Treatment of Madelung deformity (2023)

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A recent follow-up revealed debilitating mechanical pain at the ulnar edge of the wrist and decreased pronation and supination (Tables 1 and 2). MD surgery improved pain symptoms, range of motion, grip strength, and radiological parameters in patients treated at our center, with results comparable to those reported in the literature [8,10–13,21] . Surgical treatment was influenced by the severity of distal radius deformity, including prominent lunate and sagittal inclination of the radius.

Madelung's deformity is a rare congenital wrist disorder that can cause pain, aesthetic problems, limited range of motion and grip strength. There is currently no consensus on the optimal age for surgery or whether surgical interventions can be isolated or combined depending on the degree of deformity. The main aim of the study was to analyze postoperative functional clinical outcomes in at least 3-year follow-up of patients operated on for Madelung's deformity. Secondary objectives were (1) to compare preoperative and postoperative radiographic parameters and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical intervention.

The operation offered in our center achieves the clinical and radiological effect necessary for prolonged everyday activity and is differentiated depending on the degree of distal radius deformity.

We performed a retrospective monocentric observational study involving patients operated between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score) and radiographic assessments were performed before and after the last follow-up visit.

The study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up period of 8.1 years (4-12.3). The mean VAS was 2.3 (0-6) and the mean PRWE score was 37 (0-108). The mean arc of flexion and extension was 134°, and that of pronation and supination was 142°. The mean grip strength was 25.8 ± 11.8 kg. Four of the six radiological criteria were significantly improved. Isolated radial osteotomy or combined radioulnar osteotomy was performed when radial sagittal inclination was greater than 30° and lunate projection greater than 5 mm, otherwise isolated ulnar osteotomy was performed below these values.

Our center offers surgical treatment of Madelung's deformity by osteotomy, which improves most postoperative radiographic parameters and provides satisfactory clinical and radiological results after an average of 8.1 years of follow-up. The degree of deformity of the distal radius, including prominence of the lunate and sagittal inclination of the radius, affects the operation.

IV, retrospective study.

Madelung's disease is a rare congenital wrist disorder that can cause pain, limited range of motion, reduced grip strength and an unsightly appearance. There is currently no consensus on the optimal age for surgery or whether procedures can be isolated or combined depending on the severity of the deformity. The main aim of our study is to analyze postoperative functional clinical outcomes in a minimum 3-year follow-up of patients operated for Madelung's disease. Secondary objectives are: 1) comparison of pre- and postoperative radiological parameters; and 2) assess whether certain preoperative radiographic parameters influence the choice of surgical intervention.

The surgical procedure proposed at our center provides clinical and radiological results consistent with daily activities in the long term and varies depending on the degree of deformity of the distal radius.

We conducted a retrospective, observational, single-center study of patients operated on in the years 2004-2016. Clinical (VAS, mobility), functional (PRWE score) and pre- and postoperative radiological assessments were performed at the last follow-up visit.

The study included 11 patients (12 wrists) with a mean age of 17 ± 7.3 years and a mean follow-up of 8.1 years (4-12.3). The mean VAS was 2.3 (0-6) and the mean PRWE score was 37 (0-108). The mean angle of flexion-extension was 134° and prono-supination was 142°. The mean grip strength was 25.8 ± 11.8 kg. Four of the six radiographic criteria were significantly improved. An isolated radial osteotomy or a combined radioulnar osteotomy was performed when the radial fibular inclination was greater than 30° and the lunate projection greater than 5 mm below the isolated ulnar osteotomy.

The surgical treatment of Madelung's disease by osteotomy proposed in our center improves most postoperative radiographic parameters and provides satisfactory clinical and radiological results with a mean follow-up time of 8.1 years. Surgery is influenced by the severity of the distal radius deformity, including lunate prominence and sagittal radius tilt.

IV, retrospective study.

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To interpret whether this case is an acquired or idiopathic condition, it is necessary to consider the rarer causes of deformity (see Supplement 2.2). Excessively bent abnormal hand positioning suggests a rather extreme form compared to those in the modern medical literature (Peymani et al., 2018; Saffar and Badina, 2016). It exceeds all modern medical classifications of severity (cf. Tuder et al., 2008).

The article presents a probable case of Madelung-type deformity of the right forearm in an individual from a Merovingian cemetery (7th and 8th century AD) from Gotha-Boilstädt (Germany).

The study involved a woman aged 40-50 years at the age of death.

Macroscopic, osteometric and radiographic analyzes were performed by standard methods.

The subject exhibits an atypical case of dysmelia in the right upper extremity. The shoulder and arm showed slender traces of muscle attachment and less strength compared to the left side. The ulna was shortened and malformed, and the radius was severely deformed.

The results indicate that the person may have been affected by a unilateral Madelung deformity. The severity of this case is greater than reported in the clinical literature.

This study places an ancient rare disease in archaeological and paleopathological contexts, allowing the concept of "ancient rare disease" to be evaluated. It also emphasizes the importance of reporting strictly diagnosed cases to increase our awareness of the occurrence and course of this rare disease in the past.

The diagnosis cannot be made with certainty, and only a few possible diagnoses can be made. Congenital and acquired etiology must be considered, especially compared to clinical cases where the severity of the condition can be modified by medical intervention.

Genetic analysis may be helpful in determining the etiology of the observed Madelung deformity.

Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are performed in the area of ​​the brachial plexus (BP). We performed an anatomical study to describe the anatomy of the endoscopic BP and the technique used to dissect and expose the endoscopic BP. Thirteen fresh bodies were autopsied. We first performed endoscopic BP dissection using classic extra-articular portals for shoulder arthroscopy. Through each portal we analyzed as many structures as possible and identified them. We then performed an open autopsy to confirm the endoscopic findings and look for damage to adjacent structures. In the supraclavicular region, we were able to expose the C5, C6, and C7 roots and upper and middle trunks in 11 of the 13 specimens through two transtrapezoidal portals after the suprascapular nerve. The entire subclavian portion of the BP (except the medial medulla and its branches) was exposed in 11 of the 13 specimens. Access to the subclavian BP led directly to the lateral and posterior bundles, but the axillary artery covered the medial bundle. The musculocutaneous nerve was the first nerve encountered during medial dissection from the anterior coracoid process. The axillary nerve was the first nerve encountered after the medial anterior border of the subscapular bone from the posterior side of the coracoid process. Knowledge of the endoscopic anatomy of the BP is essential to reveal and protect this structure during advanced shoulder arthroscopic procedures.

With the development of shoulder arthroscopy beyond the shoulder joint, it becomes important to master the endoscopic anatomy of the brachial plexus (BP). We performed a descriptive cadaveric study of the endoscopic anatomy of the PB and nerves around the shoulder. We compared the results of endoscopy with open dissection. We performed endoscopic dissection of the PB of 13 anatomical objects from the arthroscopic approach to the shoulder. We dissected the roots and trunks, then the bundles and terminal branches of the brachial plexus. We performed an open autopsy to confirm the endoscopy results. In the supraclavicular region, we exposed the C5, C6, and C7 roots, the upper and middle trunks, then we exposed the subclavian plexus in 11 of 13 cases, and the medial bundle in 3 cases. The musculocutaneous nerve was visible in all cases and was the first nerve identified during dissection starting anterior to the medial coracoid process. The axillary nerve was the first nerve visualized, starting dissection posterior to the coracoid process and passing inward. We describe the endoscopic anatomy of the PB, the mastery of which is now essential to protect the plexus in extra-articular endoscopic shoulder interventions. We describe in detail the surgical technique to approach PB based on the anatomical work of endoscopic dissection, with open correlation.

38 hands of 36 patients with recurrent or persistent carpal tunnel syndrome (CTS) were retrospectively evaluated after a mean of 51 months (range 12–86) to identify factors that may lead to poor surgical outcomes. Clinical evaluation focused on the return of pain and sensitivity, as measured by the VAS and the Weber two-point discrimination test, respectively. During the last observation, we found 11 excellent, 15 good, 9 satisfactory and 3 poor results. The risk of achieving a satisfactory or poor result was significantly higher in the presence of intraneural fibrosis, significant preoperative sensory deficit, palmar cutaneous neuroma of the median nerve, staffing requirements and the number of operations. The latter factor also significantly increased the risk of intraneural fibrosis. Despite the disappointing results, identification of these factors may improve our predictive ability for revision surgery in cases of recurrent FTE.

38 hands of 36 patients with recurrent or persistent carpal tunnel syndrome were retrospectively analyzed with a mean follow-up of 51 months (12–86 months) to identify factors leading to poor surgical outcomes. Clinical evaluation was based on pain development and sensory recovery by EVA and Weber's Sensitive Discrimination Test, respectively. During the last observation, we recorded 11 excellent results, 15 good results, 9 average results and 3 poor results. Poor and satisfactory results were significantly related to the presence of intraneural sclerosis, the severity of preoperative sensory deficit, palmar cutaneous neuromas, occupational accident status, and the number of revision surgeries. Moreover, the latter factor significantly increased intraneural sclerosis. Despite the disappointing results, identification of these factors may improve our ability to predict these cases of revision surgery for recurrent or persistent carpal tunnel syndrome.

Ulnar nerve entrapment is the second most common compression neuropathy after carpal tunnel syndrome. The accessory anconeus epitrochlearis muscle – found in 4-34% of the general population – is a known but rare cause of ulnar nerve entrapment in the elbow joint. The purpose of the article was to expand our knowledge of this disease based on six cases encountered in our hospital in 2011-2015. Each patient had a typical clinical picture: hypoesthesia or sensory deficit in the 4th and 5th fingers; potential internal atrophy of the fourth intermetacarpal space; loss of strength and difficulty in abducting the fifth finger. Although it may be helpful to have the patient undergo an ultrasound or MRI to aid in the diagnosis, only electromyography (EMG) was performed on our patients. EMG showed marked compression in the ulnar groove with conduction block and a large decrease in nerve conduction velocity. Treatment usually involves conservative treatment first (splint, painkillers). Surgical treatment should be considered when medical treatment fails or in a patient with severe neurological deficits. In all our patients, the ulnar nerve was surgically released but not transposed. Five of the six patients recovered completely after 0.5 to 4 years of follow-up. Entrapment of the ulnar nerve at the elbow by the anconeus epitrochlearis muscle is uncommon but should not be ignored. Only ultrasound, MRI or ideally surgical exploration can make the diagnosis. EMG findings, such as reduced motor nerve conduction velocity in the short ulnar artery, are suggestive of anconeus epitrochlear neuropathy.

Ulnar nerve entrapment in the elbow joint is the second most common compression neuropathy after median nerve entrapment in the carpal tunnel. Compression of the anconeus epitrochlearis muscle, a supernumerary muscle occurring in 4 to 34% of cases, is a known but rare cause. The purpose of this article was to summarize this cause from the six cases we encountered, a series that constitutes the largest series in the literature. We illustrate this development in six cases showing compression of the ulnar nerve at the elbow level by the anconeus epitrochlearis muscle, reviewed prospectively and monocentrically from 2011-2015. All patients in our series presented a classic picture of compression of the ulnar nerve at the level of the elbow elbow elbow: sensory disturbances in the fourth and fifth fingers, motor disturbances with possible atrophy of the internal organ in the fourth metacarpal space. The diagnostic procedure consists of performing an electromyogram (EMG) and, in some cases, an ultrasound of the elbow joint and magnetic resonance imaging (T1-weighted edema). None of our patients received ultrasound or MRI. All EMGs showed marked ulnar sulcus compression with conduction block and decrease in conduction velocity. Therapeutic treatment initially consisted of conservative treatment (orthosis, analgesics), then in case of failure or occurrence of significant neurological symptoms, surgical treatment: decompression of the nerve with or without transposition. In all cases, we performed ulnar nerve neurolysis without nerve transposition. Long-term results were good, with five out of six patients making a full recovery. Compression of the ulnar nerve in the area of ​​the elbow by the anconeus epitrochlearis muscle is rare, but you need to know how to think about it. Only ultrasound, MRI, or better surgery can establish the diagnosis, although certain EMG symptoms, such as slowing of motor conduction over a short segment of the ulnar nerve, support this etiology.

The purpose of this study was to compare the results of two groups of patients with quad fusion, one group immobilized with shape memory staples and the other with locked round plates. This retrospective study compared 52 wrists operated for scaphoid excision and four horn fusion between 2005 and 2011. Arthrodesis was provided by four-legged memory braces (4Fusion^®, Memometal™) in 37 cases and a locking peripheral dorsal plate (Xpode^®, Biotech Ortho™) in 15 cases. In the primary group, the mean age was 58.5 years and the mean follow-up was 4.3 years. In the round plate group, the average age was 58.6 years, and the average follow-up was 3.1 years. Pain, range of motion, grip strength, functional scores (QuickDASH and PWRE), midcarpal fusion, complications (implant fracture and reoperation), and patient satisfaction were used as outcome measures. There was no pain during follow-up in 43% of patients in the staple group and 40% of patients in the round plate group; range of motion and functional scores were similar in both groups. 75 percent of patients in the staple group were satisfied or very satisfied compared to 60% in the round plate group. The implant ruptured in 24.3% of cases in the group with staples and 60% in the group with round plates. Reoperation was required in 18% of cases with staples and 14% of cases with plaques. There was no difference between the implants in terms of pain, mobility, functional outcomes and patient satisfaction. The rate of implant fracture in the plate group was high. This study casts doubt on the reliability of the implant for the four-horn fusion procedure.

The purpose of this study was to compare the results of two series of tetrapod arthrodeses, one osteosynthesized using tetrapod shape memory staples and the other using a screw-locked circular plate. This retrospective study compared 52 wrists operated for scaphoid excision and four-bone arthrodesis between 2005 and 2011. Arthrodesis immobilization was secured with a 4Fusion shape memory clamp^®(Stryker/Memometal™) in 37 cases or screw-on Xpode plate^®(Biotech Ortho™) in 15 cases. In the primary group, the mean age was 58.5 years and the mean follow-up time was 4.3 years; in the round plaque group, the average age was 58.6 years and the follow-up was 3.1 years. The analysis of the results focused on pain, mobility, grip strength (grip) and QuickDASH and PWRE functional scores, mid-carpal fusion, complications (implant fracture and revision surgery) and patient satisfaction. Indolence was restored in 43.2% of patients in the staple group and 40% of patients in the round plate group, and mobility and dexterity scores were comparable between the two groups. 75 percent of patients in the staple group were satisfied or very satisfied compared to 60% in the round plate group. The fracture rate of the implants was 24.3% in the clamp group and 60% in the round plate group. The revision rate was 18% in the staple group and 14% in the round plate group. There was no significant difference in pain, range of motion or patient satisfaction. The group of round plates showed a significant fracture rate of the material. The paper addresses the question of the reliability of the proposed implants in the fixation of four bone arthrodeses.

Coverage of thumb soft tissue defects includes a variety of techniques ranging from simple second-end healing, to skin grafts with or without skin substitutes, to localized homo- or hetero-digital flaps and partial finger transfers. The arsenal in relation to covering the skin and especially flakes is very diverse. Our goal is not to compile an exhaustive catalog of all the technical possibilities described in the literature, but rather to present in detail the possibilities that we have adopted in our daily practice. For each of these techniques, we present the principles of their implementation (anatomical basis, surgical techniques) and their topographical indications.

Covering thumb skin defects requires a variety of techniques, from simple targeted healing, to skin grafts with or without skin substitutes, to localized homodactylic or heterodactylic flaps to partial finger transfers. The therapeutic arsenal in terms of covering the skin, and especially the flaps, is very diverse. Our goal is not to create a simple exhaustive catalog of all the technical possibilities described in the literature, but rather to present in detail the possibilities that have appeared in our daily practice. For each of the techniques, we present the basic principles of their implementation (anatomical basis, surgical techniques) and their topographical indications.