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. 2023 Mar;18(2_suppl):17S-23S.
doi: 10.1177/15589447211017223. Epub 2021 Jun 6.

Madelung Deformity: Radioscapholunate Arthrodesis With a Neo-DRUJ

Annelinde R Piek  1 , Abbas Peymani  1 , Johannes G G Dobbe  1 , Geert A Buijze  1   2 , Michel Chammas  2 , Geert J Streekstra  1 , Simon D Strackee  1
Affiliations

Madelung Deformity: Radioscapholunate Arthrodesis With a Neo-DRUJ

Annelinde R Piek et al. Hand (N Y). 2023 Mar.

Abstract

Background: Madelung deformity is a rare wrist anomaly that causes considerable pain while restricting function. In this study, we describe a radioscapholunate (RSL) arthrodesis with a neo-distal radioulnar joint (DRUJ) in Madelung deformity patients with an abnormal sigmoid notch and compare results to patients after a reverse wedge osteotomy.

Methods: Six wrists underwent RSL arthrodesis with a neo-DRUJ in a two-phase approach: (1) modified RSL arthrodesis with triquetrectomy; and (2) distal scaphoidectomy. Seven wrists underwent a reverse wedge osteotomy procedure.

Results: There were no differences found in postoperative pain, grip strength, or range of motion (ROM), apart from extension, which was decreased after RSL arthrodesis with a neo-DRUJ. Quality of life and Michigan Hand Outcomes Questionnaire scores were similar.

Conclusions: Although clinical outcome parameters are not different among the two groups, the RSL arthrodesis with construction of a neo-DRUJ could prove a valid treatment option for a subset of patients with a severely affected sigmoid notch.

Keywords: Madelung deformity; radial osteotomy; radiocarpal joint; radioulnar joint; reconstruction; reverse wedge osteotomy; sigmoid notch; wrist.

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Conflict of interest statement

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.
Preoperative distal radioulnar joint (DRUJ) of a patient who underwent radioscapholunate arthrodesis with a neo-DRUJ (left) and preoperative DRUJ of a patient who underwent reverse wedge osteotomy (right).
Figure 2.
Figure 2.
(a) The distal radius is shortened by carving out a piece of bone and replacing it by the scaphoid and lunate. The proximal articular surfaces of the lunate and scaphoid are dechondrified. The triquetrum is released and excised. (b) The scaphoid and lunate are fixated to the dorsal radius using a L-plate 2.4 and locking screws. The ulnar side of the lunate will articulate with the ulnar head as a neo-distal radioulnar joint (DRUJ). (c) Neo-DRUJ showing articulation with the capitate and ulnar bone. Note that the distal pole of the scaphoid (Figure 2b) is excised.
Figure 3.
Figure 3.
Preoperative (a) posteroanterior and (b) lateral radiographs, and postoperative (c) posteroanterior and (d) lateral radiographs of a patient who underwent radioscapholunate arthrodesis with a neo-distal radioulnar joint.
Figure 4.
Figure 4.
Preoperative (a) posteroanterior and (b) lateral radiographs, and postoperative (c) posteroanterior and (d) lateral radiographs of a patient who underwent reverse wedge osteotomy.
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