Modified Ilizarov technique in Madelung’s deformity

Abstract

Background Madelung’s deformity is caused by arrest of growth on the ulnar side of the distal epiphysis of the radius. It results in palmar and ulnar tilt of the articular surface, volar translation of the hand and wrist, shortening of the radius, and dorsal subluxation of the ulnar head with incongruity of the distal radioulnar joint. Patients and methods Six patients with Madelung’s deformity were treated with the Ilizarov method at the Orthopedic Department of health insurance hospitals. Correction was undertaken for pain in the case of two patients, because of impaired function in two, and because of bad cosmoses in another two patients. The cause of the deformity was congenital in four cases and acquired in two after fractures. The patients included five girls and one boy. The ages of the patients varied from 11 to 17 years, with an average age of 14.6 years. Results All patients were free from pain at follow-up. Supination improved by a mean of 30π and pronation by a mean of 10π. The mean improvement in flexion was 20π. Extension did not change. Radial and ulnar deviations were increased by a mean of 5 and 10π, respectively, and lengthening of the radius by a mean of 12 mm (6–25). Radiological measurement showed that the mean volar angulation had been reduced from 20 to 10π and ulnar inclination from 40 to 25π. The most common problem was minor pin-tract infection in all cases, which was treated with antibiotics. No loosening of pins or bone fracture occurred. There were no deep pin-tract infections or neurovascular injury. Conclusion The Ilizarov technique should be considered for the surgical treatment of Madelung’s deformity in patients suffering from persistent pain when gradual correction and lengthening is indicated. The Ilizarov method is useful for obtaining correction of forearm deformity.