Madelung's Deformity: Difference between revisions
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== Introduction == | == Introduction == | ||
Madelung’s deformity is a condition of the [[Wrist and Hand|wrist]] characterized by a shortened distal [[radius]] with volar–ulnar curvature and a dorsally prominent distal [[ulna]].<ref>Dubey A, Fajardo M, Green S, Lee SK. [https://journals.sagepub.com/doi/10.1177/1753193409346070 Madelung’s deformity: a review]. Journal of Hand Surgery (European Volume). 2010 Mar;35(3):174-81.</ref> | Madelung’s deformity is a condition of the [[Wrist and Hand|wrist]] characterized by a shortened distal [[radius]] with volar–ulnar curvature and a dorsally prominent distal [[ulna]].<ref>Dubey A, Fajardo M, Green S, Lee SK. [https://journals.sagepub.com/doi/10.1177/1753193409346070 Madelung’s deformity: a review]. ''Journal of Hand Surgery'' (European Volume). 2010 Mar;35(3):174-81.</ref> | ||
[[File:Madelung's Deformity.jpg|center|thumb|500x500px|Madelung's deformity]] | [[File:Madelung's Deformity.jpg|center|thumb|500x500px|Madelung's deformity]] | ||
A Vickers’ [[ligament]] is the feature to differentiate Madelung’s deformity from Madelung-like deformities.<ref>Prasad N, Venkatesh M. [https://www.ijcmsr.com/uploads/1/0/2/7/102704056/ijcmsr_456.pdf Madelung Deformity of the Wrist: A Classic Presentation]. International Journal of Contemporary Medicine Surgery and Radiology. 2020;5:C4-5</ref> | A Vickers’ [[ligament]] is the feature to differentiate Madelung’s deformity from Madelung-like deformities.<ref>Prasad N, Venkatesh M. [https://www.ijcmsr.com/uploads/1/0/2/7/102704056/ijcmsr_456.pdf Madelung Deformity of the Wrist: A Classic Presentation]. ''International Journal of Contemporary Medicine Surgery and Radiology''. 2020;5:C4-5</ref> | ||
== Epidemiology == | == Epidemiology == | ||
Predominantly adolescent females are affected by a ratio of 4:1. The deformity is bilateral most often.<ref name=":0">Thomson C, Hawkes D, Nixon M. [http://www.journaloforthoplasticsurgery.com/index.php/JOPS/article/view/54/29 Madelung’s Deformity: Diagnosis, Classification and Treatment]. Journal of Orthoplastic Surgery. 2020 Apr 17;4(1):1-1.</ref> | Predominantly adolescent females are affected by a ratio of 4:1. The deformity is bilateral most often.<ref name=":0">Thomson C, Hawkes D, Nixon M. [http://www.journaloforthoplasticsurgery.com/index.php/JOPS/article/view/54/29 Madelung’s Deformity: Diagnosis, Classification and Treatment]. ''Journal of Orthoplastic Surgery''. 2020 Apr 17;4(1):1-1.</ref> | ||
== Clinical Features == | == Clinical Features == | ||
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* Loss of wrist extension | * Loss of wrist extension | ||
* Compromised forearm rotation | * Compromised forearm rotation | ||
* “Bayonet” deformity- prominent distal ulna as a result of dorsal [[Subluxation of the distal radioulnar joint|subluxation]]<ref>Babu S, Turner J, Seewoonarain S, Chougule S. [https://mkhand.org.mk/s-0039-1685488.pdf Madelung's Deformity of the Wrist—Current Concepts and Future Directions]. Journal of wrist surgery. 2019 Jun;8(03):176-9.</ref> | * “Bayonet” deformity- prominent distal ulna as a result of dorsal [[Subluxation of the distal radioulnar joint|subluxation]]<ref>Babu S, Turner J, Seewoonarain S, Chougule S. [https://mkhand.org.mk/s-0039-1685488.pdf Madelung's Deformity of the Wrist—Current Concepts and Future Directions]. ''Journal of wrist surgery''. 2019 Jun;8(03):176-9.</ref> | ||
* Girls are more often affected than boys | * Girls are more often affected than boys | ||
* Presents between the ages of 6 and 13 years<ref name=":1">Knutsen EJ, Goldfarb CA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152440/ Madelung's deformity]. Hand. 2014 Sep;9(3):289-91.</ref> | * Presents between the ages of 6 and 13 years<ref name=":1">Knutsen EJ, Goldfarb CA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152440/ Madelung's deformity]. ''Hand''. 2014 Sep;9(3):289-91.</ref> | ||
== Pathogenesis == | == Pathogenesis == | ||
Premature growth plate arrest at the medial volar aspect of the distal radius causes Madelung deformity. Repetitive traumatic pressure may result in Madelung-like deformity. Mutation or absence of the short stature homeobox (SHOX) gene is thought to be the cause of congenital madelung deformity. | Premature growth plate arrest at the medial volar aspect of the distal radius causes Madelung deformity. Repetitive traumatic pressure may result in Madelung-like deformity. Mutation or absence of the short stature homeobox (SHOX) gene is thought to be the cause of congenital madelung deformity. | ||
Congenital madelung deformity can occur as a part of Leri-Weill dyschondrosteosis (LWD) or Turner syndrome.<ref>Tranmer A, Laub Jr D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993032/ Madelung deformity]. Eplasty. 2016;16.</ref> | Congenital madelung deformity can occur as a part of Leri-Weill dyschondrosteosis (LWD) or Turner syndrome.<ref>Tranmer A, Laub Jr D. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993032/ Madelung deformity]. ''Eplasty''. 2016;16.</ref> | ||
== Diagnosis == | == Diagnosis == | ||
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* [[Achondroplasia]] | * [[Achondroplasia]] | ||
* Multiple epiphyseal dysplasias | * Multiple epiphyseal dysplasias | ||
* Mucopolysaccharidoses (Hurler and Morquio syndrome)<ref>Kakarla S. [https://www.researchgate.net/publication/334069794_Madelung_and_pseudo_Madelung_deformities-Pictorial_essay Madelung and pseudo Madelung deformities-Pictorial essay]. Journal of Medical and Scientific Research. 2019;7:1-6</ref> | * Mucopolysaccharidoses (Hurler and Morquio syndrome)<ref>Kakarla S. [https://www.researchgate.net/publication/334069794_Madelung_and_pseudo_Madelung_deformities-Pictorial_essay Madelung and pseudo Madelung deformities-Pictorial essay]. ''Journal of Medical and Scientific Research''. 2019;7:1-6</ref> | ||
== Treatment == | == Treatment == | ||
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* oral analgesics | * oral analgesics | ||
* activity restriction | * activity restriction | ||
* volar [[splint]]<ref>Shahi P, Sudan A, Sehgal A, Meher D, Meena U. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306668/ Madelung Deformity of the Wrist Managed Conservatively]. Cureus. 2020 May;12(5).</ref> | * volar [[splint]]<ref>Shahi P, Sudan A, Sehgal A, Meher D, Meena U. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306668/ Madelung Deformity of the Wrist Managed Conservatively]. ''Cureus''. 2020 May;12(5).</ref> | ||
==== '''Surgical Management''' ==== | ==== '''Surgical Management''' ==== | ||
* Radial or ulnar [[osteotomy]] | * Radial or ulnar [[osteotomy]] | ||
* Vickers’ ligament resection | * Vickers’ ligament resection | ||
* Ulnar epiphysiodesis<ref>Bebing M, de Courtivron B, Pannier S, Journeau P, Fitoussi F, Morin C, Violas P. [https://www.sciencedirect.com/science/article/abs/pii/S1877056820302486 Madelung's deformity in children: Clinical and radiological results from a French national multicentre retrospective study]. Orthopaedics & Traumatology: Surgery & Research. 2020 Nov 1;106(7):1339-43.</ref> | * Ulnar epiphysiodesis<ref>Bebing M, de Courtivron B, Pannier S, Journeau P, Fitoussi F, Morin C, Violas P. [https://www.sciencedirect.com/science/article/abs/pii/S1877056820302486 Madelung's deformity in children: Clinical and radiological results from a French national multicentre retrospective study]. ''Orthopaedics & Traumatology: Surgery & Research''. 2020 Nov 1;106(7):1339-43.</ref> | ||
== References == | == References == |
Revision as of 13:06, 26 December 2020
Introduction[edit | edit source]
Madelung’s deformity is a condition of the wrist characterized by a shortened distal radius with volar–ulnar curvature and a dorsally prominent distal ulna.[1]
A Vickers’ ligament is the feature to differentiate Madelung’s deformity from Madelung-like deformities.[2]
Epidemiology[edit | edit source]
Predominantly adolescent females are affected by a ratio of 4:1. The deformity is bilateral most often.[3]
Clinical Features[edit | edit source]
- Initially asymptomatic, progressive clinical deformity
- Pain at wrist
- Loss of wrist extension
- Compromised forearm rotation
- “Bayonet” deformity- prominent distal ulna as a result of dorsal subluxation[4]
- Girls are more often affected than boys
- Presents between the ages of 6 and 13 years[5]
Pathogenesis[edit | edit source]
Premature growth plate arrest at the medial volar aspect of the distal radius causes Madelung deformity. Repetitive traumatic pressure may result in Madelung-like deformity. Mutation or absence of the short stature homeobox (SHOX) gene is thought to be the cause of congenital madelung deformity.
Congenital madelung deformity can occur as a part of Leri-Weill dyschondrosteosis (LWD) or Turner syndrome.[6]
Diagnosis[edit | edit source]
Key Features from X-Ray[edit | edit source]
- increased dorsal and radial convexity of the distal radius
- increased volar and ulnar tilt of the distal radial articular surface
- widened interosseous space
- relative dorsal position of the ulnar head
- pyramiding of the carpus[3]
MRI[edit | edit source]
MRI is done on the patients who need the surgical release of Vickers’ ligament to prevent deformity progression.[5]
Differential Diagnosis[edit | edit source]
- Turner syndrome
- Nail-patella syndrome
- Hereditary, multiple exostosis
- Ollier’s disease
- Achondroplasia
- Multiple epiphyseal dysplasias
- Mucopolysaccharidoses (Hurler and Morquio syndrome)[7]
Treatment[edit | edit source]
Conservative Management[edit | edit source]
Conservative management of Madelung’s deformity may be helpful for skeletally mature patients with following measures:
Surgical Management[edit | edit source]
References[edit | edit source]
- ↑ Dubey A, Fajardo M, Green S, Lee SK. Madelung’s deformity: a review. Journal of Hand Surgery (European Volume). 2010 Mar;35(3):174-81.
- ↑ Prasad N, Venkatesh M. Madelung Deformity of the Wrist: A Classic Presentation. International Journal of Contemporary Medicine Surgery and Radiology. 2020;5:C4-5
- ↑ 3.0 3.1 Thomson C, Hawkes D, Nixon M. Madelung’s Deformity: Diagnosis, Classification and Treatment. Journal of Orthoplastic Surgery. 2020 Apr 17;4(1):1-1.
- ↑ Babu S, Turner J, Seewoonarain S, Chougule S. Madelung's Deformity of the Wrist—Current Concepts and Future Directions. Journal of wrist surgery. 2019 Jun;8(03):176-9.
- ↑ 5.0 5.1 Knutsen EJ, Goldfarb CA. Madelung's deformity. Hand. 2014 Sep;9(3):289-91.
- ↑ Tranmer A, Laub Jr D. Madelung deformity. Eplasty. 2016;16.
- ↑ Kakarla S. Madelung and pseudo Madelung deformities-Pictorial essay. Journal of Medical and Scientific Research. 2019;7:1-6
- ↑ Shahi P, Sudan A, Sehgal A, Meher D, Meena U. Madelung Deformity of the Wrist Managed Conservatively. Cureus. 2020 May;12(5).
- ↑ Bebing M, de Courtivron B, Pannier S, Journeau P, Fitoussi F, Morin C, Violas P. Madelung's deformity in children: Clinical and radiological results from a French national multicentre retrospective study. Orthopaedics & Traumatology: Surgery & Research. 2020 Nov 1;106(7):1339-43.