Madelung’s Deformity

Symptomatic adolescent with considerable Madelung’s deformity

Volar incision over the flexor carpi radialis (FCR) tendon beginning at wrist crease and extending 6 to 8 cm up the forearm (Fig. 62-1).
Open FCR tendon sheath and retract tendon in radial direction. Incise the floor of the tendon sheath.
Retract FCR tendon and sheath in a radial direction along with the radial artery.
Retract carpal tunnel contents in an ulnar direction. Identify pronator quadratus (PQ) over metaphysis of distal radius.
Incise PQ along radial margin and elevate from distal radius. Dissection is extraperiosteal to preserve osseous blood supply.
Identify Vicker’s ligament on the metaphysis of the radius and release from the radius in a proximal to distal direction up to the radiocarpal joint (Fig. 62-2).
Create a biplanar dome osteotomy in the metaphysis. The concavity faces distal in the sagittal and coronal planes. Osteotomy is created with curved osteotomes (Fig. 62-3).
Rotate the distal fragment to obtain better coverage beneath the lunate, and translate from volar to dorsal. Thumb pressure on the distal fragment facilitates correction (Fig. 62-4).
Insert two percutaneous 0.062 in. pins from the radial styloid across the osteotomy site and into the proximal radius (Fig. 62-5A,B). Verify position by fluoroscopy. Cut pins beneath the skin.
Remove protruding bone from the radius just proximal to osteotomy site using a rongeur (Fig. 62-6A,B).
Close subcutaneous tissue and skin.