Madelung deformity is characterized as a radius that is typically bowed and short with a prominent ulnar head on the dorsal aspect of the wrist
Here, the distal articulating surface of the radius is inclined in the ulnar and palmar direction
Carpus appears to be subluxed volarly and ulnarwards
F: M::4:1
Congenital cause of Madelung deformity is Leri-Weil dyschondrosteosis (Bilateral)
Acquired
Partial physeal closure due to trauma (Usually unilateral)
Etiopathology of Madelung deformity
Delayed growth/premature closure of ulnar volar radial physis with progressive loss of support of lunate
Affection in Ulnar Volar Radial Physis
Truncated appearances of metaphysis with tapering of the epiphysis with bowing radial shaft
Due to reduced growth potential, a clear triangular zone is seen in metaphysics adjacent to the abnormal physis zone
(Histopathologically, this area shows delayed in endochondral ossification and disorganization of chondrocytes)
Reverse Madelung Deformity
Ulnar dorsal physis is involved
Chevron Carpus
Abnormality is the central, distal articulating surface of the radius with wedge shape carpus
Location of metaphysis clear zone: Clues to the location of physeal arrest
An abnormal thick fibrocartilagenous ligament is found to extend between volar radial metaphysis to lunate and TFCC
Radiological Assessment
It is a 3-dimensional deformity
Routine X-Ray does not provide adequate evaluation of problems
4 radiological parameters were described by McCarrol
In PA view
- Ulnar tilt (>28°)
- Lunate subsidence (> 3 mm)
- Lunate fossa angle
In lateral view
- Palmar carpal displacement (> 19 mm)
Clinical Features
Ulnar-sided wrist pain due to Ulna impingement
Treatment
If presented early during the growth period: Release of Vicker’s ligament and physiolysis
It will stop the progression of the deformity
Presentation after established deformity:
- Vicker’s ligament excision + Dome osteotomy (Volar approach)
Other techniques
Distal Closing wedge osteotomy of the radius with ulnar shortening (Isolated ulnar head shortening)-
Darrach Procedure:- Not preferred due to Volar subluxation of carpus
Joint leveling: Ilizarov fixation
Sauve-Kapandji Procedure
Total Wrist Fusion
