Conservative Management of Madelung Deformity of the Wrist in a 15-Year-Old Male: A Case Report.

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Abstract

Conflict of interest statement: The authors have declared that no competing interests exist. 17. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):810-814. doi: 10.7507/1002-1892.202303080. [Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening]. [Article in Chinese; Abstract available in Chinese from the publisher] Wang W(1), Deng X(1), Li W(1), Yang M(2), Zhang Y(1), Shi P(1), Shen W(1), Liu R(3), Shi J(1), Li C(1), Xue Y(1), Gao Q(1). Author information: (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. 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