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Barrientos A, Margalit A, Ayalon O. Radioscapholunate Arthrodesis for Management of Madelung Deformity: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00019. [PMID: 39058794 DOI: 10.2106/jbjs.cc.24.00109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
CASE A 32-year-old woman with bilateral Madelung deformity presented with severe pain and arthritis of the radiocarpal and distal radioulnar joints. At final follow-up, 17 months for the left and 12 months for the right wrist, she had excellent functional results with no pain. Range of motion was 30° of flexion and 30° of extension with full pronosupination. CONCLUSION There is paucity in the literature regarding salvage procedures in adults with this deformity. We demonstrate treatment with distal ulna excision and an radioscapholunate arthrodesis. This procedure may be indicated in Madelung deformity and proximal radiocarpal and distal radioulnar joint arthritis.
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王 伟, 邓 晓, 李 文, 杨 苗, 张 亚, 时 培, 沈 伟, 刘 锐, 石 杰, 李 闯, 薛 云, 高 秋. [Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:810-814. [PMID: 37460176 PMCID: PMC10352512 DOI: 10.7507/1002-1892.202303080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/01/2023] [Indexed: 07/20/2023]
Abstract
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.
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Affiliation(s)
- 伟 王
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 晓文 邓
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 文波 李
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 苗苗 杨
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 亚强 张
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 培晟 时
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 伟伟 沈
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 锐 刘
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 杰 石
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 闯兵 李
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 云 薛
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
| | - 秋明 高
- 中国人民解放军联勤保障部队第九四〇医院骨科中心创伤骨科(兰州 730050)Department of Orthopaedics and Traumatology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P. R. China
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Benign paroxysmal positional vertigo in a patient with persistent hypoglossal artery and bilateral madelung deformity. IBRO Neurosci Rep 2022; 14:77-79. [PMID: 36618578 PMCID: PMC9813689 DOI: 10.1016/j.ibneur.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
We explore a case of Benign Paroxysmal Positional Vertigo in the context of Persistent Hypoglossal Artery (PHA) and bilateral Madelung Deformity (MD). PHA is associated with a raft of major adverse cardiovascular events. MD can result from manifold conditions such as Turner's Syndrome and mesomelic dwarfism. In this case, the patient's positive family history of MD across generations is suggestive of inherited mutation in the Short Stature Homeobox (SHOX) Gene. We discuss the putative impact of SHOX on the genesis of Benign Paroxysmal Positional Vertigo (BPPV) in a patient with PHA and bilateral MD.
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Abstract
PURPOSE OF REVIEW Turner syndrome is the most common sex chromosome abnormality in female individuals, affecting 1/2000-1/2500 female newborns. Despite the high incidence of this condition, the mechanisms underlying the development of multiorgan dysfunction have not been elucidated. RECENT FINDINGS Clinical features involve multiple organ systems and include short stature, dysmorphic facial features, delayed puberty and gonadal failure, cardiac and renal abnormalities, audiologic abnormalities, and a high prevalence of endocrine and autoimmune disorders. Paucity of available genotype/phenotype correlation limits the ability of clinicians to provide accurate guidance and management. Given the advent of robust genetic testing and analysis platforms, developments in the genetic basis of disease are materializing at a rapid pace. SUMMARY The objective of this review is to highlight the recent advances in knowledge and to provide a framework with which to apply new data to the foundational understanding of the condition.
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Pediatric Ulnar-sided Wrist Pain: A Review of the Current Literature. J Am Acad Orthop Surg 2022; 30:711-720. [PMID: 35862211 DOI: 10.5435/jaaos-d-21-01029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Patients presenting with ulnar-sided wrist pain can pose a diagnostic and therapeutic challenge to physicians because there are several pathologies with similar signs and symptoms. In comparison with adult patients, other etiologies must be considered in the pediatric patient, given the skeletal immaturity and potential for known or unrecognized syndromes. In addition, these patients may not be able to articulate their symptoms as clearly as an adult patient, further stressing the importance of obtaining a pertinent history and performing a focused physical examination. Having a thorough understanding of the anatomy, the varying pathologies, and the indications for surgical and nonsurgical management will assist in improved patient outcomes.
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Catena N, Arrigoni C, Origo C. Use of a 3D Model for the Correction of a Complex Madelung Deformity in a Teenager: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00008. [PMID: 36099456 DOI: 10.2106/jbjs.cc.21.00622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE The aim of the article is to report on a case of a teenager affected by Madelung deformity treated with a double osteotomy, planned by means of a 3D model. Using a custom-made cutting guide, the radial osteotomy was performed, and after the reorientation, a shortening ulnar osteotomy completed the procedure. Postoperative clinical assessment showed a normal alignment of the ulna with increased range of motion wrist motion. CONCLUSIONS Using a 3D model when planning a multidirectional correction of a Madelung deformity may be advantageous to achieve a more accurate and precise realignment of the carpus and distal radioulnar joint.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Arrigoni
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carlo Origo
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Oliveira RKD, Ribak S, Brunelli JPF, Aita M, Delgado PJ. Madelung Deformity: Diagnosis and Treatment Options. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1739452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMadelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment.The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology.When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability.We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD.
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Affiliation(s)
| | - Samuel Ribak
- Department of Hand Surgery, Pontifícia Universidade Católica de Campinas, Campinas, Brazil
| | | | - Márcio Aita
- Department of Hand Surgery, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Pedro J. Delgado
- Department of Hand and Upper Limb Surgery, Hospital Universitário HM Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madrid, Spain
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Grunz JP, Gietzen CH, Christopoulos G, van Schoonhoven J, Goehtz F, Schmitt R, Hesse N. Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment. Semin Musculoskelet Radiol 2021; 25:294-303. [PMID: 34374064 DOI: 10.1055/s-0041-1730948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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De Leucio A, Castelein S, Bellemans M, Simoni P. Radiotriquetral Ligament in Madelung's Deformity Associated with Leri-Weill's Dyschondrosteosis. Cureus 2020; 12:e7100. [PMID: 32231895 PMCID: PMC7098412 DOI: 10.7759/cureus.7100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Madelung's deformity (MD) is frequently associated with Leri-Weill's dyschondrosteosis (LWD) even if the primary isolated form (PI-MD) is much more common. Recent studies pointed out how two abnormal ligaments, the Vickers ligament (VL) and the radiotriquetral ligament (RTL), are defining traits of MD. To date, in PI-MD, both VL and RTL have been reported. In MD associated with LWD (LWD-MD), the VL is also present, but the RTL has never been reported. We herein report the first case of MD associated with a genetically confirmed LDW with an RTL, detected on MRI. This report describes the MRI imaging features of MD-LWD, which have not been adequately characterized in previous literature.
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Affiliation(s)
- Alessandro De Leucio
- Radiology and Medical Imaging, Queen Fabiola Children's University Hospital, Brussels, BEL
| | - Sybille Castelein
- Orthopedics and Traumatology, Queen Fabiola Children's University Hospital, Brussels, BEL
| | - Michel Bellemans
- Orthopedics and Traumatology, Queen Fabiola Children's University Hospital, Brussels, BEL
| | - Paolo Simoni
- Radiology and Medical Imaging, Queen Fabiola Children's University Hospital, Brussels, BEL
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