Rare Conditions Video

Madelungs Deformity Surgical Technique

I have posted a few times on Madelung Deformity, as may be seen HERE.  While there have been a number of surgical techniques recommended over the years, I believe that the dome osteotomy of the distal radius is the best option.  That procedure was described well in this important MANUSCRIPT.

Below is a brief surgical technique video on the dome osteotomy for Madelung Deformity.   While this is not a truly graphic video (no notable blood loss), it does provide a look inside the forearm and shows how this procedure is performed with drills, wires, and chisels (osteotomes).  What I mean to say is that everyone may not want to watch this!

I use this surgery for Madelung Deformity when patients have pain in the central wrist or radial wrist (thumb size).  That is typically in younger patients (example, 12 year old female) and may be part of a surgery which includes excision of Vickers ligament and physiolysis.  However, in older patients with pain on the pinky side of the wrist (the ulnar side), this may not be the best option- instead, an ulnar shortening osteotomy might be the ideal surgery.

Thanks to Andrew Yee for his expertise in creating this video!

Charles A. Goldfarb, MD

My Bio at Washington University
Email me: congenitalhand@wudosis.wustl.edu

8 Comments

  1. hello I am a 41 year old female with madelung deformity in both arms my symptoms presented since I was about 12 years old I am having pain numbness and I am looking into having surgery if you have any recommendations I would greatly appreciate it

  2. Hello. Often the pain is on the pinky side of the wrist once you are fully grown. If that is the case, shortening the ulna bone can help. I would recommend seeing a hand surgeon with experience in this area. Good luck.

    1. Are you who she should see if she has pain on her pinky side of her hand or do you not do Madelungs deformity surgeries? Anyone you suggest if you don’t do them?

      1. Hello and thank you. Yes, pinky- sided pain (typically at the wrist) certainly can be an issue. In my experience, this pain most commonly happens in older adolescents or young adults (but can happen to all). A careful evaluation can help confirm pain origin- often this is related to the ulna bone and its length (being long compared to the radius bone). So, while radius development is the issue, the ulna length can be a problem. I am always happy to care for patients with any pain related to Madelungs.

  3. hola dr.. vi todo lo que habla del madelung.
    una pregunta….nena de 12 años, dolor en el lado central de la muñeca. como ud dice, la cirugia en domo es la mejor opcion, pero sin tocar el cubito ? si el cubito está largo, no se acorta ?

    1. Auugusto,

      Thank you. I will first provide an English translation of your question (I hope a good one).
      “hello dr.. i saw everything that talks about madelungs.
      One question…12-year-old girl, pain in the central side of her wrist. As you say, dome surgery is the best option, but without touching the ulna? If the ulna is long, it does not shorten?”

      My response in English first. Yes, I have had very good results with the dome osteotomy of the radius without treating the ulna in this age group. In older adults- much older teenagers or those in their 20’s- I do shorten the ulnar with, or without, the dome osteotomy of the radius. I hope this is helpful.

      Sí, he tenido muy buenos resultados con la osteotomía de cúpula del radio sin tratar el cúbito en este grupo de edad. En los adultos mayores, adolescentes mucho mayores o en sus 20 años, acorto el cúbito con o sin la osteotomía de cúpula del radio. Espero que esto sea útil.

      1. excelente la traduccion del castellano al ingles.. jajaj
        muchisimas gracias doctor por responder !!!!!!
        entendí perfecto . tengo una paciente de 12 años, con dolor en el lado central de la muñeca. y estuve viendo que algunos hacen la osteotomia del radio , a traves de un abordaje dorsal, mas la osteotomia del cubito con placa …
        De nuevo, muchas gracias.

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