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The Surgical Treatment of Madelung Deformity: A Systematic Review and Meta-Analysis
Rommy Obeid, BS
1; Osama Darras, MD
1; Christopher Jou, MD
1; Abby Brown, BS
2; Diwakar Phuyal, MD
1; Fuad Abbas, BS
1; Bahar Bassiri Gharb, MD, PhD
3; Antonio Rampazzo, MD, PhD
31Cleveland Clinic Foundation, Cleveland, OH; 2West Virginia School of Osteopathic Medicine, Lewisburg, WV; 3Cleveland Clinic, Cleveland, OH
Introduction: Madelung deformity is a rare hand deformity characterized by abnormal growth arrest of the distal radial epiphysis resulting in wrist pain, decreased range of motion, and loss of grip strength. As Madelung deformity is a rare pediatric hand deformity, there is no consensus on the preferred surgical management and, outcomes after surgical procedures are not well understood. We aim to identify treatment techniques in the literature and analyze the results of these treatments which yield the least incidence of reoperation.
Methods: A comprehensive systematic review was conducted using MEDLINE, Embase, and Cochrane in adherence with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Search criteria was "Madelung” AND "Surgery” OR "Treatment”. Inclusion criteria was studies which clearly documented surgical technique for the treatment of Madelung Deformity. Exclusion criteria was studies which did not clearly document their surgical technique, did not document any outcomes of interest, did not delineate between the outcomes of different surgical techniques, and case reports (n<3).
Results: 603 studies were identified, and 26 studies were included ranging between 1975 and 2023. The mean age at surgery was 17.0
+ 6.9 years old. 92.5% of patients were female. 248 patients and 345 wrists underwent six main categories of surgical correction. Surgical categories included radial correction only (n=150), ulnar correction only (n=25), correction of both (n=102), progressive lengthening with external fixation (n=21), Sauve-Kapandji technique (n=28), and other (n=19).
The decision to surgically treat the radius only (n=150) versus treatment of the radius and ulna (n=102) was of high interest. 17.3% of patients who underwent treatment of only the radius required a secondary correction for a continuous deformity as compared to just 3.1% percent of patients who underwent simultaneous correction of the radius and ulna (p=0.000). In the radial-only treatment group, secondary correction consisted of 19/24 (79.2%) secondary ulnar corrections, 1/24 (4.2%) secondary radial corrections, and 3/24 salvage procedures (arthrodesis, Bower procedure, and Scheker prosthesis). Reasons for secondary correction were pain, radioulnar impingement, and continued ulnar growth.
Conclusion: Madelung deformity is a multifactorial disease that primarily affects young females with no consensus as to the optimal treatment. Our analysis suggests that addressing the ulna during the primary correction may be necessary to limit recurrence of pain and deformity.
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