Abstract
Background Madelung's deformity (MD) comprises increased volar and ulnar tilt of the distal
radius joint facet, secondary to an idiopathic physeal dysplasia. Such change causes
radial shortening and a consequent distal ulnar prominence, along with wrist pain
and loss of motion. Classic surgical techniques are problematic for adults, as they
are specific for children and adolescents whose distal radial physis is still open.
Description of Technique It is suggested a new treatment method for MD in skeletally mature patients: a distal
radius osteotomy and joint realignment are performed through a volar approach to increase
the support area of the lunate bone. The rotation and lengthening of the distal epiphysis
of the radius generate support and cover to the lunate bone, with improvement of both
radiocarpal and distal radioulnar joints.
Patients and Methods We describe the technique in details and report the treatment of a 25-year-old female
patient.
Results Early clinical and radiographic outcomes are encouraging for the treatment of symptomatic
patients.
Conclusion There is a plethora on the literature about conflicting opinions on the best treatment
options and surgical techniques are quite variable, although usually with good results.
Besides, the technique here described is indicated during a specific stage of disease
presentation, consisting of young adults without any wrist-degenerative changes. Having
said that, it is possible to claim that MD treatment with shelf osteotomy is a concept
change. Our main goal is to reconstruct the diseased segment and improve wrist stability.
Keywords Madelung's deformity - radius dysplasia - wrist deformity - radiocarpal joint - corrective
osteotomy
