Back to 2025 Abstracts
Comparison of long term objective and patient reported outcomes after surgery for Madelung deformity in pediatric and adult patients
Andrew F. Emanuels, MD
1; Nicole Sanchez Figueroa, MD MSc
1; Moran L Steven, MD
2; Nicholas Pulos, MD
11Mayo Clinic, Rochester, MN; 2Division of Plastic Surgery, Mayo Clinic, Rochester, MN
Introduction Madelung deformity is a congenital disorder characterized by longitudinal growth arrest of the distal radius. There is a paucity of long-term comparative outcome studies. The purpose of this study is to quantify objective and patient reported outcomes after surgical intervention for Madelung deformity in pediatric and adult patients. MethodsPatients with surgically managed Madelung deformity treated at a single institution were identified from 2001-2019. Demographic and objective metrics were extracted from the electronic medical record. Retrospective surveys were distributed to the available patient population. Student's t-test and Chi-squared were used to determine significance in continuous and categorical variables, respectively. ResultsThirty-six patients (21 pediatric, 17 adult) were identified with 50 surgically managed wrists. Most patients were female (33/36) and the mean age at surgical intervention was 24. The mean duration of follow up was similar between adults and children (21 mos vs. 34 mos; p=0.31). The most common indication for surgery was painful activity. There was no difference in the rates of prior wrist surgery. The most common procedures in pediatric patients were Vicker's ligament release, physeal bar excision, ulnar shortening, and radial dome osteotomy. In adult patients, procedures included ulnar shortening, ulnar head resection, wrist denervation, DRUJ arthrodesis and DRUJ arthroplasty. Children were more likely to undergo bilateral procedures (11% vs 63%, p=0.009). Significantly higher rates of return to the OR for an unplanned revision was seen in adults (35% vs. 18%, p=0.004). The most common reason for reoperation was painful or visible hardware requiring removal. Range of motion in all planes except ulnar deviation was significantly improved (p<0.05). There was significant improvement between preoperative and postoperative pain scores (4.6 ±3.2 vs.0.5294 ±0.5145; p=.00005). Retrospective surveys were distributed to the available patient population with a response rate of 25%. The median level of satisfaction was 7 (range 5-9) when ranked on a 10-point Likert scale. Median pain was rated 2 (range 0-4) with intensity ranging from mild to moderate. 10 of 14 wrists were able to work without restrictions, three reported mild limitation, and one was unemployed. The mean postoperative DASH scores and PRWE were 14.4±7.6 and 23.5±10.5 respectively. Discussion Surgical intervention for Madelung deformity in adult and pediatric patients demonstrated significant improvement in range of motion and patient reported outcomes. However, adults had a higher rate of reoperation for hardware related complications. To avoid unnecessary complications, early intervention is recommended.
Back to 2025 Abstracts
