Modified Distal-Radial Dome Osteotomy With Segmental Resection for Madelung Deformity

CASE: A 19-year-old woman had 4 years of right-wrist pain, weakness, and limited motion. No syndromic stigmata or family history. Radiographs showed isolated unilateral Madelung deformity with negative ulnar variance. Planning required radial shortening; a modified double-cut dome osteotomy with segmental resection was performed, with Vickers ligament release and volar plate fixation. At 12 months, union was achieved with restored alignment and neutral ulnar variance; she reported complete pain relief and full function. Wrist motion and grip strength normalized. CONCLUSION: This modified double-cut dome osteotomy permits intentional resection for radial shortening while preserving multiplanar correction in atypical negative ulnar variance. LEVEL OF EVIDENCE: IV.