Madelung Deformity: A Wrist That Grows Crooked

Madelung deformity is a growth problem of the wrist. Part of the growth plate at the lower end of the radius grows too slowly, so the end of the radius tilts and the wrist drifts forward and towards the little-finger side, while the end of the ulna sticks out at the back of the wrist. It usually becomes noticeable in late childhood or the teenage years, more often in girls, and frequently affects both wrists.

Causes

Many cases have no clear cause. Some are linked with a genetic condition affecting growth (Leri–Weill dyschondrosteosis, related to the SHOX gene), which can also cause short stature. Injury or infection of the growth plate can produce a similar deformity.

Symptoms

• A visible bump of the ulna at the back of the wrist
• Wrist pain, especially with activity
• Reduced wrist bending back and reduced forearm rotation (turning the palm up)
• Concern about appearance

Evaluation

Examination of both wrists and forearms, measurement of movement and grip, X-rays of both wrists, and sometimes MRI to look at the growth plate and a tight abnormal ligament that tethers the radius. Short stature or family history may prompt genetic assessment.

Treatment options

• Observation and activity modification when the deformity is mild and painless
• In growing children: releasing the tight ligament and the abnormal part of the growth plate can reduce further deformity
• Corrective osteotomy of the radius (for example, a dome osteotomy) to realign the wrist, often combined with shortening or reshaping of the ulna to relieve the prominence and improve rotation
• Gradual correction with a small external fixator when the deformity is large or the forearm also needs lengthening

Recovery

A splint or cast protects the wrist for some weeks, followed by hand therapy to regain movement and strength. Most patients notice less pain and a better-looking wrist; movement improves to a variable degree.

Possible complications

Stiffness, nerve irritation, delayed bone healing, residual prominence and recurrence in younger patients.