Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up

Suzanne Steinman, Scott Oishi, Janith Mills, Patricia Bush, Lesley Wheeler, Marybeth Ezaki
Journal of Bone and Joint Surgery. American Volume 2013 July 3, 95 (13): 1198-204

BACKGROUND: Madelung deformity is a disorder of growth of the distal aspect of the radius that is usually recognized in late adolescence near skeletal maturity. It results in a characteristic wrist deformity, decreased wrist motion, and wrist pain. The purpose of this study was to evaluate long-term results in patients treated by volar ligament release and distal radial dome osteotomy for Madelung deformity.

METHODS: Patients who had undergone volar ligament release and dome osteotomy for Madelung deformity at our institution from 1990 to 2002 and who were the subjects of a previous report on this treatment were contacted for clinical and radiographic evaluation at mid-term to long-term follow-up. Forearm and wrist motion was evaluated. Posteroanterior and lateral radiographs of both forearms were assessed for radial inclination, lunate subsidence, and arthritis changes. A Disabilities of the Arm, Shoulder and Hand (DASH) survey was completed.

RESULTS: Twenty-seven patients underwent volar ligament release and distal radial dome osteotomy. Eight patients were either lost to follow-up or were unable to return for follow-up. Nineteen patients with thirty-one operatively treated wrists were available for follow-up. After further review, eighteen patients and twenty-six wrists were included in the study. The average age at the time of follow-up was twenty-five years (range, nineteen to thirty-one years), with an average length of follow-up of eleven years (range, seven to fourteen years). There was no change in radial inclination or in wrist motion between the immediate postoperative and long-term follow-up evaluations. There was a positive correlation between the amount of deformity correction based on more severe preoperative parameters and an increased arthritic grade at the time of follow-up. There was positive correlation between an increased DASH score and arthritis grade as well as a correlation between whole bone deformity and increased arthritis grade and DASH score.

CONCLUSIONS: Volar ligament release and distal radial dome osteotomy for Madelung deformity provides lasting correction of the deformity. Long-term follow-up shows maintenance of original radiographic correction with good to excellent functional outcome. Patients with radiographic evidence of more severe disease preoperatively and the whole bone variety of Madelung deformity have poorer radiographic outcomes and trend toward poorer functional outcomes.

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