Volar Dome Osteotomy of the Distal Radius for Madelung’s Deformity - Extended (Feat. Dr. Goldfarb)

Video Description

Corrective Volar Dome Osteotomy of the Distal Radius for Madelung’s Deformity
Authors: Goldfarb CA1, Yee A2
Published: January 30, 2019

Author Information
1 Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

Extended Edition (190123.190123)

ABSTRACT
Madelung’s deformity consists of anterior-ulnar bowing of the radius and a dorsally prominent ulnar head. This deformity is diagnosed in early adolescence when the prominence of the distal ulna and/or nonspecific wrist pain leads to a patient seeking an orthopedic opinion. Several operative techniques have been proposed for the painful or aesthetically unacceptable deformity. Vickers drew attention to an abnormal ligament (Vickers ligament) of the volar-ulna aspect of the radiocarpal joint. He subsequently reported success with the volar release of this ligament and physiolysis for Madelung’s deformity in early adolescence. The procedure has evolved to include a dome-shaped distal radius osteotomy to allow a 3D repositioning of the bone. Indications for correction of Madelung’s deformity include a painful wrist not responsive to conservative management and/or significant aesthetic deformity. In this case, a 17-year-old female presented with bilateral Madelung’s deformity with primarily central right wrist pain for several years and worsening over the last few months. Corrective volar dome osteotomy of the distal radius was elected following failed conservative management.

KEYWORDS
Madelung’s deformity, dome osteotomy, radius, wrist pain

POSITION
Supine.

TABLE OF CONTENTS (Extended)
00:00 Introduction
00:30 Incision
00:59 Dissection through Superficial Fascia
01:20 Identifying the Radial Artery
02:02 Identifying the Flexor Carpi Radialis Tendon
02:22 Retracting the Flexor Carpi Radialis Tendon and Protecting the Radial Artery
02:46 Identifying the Flexor Tendons
03:22 Retracting the Flexors and Protecting the Median Nerve
03:33 Exposure of Pronator Quadratus
04:27 Release the Pronator Quadratus Attachment from the Radius
04:55 Exposure of Vickers Ligament
05:35 Incising and Releasing Vickers Ligament from the Radius
06:10 Marking the Distal Radius for Osteotomy
06:30 Insertion of 2.062 K-wire into Distal Radius
06:45 Fluoroscopy of K-wire for Osteotomy Placement
06:53 Further Incising and Releasing Vickers Ligament from the Radius
08:25 Drilling the Distal Radius
09:21 Preparing for Dome Osteotomy Using Straight Osteotome
10:18 Creating Dome Osteotomy Using Curved Osteotome
12:11 Checking Mobility of Proximal and Distal Segment of Radius
12:20 Further Dome Osteotomy and Release of Proximal Radius
12:40 Checking Mobility of Proximal and Distal Segment of Radius
12:54 Positioning the Distal Radial Segment Dorsally and Radially to Correct Deformity
14:21 Further Incising and Releasing Vickers Ligament from the Distal Radius
14:36 Further Positioning the Distal Radial Segment Dorsally and Radially to Correct Deformity
15:13 Correction of Deformity
15:58 Insertion of First K-wire Fixation
16:50 Incision to Protect Cutaneous Nerves
17:36 Insertion of Second K-wire Fixation
18:28 Fluoroscopy of K-wire Fixation
18:35 Removal of Volar Cortex and Minor Grafting of Union
19:14 Credits