History and Physical Examination
Symptoms of Madelung deformity (MD) usually begin during adolescence in girls aged 10-14 years; patients rarely present when younger than 8-9 years. Because MD is observed so rarely in males, it has been proposed that a true severe case of MD never occurs in males.
Patients experience increasing deformity and pain in the wrist with decreased range of motion (ROM). On physical examination, the hand is translated volarly to the long axis of the forearm. The ulna, being relatively unaffected, abuts the carpus and becomes prominent dorsally relative to the carpus and hand. ROM is decreased, with a limitation of supination, dorsiflexion, and radial deviation. Pronation and flexion usually are normal. (See the images below.)
Preoperative photograph of 17-year-old girl (patient C) with idiopathic Madelung deformity.
Preoperative photograph of 17-year-old girl (patient C) with idiopathic Madelung deformity.
A few case reports have described extensor tendon rupture occurring in conjunction with chronic Madelung deformity. [19]
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Preoperative wrist posteroanterior radiograph of a 13-year-old girl (patient A) with dyschondrosteosis and Madelung deformity of the wrist.
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Preoperative lateral wrist radiograph of patient A.
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Lateral radiograph of elbow of patient A, depicting a dysplastic proximal radius. This is characteristic of dyschondrosteosis.
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Preoperative anteroposterior radiograph of wrist of patient B. This patient has primary Madelung deformity (no sign of dyschondrosteosis).
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Preoperative lateral radiograph of wrist of patient B. The flame-shaped radiolucency in the metaphysis of the radius is occupied by the fibrocartilaginous Vickers ligament.
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Postoperative anteroposterior radiograph of wrist of patient B following Vickers physiolysis. Vickers ligament and the ulnar abnormal physis have been excised.
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Postoperative lateral radiograph of the wrist of patient B following Vickers physiolysis.
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Postoperative anteroposterior radiograph from patient A following biplane osteotomy of distal radius and ulnar shortening procedure.
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Postoperative lateral radiograph from patient A following biplane osteotomy of radius and ulnar shortening procedure.
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Preoperative photograph of 17-year-old girl (patient C) with idiopathic Madelung deformity.
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Preoperative photograph of 17-year-old girl (patient C) with idiopathic Madelung deformity.
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Preoperative posteroanterior radiograph of wrist from patient C.
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Preoperative lateral radiograph of wrist from patient C.
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Intraoperative photo of Vickers ligament, outlined in red.
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Intraoperative color photograph of Vickers ligament. The ligament is outlined in the previous image.
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Postoperative result in patient C. Compare with preoperative appearance.
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Postoperative lateral radiograph. Note dorsal translation of distal radius after Carter-Ezaki dome osteotomy.
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Postoperative posteroanterior radiograph with Kirschner-wire fixation in place. Note combination of ulnar translation of distal radius and correction of radial tilt towards normal after Carter-Ezaki dome osteotomy.
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Preoperative plan prior to Carter-Ezaki dome osteotomy. Dorsal translation of the distal radius is depicted.
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Preoperative plan prior to Carter-Ezaki dome osteotomy. Rotation of the distal radius to accomplish both ulnar translation and normalization of radial tilt is depicted.
