Treatment of Madelung’s Deformities

Journal of the Korean Society for Surgery of the Hand 2006;11(3):148-156.
Published online September 1, 2006.

Man-Kue Bae, Seok-Whan Song, Yong-Hoon Kim, Ho-Yeoun Won, Seung-Koo Rhee

Madelung씨 완관절 변형의 치료

배만규, 송석환, 김용훈, 원호연, 이승구

Abstract

Background: Madelung’s wrist deformity can be derived from the congenital early closure of palmar-ulnar physis of wrist in children or from the post-traumatic wrist fractures. Their treatments are very difficult because of complicated wrist deformities, malformed distal radioulnar joint (DRUJ) and triangular fibro-cartilagenous complex (TFCC) etc. Purpose: To define the proper way of surgical correction, and to confirm the deformed TFCC in congenital or post-traumatic Madelung’s deformities. Materials and Methods: Since 1997, total 12 wrists in 8 patients with Madelung’s deformities, 9 congenital (4 bilateral, 1 unilateral) and 3 post-traumatic, were preoperatively evaluated by MRI (3 cases), 3D-CT (7 cases) and wrist arthrogram (2 cases), and have performed new surgical method, and followed for 18 months after surgery. Results: Their average age was 12.4 years in congenital, but 20.9 years in post-traumatic Madelung’s deformities, 7 females and 1 male. Their chief complaints for surgery were cosmetic in congenital children’s deformity, but the wrist pain and LOM in post-traumatic deformities. 3D-CT was very effective in confirmation of the articular changes of wrist and TFCC deformities and also in making the proper way of treatment. A geographic 3-dimensional wedge-in osteotomy combined with ulnar shortening for congenital deformitiy, but combined with Sauve´ -Kapandji operation for post-traumatic deformity was very effective. Their TFCC in congenital Madelung’s deformity are thickened, elongated and deformed, and should be surgically debrided in 3 deformed TFCC to make a stable DRUJ. Conclusion: Pre-operative 3D-CT was very effective to confirm the changes of wrist articular surface, but MRI for TFCC in Madelung’s deformities. A geographic 3 dimensional wedge-in osteotomy in all with ulnar shortening in congenital deformity, or with Sauvé-Kapandji operation in post-traumatic deformity are the best to correct the deformity. The TFCC in congenital deformity shows thickened, elongated and act on wrist joint to widen DRUJ, but their surgical managements are still in problems and need to further studies.