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Madelung Hand Deformity Treatment Selection and Outcomes: A Systematic Review and Meta-analysis
Rommy Obeid, BS, Osama Darras, MD, Chris Jou, MD, Diwakar Phuyal, MD, Abigail Brown, BS, Fuad Abbas, BS, Bahar Bassiri Gharb, MD, PHD, Antonio Rampazzo, MD, PHD
Cleveland Clinic Foundation
2025-01-10
Presenter: Rommy Obeid
Affidavit:
Rommy Obeid
Director Name: Antonio Rampazzo
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Madelung deformity is characterized by abnormal growth arrest of the distal radial epiphysis. We aim to identify the preoperative characteristics which influence technique selection and analyze the results of these treatments.
Methods: Systematic review was conducted using MEDLINE, Embase, and Cochrane in adherence with PRISMA guidelines. Search criteria were "Madelung" AND ("Surgery" OR "Treatment").
Results: 603 studies were identified, and 33 studies were included ranging between 1955 and 2023. 346 patients and 428 wrists underwent surgical correction at a mean age of 17.4 years old (6-57). Radial osteotomy, either alone (25.5%) or combined with ulnar osteotomy (22.7%), was the most frequently performed procedure and treated skeletally mature and immature patients. Radial physiolysis with fat grafting (7.9%) and Vicker's ligament release (3.0%) treated only skeletally immature patients. Sauvé-Kapandji (7.7), Darrach (4.0%), and ulnar shortening osteotomy alone (4.7%) treated predominantly skeletally mature patients. Meta-analysis revealed significant improvement in radiographic parameters, range of motion, pain, patient reported outcome measures, and grip strength.
47 wrists required reoperation. The most common reoperation was an ulnar shortening osteotomy (n=15), followed by radial osteotomy (n=10) and ulnar epiphysiodesis (n=5). Average age at index procedure in patients that required reoperation was 8.54 years old (n=15). Older age significantly correlated with worse range of motion (p<0.001).
Conclusion: Our analysis suggests that addressing Madelung prior to skeletal maturity may risk the need for reoperation while symptoms may worsen with age. Treatment of Madelung deformity should be tailored to the patient's age, presentation, severity of symptoms, and radiographic parameters.
