Scientific Article|Articles in Press

Early Results of 3-Dimensional Planning and Customized Cutting Guides for the Treatment of Severe Madelung Deformity

Published:February 09, 2023DOI:


      Surgical treatment of Madelung deformity can present challenges due to a need for multiplanar correction. Developing customized cutting guides for osteotomies may improve surgical outcomes by enhancing the surgeon’s understanding and surgical correction.


      All patients who underwent forearm osteotomies for Madelung deformity using computed tomography planning with 3-dimensional–printed customized cutting guides were retrospectively reviewed (n = 8). Seven patients underwent a double osteotomy of the radius, and 1 underwent a single osteotomy.


      Ulnar tilt was improved in all cases. Correction of deformity was significant on anteroposterior but not on lateral views. The mean preoperative and postoperative radial bow was measured in 2 planes, with an average preoperative bow of 32° (± 21°) on anteroposterior radiographs and 36° (± 17°) on lateral radiographs, and an average bow of 10° (± 6°) on anteroposterior radiographs and 7° (± 6°) on lateral films after surgery. The predicted radial bow was calculated to be 9.1° (± 8°).


      Three-dimensional planning allows predictable deformity correction across multiple but not all parameters. Future studies comparing clinical and radiographic outcomes of guided versus nonguided osteotomies are required to justify the additional expense and preoperative planning efforts.

      Type of study/level of evidence

      Therapeutic V.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zebala L.P.
        • Manske P.R.
        • Goldfarb C.A.
        Madelung’s deformity: a spectrum of presentation.
        J Hand Surg Am. 2007; 32: 1393-1401
        • Nielsen J.B.
        Madelung’s deformity. A follow-up study of 26 cases and a review of the literature.
        Acta Orthop Scand. 1977; 48: 379-384
        • Vickers D.
        • Nielsen G.
        Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion.
        J Hand Surg Br. 1992; 17: 401-407
        • Kozin S.H.
        • Zlotolow D.A.
        Madelung deformity.
        J Hand Surg Am. 2015; 40: 2090-2098
        • Hanson T.J.
        • Murthy N.S.
        • Shin A.Y.
        • Kakar S.
        • Collins M.S.
        MRI appearance of the anomalous volar radiotriquetral ligament in true Madelung deformity.
        Skeletal Radiol. 2019; 48: 915-918
        • Arora A.S.
        • Chung K.C.
        • Otto W.
        Madelung and the recognition of Madelung’s deformity.
        J Hand Surg Am. 2006; 31: 177-182
        • Otte J.E.
        • Popp J.E.
        • Samora J.B.
        Treatment of Madelung deformity with Vicker ligament release and radial physiolyses: a case series.
        J Hand Surg Am. 2019; 44: 158.e1-158.e9
        • Harley B.J.
        • Brown C.
        • Cummings K.
        • Carter P.R.
        • Ezaki M.
        Volar ligament release and distal radius dome osteotomy for correction of Madelung’s deformity.
        J Hand Surg Am. 2006; 31: 1499-1506
        • Ali S.
        • Kaplan S.
        • Kaufman T.
        • Fenerty S.
        • Kozin S.
        • Zlotolow D.A.
        Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics.
        Pediatr Radiol. 2015; 45: 1856-1863
        • Steinman S.
        • Oishi S.
        • Mills J.
        • Bush P.
        • Wheeler L.
        • Ezaki M.
        Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up.
        J Bone Joint Surg Am. 2013; 95: 1198-1204
        • Farr S.
        • Kalish L.A.
        • Bae D.S.
        • Waters P.M.
        Radiographic criteria for undergoing an ulnar shortening osteotomy in Madelung deformity: a long-term experience from a single institution.
        J Pediatr Orthop. 2016; 36: 310-315
        • dos Reis F.B.
        • Katchburian M.V.
        • Faloppa F.
        • Albertoni W.M.
        • Laredo Filho J.
        Osteotomy of the radius and ulna for the Madelung deformity.
        J Bone Joint Surg Br. 1998; 80: 817-824
        • Peymani A.
        • Foumani M.
        • Dobbe J.G.G.
        • Strackee S.D.
        • Streekstra G.J.
        Four-dimensional rotational radiographic scanning of the wrist in patients after proximal row carpectomy.
        J Hand Surg Eur Vol. 2017; 42: 846-851
        • Benayoun M.
        • Langlais T.
        • Laurent R.
        • et al.
        3D planning and patient-specific surgical guides in forearm osteotomy in children: radiographic accuracy and clinical morbidity.
        Orthop Traumatol Surg Res. 2022; 108102925
        • Tang J.B.
        • Giddins G.
        Why and how to report surgeons’ levels of expertise.
        J Hand Surg Eur Vol. 2016; 41: 365-366
        • McCarroll H.R.
        • James M.A.
        • Newmeyer W.L.
        • Molitor F.
        • Manske P.R.
        Madelung’s deformity: quantitative assessment of x-ray deformity.
        J Hand Surg Am. 2005; 30: 1211-1220
        • Damore E.
        • Kozin S.H.
        • Thoder J.J.
        • Porter S.
        The recurrence of deformity after surgical centralization for radial clubhand.
        J Hand Surg Am. 2000; 25: 745-751
        • Manske P.R.
        • McCarroll H.R.
        • Swanson K.
        Centralization of the radial club hand: an ulnar surgical approach.
        J Hand Surg Am. 1981; 6: 423-433
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Peymani A.
        • Dobbe J.G.G.
        • Streekstra G.J.
        • McCarroll H.R.
        • Strackee S.D.
        Quantitative three-dimensional assessment of Madelung deformity.
        J Hand Surg Eur Vol. 2019; 44: 1041-1048
        • McCarroll Jr., H.R.
        • James M.A.
        Very distal radial osteotomy for Madelung’s deformity.
        Tech Hand Up Extrem Surg. 2010; 14: 85-93
        • Skelley NWm
        • Smith M.J.
        • Ma R.
        • Cook J.L.
        Three-dimensional printing technology in orthopaedics.
        J Am Acad Orthop Surg. 2019; 27: 918-925
        • McCarroll H.R.
        • James M.A.
        • Newmeyer W.L.
        • Manske P.R.
        Madelung’s deformity: diagnostic thresholds of radiographic measurements.
        J Hand Surg Am. 2010; 35: 807-812
        • McCarroll H.R.
        • James M.A.
        • Newmeyer W.L.
        • Manske P.R.
        Madelung’s deformity: quantitative radiographic comparison with normal wrists.
        J Hand Surg Eur Vol. 2008; 33: 632-635
        • Potenza V.
        • Farsetti P.
        • Caterini R.
        • Tudisco C.
        • Nicoletti S.
        • Ippolito E.
        Isolated Madelung’s deformity: long-term follow-up study of five patients treated surgically.
        J Pediatr Orthop B. 2007; 16: 331-335