Successful Early Surgical Intervention for a Wrist Deformity

Columbus, OH — January 2018

Madelung’s deformity is a rare congenital condition of the wrist, most commonly seen in adolescent females. Patients can experience pain, decreased mobility and wrist deformity.

New research from orthopedic surgeons at Nationwide Children’s Hospital demonstrates that early treatment of Madelung’s deformity with Vickers ligament release minimizes progression of the deformity and may prevent the need for future surgeries. The case series was presented at the 73rd annual meeting of the American Society for Surgery of the Hand.

This surgical technique was first described by Vickers and Nielsen in 1992. In their original case series, patients ranging in age from 11 to 14 years old underwent release of the thickened radiolunate ligament (Vickers ligament).

In the new study, the authors from Nationwide Children’s reviewed a group of patients (12 total wrists) that were diagnosed with bilateral Madelung’s deformity at an earlier age, from 7 to 9 years old.  All of these patients underwent Vickers ligament resection and radial physiolysis.

“When this diagnosis is made early on, there is an opportunity to eliminate the thick, abnormal Vickers ligament that is causing problems, to try to improve the unhealthy physis, and to prevent progression of the deformity,” says Julie Samora, MD, PhD, director of Quality Improvement in the Department of Orthopaedics at Nationwide Children’s, a surgeon in the hospital’s Hand and Upper Extremity Program and the senior study author.

Overall, the researchers say the surgery is minimally invasive, safe and effective. Within a month after surgery, all patients experienced less pain and returned to their pre-surgery activities. Range of motion improved or was maintained in all wrists, and there were also improvements in radiographic measurements of deformity. None of the patients displayed significant progression of the deformity.  

“Our conclusion is that this is a low-risk, safe, and effective surgery that may prevent progression of this deformity,” says Dr. Samora, who is also associate clinical professor of Orthopaedic Surgery at The Ohio State University College of Medicine.

The Hand and Upper Extremity Program at Nationwide Children’s involves the Departments of Plastic and Reconstructive Surgery and Orthopaedics. This multidisciplinary team provides a comprehensive approach to upper extremity care in children with trauma or congenital defects.

References:

Otte, J. E., Popp, J. E., and Samora, J. (2017). Treatment of Madelung’s Disease with Vicker’s Ligament Release: A Case Series. Poster presented at the 73rdannual meeting of the American Society for Surgery of the Hand.

Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. Journal of Hand Surgery. 1992; 17B: 401-407.