Management of pediatric Madelung’s deformity of the forearm due to physeal growth arrest of the distal ulna: a case report

Abstract

Introduction and importance: The authors presented a treatment option for Madelung’s deformity due to physeal growth arrest of the distal ulna after Kirschner wire (K-wire) fixation for pediatric forearm fractures. Case presentation: A boy, 16 years old, suffered from a close fracture of the middle third of the left radius and ulna and was treated with open reduction and internal fixation (ORIF) pinning with intramedullary K-wires. Eight months after surgery, the implant was removed. There was no complaint for more than 10 years. Nevertheless, the patient complained of a bowing hand and was diagnosed with Madelung’s deformity of the left forearm due to physeal growth arrest 12 years ago. The authors treated this patient with the release of fibrous tissue of the distal ulna, Darrach’s procedure, and extensor carpi ulnaris (ECU) tenodesis, along with a close wedge osteotomy of the distal radius and an ORIF of the distal radius. Four months after surgery, the clinical and radiological results were satisfactory. Clinical discussion: Pinning across a physis has the potential to cause full or partial development to stop. Madelung’s deformity is usually treated conservatively or surgically, depending on the severity of the symptoms. Darrach’s procedure, ECU tenodesis, close wedge osteotomy, and ORIF of the distal radius are available options to treat Madelung’s deformity. Conclusion: The use of transphyseal K-wires may result in physeal growth interruption. The developed Madelung’s deformity can be satisfactorily managed by Darrach’s procedure, ECU tenodesis, in combination with a close wedge osteotomy and ORIF of the distal radius.