Otto W. Madelung described the wrist deformity bearing his name in 1878 as ”Die spontane subluxation der hand nocte vorne” or “spontaneous forward subluxation of the hand.” Several authors prior to Madelung, including Dupuytren in 1834, Nelaton in 1847, and Malgaigne in 1855, had described entities termed carpus curvus, radius curvus, progressive subluxation of the wrist, manus valgus, manus furca, and idiopathic progressive curvature of the radius. However, Madelung first accurately described it clinically and proposed both an etiology and treatment.
- Posttraumatic--has been found following repetitive trauma or following a single event that disrupts growth of the distal radial ulnar-volar physis.
- Dysplastic--Bone dysplasias associated with MD include multiple hereditary osteochondromatosis, Ollier disease, achondroplasia, multiple epiphysial dysplasias, and the mucopolysaccharidoses (eg, Hurler and Morquio syndromes). The most important dysplasia associated with MD, however, is dyschondrosteosis
- Chromosomal or genetic (Turner syndrome)
- Idiopathic or primary
1. Correct the primary deformity of the radius
- Vickers Physiolysis--In 1992, Vickers and Nielsen described the lesion in the volar and ulnar distal radius as both bony and ligamentous, and they stated that it is an inherent failure of focal growth and structural tethering of further growth. They described an ulnar-volar release for MD of the physis, called physiolysis. This then allows normal and compensatory growth to correct the deformity. The deformity must be noticed early when significant growth remains.
- Osteotomy of radius--If the deformity has progressed in an older child and remaining growth is insufficient, several procedures can be used to correct the position of the distal radiocarpal joint surface. They usually consist of a biplane osteotomy, either closing or opening wedge, which corrects the position of the joint surface and brings the radius and ulna into a more proper position. If a positive ulnar variance remains, an ulnar shortening procedure can be performed.
- Radioulnar length adjustment--In MD, the ulna grows normally and becomes longer than the radius. Because the radius is volar, the ulna appears to be subluxed dorsally. The incongruence at the distal radioulnar joint and the impingement of the radius on the ulna in supination may cause pain and contribute to decreased range of motion in supination. In order to allow unrestricted rotation, several ulnar procedures have been described. These include 1) ulnar shortening, 2) ulnar head resection and a DRUJ arthrodesis, and 3) ulnar pseudoarthrosis. Some have advocated both radial and ulnar procedures.
- Ulnar resection--The Darrach procedure long has been a treatment option for MD. This construct in isolation may leave the carpus unstable, especially in light of the increased ulnar and volar slope of the radial articular surface. The carpus therefore tends to slide off of the ulnar side of the wrist. Several authors have devised procedures to solve this problem. The Sauve-Kapandji (Lauenstein) procedure may be a viable option for MD as the ulnar head is preserved and there is less chance for ulnar migration of carpus.
- In 2000, Carter and Ezaki reported a combined procedure using a Vickers ligament release and a dome-shaped osteotomy of the radius to correct all of the aspects of the radial deformity, including the radial and volar translation of the distal metaphysis. It not only corrects the deformity but also decreases pain and increases range of motion.
- Madelung Deformity by Paul M Lamberti, MD--eMedicine Article
- Carter PR, Ezaki M: Madelung's deformity. Surgical correction through the anterior approach; Hand Clin 2000 Nov; 16(4): 713-21 [Medline]
- 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 [Medline]
- Madelung's Deformity--Wheeless' Online Textbook of Orthopedics
- Madelung's Deformity--Children's Hospital Boston