Double Osteotomy Based on Three-Dimensional Planning for the Treatment of Severe Madelung Deformity: Technique and Radiographic Results

Abstract Corrective osteotomy for severe Madelung deformity with a radioulnar inclination exceeding 50 degrees and additional diaphyseal bowing of the radius remains a surgical challenge. Virtual preoperative planning based on three-dimensional (3D) evaluation of the deformity may enhance understanding and improve the execution of multiplanar correction. Four female patients (mean age: 17 ± 1 years) underwent double osteotomy for correction of severe Madelung deformity. Quantitative assessment of the deformity included measurements of radioulnar inclination, lunate subsidence, and carpal alignment. Virtual planning was performed in a standardized manner, and surgery was executed using patient-specific, 3D-printed sawing and cutting guides as well as custom-designed implants. At a mean follow-up of 2.5 years, radioulnar inclination was reduced from 57 to 31 degrees, lunate subsidence was normalized (stage 0), and carpal alignment was restored in all patients. The desired radial joint level was achieved without the need for any additional ulnar procedures. In severe Madelung deformity involving the diaphysis, double osteotomy can restore distal radial alignment and radial bow. Incorporating 3D preoperative planning with printed surgical guides and patient-specific plates increases accuracy and reliability in managing this complex pathology.