Treatment of Madelung's deformity in adults by ulna reduction osteotomy.
OBJECTIVE
Adult patients with Madelung's deformity may present with ulnar-sided wrist pain. Treatment often involves addressing the distal radial deformity. If there is focal wrist pathology and a positive ulnar variance, however, then an isolated ulnar-shortening osteotomy may provide symptomatic relief in these patients. The purpose of this study was to report our results of ulnar-shortening osteotomy without radial osteotomy in adult patients with Madulung's deformity.


METHODS
From 1988 to 2001 9 wrists in 9 adult patients with Madelung's deformity and ulnar-sided wrist pain underwent ulnar-shortening osteotomy. The distal radius abnormality was not addressed. All of the patients were women and the average age at the time of surgery was 34 years (range, 29-45 y). Two of the individuals were mesomelic dwarfs and the remaining 7 patients were otherwise normal. Surgery was performed after the patients failed at least 6 months of nonsurgical management.


RESULTS
All patients had improvement of their symptoms at an average follow-up evaluation of 42 months (range, 6-112 mo). All of the osteotomies united. One patient required replating for a delayed union. There were no infections and no ulnar carpal subluxation. Ulnar-positive variance correction averaged 4.4 mm. Postoperative range of motion and grip strength were equivalent to the contralateral wrist.


CONCLUSIONS
Ulnar-shortening osteotomy is a safe and reliable surgical procedure that can relieve ulnar-sided wrist pain in adult patients with symptomatic Madelung's deformity and positive ulnar variance.
Bruno
Roderick J
RJ
Department of Orthopaedic Surgery, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Blank
John E
JE
Ruby
Leonard K
LK
Cassidy
Charles
C
Cohen
Glenn
G
Bergfield
Thomas G
TG
D000328:Adult; D018771:Arthralgia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology; D013997:Time Factors; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint / Q000002:abnormalities* / Q000503:physiopathology