April 11, 2024

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

McCarroll Parameters for Madelung deformity in PA view
McCarroll Parameters for Madelung deformity in PA view
McCarroll Parameters for Madelung deformity in Lateral view
McCarroll Parameters for Madelung deformity in Lateral view

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