Madelung's Deformity of the Wrist—Current Concepts and Future Directions

Abstract

Madelung's deformity of the wrist arises from premature closure of the medial and volar aspect of the distal radial physis. True Madelung deformities reveal the presence of a “Vickers” ligament which is a short, volar, radioulnar ligament. Clinically, patients report increasing deformity, pain, and poor range of motion. Radiological features include increased radial inclination, volar tilt of the distal radius, and a positive ulnar variance. Surgical intervention usually comprises either a “Vickers” ligament release and distal radius physiolysis or a radial dome osteotomy. In future, EOS Imaging could aid diagnosis by providing more detailed images of the deformity while minimizing radiation exposure. Furthermore, three-dimensional printing and computer-navigated deformity correction could revolutionize management by facilitating simulation training, expediting surgery, and reducing intraoperative error.

Madelung deformitesi

“…[18,19] İleri görüntüleme bu hastalar için gereksiz ancak teşhiste yardımcıdır. [6,14] Manyetik rezonans (MR) görüntülemeden gerçek Madelung deformitesindeki Vicker bağını göstermek için yararlanılabilir (Şekil 3). Deformitenin üç boyutlu olarak değerlendirilmesinde yardımcı olur.…”

“…Bilgisayarlı tomografi (BT) ameliyat öncesi planlama aşamasında yardımcı olabilir. [14] Şekil 2. a-d. Ulnar tilt açısı; ulna longitudinal aksı ile skafoid proksimal kutbu arasındaki açı "A" (a). Lunat çökme; arka-ön grafide lunatumun, ulnanın longitudinal aksının distal eklem yüzüne dik açıyla yapılan çizime göre uzaklığı "B" (b).…”

“…Bu strateji büyüme potansiyeline dayanır bu nedenle ilerlemiş deformiteler veya çok az büyümesi kalmış olanlar için uygun değildir. [6,14] Çoğu hasta başvuru anında iskelet olgunluğuna daha yakındır. Bu nedenle bu hastalarda fizyoliz ya da epifizyodez yeterli değildir.…”

Radiotriquetral Ligament in Madelung’s Deformity Associated with Leri-Weill’s Dyschondrosteosis

“…A supernumerary volar extrinsic ligament of the wrist, the so-called "Vickers ligament" (VL), allows distinguishing MD from "pseudo-MD" in which the VL is not visualized [1][2][3]. In LWD, the carpal abnormities of MD coexist with mesomelia and short stature, defining a rare autosomal dominant inherited condition with unknown prevalence [4][5].…”

“…Vickers ligament is considered an abnormally short and thickened radiolunate ligament. Unlike the normal radiolunate ligament originates from the epiphysis of the distal radius, the VL rises more proximally from the radial metaphysis, creating a tether across the volar-ulnar physis that restricts growth across this segment, resulting in a "V" shaped deformity of the whole distal radio-ulnar joint surface [2,3,6]. More recently, another anomalous volar ligament just lateral to the VL, defined "radiotriquetral ligament" (RTL), was described in MD.…”