Madelung's Deformity

Madelung's deformity with fracture




Premature fusion of the volar & ulna aspects of the distal radius

- progressive ulnar & volar tilt of distal radial surface


Ulna becomes prominent through normal growth & subluxes dorsally


Lunate lies deeply between lower end of radius and ulna




1. Volar-ulnar radial physeal arrest

- focal physeal dysplasia


2. Carpal tether from same area to lunate

- Vicker's ligament


Anatomy Vickers' ligament 


Vickers describes fibrous band 

- runs from radius to lunate

- volar position

- large ligament ~ 0.5cm diameter

- may be the cause

- if excise early / before age 8 the radius improves in shape




Idiopathic condition

- AD with incomplete penetrance

- F > M

- often bilateral




Turner's Syndrome


Disorder of gonadal differentiation

- 45 X / XO

- female phenotype / sterile

- webbing of neck

- low posterior hairline

- cubitus valgus

- cardiac abnormalities


DDx Madelung Deformity


Post Traumatic

Enchondromatosis (Ollier's)

Hereditary Multiple Exostoses

Turner Syndrome

Idiopathic = Dyschondrosteosis


General dysplasia




Madelung's - ulnar, volar 

Chevron - ulnar, central 

Reverse Madelung - ulnar, dorsal




Usually asymptomatic and good function


Wrist is in radial deviation


Dorsal subluxation of distal ulna


Reduced dorsiflexion / supination




Not apparent in childhood

Usually becomes obvious as hits adolescent growth spurt




Madelungs APMadelung's Lateral


Volar-ulna tilt of the distal radius with dorsal subluxation of ulna / distal radius triangular shape


Proximal carpal row becomes wedge shaped

- lunate "falls into" the radio-ulna gap


DRUJ widened



- proximal carpal row distorted / V-shape

- lunate in apex between radius and ulna




Look for Vicker's ligament




Mothers function is a good guide to management


Surgical Indications


1. Pain 

- must operate

- surgery very good at relieving pain

- in adults division Vickers' ligament almost always relieves pain 


2. Deformity 

- deformity starts ~ age 9 years (doesn't occur much before then) 

- best to operate early as will get good result




1.  Excision Vicker's ligament + Epiphysiolysis of fused physis with fat graft


2.  Complete epiphysiodeses 


3.  Epiphysiodeses of distal Ulna


4. Ulna Shortening / Darrach


Madelung's with Darrachs


5.  Opening Wedge Osteotomy


Madelung's Osteotomy


6.  Wrist Arthrodesis