Madelung's Deformity: Difference between revisions

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'''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" />'''
=='''Clinical Features'''==
*'''Initially asymptomatic, progressive clinical deformity'''
*'''Pain at wrist'''
*  
*  
'''itor '''- [[User:Shwe Shwe U Marma|Shwe Shwe U Marma]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>  
'''Original Editor '''- [[User:Shwe Shwe U Marma|Shwe Shwe U Marma]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>  


== 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>This condition could be congenital or acquired<ref>[https://www.ncbi.nlm.nih.gov/books/NBK580535/ Madelung Deformity Tara A. Saxena, Janay Mckie StatPearls, 5 2022]
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>This condition could be congenital or acquired as a result of a trauma to the growth plate, e.g. Salter-Harris fracture (type V). <ref>[https://www.ncbi.nlm.nih.gov/books/NBK580535/ Madelung Deformity Tara A. Saxena, Janay Mckie StatPearls, 5 2022]


</ref>caused by an abnormal ligament discovered by Vickers and Nielsen<ref>[https://pubmed.ncbi.nlm.nih.gov/1402266/ Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992 Aug;17(4):401-7. doi: 10.1016/s0266-7681(05)80262-1. PMID: 1402266.]</ref>This ligament,5mm in diameter lies anterior to the volar-ulnar corner of the distal radial metaphysis, crosses the physis and inserts onto the lunate<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056710/ Farr S, Martínez-Alvarez S, Little KJ, Henstenburg J, Ristl R, Stauffer A, Soldado F, Zlotolow DA. The prevalence of Vickers' ligament in Madelung's deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg Eur Vol. 2021 May;46(4):384-390. doi: 10.1177/1753193420981522. Epub 2021 Jan 17. Erratum in: J Hand Surg Eur Vol. 2021 Jan 27;:1753193421993305. PMID: 33459142; PMCID: PMC8056710.]</ref>. It is found more in females and is usually associated with a mesomelic form of dwarfism known as Leri-Weill dyschondrosteosis<ref>[https://pubmed.ncbi.nlm.nih.gov/26341718/ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.]</ref>.  
</ref>caused by an abnormal ligament discovered by Vickers and Nielsen<ref>[https://pubmed.ncbi.nlm.nih.gov/1402266/ Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992 Aug;17(4):401-7. doi: 10.1016/s0266-7681(05)80262-1. PMID: 1402266.]</ref>This ligament,5mm in diameter lies anterior to the volar-ulnar corner of the distal radial metaphysis, crosses the physis and inserts onto the lunate<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056710/ Farr S, Martínez-Alvarez S, Little KJ, Henstenburg J, Ristl R, Stauffer A, Soldado F, Zlotolow DA. The prevalence of Vickers' ligament in Madelung's deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg Eur Vol. 2021 May;46(4):384-390. doi: 10.1177/1753193420981522. Epub 2021 Jan 17. Erratum in: J Hand Surg Eur Vol. 2021 Jan 27;:1753193421993305. PMID: 33459142; PMCID: PMC8056710.]</ref>. It is found more in females and is usually associated with a mesomelic form of dwarfism known as Leri-Weill dyschondrosteosis<ref>[https://pubmed.ncbi.nlm.nih.gov/26341718/ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.]</ref>.  


The volar ulnar corner of the distal radius is a critical point located between the radial calcar, distal ulna, and carpus and it is responsible for maintaining stability while transferring force from the carpus<ref>[https://pubmed.ncbi.nlm.nih.gov/35837591/ Chiri W, MacLean SB, Clarnette J, Eardley-Harris N, White J, Bain GI. Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures. J Wrist Surg. 2022 Jul 12;11(3):238-249. doi: 10.1055/s-0042-1748674. PMID: 35837591; PMCID: PMC9276061.]</ref>.Due to the posiition of the Vickman's ligament of crossing the volar-ulnar part of the distal radial metaphysis it restricts movements of the wrist and causing reduced stability of the wrist joint<ref>[https://pubmed.ncbi.nlm.nih.gov/35837591/ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.]</ref> [[File:Madelung's Deformity.jpg|center|thumb|500x500px|Madelung's deformity]]
The volar ulnar corner of the distal radius is a critical point located between the radial calcar, distal ulna, and carpus and it is responsible for maintaining stability while transferring force from the carpus<ref>[https://pubmed.ncbi.nlm.nih.gov/35837591/ Chiri W, MacLean SB, Clarnette J, Eardley-Harris N, White J, Bain GI. Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures. J Wrist Surg. 2022 Jul 12;11(3):238-249. doi: 10.1055/s-0042-1748674. PMID: 35837591; PMCID: PMC9276061.]</ref>.Due to the posiition of the Vickman's ligament of crossing the volar-ulnar part of the distal radial metaphysis it restricts movements of the wrist and causing reduced stability of the wrist joint<ref>[https://pubmed.ncbi.nlm.nih.gov/35837591/ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.]</ref>.  [[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 ==
* he 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>
* Predominantly adolescent females are affected by a ratio of 4:1. does not usually manifest until 10-14 years of age<ref>[https://radiopaedia.org/articles/madelung-deformity Madelung deformity Henry Knipe, Frank Gaillard]
 
[https://radiopaedia.org/articles/madelung-deformity Radiopaedia.org, 11 2009]</ref>, The deformity is bilateral most often.<ref name=":02">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> Madelung deformity is relatively rare, with a prevalence of less than 2% of pediatric hand deformities, therefore less than 0.03% of the total population<ref>[https://pubmed.ncbi.nlm.nih.gov/16473675/ Arora AS, Chung KC. Otto W. Madelung and the recognition of Madelung's deformity. J Hand Surg Am. 2006 Feb;31(2):177-82. doi: 10.1016/j.jhsa.2005.09.001. PMID: 16473675.]</ref>.


== Pathogenesis  ==
== Pathogenesis  ==
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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>


=== '''Clinical Features''' ===
*'''Initially asymptomatic, progressive clinical deformity'''
*'''Pain at wrist'''
== Diagnosis ==
== Diagnosis ==


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* widened interosseous space
* widened interosseous space
* relative dorsal position of the ulnar head
* relative dorsal position of the ulnar head
* pyramiding of the carpus<ref name=":0" />
* pyramiding of the carpus<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>


=== MRI ===
=== MRI ===
MRI is done on the patients who need the surgical release of Vickers’ ligament to prevent deformity progression.<ref name=":1" />
MRI is done on the patients who need the surgical release of Vickers’ ligament to prevent deformity progression.<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>


== Differential Diagnosis ==
== Differential Diagnosis ==

Revision as of 22:28, 12 April 2023

Original Editor - Shwe Shwe U Marma Top Contributors - Shwe Shwe U Marma, Oluwafikunayomi Wole-Bankole and Kim Jackson

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]This condition could be congenital or acquired as a result of a trauma to the growth plate, e.g. Salter-Harris fracture (type V). [2]caused by an abnormal ligament discovered by Vickers and Nielsen[3]This ligament,5mm in diameter lies anterior to the volar-ulnar corner of the distal radial metaphysis, crosses the physis and inserts onto the lunate[4]. It is found more in females and is usually associated with a mesomelic form of dwarfism known as Leri-Weill dyschondrosteosis[5].

The volar ulnar corner of the distal radius is a critical point located between the radial calcar, distal ulna, and carpus and it is responsible for maintaining stability while transferring force from the carpus[6].Due to the posiition of the Vickman's ligament of crossing the volar-ulnar part of the distal radial metaphysis it restricts movements of the wrist and causing reduced stability of the wrist joint[7].

Madelung's deformity

A Vickers’ ligament is the feature to differentiate Madelung’s deformity from Madelung-like deformities.[8]

Epidemiology[edit | edit source]

  • Predominantly adolescent females are affected by a ratio of 4:1. does not usually manifest until 10-14 years of age[9], The deformity is bilateral most often.[10] Madelung deformity is relatively rare, with a prevalence of less than 2% of pediatric hand deformities, therefore less than 0.03% of the total population[11].

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.[12]

Clinical Features[edit | edit source]

  • Initially asymptomatic, progressive clinical deformity
  • Pain at wrist

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[13]

MRI[edit | edit source]

MRI is done on the patients who need the surgical release of Vickers’ ligament to prevent deformity progression.[14]

Differential Diagnosis[edit | edit source]

  • Turner syndrome
  • Nail-patella syndrome
  • Hereditary, multiple exostoses
  • Ollier’s disease
  • Achondroplasia
  • Multiple epiphyseal dysplasias
  • Mucopolysaccharidoses (Hurler and Morquio syndrome)[15]

Treatment[edit | edit source]

Conservative Management[edit | edit source]

Conservative management of Madelung’s deformity may be helpful for skeletally mature patients with the following measures:

  • Physiotherapy
    • to reduce pain
      • Icing
      • Cold whirlpool immersion
      • Transcutaneous electrical nerve stimulation
    • limited pronation and supination suggests the need of exercise to help maintaining and/or increasing the power of involved muscles, i.e.- pronators and supinators[16]
  • oral analgesics
  • activity restriction
  • volar splint[17] is used to immobilize tissue injuries which could be traumatic or non-traumatic conditions of the hand and the wrist[18]

Surgical Management[edit | edit source]

  • Radial or ulnar osteotomy
  • Vickers’ ligament resection
  • Ulnar epiphysiodesis[19]

References[edit | edit source]

  1. ↑ 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.
  2. ↑ Madelung Deformity Tara A. Saxena, Janay Mckie StatPearls, 5 2022
  3. ↑ Vickers D, Nielsen G. Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br. 1992 Aug;17(4):401-7. doi: 10.1016/s0266-7681(05)80262-1. PMID: 1402266.
  4. ↑ Farr S, Martínez-Alvarez S, Little KJ, Henstenburg J, Ristl R, Stauffer A, Soldado F, Zlotolow DA. The prevalence of Vickers' ligament in Madelung's deformity: a retrospective multicentre study of 75 surgical cases. J Hand Surg Eur Vol. 2021 May;46(4):384-390. doi: 10.1177/1753193420981522. Epub 2021 Jan 17. Erratum in: J Hand Surg Eur Vol. 2021 Jan 27;:1753193421993305. PMID: 33459142; PMCID: PMC8056710.
  5. ↑ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.
  6. ↑ Chiri W, MacLean SB, Clarnette J, Eardley-Harris N, White J, Bain GI. Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures. J Wrist Surg. 2022 Jul 12;11(3):238-249. doi: 10.1055/s-0042-1748674. PMID: 35837591; PMCID: PMC9276061.
  7. ↑ Kozin SH, Zlotolow DA. Madelung Deformity. J Hand Surg Am. 2015 Oct;40(10):2090-8. doi: 10.1016/j.jhsa.2015.03.033. Epub 2015 Sep 1. PMID: 26341718.
  8. ↑ Prasad N, Venkatesh M. Madelung Deformity of the Wrist: A Classic Presentation. International Journal of Contemporary Medicine Surgery and Radiology. 2020;5:C4-5
  9. ↑ Madelung deformity Henry Knipe, Frank Gaillard Radiopaedia.org, 11 2009
  10. ↑ Thomson C, Hawkes D, Nixon M. Madelung’s Deformity: Diagnosis, Classification and Treatment. Journal of Orthoplastic Surgery. 2020 Apr 17;4(1):1-1.
  11. ↑ Arora AS, Chung KC. Otto W. Madelung and the recognition of Madelung's deformity. J Hand Surg Am. 2006 Feb;31(2):177-82. doi: 10.1016/j.jhsa.2005.09.001. PMID: 16473675.
  12. ↑ Tranmer A, Laub Jr D. Madelung deformity. Eplasty. 2016;16.
  13. ↑ Thomson C, Hawkes D, Nixon M. Madelung’s Deformity: Diagnosis, Classification and Treatment. Journal of Orthoplastic Surgery. 2020 Apr 17;4(1):1-1.
  14. ↑ Knutsen EJ, Goldfarb CA. Madelung's deformity. Hand. 2014 Sep;9(3):289-91.
  15. ↑ Kakarla S. Madelung and pseudo Madelung deformities-Pictorial essay. Journal of Medical and Scientific Research. 2019;7:1-6
  16. ↑ Brooks TJ. Madelung deformity in a collegiate gymnast: a case report. Journal of Athletic Training. 2001 Apr;36(2):170.
  17. ↑ Shahi P, Sudan A, Sehgal A, Meher D, Meena U. Madelung Deformity of the Wrist Managed Conservatively. Cureus. 2020 May;12(5).
  18. ↑ Volar Splinting Courtney A. Bethel, Menachem M. Meller StatPearls, 7 2022
  19. ↑ 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.
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