Madelung’s Deformity

Information

Madelung’s deformity is a deformity of the wrist where part of the distal radius does not develop properly, leading to subluxation (partial dislocation) of the wrist bones between the radius and ulna. The distal joint between the radius and ulna is dislocated, leading to a prominent bump from the head of the ulna. Madelung’s deformity is a Blount’s deformity of the wrist; there is a bowing of the radius. The condition was first described by German physician, Otto Madelung, in 1878.

 

Madelung’s deformity occurs most prominently in adolescent females who complain of pain and decreased wrist range of motion. It is thought that Madelung’s deformity is caused by mutations on the X-chromosome. Many cases of Madelung’s deformity are hereditary and some are related to mesomelic dysplasia. The condition manifests bilaterally (affecting both limbs) in 50% of cases.

 

Symptoms of madelung’s deformity do not begin until the patient begins adolescence (ages of 10-14). It is very rare for patients to present under 10 years of age. The mechanism that causes the deformity to develop in adolescence is a partial closure of the distal radial growth plate. This leads to the characteristic shortening of the radius and resultant dislocation of the wrist joint. Various factors have been identified to explain this development, and Madelung’s deformity has been divided into the following types:

 

Post-traumatic

  • Damage to the growth plate following injury

 

Dysplastic

Damage to the growth plate due to bony dysplasias, such as

  • Multiple Hereditary Exostoses
  • Ollier’s Disease
  • Achondroplasia

Genetic

  • Genes on the X-chromosome have been linked to a hereditary form of Madelung’s deformity

 

Idiopathic

  • Unknown or spontaneous origin

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At the Paley Institute, we recommend surgical treatment of Madelung’s deformity for the alleviation of pain and to restore function to the wrist.

 

Treatment Strategies

A Madelung deformity is a Blount’s disease of the wrist. Therefore, surgical treatment is functionally similar to the treatment of Blount’s disease. In patients with Madelung’s deformity, one of the small wrist bones (the lunate facet), where the radius meets the wrist, is underdeveloped (hypoplastic). This leads to subluxation (partial dislocation) of the wrist bones between the radius and ulna.

 

Dr. Paley treats this complication by opening the wrist joint from the palm-side and performing a complicated intra-articular osteotomy (bone cutting inside the joint) to elevate the depressed part of the radius and reduce the wrist bones into a joint combined with a second osteotomy to realign the lower radius and fix it with a metal plate. The osteotomies are combined with reduction and ligamentous reconstruction of the distal radio-ulnar joint.

 

After reconstruction of the wrist joint, the radius may be lengthened if it is significantly shorter than the ulna. Lengthening is done after the wrist surgery has healed. An external fixator is applied to the radius and an osteotomy of the radius is performed. The external fixator slowly distracts (pulls apart) the two segments of bone and new bone forms in the gap resulting in increased length. Once the radius has reached its proper length, no further lengthening is performed. The external fixator remains until the bone has healed (consolidated), at which point the fixator is removed in a minor outpatient procedure.

 

Dr. Paley has extensive experience in treating Madelung’s deformity, as well as almost 30 years of experience in limb lengthening and deformity correction. He has performed countless surgeries to reconstruct the wrist and lengthen the upper extremities.