Kayahan KARAYTUĞ, Hayati DURMAZ, Ahmet SALDUZ, Ömer Naci ERGİN, Murat KORKMAZ

The Result of Correction Osteotomy of the Radius and Shortening Osteotomy of the Ulna for Madelung Deformity: Case series

Amaç: Madelung deformitesi, radius distal büyüme plağının volar ve ulnar tarafında erken büyüme duraklaması ile tanımlanan nadir bir deformitedir. Tedavisi için literatürde farklı cerrahi girişimler tanımlanmıştır. Bu çalışmada Madelung deformitesinde kullandığımız cerrahi tekniğin klinik ve radyolojik sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: 2005-2014 yılları arasında kliniğimizde 4 hastaya (3 kadın, 1 erkek) ait beş el bileği Madelung deformitesi nedeniyle opere edildi. Hastaların ortalama yaşı 15,4 (14-17) ve ortalama takip süresi 65 (29-111) ay idi. Bir hastada bilateral deformite vardı. Hastalar ameliyat öncesi ve sonrası eklem hareket açıklığı, DASH ve VAS skorları ile değerlendirildi. Tüm hastalara radius düzeltici osteotomi, ulna kısaltıcı osteotomi ve Vickers bağı gevşetme ameliyatı uygulandı. Bulgular: Hastaların son kontrollerindeki eklem hareket açıklıkları ameliyat öncesi değerler ile karşılaştırıldığında, dorsifleksiyon ve radyal deviasyon aralığı anlamlı olarak artarken palmar fleksiyon arkı azalmıştı. Supinasyon ve pronasyon aralığında anlamlı bir değişiklik izlenmedi. Tüm osteotomi alanlarında kaynama sağlanmıştı. Son takip röntgenlerinde tüm radyolojik parametreler ameliyat öncesine göre anlamlı olarak daha iyiydi. Ameliyat öncesi ve sonrası ortalama DASH skoru sırasıyla 55,4 ve 18,8 iken, ameliyat öncesi ve sonrası VAS skoru sırasıyla ortalama 6 ve 1 idi. Tartışma ve Sonuç: İleri Madelung deformitesi olan hastalarda bu cerrahi teknik hasta memnuniyeti, fonksiyonel ve radyolojik sonuçlar bakımından iyi bir seçenek olabilir. Ağrı ve belirgin deformite bizim ana cerrahi endikasyonumuz oldu.

Madelung Deformitesi Tedavisinde Radius Düzeltici, Ulna Kısaltıcı Osteotomi Sonuçları: Olgu serisi

Aim: Madelung deformity is a rare condition characterized by premature growth arrest of the volar-ulnar aspect of the distal radius growth plate. Different surgical procedures are described in the literature. In this study, we aimed to present functional and clinical results of our technique in five wrists of 4 patients.Materials and Methods: Five wrists of 4 patients (3 females and 1 male) underwent surgery for Madelung deformity in our clinic between 2005 and 2014. The mean age of the patients was 15.4 (14-17) and the mean follow up duration was 65.6 months (29-111). One patient had bilateral deformity. The patients were evaluated in terms of wrist range of motion (ROM), DASH score, and VAS score pre-and post-operatively. Corrective osteotomy to the radius, shortening osteotomy to the ulna, and release of the Vickers ligament were performed on all of the patients.Results: Although there were no meaningful changes in the range of supination-pronation, palmar flexion was decreased, and dorsiflexion and radial deviation were significantly higher in the last follow-up compared to the preoperative values. Union was achieved at all of the osteotomy sites. All radiological parameters were significantly better in the last follow-up X-rays. The preoperative and postoperative mean DASH scores were 55.4 and 18.8, respectively, and the preoperative and postoperative mean VAS scores were 6 and 1, respectively.Discussion and Conclusion: This surgical technique may be a good option for severe Madelung deformity in terms of functional and radiological results and patient satisfaction in the midterm follow-up. Pain and gross deformity were our main surgical indications.

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