Management

The management of Madelung's Deformity is dependent on the severity at presentation. Function may be surprisingly good and surgical intervention frequently is unwarranted. (1) Later presentation is associated with a deformity, reduced range of motion due to carpal subluxation and pain. Pain, reduced range of motion and functional limitation are indications for surgery; cosmetic deformity is not.

The surgical treatment depends on the stage of the disease process: (2,3,4)

• if skeletally immature, the abnormal physis is ablated on the ulnar side and a fat graft can be inserted
• if skeletally mature, the distal radius is exposed by a volar longitudinal incision, the anomalous volar ligament is released where it attaches to the lunate; the distal radius is osteotomised to achieve a more functional position
• distraction osteogenesis; the anomalous radiolunotriquetral (‘Vickers’) ligament may prove problematic

There may be a role for early childhood radiography in the children of parents who have themselves had Madelung's Disease, Leri-Weill or Turners syndromes. Genetic testing is warranted if a syndrome is suspected.

Reference

1. Shahi P et al. Madelung Deformity of the Wrist Managed Conservatively. Cureus. 2020 May 21;12(5):e8225
2. Steinman S et al. Volar ligament release and distal radial dome osteotomy for the correction of Madelung deformity: long-term follow-up. J Bone Joint Surg Am. 2013 Jul 03;95(13):1198-204.
3. Coffey MJ, Scheker LR, Thirkannad SM. Total distal radioulnar joint arthroplasty in adults with symptomatic Madelung's deformity. Hand (N Y). 2009 Dec;4(4):427-31
4. Carvalho M et al. Madelung Deformity - Esthetic and Functional Outcomes from the Surgical Treatment with Distal Radial Dome Osteotomy and Vickers Ligament Section. Rev Bras Ortop (Sao Paulo). 2022 Feb;57(1):113-119.