Correction of Madelung Deformity Using Internal Distraction Procedure and Dome Osteotomy
Gabrielle LaBove, MD1, Shawn Diamond, MD2, Jennifer Fligor, MD3, Joseph Talbet, MD4, James Learned, MD1 and Amber Leis, M.D.1, (1)University of California, Irvine, Orange, CA, (2)Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, TX, (3)University of California Irvine, Orange, CA, (4)Howard University College of Medicine, Washington, DC
Introduction: Madelung's deformity is a rare congenital anomaly of the wrist characterized by a shortened radius with volar-ulnar curvature most commonly seen in adolescent females. Pain over the ulnar aspect of wrist joint is the most common presentation. Progressive pain and worsening range of motion are the most common indications for surgical intervention. We present a single case report of application of PRECICE internal distractor that is typically used in lower extremity lengthening procedures to correct Madelung Deformity and lengthen the radius.
Methods: A single case was reviewed for this case report. The patient is a now 18-year-old (17 at time of initial surgery) right-hand-dominant female who presented with bilateral Madelung deformity, worse on the right compared to the left. She was treated with dome osteotomy and internal distraction of the right radius.
Results: On presentation to our plastic surgery clinic, the patient was experiencing increasing wrist pain with wrist extension, lifting, pushing, or pulling. Examination demonstrated bilateral volar radial displacement of the hand and imaging of the right wrist demonstrated approximately 15-18 cm discrepancy from level DRUJ. 3D CT imaging was obtained for surgical planning, and a right radius dome osteotomy was performed in conjunction with application of a Precise internal bone distractor. The radius was distracted 18 mm at a rate of 0.25 mm twice daily. A 3.5-month period of consolidation followed. The Precise internal bone distractor was then removed, and a radial shaft fixation plate was placed due to a fibrous-appearing central segment of the distraction zone. The patient was provided with a bone stimulator, and engaged in occupational therapy to work on range of motion post-operatively. At follow-up approximately 5 months post-operatively, patient was found to have approximately 45 degrees of wrist flexion and extension, near-full pronation, and full supination.
Conclusion: Several surgical procedures have been described to treat Madelung's deformity with satisfactory outcomes, including lengthening of the radius, shortening of the ulna or both. We describe dome osteotomy combined with the novel application of a PRECICE device internal distractor for correction of Madelung deformity with significant post-operative improvement in range of motion and pain relief.
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