Wednesday, June 19, 2013

Traumatic Madelungs Deformity

Madelungs is a deformity of the wrist related to abnormal growth.  It is typically an inherited condition but may appear without any family members being affected.  I just realized that I have not posted on this condition and will blog more on the topic soon.  Today I want to write about one variety of Madelungs- the traumatic type.

Sometimes Madelungs deformity is related to trauma- an injury to the growth plate of the distal radius.  There can be a variety of different causes but a typical fracture that injuries the growth plate is most common.    In these cases, there is usually a clear fracture and, in a delayed fashion, the Madelungs deformity will appear because of abnormal growth of the radius.  The ulna (pinky sided wrist bone) become notable.  The wrist "sags" and pain may develop.  These pictures tell the story.

Acquired Madelungs deformity.  Note the bump on the ulna related to its normal growth with abnormal growth of the radius.

Note the sag of the wrist in Madelungs.

From a top down view, the wrist looks generally fairly normal in Madelungs.


The x-rays also tell the tale.  The radius is short and has an abnormal appearance.  The ulna is long and prominent.
In this case of Madelungs, the bone on the left (the ulna) is longer than the bone on the right (the radius).  That corresponds with the pictures.


As usual, there can be 2 issues: appearance and function.  We always worry more about function and in this case there can be decreased wrist motion and forearm motion and there may be pain.  If so, we consider treatment.  However, those with Madelungs do also complain about the appearance.  This wrist is not as severe as some but was bad enough to the patient and family for surgery.  The wrist was painful and interfered with activities.

More to come soon on all types of Madelungs.

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