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Title: [Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening].
Author: Wang W, Deng X, Li W, Yang M, Zhang Y, Shi P, Shen W, Liu R, Shi J, Li C, Xue Y, Gao Q.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Jul 15; 37(7):810-814. PubMed ID: 37460176.
Abstract:
OBJECTIVE: To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening. METHODS: The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded. RESULTS: After the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation ( P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case. CONCLUSION: Ulnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness. 目的: 探讨尺骨截骨短缩术序贯钢板内固定矫正Madelung畸形的临床效果。. 方法: 回顾性分析2015年9月—2021年7月收治的13例腕部Madelung畸形患者临床资料，其中男5例，女8例；年龄17～23岁，平均18.3岁。病程12～24个月，平均17个月。3例有明确外伤史。患者均存在腕关节桡偏畸形、尺偏活动受限，尺偏活动时尺骨撞击痛明显；9例患者腕关节旋后活动受限，旋前活动自如。13例患者一期行尺骨截骨短缩术联合外固定架矫正腕部畸形，术后进行骨搬移，每4小时调节1次，6次/d，每日调节1 mm；待截骨断端搬移到位后二期予以尺骨钢板内固定重建尺骨稳定性。采用Cooney腕关节评分对术前及术后内固定物取出前腕关节疼痛、功能、活动范围、屈伸活动度、握力评分，同时记录患者主观感觉及外观满意度。. 结果: 13例患者术后均获随访，二期术后随访时间10～22个月，平均15个月。患者术后腕关节畸形消失，屈伸、尺偏活动基本正常，无尺骨撞击征、骨不连及感染等并发症发生。除1例患者旋转活动及疼痛改善不明显外，其余患者术后腕关节功能、疼痛及活动度均较术前明显改善。患者于二期术后10～18个月截骨断端完全愈合后取出尺骨内固定物，取出内固定物前Cooney腕关节评分中疼痛、功能、活动范围、屈伸活动度及握力评分均较术前显著改善（ P<0.05）。所有患者主观感觉满意度及外观满意度达优9例、良3例、可1例。. 结论: 尺骨截骨短缩术序贯钢板内固定矫正Madelung畸形，术后疼痛轻，可有效避免骨不连，改善腕关节功能。.

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