Madelung Deformity

Madelung deformity is a growth disturbance of the distal radius caused by focal dysplasia of the physis that results in triangular deformity and medial and volar tilt of the distal radius. Females are more commonly affected than males.

Radiographs will show increased volar bowing of the distal radius, a widened distal radioulnar joint, increased volar tilt of the distal radial articular surface, and an exaggerated ulnar tilt of the distal radius. The carpal bones wedge into the triangular deformity created by the distal radius. In addition, osteophytes may form along the inferior ulnar border of the radius.

Some measurements can be used for the diagnosis of Madelung deformity. When any one of these thresholds is met, a diagnosis of a Madelung deformity can be made.

• Ulnar tilt ≥ 33°: On frontal radiographs, the acute angle between the longitudinal axis of the ulna and a line tangential to the proximal surfaces of the scaphoid and lunate is subtracted from 90.
• Lunate subsidence ≥ 4 mm: On frontal radiographs, the distance between the most proximal point of the lunate and a line perpendicular to the longitudinal axis of the ulna and through its distal articular surface.
• Lunate fossa angle ≥ 40°: On frontal radiographs, the acute angle between the longitudinal axis of the ulna and a line across the lunate fossa of the radius subtracted from 90.
• Palmar carpal displacement ≥ 20 mm: Distance between the longitudinal axis of the ulna and the most palmar point on the surface of the lunate or capitate.

The images show a case where a diagnosis of Madelung deformity was suspected, but only the lunate subsidence was positive.

On MRI, in addition to the radiographic findings, there will be a thickened ligament arising from the ulnar aspect of the distal radius to the lunate, the so-called Vickers ligament.

Differential considerations include:

• Idiopathic Madelung deformity:
• Turner syndrome:
• Dyschondrosteosis: Rare form of mesomelic dysplasia. Characterized by short stature and a Madelung deformity.

References

• Castriota-Scanderbeg A, Dallapiccola B. Chapter 5: Long bones. In Abnormal skeletal phenotypes. Castriota-Scanderbeg A and Dallapiccola B. Springer-Verlag Berlin Heidelberg, 2005. page 313.
• Dawe C, Wynne-Davies R, Fulford GE. Clinical variation in dyschondrosteosis. A report on 13 individuals in 8 families. J Bone Joint Surg Br. 1982;64(3):377-81.
• Dubey A, Fajardo M, Green S, Lee SK. Madelung's deformity: a review. J Hand Surg Eur Vol. 2010 Mar;35(3):174-81.
• Kim HK. Madelung deformity with Vickers ligament. Pediatr Radiol. 2009 Nov;39(11):1251.
• McCarroll HR Jr, James MA, Newmeyer WL 3rd, Manske PR. Madelung's deformity: diagnostic thresholds of radiographic measurements. J Hand Surg Am. 2010 May;35(5):807-12.