Madelung deformity

INFORMATION

Madelung's deformity is a deformity of the wrist, where the distal end of the radial bone does not develop properly, leading to subluxation (partial dislocation) of the wrist bone between the radial and ulnar bones. The distal end of the joint, between the radial and ulnar bones is dislocated, this leads to a bump from the head of the ulnar bone. Madelung's deformity is Blount's deformity at the wrist; it bends toward the radial bone. The first case was described by German physician Otto Madelung in 1878.

Madelung's deformity occurs primarily in adolescent girls, who complain of pain and reduced range of motion of the wrist. Madelung's deformity is believed to be caused by mutations on the X chromosome. Many cases of the deformity are hereditary, and some are associated with mesomelic dysplasia. The condition manifests bilaterally (affecting both limbs) in 50% of cases. Symptoms of the deformity show up when the patient is about 10-14 years old. It is very rare for patients to be under 10 years old. The mechanism that causes the deformity to develop during adolescence is the closure of the growth plate of the distal end of the radius bone. This leads, characteristically, to shortening of the radius bone, resulting in displacement of the carpal joint.

Various factors affecting development were identified, and deformities were divided into the following types:

Post-traumatic

1. Damage to the growth plate after an illness

Dysplastic

Damage to the growth plate due to bone dysplasias, such as:

1. Multiple Inheritance of Exostosis
2. Olliers diseases
3. Achondroplasia

Genetic

Genes on the X chromosome have been linked to an inherited form of Madelung's deformity

Idiopathic

Unknown or spontaneous origin

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

TREATMENT STRATEGY

Madelung's deformity is 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 bones of the wrist (the lunate bone), where the radial bone meets the wrist, is undeveloped (hypoplastic). This causes subluxation (partial dislocation) of the wrist bone between the radial and ulnar bones.

Dr. Paley treats this complication by opening the wrist joint from the palm and performing a complex intra-articular osteotomy (cutting the bone inside the joint) to lift the reduced portion of the radius bone and reduce the carpal bones into the joint in conjunction with a second osteotomy to align and insert a metal plate. The osteotomy is combined with reduction and ligamentous reconstruction at the distal radial-elbow joint.

After reconstruction at the wrist joint, the radius bone can be lengthened if it is significantly shorter than the ulnar bone. Lengthening is done after the operated wrist has healed. An external stabilizer is placed on the radial bone and an osteotomy of the radial bone is performed. The external stabilizer slowly stretches the two ends of the bone and the newly formed bones in the gap, resulting in increased length. When the radius bone reaches the appropriate length, the lengthening is stopped. The external stabilizer is left until the bone heals, at which point the stabilizer is removed in a minor surgical procedure.

Dr. Paley has extensive experience in treating Madelung's deformity and nearly 30 years of experience in limb lengthening and deformity correction. He has performed countless surgeries to reconstruct the wrist and lengthen the upper limb.