Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Wei ¹ , DENG Xiaowen ¹ , LI Wenbo ¹ , YANG Miaomiao ² , ZHANG Yaqiang ¹ , SHI Peisheng ¹ , SHEN Weiwei ¹ , LIU Rui ³ , SHI Jie ¹ , LI Chuangbing ¹ , XUE Yun ¹ ,  GAO Qiuming ¹

1. Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China;
2. Outpatient Department, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China;
3. Department of Orthopedics, Gansu Provincial Central Hospital, Lanzhou Gansu, 730050, P. R. China;

Corresponding?author：

GAO Qiuming, Email: gaoqiuming@163.com

Keywords：

Madelung deformity; ulnar osteotomy and shortening; Ilizarov technique; plate internal fixation

DOI：

10.7507/1002-1892.202303080

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Objective To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening. Methods The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded. Results After the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation (P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case. Conclusion Ulnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness.

Citation： WANG Wei, DENG Xiaowen, LI Wenbo, YANG Miaomiao, ZHANG Yaqiang, SHI Peisheng, SHEN Weiwei, LIU Rui, SHI Jie, LI Chuangbing, XUE Yun, GAO Qiuming. Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 810-814. doi: 10.7507/1002-1892.202303080 Copy

1.	Guillaume PA, Mainard N, Canavese F, et al. Medium to long term functional and radiographic outcomes in patients with Madelung’s deformity treated by isolated or combined radioulnar osteotomy. Orthop Traumatol Surg Res, 2022, 108(7): 103374. doi: 10.1016/j.otsr.2022.103374.
2.	鄭軍, 洪云飛, 康智. 探討先天性橈骨遠端馬德隆畸形的分型和治療方法. 中華手外科雜志, 1998, 14(3): 142.
3.	宋玉鑫, 王增平, 劉林, 等. 馬德隆畸形的研究進展. 中國骨傷, 2017, 30(10): 976-978.
4.	Kozin SH, Zlotolow DA. Madelung deformity. J Hand Surg (Am), 2015, 40(10): 2090-2098.
5.	Sellami M, Maatallah K, Riahi H, et al. Madelung deformity. J Clin Rheumatol, 2020, 26(8): e317-e318.
6.	Babu S, Turner J, Seewoonarain S, et al. Madelung’s deformity of the wrist-current concepts and future directions. J Wrist Surg, 2019, 8(3): 176-179.
7.	Peymani A, de Roo MGA, Dobbe JGG, et al. Carpal kinematics in madelung deformity. J Hand Surg (Am), 2021, 46(7): 622.e1-622.e12.
8.	Peymani A, Dobbe JGG, Streekstra GJ, et al. Quantitative three-dimensional assessment of Madelung deformity. J Hand Surg (Eur Vol), 2019, 44(10): 1041-1048.
9.	陸陳林, 祝斌, 竺楓, 等. 骨性結構異常對下尺橈關節穩定影響的研究進展. 中國骨傷, 2020, 33(8): 770-775.
10.	Burgos L, Walker M, Daley RA. A variant of madelung deformity: Management of the distal ulna within the carpal canal. J Hand Surg (Am), 2021, 46(5): 429.e1-429.e6.
11.	Piek AR, Peymani A, Dobbe JGG, et al. Madelung deformity: Radioscapholunate arthrodesis with a Neo-DRUJ. Hand (N Y), 2023, 18(2_suppl): 17S-23S.
12.	Farr S, Martínez-Alvarez S, Little KJ, et al. The prevalence of Vickers’ ligament in Madelung’s deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg (Eur Vol), 2021, 46(4): 384-390.
13.	Zheng W, Su J, Cai L, et al. Application of 3D-printing technology in the treatment of humeral intercondylar fractures. Orthop Traumatol Surg Res, 2018, 104(1): 83-88.
14.	Tang ZW, Cao YL, Liu T, et al. Management of forearm deformities with ulnar shortening more than 15 mm caused by hereditary multiple osteochondromas. Eur J Orthop Surg Traumatol, 2013, 23(5): 611-618.
15.	吳鴻飛, 郭保逢, 趙巍, 等. Ilizarov骨延長術治療尺橈骨短縮并腕關節畸形. 中國矯形外科雜志, 2017, 25(17): 1618-1620.
16.	Saffar P, Badina A. Treatment of Madelung’s deformity. Chir Main, 2015, 34(6): 279-285.
17.	Shahi P, Sudan A, Sehgal A, et al. Madelung deformity of the wrist managed conservatively. Cureus, 2020, 12(5): e8225. doi: 10.7759/cureus.8225.

1. Guillaume PA, Mainard N, Canavese F, et al. Medium to long term functional and radiographic outcomes in patients with Madelung’s deformity treated by isolated or combined radioulnar osteotomy. Orthop Traumatol Surg Res, 2022, 108(7): 103374. doi: 10.1016/j.otsr.2022.103374.
2. 鄭軍, 洪云飛, 康智. 探討先天性橈骨遠端馬德隆畸形的分型和治療方法. 中華手外科雜志, 1998, 14(3): 142.
3. 宋玉鑫, 王增平, 劉林, 等. 馬德隆畸形的研究進展. 中國骨傷, 2017, 30(10): 976-978.
4. Kozin SH, Zlotolow DA. Madelung deformity. J Hand Surg (Am), 2015, 40(10): 2090-2098.
5. Sellami M, Maatallah K, Riahi H, et al. Madelung deformity. J Clin Rheumatol, 2020, 26(8): e317-e318.
6. Babu S, Turner J, Seewoonarain S, et al. Madelung’s deformity of the wrist-current concepts and future directions. J Wrist Surg, 2019, 8(3): 176-179.
7. Peymani A, de Roo MGA, Dobbe JGG, et al. Carpal kinematics in madelung deformity. J Hand Surg (Am), 2021, 46(7): 622.e1-622.e12.
8. Peymani A, Dobbe JGG, Streekstra GJ, et al. Quantitative three-dimensional assessment of Madelung deformity. J Hand Surg (Eur Vol), 2019, 44(10): 1041-1048.
9. 陸陳林, 祝斌, 竺楓, 等. 骨性結構異常對下尺橈關節穩定影響的研究進展. 中國骨傷, 2020, 33(8): 770-775.
10. Burgos L, Walker M, Daley RA. A variant of madelung deformity: Management of the distal ulna within the carpal canal. J Hand Surg (Am), 2021, 46(5): 429.e1-429.e6.
11. Piek AR, Peymani A, Dobbe JGG, et al. Madelung deformity: Radioscapholunate arthrodesis with a Neo-DRUJ. Hand (N Y), 2023, 18(2_suppl): 17S-23S.
12. Farr S, Martínez-Alvarez S, Little KJ, et al. The prevalence of Vickers’ ligament in Madelung’s deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg (Eur Vol), 2021, 46(4): 384-390.
13. Zheng W, Su J, Cai L, et al. Application of 3D-printing technology in the treatment of humeral intercondylar fractures. Orthop Traumatol Surg Res, 2018, 104(1): 83-88.
14. Tang ZW, Cao YL, Liu T, et al. Management of forearm deformities with ulnar shortening more than 15 mm caused by hereditary multiple osteochondromas. Eur J Orthop Surg Traumatol, 2013, 23(5): 611-618.
15. 吳鴻飛, 郭保逢, 趙巍, 等. Ilizarov骨延長術治療尺橈骨短縮并腕關節畸形. 中國矯形外科雜志, 2017, 25(17): 1618-1620.
16. Saffar P, Badina A. Treatment of Madelung’s deformity. Chir Main, 2015, 34(6): 279-285.
17. Shahi P, Sudan A, Sehgal A, et al. Madelung deformity of the wrist managed conservatively. Cureus, 2020, 12(5): e8225. doi: 10.7759/cureus.8225.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening

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