gms | German Medical Science

Objectives/Interrogation: The malformation of the wrist joint in case of Madelung deformity is characterized by shortening of the ulnar part of the radius with increased palmar shift and angulation leading to increased radial inclination and incongruency at the DRUJ with dorsal displacement of the ulnar head. Usually the patients if symptomatic are seen in young age with painful restricted forearm rotation. Indication for correction is based on complaints of the patient and the goal to prevent rapid osteoarthritic changes. Additionally the deformed wrist joint with the prominent ulnar head should be corrected from patients point of view for aesthetic reasons.

Methods: Corrective osteotomy was performed in 24 patients by an oblique open wedge osteotomy at the ulnar side. An open book technique was used leaving the radial cortex intact. The ulnar part was lifted to the level of the ulnar head. By bending a fixed angle corrective plate straight the palmar shift was corrected by plate fixation. The osteotomy gap was left open. In 2 cases due to significant bending of the radius shaft double osteotomy was done distal and at the radius shaft.

Results and Conclusions: All osteotomies showed primary healing without loss of reduction. 22 patients would have the procedure again. Significant pain relief was seen in 18 patients. ROM showed no significant change. From aesthetic point of view 23 patients were satisfied and felt real improvement. One patient where due to severe malformation a second correction was done remained still unhappy with the result.

Corrective osteotomy at the distal radius lead to improvement of the malformed wrist joint in Madelung deformity. With fixed angele plates there is no more need for bonegraft. If arthritic changes can be decreased or even prevented will be examined by longtime follow-up.