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Madelung’s Deformity 755.4

Carpal Ossification Sequence

synonyms:

Madelung’s Deformity ICD-9

  • 755.54 Madelung's Deformity

Madelung’s Deformity Etiology / Epidemiology / Natural History

  • growth disturbance of the ulnar, palmar aspect of the distal radial epiphysis
  • may be combination of a bony leasion in ulnar portion of distal radial physis and abnormal palmar ligament tethering lunate to radius proximal to physis
  • most commonly caused by dysplasia associated with Leri-Weill syndrome(dyschondrosteosis)-AD 50% penetrance
  • may be caused by repetive loading(gymnast wrist))
  • female > male

Madelung’s Deformity Anatomy

  • normal distal radial epiphysis appears at 2 and begins to flatten at 6yrs
  • associated with Vicker's ligament (thick volar ligament which tethers the lunate to the distal radius.

Madelung’s Deformity Clinical Evaluation

  • Most common complaint-writst deformity becoming noticeable between 8-12 yrs old. 
  • Pain is uncommon. 
  • Weakness due to subluxation of the wrist into radioulnar space and limited rotation are common

Madelung’s Deformity Xray / Diagnositc Tests

  • PA, Lateral wrist films
  • Diagnostic criteria: any one of the following: ulnar tilt >33, lunate subsidence >4mm, lunate fossa angle of > 40 or palmar carpal displacement >20mm. (J Hand Surg 2010)

Madelung’s Deformity Classification / Treatment

  • Asymptomatic: no treatment necessary. 
  • Symptomatic (painfu), skeletally immature: physiolysis(resection of arrested growth plate) indicated. 
  • Symptomatic, skeletally mature=radial and dorsal closing wedge osteotomy and ulnar shortening (Harley, BJ, J Hand Surg 2006;31A:1499).
  • may cause spontaneous extensor tendon ruptures.

Madelung’s Deformity Associated Injuries / Differential Diagnosis

  • Osteochondromatosis
  • Skeletal dyspasia
  • Ler-Weill Syndrome
  • Distal radial physeal arrest
  • Infection

Madelung’s Deformity Complications

Madelung’s Deformity Follow-up Care

Madelung’s Deformity Review References

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