Here are my thoughts.
1) Most patient have disease on both sides. When I treated one side, almost every single patient comes back for surgery on the other side which, to me, implies satisfaction with surgery.
2) The surgery for established Madelungs Deformity cuts and repositions the bone and attempts to re- establish growth plate lengthening. The surgery for those with early or mild Madelungs (or even those patients predicted to develop Madelungs because of the genetics) is different. In these cases, we try to release a tether that may contribute or cause the development of Madelungs.
3) Surgery for older patients (adults) is typically related to pain on the ulnar side of the wrist (the pinky side) and for those patients, we shorten the over- long ulna. This surgery has good success.
Below is an excellent example of one patient with Madelungs Deformity without pain or significant limitations. She does have mild decreased wrist and forearm motion but is able to participate in all activities as desired. She presented to my office only after a routine wrist x-ray detected the abnormality and she was referred. Our discussion included all of the above. She has notable deformity but only on one side. Surgery can certainly help the deformity and, I believe, will help decrease the chance of future problems. But, this is a tough family decision because she does not have current symptoms. The family understand the issue and will consider how they would like to proceed.
Madelungs Deformity, only side affected. It is likely associated with a syndrome including short stature and short forearms. |
Madelungs Deformity on the left side only. Not the deformity on the left and the straight wrist on the right. |
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X-rays of typical Madelungs Deformity |
Charles A. Goldfarb, MD
My Bio at Washington UniversityEmail me: congenitalhand@wudosis.wustl.edu
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