We believe that Madelungs deformity is caused by a growth plate abnormality of the distal radius. Also, there can be a large ligament (Vickers ligament) which some believe contributes to the deformity. Patients typically present in the early adolescent years (10-14 years) and if conservative care does not help, surgery can be considered. If symptoms are on the thumb side of the wrist, we often consider an osteotomy (cutting) of the radius bone in a very specific way- a dome osteotomy. Drs Carter and Ezaki pioneered this treatment for Madelungs and describe it in this technique article: http://journals.lww.com/techhandsurg/Fulltext/2002/03000/Volar_Surgical_Correction_of_Madelung_s_Deformity.6.aspx
The same group has published their results twice, short term and more than 10 years after surgery. Both reports detail the success of the procedure for many patients. The second article is from July of 2013- hot off the press!
If the pain is related to the pinky side of the wrist, sometimes we only address the ulna bone and shorten it.
I recently had the chance to see a patient back more than one year after a dome osteotomy of the radius for Madelungs. Her pain and her motion were both better and she and her mom were happy. However, it is important to note that even if surgery goes very well, the wrist will not be "normal." Additionally, later surgery can be required to deal with pain on the pinky side of the wrist.
|Front view of Madelungs. There is a great deal of deformity of the wrist|
|Side view of Madelungs with curving radius and split between the radius and ulna|
|White metal pins after surgery to hold the bone in place for healing in Madelungs Dome Osteotomy.|
|Appearance after surgery for Madelungs. The wrists now look similar.|
|The wrist does not look "normal" after surgery for Madelungs but looks much more typical.|
|Side view after surgery for Madelungs. Note that the radius and ulna line up much better now.|