gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Computer Assisted Double Osteotomy (CADO) for Madelung Disease – A New Approach of Treatment

Meeting Abstract

  • presenting/speaker Julian Suarez-Gomez - Fundacion Universitaria de Ciencias De La Salud, Hospital de San Jose, Bogota, Colombia
  • Julian Hernandez-Beltran - Fundacion Universitaria de Ciencias De La Salud, Hospital de San Jose, Bogota, Colombia
  • Dario Fernandez-Loaiza - Fundacion Universitaria de Ciencias De La Salud, Hospital de San Jose, Bogota, Colombia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1377

doi: 10.3205/19ifssh1425, urn:nbn:de:0183-19ifssh14253

Published: February 6, 2020

© 2020 Suarez-Gomez et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives/Interrogation: Establish the applicability and reproductibility for the treatment of an advanced case of Madelung Deformity (MD) in a young patient using computer assisted double osteotomy (CADO).

Methods: It was the case of a 12 year old female with an advanced bilateral MD who was seen in our Hospital with complains of progressive deformity, pain and limitation of wrist extension. Initially it was planed to perform a CADO using X rays and CAT scan with tridimensional reconstruction, determinating the length of the ulna, radius and the radioulnar joint angles, then comparing the results with the same meassurements of a healthy person of same sex, age and height, same measures that were used as a mold to develp customized cutting guides and fixation plates for both extremities performing the surgeries at first for the left forearm and 6 months later after gaining full recovery for the right forearm. Also an epiphysiodesis of the ulna was performed on each side to stop its growth to prevent an ulnar impactation syndrome in the future. The patient's bone angles, range of motion of the radioulnar and radiocarpal joints, grip stength were measured preoperative. Recovery was followed with the Quick DASH scale and X rays to follow the consolidation of the osteotomies as well as all the same parameters were measured.

Results and Conclusions: Applying CADO led to a short intraoperatory time, improvement in exact location for the osteotomies, leaving enough bone to place the fixation plate and good bone surface contact in the osteotomies places to allow correct consolidation and start early rehabilitation. The patient's deformity, arcs of movement of the radioulnar and radiocarpal joints, grip strength and pain improved and were demonstrated with the measures in the Quick DASH scale.

In the case of this young age patient with an uncommon pathology with advanced deformity and functional limitation, the decision was made to operate applying the CADO instead of the usual release of the Vicker's ligament and performing an epiphysiolisis, as it was considered not indicated based on the severity of her case, nor waiting for a more advanced age to perform a Sauve-Kapandji or another salvage procedure. It was found that applying a CADO using the measures of a healthy person of the same sex, height and age as a mold to develop cutting guides and a customized fixation plate, gave a much better aesthetic and functional result than with the conventional treatments.