Madelung's Deformity
pe Predominantly adolescent females are affected by a ratio of 4:1. The deformity is bilateral most often.[1] Predominantly adolescent females are affected by a ratio of 4:1. The deformity is bilateral most often.[1]
Clinical Features[edit | edit source]
- Initially asymptomatic, progressive clinical deformity
- Pain at wrist
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.[2]This condition could be congenital or acquired[3]caused by an abnormal ligament discovered by Vickers and Nielsen[4]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[5]. It is found more in females and is usually associated with a mesomelic form of dwarfism known as Leri-Weill dyschondrosteosis[6].
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[7].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[8]
A Vickers’ ligament is the feature to differentiate Madelung’s deformity from Madelung-like deformities.[9]
Epidemiology[edit | edit source]
- he ages of 6 and 13 years[10]
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.[11]
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[1]
MRI[edit | edit source]
MRI is done on the patients who need the surgical release of Vickers’ ligament to prevent deformity progression.[10]
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)[12]
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[13]
- to reduce pain
- oral analgesics
- activity restriction
- volar splint[14] is used to immobilize tissue injuries which could be traumatic or non-traumatic conditions of the hand and the wrist[15]
Surgical Management[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Thomson C, Hawkes D, Nixon M. Madelung’s Deformity: Diagnosis, Classification and Treatment. Journal of Orthoplastic Surgery. 2020 Apr 17;4(1):1-1.
- ↑ 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.
- ↑ Madelung Deformity Tara A. Saxena, Janay Mckie StatPearls, 5 2022
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Prasad N, Venkatesh M. Madelung Deformity of the Wrist: A Classic Presentation. International Journal of Contemporary Medicine Surgery and Radiology. 2020;5:C4-5
- ↑ 10.0 10.1 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
- ↑ Brooks TJ. Madelung deformity in a collegiate gymnast: a case report. Journal of Athletic Training. 2001 Apr;36(2):170.
- ↑ Shahi P, Sudan A, Sehgal A, Meher D, Meena U. Madelung Deformity of the Wrist Managed Conservatively. Cureus. 2020 May;12(5).
- ↑ Volar Splinting Courtney A. Bethel, Menachem M. Meller StatPearls, 7 2022
- ↑ 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.
