The Madelung deformity was first described in 1878 by Otto Wilhelm Madelung, German surgeon (1846-1926) It is an epiphyseal growth plate disturbance characterised by dorsal and radial bowing of the radius with resultant deformity, pain and decreased grip strength. It often occurs as rare congenital deformity and does not usually present until 10-14 years. It may also be seen as an acquired consequence of trauma to the growth plate, e.g. Salter V fracture.
Madelung’s is more common in females and can be bilateral in 50-65% of patients
Whether congenital or traumatic, the common mechanism for all causes of Madelung deformity is due to partial closure, or failure of development of the ulnar side of the distal radial growth plate. There is an arrest of epiphyseal growth of the ulnar and volar aspect of the radius. This leads to shortening of the radius and relative overgrowth of the ulna.
The radiological features include
exaggerated palmar (up to 35°) and ulnar tilt (up to 60°) of the radiocarpal articulation
exaggerated radial inclination
carpal subluxation in a palmar and ulnar direction
lunate is gradually forced to the apex of the V-shaped radioulnaocarpal joint
“V-shaped” proximal carpal row or herniated proximal carpal row
dorsal subluxation of the distal ulna and positive ulnar variance
wedging of the carpus between the radius and ulna
Many treatments have been proposed and tried, often with limited success. Conservative measures tend to be ineffective. Surgical options include
radial epiphysiodesis
radial corrective osteotomy
radial physiolysis
ulnar epiphysiodesis
excision of the distal ulnar
ulnar shortening osteotomy
Not all the information will necessarily be relevant to you and your surgeon will discuss options with you.
