Madelung’s deformity: distal radioulnar joint re-optimization

Background Although Madelung’s deformity (MD) is believed to be a rare congenital anomaly of the wrist, the symptoms do not manifest till late childhood. It is caused by asymmetric growth at the distal radial physis secondary to premature and partial volar–ulnar-sided arrest, and a thickened radiolunate volar ligament (Vickers ligament) that creates a tether across that physis segment, restricting growth across it. Radial growth disturbance causes the distal radius to deform in the coronal (increasing radial inclination) and sagittal (increasing volar tilt) planes, and eventually lead to a progressive, three-dimensional wrist deformity including radiocarpal and distal radioulnar joint (DRUJ) malalignment. Various techniques for the surgical management of MD have been described, but clear evidence to support the use of any single approach is lacking. Patients and methods Eight wrists in six patients with MD were included in this study. All patients underwent combined radial biplane closing wedge osteotomy above Vickers’ ligament radial origin, which allowed for three-dimensional correction of the deformity and reposing of the ligament, making it easy to achieve more congruity of the DRUJ, and temporary fixation with dual percutaneous K-wires of the DRUJ in the achieved re-optimized new components’ correlation. Results At 22 months of an average follow-up, patients were satisfied with the appearance of their wrists and forearms. The range of active pain-free wrist movements improved notably in supination and extension, correction toward normal values for the mean measurements of radiographic parameters was reported, and the DRUJ was congruent with sustained improvement of its mean gap distance at the latest follow-up radiographs. Conclusion This technique seems to be safe and can reliably restore hand–forearm alignment with respect to DRUJ re-optimization through the redesigned distal radial alignment in both coronal and sagittal planes, and improve joint congruity.