekstra  1 , Simon D Strackee  1
Affiliations

Surgical Management of Madelung Deformity: A Systematic Review

Abbas Peymani et al. Hand (N Y). 2019 Nov.

Abstract

Background: Madelung deformity is a congenital wrist condition characterized by volar subluxation of the wrist caused by premature growth arrest of the distal radius. Progressive symptoms can necessitate surgical intervention, yet optimal treatment strategy remains unknown. The aim of this study is to determine treatment options, surgical indications, and operative outcomes for Madelung deformity. Methods: This study adhered to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive systematic review was performed to identify all studies describing surgical interventions for Madelung deformity. All studies were evaluated by level of evidence and a self-developed quality assessment tool. Results: Twenty-five studies met inclusion criteria; all case series with type IV level of evidence. Studies assessed pain, range of motion, aesthetic deformity, and grip strength. The primary indication for surgery was the presence of wrist pain. Various surgical procedures exist and could be categorized as radial lengthening, ulnar shortening, or a combination of both. All studies report postoperative pain reduction and most studies report an improved range of motion. Conclusions: A variety of surgical procedures reportedly have satisfactory outcomes. However, outcomes are reported in an inconsistent manner, prohibiting pooling of studies and comparisons of surgical procedures and their outcomes. We propose several methodological changes for implementation in future studies, increasing the quality of evidence to compensate for small patient numbers.

Keywords: Madelung deformity; congenital hand; hand surgery; osteotomy; wrist.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram.
Figure 2.
Figure 2.
Madelung deformity protocol for use in future studies. Note. PROM = Patient Reported Outcome Measures.
See this image and copyright information in PMC

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