Steven R. Boyea M.D.,
Peter F. Townsend M.D.
Alfred I. duPont Institute
1600 Rockland Road
Wilmington, Delaware 19803
INTRODUCTION: Madelung s deformity is a rare condition that affects the wrists in individuals causing deformity, loss of motion and pain. This is a deformity caused by early closure of the ulnar portion of the distal radial physis. This subsequently leads to an ulnar/volar deformity of the distal radial articular surface, which ultimately affects the carpus and ulna. The primary cases of Madelung s deformity are congenital, secondary causes are associated with trauma, infection, and conditions such as osteochondromatosis. Studies have shown that this deformity can and often is associated with pain and loss of motion of the wrists. The pain is usually seen in the adolescent years and associated with the growth spurt . The pain usually resolves after growth ceases although the loss of motion persists. Surgical correction for this deformity is for unremitting wrist pain, but will not improve motion. There have been no studies evaluating people with this deformity, with respect to employability, disability, and satisfaction of treatment. This study evaluates patients with Madelung s deformity that have been treated conservatively with non-operative therapy. The study focuses on the patients level of pain, employment, disability, present hobbies and activities, and satisfaction with treatment.
MATERIALS AND METHODS: Individuals with Madelung s deformity had their records retrospectively reviewed. Any patients with operative procedures to their wrists were excluded from the study. All patients must have undergone only conservative non-operative treatment. Each study participant was contacted by telephone and asked a series of questions pertaining to demographics, pain, motion, appearance, activities/hobbies, employment, disability and satisfaction with treatment. All responses were evaluated for correlation.
RESULTS: Twelve patients with Madelung s deformity were found, two were excluded because they had undergone corrective surgeries. Seven of the patients were female and three were male, the mean age at follow-up was 24.2 years (Range 15-36 years). The patients mean age at diagnosis was 11.2 years (Range 4-16 years). Seven of the patients had bilateral involvement and the remaining three had unilateral involvement. Seven of the ten patients were diagnosed with congenital Madelung s while the other three had a corresponding diagnosis of osteochondromatosis. Three of the patients have had subsequent injury to the affected wrist(s), one gentleman sustained a fracture of his affected wrist, while two other patients have a history of wrist sprains. Eight of the patients continue to have pain in the affected wrist(s), seven with intermittent pain and one with constant pain. The patient with the constant wrist pain is a 15 year old female that is still growing. Seven of the ten patients complain of loss of motion, all in extension and one in both flexion and extension. Half of the individuals interviewed were satisfied with the appearance of their wrists, the remaining half were not satisfied, but had become accustomed to the appearance. Nine of the ten patients participated in sports activities or hobbies, four individuals played in sports, seven participated in fine motor activities, and seven used the computer frequently for word processing or games. All patients over the age of 21 were employed full time for an average of 2.5 years (Range 1-6) at their current occupation. No individual was receiving disability. All of the patients under the age of 21 years were full time students without special needs. All of the patients were satisfied with their treatment course 8/10 completely and 2/10 partially satisfied. All patients would not change their treatment programs.
CONCLUSION: The indication for surgical correction of Madelung s deformity is unremitting pain or loss of function of wrist. Surgery usually includes a distal radial osteotomy and an ulnar shortening. More recently it has been shown that the wrist pain associated with Madelung s deformity is usually transient and associated with growth spurts , and usually resolves with time. No studies have followed patients into adulthood to determine if the pain and function place any limitations on their lives. Our study demonstrates that with non-operative therapy patients still have some residual wrist pain, it is usually intermittent, also some perceived loss of motion, but these do not affect daily activities. All patients of working age are gainfully employed and the majority are enjoying sports and physical activities. These factors influencing the patients life as well as the use of non-operative treatment made all patients satisfied with their treatment such that none would change their treatment regimen. Although there are only a limited number of participants in this study, it gives us the indication that wrist disability in patients with Madelung s deformity is transient and associated with growth. We also see that patients with this deformity treated non-operatively live productive lives without significant disability.
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