The prevalence of Vickers' ligament in Madelung's deformity: a retrospective multicentre study of 75 surgical cases

Abstract

In a retrospective multicentre study, we aimed to correlate clinical factors and findings on plain radiographs and MRI with the intraoperative presence of Vickers' ligament in Madelung's deformity. We screened the records, in which the absence or presence of Vickers' ligament was affirmatively indicated, of 75 consecutive operated extremities in 58 patients. In 83% a Vickers' ligament was observed intraoperatively. The whole bone Madelung type (as opposed to the distal type) and a distal radial notch were independent, significant predictors for the presence of the ligament. The correct Vickers detection rate using MRI was 85% of the 27 cases for which MRI was available. Thus, the MRI was a good but not perfectly reliable modality. We conclude that Vickers' ligament is present in the majority but not all cases with Madelung deformity. We advise that patients with a more severe type of Madelung's deformity and a distal radial notch should be monitored closely.Level of evidence: IV.

Keywords: Madelung deformity; Vickers ligament; Zebala type; lunate subsidence; radius deformity; radius notch; ulnar tilt.

Figure 1.

This figure shows a thick Vickers’ ligament during intraoperative dissection (a, arrowhead). An MRI-series of another patient shows the anatomic course of this ligament (arrowheads). It attaches to both the lunate and triquetrum (b) and originates rather proximally on the distal ulnar-sided radius (c). Some fibres also seem to attach to the distal ulna (c, d).

Figure 2.

This figure shows four different types of Madelung’s deformity with their different radiographic and intraoperative characteristics. Case one (a) shows a classic distal radial notch and an intraoperatively confirmed Vickers’ ligament. Case two (b) revealed a small spur instead of a true notch but had a Vickers’ ligament noted during surgery. Case three (c) had neither a notch nor a spur but again revealed a Vickers’ ligament at surgery. Case four (d) was a patient with a marked spur in the anterior–posterior radiograph. However, no Vickers’ ligament was found at surgery.