The result of correction osteotomy of the radius and shortening osteotomy of the ulna for Madelung Deformity and literature review.

Yıl 2017, , 119 - 124, 19.04.2017

Ahmet Salduz , Murat Korkmaz , Kayahan Karaytuğ , Ömer Naci Ergin Hayati Durmaz

https://doi.org/10.21673/anadoluklin.296594

Öz

Background: Madelung deformity is a rare condition characterized by premature
growth arrest of the volar–ulnar aspect of the distal radius growth plate. Different
surgical procedures are described in the literature. In this study, we aim to
present functional and clinical results of our technique in five wrists of 4
patients.

Methods: 5 wrists of 4 patients (3 females and 1 male) underwent surgery for
Madelung deformity in our clinic between 2005-2014. Mean age of the patients
was 15,4 (14-17) and mean follow up duration was 65,6 months (29-111). One
patient had bilateral deformity. Patients were evaluated with wrist ROM, DASH
and VAS score pre and post-operatively. Corrective osteotomy to the radius,
shortening osteotomy to the ulna and release of the Vickers ligament were
performed on all patients.

Results: Although there were no meaningful changes in the range of supination-pronation;
palmar flexion was decreased; and dorsiflexion and radial deviation were significantly
higher in the last follow-up compared to the preoperative values. Union was
achieved at the all osteotomy sites. All radiological parameters were
significantly better in the last follow-up x-rays. Preoperative and
postoperative mean DASH score was 55,4 and 18,8, respectively and preoperative
and postoperative mean VAS score was 6 and 1, respectively.

Conclusions:
This surgical technique may be a good option for
severe Madelung deformity in terms of functional and radiological results and patient
satisfaction in the midterm follow-up. Pain and gross deformity were our main
surgical indications.

Anahtar Kelimeler

Madelung deformity, Osteotomy, Wirst, Radius, Ulna

Madelung Deformitesinde Radius Düzeltici, Ulna Kisaltıcı Osteotomi Sonuçları: Olgu serisi

Öz

Amaç: Madelung deformitesi, radius distal büyüme plağının volar ve ulnar
tarafında erken büyüme duraklaması ile tanımlanan nadir bir deformitedir.
Literaturde farklı cerrahi girişimler tanımlanmıştır. Bu çalışmada Madelung
deformitesinde kullandığımız cerrahi tekniğin klinik ve radyolojik sonuçlarını
değerlendirmeyi amaçladık. 

Gereç ve Yöntem: 2005-2014 yılları arasında kliniğimzide dört hastanın 5 elbileği (3 bayan, 1 erkek) Madelung deformitesi
nedeni ile opera edildi. Hastaların ortalama yaşı 15.4 (14-17) ve ortalam takip
süresi 65 (29-111) ay idi. Bir hastada bilateral deformite vardı. Hastalar
ameliyat öncesi ve sonrası eklem hareket açıklığı, DASH ve VAS skorları ile
değerlendirildi. Tüm hastalara radius düzeltici osteotomi, ulna kısaltıcı
osteotomi ve vicker ligaman gevşetme ameliyatı yapıdı.

Sonuçlar: Hastaların son kontrollerindeki eklem hareket açıklıkları ameliyat
öncesi değerler ile karşılaştırıldığında; dorsifleksiyon ve radial deviasyon
aralığı anlamlı olarak artarken palmar fleksiyon arkı azaldı. Supinasyon ve
pronasyon aralığında anlamlı bir değişiklik izlenmedi. Tüm osteotomi alanlarında kaynama izlendi. Son takip
röntgenlerinde tüm radyolojik parametreler ameliyat öncesine göre anlamlı
olarak daha iyiydi. Ameliyat öncesi ve sonrası ortalama DASH skoru sırasıyla
55.4 ve 18.8 iken, ameliyat öncesi ve sonrası VAS skoru sırasıyla ortalama 6 ve
1 idi. 

Çıkarımlar: İleri Madelung deformitesi olan hastalarda bu cerrahi teknik hasta
memnuniyeti, fonksiyonel ve radyolojik sonuçlar bakımından iyi bir seçenek
olabilir. Ağrı ve belirgin deformite bizim ana cerrahi
endikasyonumuz oldu. 

Anahtar Kelimeler

Madelung deformitesi, Osteotomi, Elbileği, Radius, Ulna

Kaynakça

• 1. Madelung W. Die spontane Subluxation der Hand nach vorne. Verhandlungen der Deutschen Gesellschaftfur Chirurgie,. 1878;7:259-76.
• 2. Dobyns JH, editor. Madelung's Deformity. Third ed. Newyork: Churchill Livingstone 1993.
• 3. Dubey A, Fajardo M, Green S, Lee SK. Madelung's deformity: a review. J Hand Surg Eur Vol. 2010 Mar;35(3):174-81. PubMed PMID: 20007414. Epub 2009/12/17. eng.
• 4. Mohan V, Gupta RP, Helmi K, Marklund T. Leri-Weill syndrome (dyschondrosteosis): a family study. J Hand Surg Br. 1988 Feb;13(1):16-8. PubMed PMID: 3361200. Epub 1988/02/01. eng.
• 5. Golding JS, Blackburne JS. Madelung's disease of the wrist and dyschondrosteosis. J Bone Joint Surg Br. 1976 Aug;58(3):350-2. PubMed PMID: 956255. Epub 1976/08/01. eng.
• 6. dos Reis FB, Katchburian MV, Faloppa F, Albertoni WM, Laredo Filho J, Jr. Osteotomy of the radius and ulna for the Madelung deformity. J Bone Joint Surg Br. 1998 Sep;80(5):817-24. PubMed PMID: 9768892. Epub 1998/10/13. eng.
• 7. Ranawat CS, DeFiore J, Straub LR. Madelung's deformity. An end-result study of surgical treatment. J Bone Joint Surg Am. 1975 Sep;57(6):772-5. PubMed PMID: 1158912. Epub 1975/09/01. eng.
• 8. Houshian S, Jorgsholm PB, Friis M, Schroder H, Weeth R. Madelung deformity treated with Ilizarov technique: a report of two cases. J Hand Surg Br. 2000 Aug;25(4):396-9. PubMed PMID: 11058013. Epub 2000/11/01. eng.
• 9. Harley BJ, Brown C, Cummings K, Carter PR, Ezaki M. Volar ligament release and distal radius dome osteotomy for correction of Madelung's deformity. J Hand Surg Am. 2006 Nov;31(9):1499-506. PubMed PMID: 17095381. Epub 2006/11/11. eng.
• 10. Burrows HJ. An Operation for the Correction of Madelung's Deformity and Similar Conditions: (Section of Orthopaedics). Proc R Soc Med. 1937 Mar;30(5):565-72. PubMed PMID: 19991053. Pubmed Central PMCID: 2076015. Epub 1937/03/01. eng.
• 11. Salon A, Serra M, Pouliquen JC. Long-term follow-up of surgical correction of Madelung's deformity with conservation of the distal radioulnar joint in teenagers. J Hand Surg Br. 2000 Feb;25(1):22-5. PubMed PMID: 10763717. Epub 2000/04/14. eng.
• 12. Schmidt-Rohlfing B, Schwobel B, Pauschert R, Niethard FU. Madelung deformity: clinical features, therapy and results. J Pediatr Orthop B. 2001 Oct;10(4):344-8. PubMed PMID: 11727381. Epub 2001/12/01. eng.
• 13. Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992 Aug;17(4):401-7. PubMed PMID: 1402266. Epub 1992/08/01. eng.
• 14. Steinman S, Oishi S, Mills J, Bush P, Wheeler L, Ezaki M. Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up. J Bone Joint Surg Am. 2013 Jul 3;95(13):1198-204. PubMed PMID: 23824388. Epub 2013/07/05. eng.
• 15. Houshian S, Schroder HA, Weeth R. Correction of Madelung's deformity by the Ilizarov technique. J Bone Joint Surg Br. 2004 May;86(4):536-40. PubMed PMID: 15174549. Epub 2004/06/04. eng.
• 16. Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol. 1995 Feb;24(2):91-4. PubMed PMID: 7747190. Epub 1995/02/01. eng.
• 17. AE F. Congenital hand anomalies St Luis: CV Mosby. 1977.
• 18. Yang Z, Mann FA, Gilula LA, Haerr C, Larsen CF. Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist. Radiology. 1997;205(3):865-9.
• 19. Luchetti R, Mingione A, Monteleone M, Cristiani G. Carpal tunnel syndrome in Madelung's deformity. J Hand Surg Br. 1988 Feb;13(1):19-22. PubMed PMID: 3361201. Epub 1988/02/01. eng.
• 20. Baskir O DU, Cakmak M, Yazicioglu O, Kokino M. Madulung deformity and its surgical treatment. Acta Orthop Traumatol Turc. 1979;Vol 13(No 4 ):250-9.