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Madelung's deformity treated with ilizarov-technique, follow-up of 8 cases
THEJOURNAL. OFHAND
34
SURFERYVOL28RSUPPLEMENTI
SESSION 8: CONGENITAL 58. ELONGATION OF THE HAND AND FOREARM IN CONGENITAL HAND RECONSTRUCTION
Leszek Romanowskit, W. Manikowski*, P. Lubiatowski2, P. Surdzie*. ‘Hand Surgery Department, 28 Czerwcn 1956 no 135, 6154 Poznan, Poland; 2 University Poznan, Poland
ofMedical
Sciences,
Bone elongation and soft tissue extension are very useful in the treatment of congenital malformations and particularly in the failure of formation of parts and undergrowth. By applying these methods we can improve remarkably the function and cosmetic appearance of the hand. Material and methods: Our material were 47 patients after arm, forearm and hand elongation. All operation were performed under local anesthesia. Using a straight incision over the bone four pins were inserted, then osteotomy between two middle pins was carefully made. Next the Wagner, Ilizarow, Pumed or custom made device was applied. Lengthening started on the seventh to tenth day at a rate of 1 mm a day in four to six stages. After proper elongation the extremity was immobilized for four - six weeks. We used X-ray and USG monitoring. Complications: In 38 cases we found 14 complications. Most had no serious consequences and were successfully resolved. In 5 cases alignment was inadequate. In 3 other cases there was insufficient release of contracted soft tissue and this was corrected at an additional operation. In 6 cases delayed bone union was reported. Conclusions: Elongation is a useful method of treatment of congenital malformations, improving the function and aesthetics of the limb. Soft tissue extension is recommended as the first step for wrist centralization. Complications that occur during lengthening are not severe and can be resolved.
59. MADELUNG’S DEFORMITY TREATED WITH ILIZAROV-TECHNIQUE,
FOLLOW-UP OF 8 CASES
Henrik Schroder, Shirzad Houshian, Rainer Weeth. Odense
University Hospital. Department. of Orthupuedics. Hand Section, Sdr Boulevard 29, SW0 Odense C, Denmurk
Madelung’s deformity results from growth arrest in the ulnar part of the distal epiphysis of the radius resulting in radial shortening and palmar and ulnar angulation of the distal radius. The Ilizarov technique for correction of the deformity has been evaluated prospectively since 1997. Material and methods: Seven patients with eight Madelung deformities (5 female and 2 male) have been operated. The mean age at surgery was 19 years. The indication was persistent pain in daily activities and limitation of movement. The aetiology was congenital deformity in six cases and acquired in two cases. Operative technique: A modified llizarov frame was constructed. Bone distraction was begun after 7 days, primarily correcting length by 1 mm a day and subsequently the angular deformity was corrected. Introduction:
Results: At a mean follow-up time of 24 months, grip strength and range of movement were improved in all cases. One patient still suffered from slight pain. Al1 patient were satisfied with the results. Discussion: Few treatment options have been recommended for these patients. The Ilizarov technique should be considered for surgical treatment of Madelung’s deformity when correction are needed for both angle and length in patients suffering persistent pain.
60. THE DOUBLE OSTEOTOMY OF RADIUS AND ULNA FOR CORRECTION OF MADELUNG’S DEFORMITY
V. Khanduja, Z. Dannawi, L. Ng, L. Heras. Newham General Hospital, London, UK Aims: The purpose of our study was to assess the efficacy of double
osteotomy of the radius and ulna for correction of Madelung’s deformity, a congenital alteration of the growth of the ulnar portion of the distal radius resulting in pain, decreased function of the wrist and hand and serious aesthetic disturbances. Patients and methuds.Four wrists in four patients with a mean age of 18.3 years were treated for symptomatic increased ulnar and volar inclination of the distal articular surface of the radius. All patients complained of wrist pain. In addition, two of them were dissatisfied with the aesthetic appearance of their wrist and the restricted range of movement. A double osteotomy of the radius and ulna was performed. The ulna was stabilised with a six-hole semi-tubular plate and the radius with a titanium T-plate. Results: At one year follow up; pain relief and cosmetic appearance were satisfactory in al1patients. Grip strength improved by 5.3 pounds. Average llexion improved from 63” to 67” and pronation from 59” to 66”. Abduction increased from 3” to 6” and adduction from 16”to 21”. Realignment of the wrist was shown radiographically by a change of ulnar inclination and volar inclination of the radius from 35.5” to 24” and 15.5” to 10.5” respectively. There was no evidence of recurrence of the deformity in any of the four wrists. Conclusion: The initial results with the double osteotomy of the radius and ulna for Madelung’s deformity arc promising but need longer follow up.
61. THE ULNAR LONGITUDINAL DEFICIENCY. NEW CLASSIFICATION BASED ON A REVIEW OF 46 CASES
Lorea Panic’, I. Medina’, G. Pajardi2, G. Pivato*, G. Foucher*. ‘Strasbourg Clinique Diaconesses. 3504 Strusbourg, France; 2~s
Palmas - Milan, Lns Palmas, Spain
Ulnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity (sometimes bilaterally). The clinical and radiological aspects are variable and none of the existing classifications takes in account all the deformities. Kum-
34
SURFERYVOL28RSUPPLEMENTI
SESSION 8: CONGENITAL 58. ELONGATION OF THE HAND AND FOREARM IN CONGENITAL HAND RECONSTRUCTION
Leszek Romanowskit, W. Manikowski*, P. Lubiatowski2, P. Surdzie*. ‘Hand Surgery Department, 28 Czerwcn 1956 no 135, 6154 Poznan, Poland; 2 University Poznan, Poland
ofMedical
Sciences,
Bone elongation and soft tissue extension are very useful in the treatment of congenital malformations and particularly in the failure of formation of parts and undergrowth. By applying these methods we can improve remarkably the function and cosmetic appearance of the hand. Material and methods: Our material were 47 patients after arm, forearm and hand elongation. All operation were performed under local anesthesia. Using a straight incision over the bone four pins were inserted, then osteotomy between two middle pins was carefully made. Next the Wagner, Ilizarow, Pumed or custom made device was applied. Lengthening started on the seventh to tenth day at a rate of 1 mm a day in four to six stages. After proper elongation the extremity was immobilized for four - six weeks. We used X-ray and USG monitoring. Complications: In 38 cases we found 14 complications. Most had no serious consequences and were successfully resolved. In 5 cases alignment was inadequate. In 3 other cases there was insufficient release of contracted soft tissue and this was corrected at an additional operation. In 6 cases delayed bone union was reported. Conclusions: Elongation is a useful method of treatment of congenital malformations, improving the function and aesthetics of the limb. Soft tissue extension is recommended as the first step for wrist centralization. Complications that occur during lengthening are not severe and can be resolved.
59. MADELUNG’S DEFORMITY TREATED WITH ILIZAROV-TECHNIQUE,
FOLLOW-UP OF 8 CASES
Henrik Schroder, Shirzad Houshian, Rainer Weeth. Odense
University Hospital. Department. of Orthupuedics. Hand Section, Sdr Boulevard 29, SW0 Odense C, Denmurk
Madelung’s deformity results from growth arrest in the ulnar part of the distal epiphysis of the radius resulting in radial shortening and palmar and ulnar angulation of the distal radius. The Ilizarov technique for correction of the deformity has been evaluated prospectively since 1997. Material and methods: Seven patients with eight Madelung deformities (5 female and 2 male) have been operated. The mean age at surgery was 19 years. The indication was persistent pain in daily activities and limitation of movement. The aetiology was congenital deformity in six cases and acquired in two cases. Operative technique: A modified llizarov frame was constructed. Bone distraction was begun after 7 days, primarily correcting length by 1 mm a day and subsequently the angular deformity was corrected. Introduction:
Results: At a mean follow-up time of 24 months, grip strength and range of movement were improved in all cases. One patient still suffered from slight pain. Al1 patient were satisfied with the results. Discussion: Few treatment options have been recommended for these patients. The Ilizarov technique should be considered for surgical treatment of Madelung’s deformity when correction are needed for both angle and length in patients suffering persistent pain.
60. THE DOUBLE OSTEOTOMY OF RADIUS AND ULNA FOR CORRECTION OF MADELUNG’S DEFORMITY
V. Khanduja, Z. Dannawi, L. Ng, L. Heras. Newham General Hospital, London, UK Aims: The purpose of our study was to assess the efficacy of double
osteotomy of the radius and ulna for correction of Madelung’s deformity, a congenital alteration of the growth of the ulnar portion of the distal radius resulting in pain, decreased function of the wrist and hand and serious aesthetic disturbances. Patients and methuds.Four wrists in four patients with a mean age of 18.3 years were treated for symptomatic increased ulnar and volar inclination of the distal articular surface of the radius. All patients complained of wrist pain. In addition, two of them were dissatisfied with the aesthetic appearance of their wrist and the restricted range of movement. A double osteotomy of the radius and ulna was performed. The ulna was stabilised with a six-hole semi-tubular plate and the radius with a titanium T-plate. Results: At one year follow up; pain relief and cosmetic appearance were satisfactory in al1patients. Grip strength improved by 5.3 pounds. Average llexion improved from 63” to 67” and pronation from 59” to 66”. Abduction increased from 3” to 6” and adduction from 16”to 21”. Realignment of the wrist was shown radiographically by a change of ulnar inclination and volar inclination of the radius from 35.5” to 24” and 15.5” to 10.5” respectively. There was no evidence of recurrence of the deformity in any of the four wrists. Conclusion: The initial results with the double osteotomy of the radius and ulna for Madelung’s deformity arc promising but need longer follow up.
61. THE ULNAR LONGITUDINAL DEFICIENCY. NEW CLASSIFICATION BASED ON A REVIEW OF 46 CASES
Lorea Panic’, I. Medina’, G. Pajardi2, G. Pivato*, G. Foucher*. ‘Strasbourg Clinique Diaconesses. 3504 Strusbourg, France; 2~s
Palmas - Milan, Lns Palmas, Spain
Ulnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity (sometimes bilaterally). The clinical and radiological aspects are variable and none of the existing classifications takes in account all the deformities. Kum-