Madelung Deformity of the Wrist Managed Conservatively

Abstract

A 19-year-old female presented with pain, deformity, and slightly restricted left wrist motion for five years with gradual progression. Physical examination revealed volar subluxation of the left hand, dorsally prominent ulnar styloid, radial and dorsal bowing of the distal forearm, and mild restriction in wrist dorsiflexion. Radiographs showed a failure of ossification of the ulnar side of the distal radial epiphysis, increased radial inclination angle, dorsal subluxation of the distal ulna, V-shaped proximal carpal row due to proximal migration of the lunate, and increased interosseous space. A diagnosis of Madelung deformity of the left wrist was made. Conservative management with oral analgesics, activity restriction, and a volar splint was done as the patient was skeletally mature, had only mild pain with no functional limitation or gross deformity. At the six-month follow-up, she was doing well with decreased pain and no new complaints.

Keywords: adolescence; conservative management; dorsal subluxation of distal ulna; madelung deformity; vickers ligament; volar-ulnar distal radial physis; wrist.

Figure 1. Clinical assessment.

(A) Ulnar bowing of the forearm (dashed arrow) and prominent ulnar styloid (solid arrow). (B) Dorsal bowing of the forearm (black arrow), dorsally subluxated ulnar styloid (yellow arrow), and volarly subluxated hand (green arrow).

Figure 2. Range of motion of the wrist joint.

(A) Slightly restricted dorsiflexion at the left wrist. (B-D) Images show comparable palmar flexion, supination, and pronation, respectively.

Figure 3. Radiographic assessment.

(A) Anteroposterior view shows a failure of ossification of the ulnar side of the distal radial epiphysis (blue arrow), increased radial inclination (angle formed by the black dashed lines), and proximal migration of the lunate causing V-shaped carpus (yellow dashed lines). (B) Lateral view shows dorsally subluxated distal ulna (yellow arrow) and volarly subluxated hand (blue arrow).