title: Volar ligament release and distal radius dome osteotomy for correction of Madelung's deformity.
abstract: OBJECTIVE
  Madelung's deformity is usually recognized near the completion of skeletal growth and corrective osteotomy of the radius is frequently performed to treat the deformity and reduce pain. This study reviewed the clinical and radiographic results of a volar approach, ligament release, and dome osteotomy technique for treatment of this deformity.
  
  
  METHODS
  Between 1990 and 2000, 26 wrists in 18 patients were treated with a volar ligament release and dome osteotomy of the distal radius. The average age of the patients at the time of surgery was 13 years. All patients were available for review at an average of 23 months after surgery. Radiographs before surgery and at final follow-up evaluation were analyzed for the extent of correction.
  
  
  RESULTS
  All patients treated with this corrective osteotomy reported a reduction in pain and improved appearance. Patients showed improvements in forearm supination and wrist extension, with no loss of pronation or flexion. Improvements in the radiographic parameters of radial inclination and lunate subsidence also were observed. Four wrists required concurrent ulnar-sided surgery, and 3 additional wrists required staged ulnar shortening. One patient required a Darrach resection 3 years after the index procedure.
  
  
  CONCLUSIONS
  The results of volar dome osteotomy provide improved range of motion, improved appearance, radiographic correction, and pain relief while preserving soft-tissue support for radial rotation around the distal ulna. Long-term follow-up evaluation is ongoing.
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Harley
authors.forename: Clayton
authors.initials: C
authors.lastname: Brown
authors.forename: Karen
authors.initials: K
authors.lastname: Cummings
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carter
authors.forename: Marybeth
authors.initials: M
authors.lastname: Ezaki
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010146:Pain / Q000601:surgery; D011859:Radiography; D011884:Radius / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D012399:Rotation; D016896:Treatment Outcome; D014457:Ulna / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014955:Wrist Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*