Treatment of Madelung's deformity in adults by ulna reduction osteotomy

J Hand Surg Am. 2003 May;28(3):421-6. doi: 10.1053/jhsu.2003.50073.


Purpose: Adult patients with Madelung's deformity may present with ulnar-sided wrist pain. Treatment often involves addressing the distal radial deformity. If there is focal wrist pathology and a positive ulnar variance, however, then an isolated ulnar-shortening osteotomy may provide symptomatic relief in these patients. The purpose of this study was to report our results of ulnar-shortening osteotomy without radial osteotomy in adult patients with Madulung's deformity.

Methods: From 1988 to 2001 9 wrists in 9 adult patients with Madelung's deformity and ulnar-sided wrist pain underwent ulnar-shortening osteotomy. The distal radius abnormality was not addressed. All of the patients were women and the average age at the time of surgery was 34 years (range, 29-45 y). Two of the individuals were mesomelic dwarfs and the remaining 7 patients were otherwise normal. Surgery was performed after the patients failed at least 6 months of nonsurgical management.

Results: All patients had improvement of their symptoms at an average follow-up evaluation of 42 months (range, 6-112 mo). All of the osteotomies united. One patient required replating for a delayed union. There were no infections and no ulnar carpal subluxation. Ulnar-positive variance correction averaged 4.4 mm. Postoperative range of motion and grip strength were equivalent to the contralateral wrist.

Conclusions: Ulnar-shortening osteotomy is a safe and reliable surgical procedure that can relieve ulnar-sided wrist pain in adult patients with symptomatic Madelung's deformity and positive ulnar variance.

MeSH terms

  • Adult
  • Arthralgia / etiology
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Humans
  • Osteotomy / methods*
  • Range of Motion, Articular / physiology
  • Time Factors
  • Ulna / surgery*
  • Wrist Joint / abnormalities*
  • Wrist Joint / physiopathology