Treatment Decision-making in Madelung Deformity: A Retrospective Review of 74 Wrists.

Abstract

Madelung deformity is a rare wrist condition characterized by progressive angular deformity secondary to asymmetric premature closure of the distal volar-ulnar radial physis. Standardized treatment guidelines remain lacking. This study aimed to evaluate clinical and radiologic outcomes following different surgical strategies and to identify key parameters to guide surgical decision-making. A retrospective review was performed on 74 wrists in 41 patients treated between 1999 and 2023. Data collected included demographics, range of motion (ROM), and radiographic parameters: ulnar tilt (UT), lunate fossa angle (LFA), lunate subsidence (LS), and palmar carpal displacement (PCD), assessed preoperatively and postoperatively. Of 74 wrists, 56 (75.7%) underwent surgical treatment: 33 (44.6%) received Vickers ligament resection (VLR) at a mean age of 11.3 ± 2.5 years, and 23 (31.1%) underwent radial dome osteotomy (RDO) at 13.0 ± 1.9 years. RDO was indicated in patients presenting with marked ROM limitations (>20 degrees), LS ≥ 7.2 mm, and PCD ≥ 25.7 mm (P < 0.01). After VLR, radiologic parameters remained stable, while RDO significantly reduced PCD (P = 0.0006); however, other radiographic changes were not statistically significant. Functional gains following RDO were limited, except for modest improvement in wrist extension. Reoperations were required in 12.1% of VLR and 17.4% of RDO cases, particularly when LS ≥ 6 mm and/or PCD ≥ 23 mm at baseline. VLR performed in early skeletal maturity may stabilize deformity progression in mild cases. In contrast, patients with advanced deformity (LS ≥ 6 mm, PCD ≥ 23 mm, and significant ROM limitation) are better candidates for primary RDO. Radiologic correction does not consistently translate into functional recovery, emphasizing the need for individualized clinical-radiological assessment. This represents the largest single-center series to date and supports LS and PCD as key objective markers for surgical decision-making in Madelung deformity. Level IV-retrospective cohort study.