RADIAL OPENING WEDGE OSTEOTOMY IN MADELUNGS DEFORMITY

Radiopalmar opening wedge osteotomy was used in 11 female patients (12 wrists) with Madelung's deformity who ranged in age from 9 to 31 year s. Five patients mel the radiographic criteria for generalized dyschon drosteosis. Clinically there was dissatisfaction with the appearance o f the wrist. The principal motion deficits were in radiocarpal extensi on and forearm pronosupination associated with varying degrees of disc omfort with sustained activity. All had a decreased radioulnar angle, lunate subluxation shown radiographically, and various degrees of dors al subluxation of the ulnar head. Indications for surgery were pain, l imited motion, cosmetic appearance, and progressive deformity in two i mmature patients. Biplanar corrective opening wedge osteotomy of the r adius was performed with iliac crest graft. Three patients had an adde d ulnar recession. Fixation was with a plate or Kirschner wire. Supple mentary distracting external fixation was used in six cases. The follo w-up period averaged 48 months. Pain relief in all patients was satisf actory. Range of motion and grip strength were not influenced. The rad ioulnar angle improved by 11 degrees, but lunate subluxation was minim ally changed. Length of the forearm and bowed appearance of the forear m were improved. Reduction of the radioulnar joints was improved but r emained incongruous.