Madelung's deformity: radial opening wedge osteotomy and modified Darrach procedure using the ulnar head as trapezoidal bone graft.

Abstract

Surgery may be indicated in treating Madelung's deformity and numerous techniques have been described. This study reports the early clinical and radiological results of a radial biplanar opening wedge osteotomy and modified Darrach procedure, using the excised ulnar head as a trapezoidal bone graft. Between 2000 and 2008, five adult wrists with symptomatic Madelung's deformity underwent surgery. All patients were female, with an average age at surgery of 34 years. Assessment included range of movement, grip strength, DASH scores and radiological imaging. All patients improved both subjectively and objectively with regards to pain, functional range of movement, and appearance at mean follow-up of 55 months (range 14-113). All osteotomies united. One patient required removal of hardware for restricted rotation. This technique provided satisfactory results that are comparable to other studies, and avoids the use of iliac crest bone graft.