Madelung’s deformity is an abnormality of the palmar ulnar part of the distal radial physis, which results in the progressive ulnar and volar tilt of distal radial articular surface with dorsal subluxation of the distal ulna.
The exact cause is unknown.
Vicker described an abnormal ligament that tethers the lunate to the distal radius proximal to the physis. This ligament is believed to impede the growth of the ulnopalmar aspect of the distal radius.
Madelung’s deformity is also associated with SHOX deficiency disorder, Leri Weill Dyschondrosteosis.
Madelung’s deformity is usually bilateral and most commonly presents between 6 and 13 years of age.
Girls are more affected than boys.
Presenting complaints will be decreased motion, deformity of the wrist, and minimal pain.
On examination, the deformity is more obvious from the ulnar side. There will be a subluxation of the distal radioulnar joint, and the wrist will be dropped forwards.
Radiographs of the wrist with forearm aids in the diagnosis.
Two orthogonal views demonstrate the radial abnormalities such as dorsally convexity curvature over distal third of radius, triangular distal radial epiphysis; ulnar abnormalities like subluxation of distal radioulnar joint; and wrist appears subluxed ulnar wards and palmar wards.
Magnetic resonance imaging will aid in identifying the ligamentous tether.
Mild asymptomatic deformities are followed up with serial radiographs.
For progressive deformities, the only treatment option is surgery.
Indications for surgical management are wrist pain, limited range of movements, and deformity.
The viable surgical option is epiphysiolysis, and release of the ligamentous tether and dome corrective osteotomy.
The long term consequences are unpredictable. It includes asymptomatic deformities, extensor tendon rupture, Carpal tunnel syndrome, kienbock’s disease, and early arthritis of the wrist.