Madelung Deformity With Prior Distal Radius Fracture: A Case Report

Abstract not available. Introduction provided instead.

Madelung¹ first described the wrist deformity bearing his name in 1878. Although previous authors had described lesions that we might now term Madelung deformity, Madelung was the first to accurately describe it clinically and to propose both an etiology and a treatment. The deformity results from epiphyseal arrest on the ulnar and volar half of the distal radius, which causes the articular surface to be directed ulnarly and volarly. In 1992, Vickers and Nielsen² further described the abnormal physeal and ligamentous anatomy on the volar aspect of the radiocarpal joint. They identified a thick fibrous band spanning the radial metaphysis to the proximal carpal row (Vickers ligament) seen in congenital Madelung deformity.

The etiologies of Madelung deformity have been thoroughly described in the literature. Although confusion continues as to the exact etiology of this condition, most reports show the deformity to be a condition inherited by an autosomal-dominant trait with variable expressivity. Common to congenital Madelung deformity is the presence of Vickers ligament, which tethers the volar-ulnar distal radial physis. Other reports have described an acquired or pseudo-Madelung deformity wherein injury to the immature physis produces a bony bridge with progression to a deformity that may mimic that of a true congenital Madelung deformity. In this report, we present the case of an acquired Madelung deformity secondary to trauma with the presence of a Vickers ligament and absence of a bony bridge affecting the volar-ulnar distal radial physis. In the literature, presence of Vickers ligament associated with posttraumatic Madelung deformity is unique; it has been described only in the congenital variant.