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Surgical correction of Madelung’s deformity by combined corrective radioulnar osteotomy: 14 cases with four-year minimum follow-up

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Abstract

Fourteen wrists in 11 girls, mean age 13.3 years (range 9–16) at surgery, were treated for Madelung’s deformity. The presenting complaint was incapacitating pain. All were treated by radial closing wedge osteotomy and ulnar shortening osteotomy. The dorsal retinaculum was also surgically repaired in six cases. At a mean follow-up of 5.1 years (range 4–8.75), we observed improved range of motion in both flexion/extension and pronation/supination and absence of pain during daily activity. Radiographically, positioning of the distal radial articular surface and lunate subsidence were improved. Union was obtained after all osteotomies without secondary procedures. Posterior displacement of the ulnar head persisted in two wrists. Combined radioulnar osteotomy restored the anatomy to as near normal as possible. This technique provides satisfactory and encouraging results and does not compromise the surgical future of the wrist. However, longer follow-up is required to assess recurrence or possible long-term degenerative consequences.

Resumé

Quatorze poignets chez 11 filles d’âge moyen 13,3 ans (9–16) à la chirurgie, ont été traités pour une déformation de Madelung. La douleur était la plainte principale. Tous les patients ont bénéficié d’une ostéotomie cunéiforme radiale de fermeture associée à un raccourcissement de l’ulna. Une plastie du retinaculum dorsal a été associée dans 6 cas. Au recul moyen de 5,1 ans (4–8,75), nous avons observé une amélioration des amplitudes articulaires aussi bien en flexion/extension qu’en pronation/supination avec absence de douleur lors des activités quotidiennes. Radiographiquement, l’orientation de la glène radiale ainsi que la subsidence du lunatum ont été améliorées. Toutes les ostéotomies ont consolidé en première intention dans des délais normaux. Un déplacement postérieur de la tête ulnaire persistait dans 2 cas. L’ostéotomie combinée radio-ulnaire permet de restaurer une anatomie le plus proche de la normale. Cette technique offre des resultants satisfaisants et encourageants et ne compromet pas le devenir chirurgical de ces poignets. Cependant, des études avec un plus long recul sont nécessaires afin de rechercher d’éventuelles récidives ou de possibles conséquences dégénératives à plus long terme.

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, Hôpital des Enfants, avenue de Grande Bretagne, Toulouse, France

    Jean-Michel Laffosse, Abdelaziz Abid, Frank Accadbled, Gorka Knör, Jérôme Sales de Gauzy & Jean-Philippe Cahuzac

  2. Service de Chirurgie Orthopédique et Traumatologique, CHU de Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France

    Jean-Michel Laffosse

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  1. Jean-Michel Laffosse
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  2. Abdelaziz Abid
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  3. Frank Accadbled
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  4. Gorka Knör
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  5. Jérôme Sales de Gauzy
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  6. Jean-Philippe Cahuzac
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Correspondence to Jean-Michel Laffosse.

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Laffosse, JM., Abid, A., Accadbled, F. et al. Surgical correction of Madelung’s deformity by combined corrective radioulnar osteotomy: 14 cases with four-year minimum follow-up. International Orthopaedics (SICOT) 33, 1655–1661 (2009). https://doi.org/10.1007/s00264-008-0711-z

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