Section extract
Materials and methods
We conducted a comprehensive query of medical records from 1960–2006 for people diagnosed with Madelung deformity. This retrospective review was approved by the institutional review board. Inclusion criteria were the diagnosis of Madelung's deformity based on the classic description of distal radius and ulnar abnormalities7,8,9,10,11 and appropriate preoperative radiographs of the wrist, forearm and elbow. People with idiopathic and familial Madelung deformity were
The distal radius and the Madelung deformity of the entire radius
We classified 31 limbs in 18 individuals with a Madelung deformity of the distal radius (Fig. 1) and 15 limbs in 8 individuals with a deformity of the entire radius (Fig. 2). The 6 subjects with unilateral Madelung deformity included 5 subjects with distal radius deformity and one subject with total radius deformity. There were no cases of bilateral involvement in which one limb was classified as the entire radius and the other as the distal radius.
Radial bue
Radial arch on AP radiograph
discussion
Previous descriptions of Madelung deformity have focused on bone abnormalities in the distal radius and wrist. In their classic description of the 12 characteristics of Madelung's deformation, Dannenberg et al7focused on the wrist but mentioned that the entire radius shaft could be affected. Of the 12 features, deformities of the radiocephalic joint and increased fibula of the radius were not included. Additional reports of Madelung deformity17, 18, 19, 20 also
Cited by (54)
Early results of 3D planning and customized cutting guides for treatment of severe Madelung deformity
2023, Journal of Hand Surgery
Surgical treatment of Madelung deformity can be challenging due to the need for multifaceted correction. The development of individualized cutting guides for osteotomy may improve surgical outcomes through better understanding of the surgeon and surgical correction.
All patients who underwent forearm osteotomy for Madelung deformities were retrospectively analyzed using CT planning with 3D-adapted cutting guides (n=8). Seven patients underwent a double radius osteotomy and a single osteotomy.
Elbow tilt was improved in all cases. Correction of the deformity was significant in the anterior-posterior views, but not in the lateral views. Mean preoperative and postoperative radius flexion was measured in 2 planes, with mean preoperative flexion of 32° (± 21°) on anteroposterior radiographs and 36° (± 17°) on lateral radiographs and a mean flexion of 10° (± 6°) ) on anteroposterior radiographs and 7° (± 6°) postoperative lateral films. The projected radial arc was calculated to be 9.1° (± 8°).
3D planning enables predictable deformation correction for many, but not all, parameters. Future studies comparing the clinical and radiological outcomes of guided versus non-guided osteotomies are needed to justify the additional cost and effort of preoperative planning.
therapeutic V
Simultaneous 3D correction of percutaneous radial osteotomy with a circular external fixator in Madelung deformity
2022, Operation and rehabilitation of the hand
Excerpt from the quote:
(Video) PULM Talk #7 / Orthopedics: Madelung deformity, Dr Sebastian Farr (Austria).In the case of the Madelung deformity, there is a clear predominance of women. Congenital dyschondrosis of the distal radius leads to a partial deficiency of the growth plate of the distal radius and palm, which can result in increased radius inclination, volar and ulnar inclination of the radiocarpal joint, proximal and palmar migration of the semilunar bone, relative displacement of the ulnar head and dorsal and wrist [5-8]. However, the etiology is unclear and is mainly attributed to inadequate vascular supply to the distal radius and disruption of the musculature and entrapment of the fibrous epiphysis of the distal radius [7,9-11].
The main pathology in Madelung deformity is a partial growth deficiency of the distal radius and palmar cartilage plate. For surgical treatment, the Taylor Spatial Frame (TSF) external fixator can be used, which provides simultaneous multiplanar correction and lengthening after radius osteotomy, sparing the Vickers ligament and the elbow. We sought to evaluate the radiological and functional outcomes of correction of Madelung deformities with TSF by retrospectively analyzing eight Madelung deformities in seven patients between August 2011 and May 2015. The mean age was 14.8 years (range 11–26) and the mean follow-up was 35 years .1 month (24-78). We assessed demographics and pre- and postoperative radiological and functional findings. The mean preoperative visual analogue pain score improved from 7.7 to 1.6. The mean preoperative DASH score improved from 19.1 (9.5–46.6) to 3.7 (2.3–6.8). The mean preoperative radial length improved from 184 mm (138–209) to 196 mm (142–213). We believe that software correction with TSF is a safe solution for Madelung deformity, with minimal margin of error and risk of postoperative stiffness and infection.
IV.
Partial growth deficiency in the radial and volar portions of the distal radius growth plate is the main cause of Madelung deformity. Surgical treatment of the Madelung deformity can be performed with Taylor Spatial Frame (TSF) external fixators, which allow simultaneous, multiplanar correction and lengthening after radius osteotomy with preservation of the Vicker's ligament and ulna. We sought to evaluate the radiological and functional results of the correction of Madelung deformity using the TSF method. We retrospectively analyzed eight Madelung deformities in seven patients between August 2011 and May 2015. Mean age was 14.8 months (11–26), mean follow-up was 35.1 months (24–78). We assessed demographics, pre- and postoperative radiological and functional findings. The mean preoperative pain score (VAS) improved from 7.7 to 1.6. The mean preoperative DASH score improved from 19.1 (9.5–46.6) to 3.7 (2.3–6.8). The mean preoperative radial length improved from 184 mm (138–209) to 196 mm (142–213). We believe that TSF software correction can be safely applied to Madelung deformity with minimal margin of error and risk of postoperative stiffness and infection.
IV.
Madelung deformity in a Merovingian woman in central Germany: a rare finding or a rare disease?
2021, International Journal of Paleopathology
Excerpt from the quote:
In modern cases, medical treatment results in a lesser degree of bone deformity. Although the ulna is still reduced in size, the ulna is often not affected (see Zebala et al., 2007, Kouassi Koame2016). In less extreme cases, weakness and abnormal muscle conduction associated with deformation of the radius and subluxation of the radioulnar joint lead to a reduction in dimensions.
The article presents a probable case of Madelung-type deformity of the right forearm in an individual from a Merovingian cemetery (7th and 8th century AD) from Gotha-Boilstädt (Germany).
The study involved a woman aged 40-50 years at the age of death.
Macroscopic, osteometric and radiographic analyzes were performed by standard methods.
The subject exhibits an atypical case of dysmelia in the right upper extremity. The shoulder and arm showed slender traces of muscle attachment and less strength compared to the left side. The ulna was shortened and malformed, and the radius was severely deformed.
The results indicate that the person may have been affected by a unilateral Madelung deformity. The severity of this case is greater than reported in the clinical literature.
This study places an ancient rare disease in archaeological and paleopathological contexts, allowing the concept of "ancient rare disease" to be evaluated. It also emphasizes the importance of reporting strictly diagnosed cases to increase our awareness of the occurrence and course of this rare disease in the past.
(Video) Rheumatoid Wrist by Dr Marc FrisoThe diagnosis cannot be made with certainty, and only a few possible diagnoses can be made. Congenital and acquired etiology must be considered, especially compared to clinical cases where the severity of the condition can be modified by medical intervention.
Genetic analysis may be helpful in determining the etiology of the observed Madelung deformity.
Wrist kinematics in Madelung deformity
2021, Journal of Hand Surgery
In Madelung's deformity, various skeletal and soft tissue abnormalities have been identified and hypothesized to play a causal role in its progressive symptomatology; however, our pathological understanding of these changes remains limited. In this study, we assessed the wrist with Madelung's deformity biomechanically using 4-dimensional computed tomography.
Nine Madelung's deformity wrists (5 patients; age, 24 ± 5 years) and 18 healthy wrists (9 volunteers; age, 28 ± 3 years) were imaged in 4D during flexion-extension and radioulnar deviation. Wrist kinematics and radiocarpal joint parameters were quantified and compared.
In the wrists with Madelung's deformity, significantly reduced rotation was observed at the lunate (-4.6°) and triangular (-4.8°) mandibular rotation during flexion-extension. During radioulnar deviation, there were significant decreases in lunate translation (–0.7 mm), triangular translation (–0.6 mm), and triangular bone rotation (–1.9°). The patients had significantly reduced articular surfaces of the scaphoid bone (1.4 ± 0.2 cm2compared to 1.6 ± 0.2 cm2) and lunate (1.2 ± 0.4 cm2compared to 1.5 ± 0.3 cm2) and significantly increased joint space thickness in scaphoid (1.3 ± 0.1 mm vs. 1.2 ± 0.1 mm) and radiolunate (1.6 ± 0.2 mm vs. 1.3 ±0.3 mm).
In Madelung's deformity, there is reduced mobility of the lunate and triangular bones.
Four-dimensional imaging may be used in future studies investigating the effects of surgical ligament release on wrist kinematics and subsequent wrist mobility.
Congenital deformities of the hands
2020, Pediatric Clinics in North America
Excerpt from the quote:
These causes are not related to Vickers ligament. There is an association with Leri-Weill dyschondrosis.26 At the time of presentation, the most common primary complaints are either diffuse pain or concerns about the cosmetic appearance of the distal prominence of the ulna, which may be bilateral.
Skeletal dysplasia and related disorders
2019, Identification of Pathological Conditions in Human Skeletal Remains by Ortner
This chapter describes birth defects that usually result in a wider distribution of changes throughout the skeleton. This section discusses the most common conditions identified in the archaeological record according to this categorization, although it should be noted that each type of defective bone development may show minor symptoms of a different type. Mucopolysaccharidosis (strictly a metabolic disorder) can cause skeletal abnormalities that can be confused with achondroplasia, which is why it is included here. Abnormalities of intramembranous bone formation and resorption are more likely to develop specific skeletal symptoms, often allowing a more precise diagnosis in archaeological remains.
(Video) PULM TALKS #23 Technique- Madelung Reverse wedge technique PT Chan
Selected articles (6)
Scientific article
Use of combined arteriography, computed tomography, phlebography and urography in laparoscopic partial nephrectomy with clamping of the segmental artery
Urology, Volume 84, Issue 6, 2014, Pages 1361-1366
Evaluation of the role of combined computed tomography (CT), arteriography (CTA), venography and urography in laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping.
Laparoscopic partial nephrectomy with segmental renal artery clamping was performed in 75 patients. Three-dimensional (3D) models of CTA, CT venography, and CT urography were reconstructed and combined before surgery. Surgeries were performed using these 3D models for surgical guidance.
All procedures were successfully performed without conversion to clamping of the main renal artery. The mean operative time was 82.6 minutes, and the mean time to clamp the target arteries was 20.3 minutes. The rates of grade I and II complications were 5.3% and 5.3%, respectively. Compared to the orientation with CTA alone, the use of the combined 3D model resulted in a change of the planned cavity access for the target preparation in 18 cases (24%). The location of the tumor correlated with the change of the planned access to the hilum. Lower pole tumors were treated with hilar access modification in 58.3% of cases, and 37.5% of running tumors were treated with a modified approach (P= 0.001). Only 11.1% of the anterior segment tumors and none of the posterior or superior pole tumors had access to the modified hilum when assessed with the combined 3D model. Tumor size and tumor growth pattern did not affect the distribution of approach modifications (P= 0,89 iP= 0,52).
The combined 3D model appears to facilitate target artery orientation and surgical dissection. The combined model may change the surgical approach used for some lower pole or kidney tumors compared to the approach suggested by conventional CTA.
Scientific article
Congenital imprinting disorders: a novel mechanism linking apparently unrelated disorders
The Journal of Pediatrics, tom 163, wydanie 4, 2013, s. 1202-1207
Scientific article
Fuzzy zoning in a feature-matching technique for 3D reconstruction of nasal endoscopic images
Computers in Biology and Medicine, Volume 67, 2015, pp. 83-94
(Video) Haglund's Deformity Treatment and Information3D reconstruction from endoscopic images of the nose is a great support for the otolaryngologist when examining the nasal passages, mucous membranes, polyps, sinuses and nasopharynx. In general, structure from movement is a popular technique. It consists of four main steps; (1) camera calibration, (2) feature extraction, (3) feature matching, and (4) 3D reconstruction. The Scale Invariant Feature Transform (SIFT) algorithm is typically used for both feature extraction and feature matching. However, the SIFT algorithm is relatively time consuming, especially in the feature matching process, as each feature in the image of interest is compared to all features in the next image to find the best matching pair. The fuzzy zoning approach was developed to limit the range of feature matching. Matching two relevant features from different images can be performed efficiently. With this approach, assembly time can be significantly reduced. The proposed technique is tested on endoscopic images created by phantoms and compared with the original SIFT technique in terms of fitting time and mean error of the reconstructed models. Finally, the original SIFT and the proposed fuzzy technique are used to reconstruct a 3D model of a real nasal cavity from images taken with a rigid nasal endoscope. The results showed that the fuzzy approach was significantly faster than the traditional SIFT technique and produced 3D models of similar quality. It can be used to create a nasal cavity taken with a rigid nasal endoscope.
Scientific article
Radial nerve transection associated with closed humeral shaft fractures: two case reports and literature review
Journal of Shoulder and Albow Surgery, tom 24, wydanie 4, 2015, s. e96-e100
Scientific article
Evidence against a subcortical gate preventing conscious sensing of respiratory stress stimuli
Respiratory physiology and neurobiology, volume 259, 2019, pp. 93-103
Respiratory evoked potentials (RREP) were used to study respiratory stimulus gating. RREPs produced by deliberately detectedvs.undetected strains close to the detection threshold were compared. Participants (n = 17) were instrumented with an EEG and a nasal mask connected to a charging manifold that presented a series of mid-inspiratory resistive loads plus a control in a randomized block design. Participants were pointed in front of the stimulus and signaled detection by pressing a button. There were statistically significant differences in the peak-to-peak amplitude of the P1 RREP peak for the detected (mean ± SD; 3.86 ± 1.45 μV;P= 0.020) and undetected loads (3.67 ± 1.27 μV;P= 0.002)vs.control (2.36 ± 0.81 μV), although differences between baseline and peak were not significantly different. In contrast, the P3 peak-to-peak amplitude was much larger for those detected (5.91 ± 1.54 μV;P< 0.001), but no undetected strains (3.33 ± 0.98 μV;P= 0.189)vs.control (3.69 ± 1.46 μV), with the same pattern observed for baseline to peak measurements. Peak P1, thought to reflect the arrival of somatosensory information, appeared to be present in response to both detected and undetected loads, but the subsequent P3 peak was only present for detected loads. This suggests that with subthreshold loads, sensory information can reach the cerebral cortex, arguing against a subcortical gating process.
Scientific article
Local performance in river systems: Lessons from Icicle Bend
Geomorphology, bind 282, 2017, s. 119-130
The evolution of fluvial systems is often described and modeled in terms of rules regarding maxima, minima or optima for various hydraulic or energetic parameters, which can generally be covered by the principle of efficiency selection (more efficient flow routes are usually preferentially selected and improved). However, efficiency selection is highly localized, and the cumulative effects of these local events may or may not create more efficient pathways on a larger scale. This is illustrated by the case of Icicle Bend on Shawnee Run, a limestone bedrock stream in central Kentucky. Field evidence indicates that the palaeochannel was abandoned during downslope, and transfer was analyzed using a flow partitioning model. The bend means the abandonment of a steeper, straighter and more efficient channel on the distance scale in favor of a longer, now less steep and less efficient flow path. This apparently occurred due to the flow of Shawnee Run being intercepted by the underground karst flow path, which was then excavated. The development of Icicle Bend illustrates the local nature of efficiency selection and the role that historical chance plays in geomorphic evolution.
Copyright © 2007 American Hand Surgery Society. Published by Elsevier Inc. All rights reserved.
FAQs
What is the criteria for Madelung deformity? ›
Madelung deformity (MD) of the wrist is characterized by a growth disturbance in the volar-ulnar distal radial physis that results in a volar and ulnar tilted distal radial articular surface, volar translation of the hand and wrist, and a dorsally prominent distal ulna.
Is Madelung's deformity serious? ›Many children with Madelung's deformity have no pain or limitations and do not need treatment. In such cases, their doctor usually recommends regular visits so they can monitor the condition as the child grows.
How common is Madelung deformity? ›Discussion. First described by Otto Madelung in 1878, MD of the wrist results from premature closure of the volar-ulnar distal radial physis [2]. It is a rare entity with a prevalence of less than 2%.
Is Madelung deformity curable? ›Volar ligament release with distal radial dome osteotomy has been shown to yield lasting correction of Madelung deformity.
How do you know if you have Madelung disease? ›Signs & Symptoms
Madelung's disease is characterized by the presence of fatty tumors (lipomas) located symmetrically around the neck, shoulders, trunk, hips, upper arms and thighs.
Madelung disease or multiple symmetric lipomatosis (MSL) is a rare entity among the overgrowth syndromes. It is characterized by painless non-encapsulated and symmetric fatty deposits in the neck, torso, mammary, and abdominal areas, and in the upper and lower limbs.
Is Madelung deformity painful? ›Madelung's deformity may cause pain and deformity, typically presenting in the adolescent population.
Is Madelung deformity hereditary? ›It is thought that Madelung's deformity is caused by mutations on the X-chromosome. Many cases of Madelung's deformity are hereditary and some are related to mesomelic dysplasia. The condition manifests bilaterally (affecting both limbs) in 50% of cases.
What is Madelung's deformity in adults? ›Madelung deformity is a rare disorder characterized by shortening of the forearm as a result of improper growth arrest of the medial portion of the distal radial epiphysis. This results in anterior and medial displacement of the radial head with radial bowing.
How is Madelung's disease treated? ›Madelung's disease is a rare lipid metabolic disorder characterized by diffuse, uncapsulated lipomas in the neck, shoulder, and other areas. It mainly affects middle-aged men and is related to alcohol abuse, and the cause is not clear. Surgical treatments include lipectomy and liposuction.
What is Madelung's deformity and disability? ›
Madelung deformity (MD) is a rare congenital (present from birth) condition in which the wrist grows abnormally and part of the radius, one of the bones of the forearms, stops growing early and is short and bowed. The other forearm bone, the ulna, keeps growing and can dislocate, forming a bump.
What is the difference between Madelung deformity and Pseudo-Madelung deformity? ›Pseudo Madelung deformity simulates Madelung deformity except in the former there is negative ulnar variance with the distal articular surface of the ulna articulating with the medial cortex of the distal radial metaphysis. It also includes 'reverse Madelung deformity'.
Why is the bone on my wrist so big? ›Conditions like osteoarthritis can damage the cartilage in your joint, leading bones to rub together and possibly form bone spurs. In the wrist, this may appear as a bossing. Overuse. If you use your wrist heavily in a repetitive way, you may irritate the joint bone and cartilage and develop a bossing from overuse.
Is it normal for your wrist bone to stick out? ›These calcium deposits can build into a bone spur that protrudes from your wrist. A bone spur is a hard, bony growth that can grow as a result of repetitive strain injuries. However, they can also occur due to underlying conditions, especially those that have caused joint damage over time.
What is a Madelung deformity of the ankle? ›Madelung deformity refers to bowing of the radial shaft with increased interosseous space and dorsal subluxation of the distal radioulnar joint. This deformity is due to premature closure or defective development of the ulnar third of the distal physis of the radius.
What autoimmune disease causes lipoma? ›Dercum's disease is a rare disorder characterized by multiple, painful growths of fatty tissue (lipomas). Fat tissue is known as loose connective tissue, hence Dercum's disease is a loose connective tissue disease.
Why is it called Madelung? ›In 1888, Otto Madelung presented 35 cases of this disease. In 1898, Launois and Bensaude described another 30 cases of patients with excessive adipose tissue growth around the neck, nape, back and shoulders. This new disease was called Madelung disease or Launois-Bensaude syndrome.
Does drinking alcohol cause lipomas? ›Madelung's disease: This condition occurs most often in men who drink alcohol excessively. Also called multiple symmetric lipomatosis, Madelung's disease causes lipomas to grow around the neck and shoulders.
Can stress cause lipomas to grow? ›Things that worsen lipoma pain in Dercum disease include stress, overactivity and extreme temperatures. If you notice multiple painful lipomas on your body, a dermatologist along with other physicians can determine if you have Dercum disease.
When should I be worried about my lipoma? ›If any lipoma increases in size or becomes painful, you must tell your doctor, as it can be a sign that the lipoma is changing. Rarely, doctors can't tell for certain whether the lump is a lipoma or not. Lipomas can be confused with malignant (cancerous) tumours, called liposarcomas.
What is pinky side of wrist called? ›
The ulnar side of your wrist is the side of your “pinkie” finger (or small finger), and pain on this side can be very common.
How do you stop lipomas from spreading? ›The most common way to treat a lipoma is to remove it through surgery . This is especially helpful if you have a large skin tumor that's still growing. Your doctor will typically carry out an excision procedure with you under a local anesthetic. They will make an incision in your skin to remove the lipoma.
What is a fat deposit in the body? ›A lipoma is a slow-growing, fatty lump that's most often situated between your skin and the underlying muscle layer. A lipoma, which feels doughy and usually isn't tender, moves readily with slight finger pressure. Lipomas are usually detected in middle age. Some people have more than one lipoma.
Is being deformity a disability? ›First and foremost, severe disfigurements are classified as disabilities under the Americans with Disabilities Act. This Act recognizes that prejudice and discrimination can happen to those with facial disfigurements, making it harder or impossible to work.
Is Madelung deformity bilateral? ›Madelung's deformity of the wrist was first officially described by Otto Madelung in 1878. This deformity arises in adolescents aged 8 to 14 and is often bilateral.
What is Madelung's disease Radiopaedia? ›Madelung deformity refers to bowing of the radial shaft with increased interosseous space and dorsal subluxation of the distal radioulnar joint. This deformity is due to premature closure or defective development of the ulnar third of the distal physis of the radius.
What is the big bump on my wrist called? ›A ganglion (gang-glee-uhn) cyst is a fluid-filled lump under the skin. It is often found over a joint or in a tendon in the hand or wrist (Picture 1). A ganglion cyst forms when there is a small tear in the sleeve of thin tissue that covers a joint or tendon. The tissue bulges and forms a sac.
What is the boney bump in my wrist? ›If you have an annoying and sometimes painful, lump on your wrist, most likely it's a ganglion cyst. Ganglion cysts are usually harmless. The soft sacs of fluid often show up on the top or bottom side of the wrist. The cyst can be the size and shape of a pea, but they can sometimes grow larger overtime.
What is the painful bony growth on my wrist? ›Ganglions can occur alongside any joint in the body, but are most common on the wrists (particularly the back of the wrist), hands and fingers. Ganglions are harmless, but can sometimes be painful.
Why does my wrist bone pop in and out? ›When the tendon in the wrist that connects the joint to the bone is damaged, it begins to rub over the bone or muscles in its way (instead of moving fluidly) and causes the “snapping” or “popping” sensation. The tendon moves in this irregular way because its foundation, the ligaments, have also become damaged or lax.
What is the most common bone in the wrist to dislocate? ›
This injury is caused by falling on an outstretched hand. Most wrist dislocations involve the lunate bone of the proximal row of carpal bones and other bones.
How do you know if your wrist bone is out of place? ›The main symptom of a dislocated wrist is intense pain that's usually worse when you try to move your wrist up and down or side to side. You might also feel pain in your forearm. You may also notice the following around your wrist: swelling.
What ligament is in Madelung deformity? ›Madelung's deformity (MD) is frequently associated with Leri-Weill's dyschondrosteosis (LWD) even if the primary isolated form (PI-MD) is much more common. Recent studies pointed out how two abnormal ligaments, the Vickers ligament (VL) and the radiotriquetral ligament (RTL), are defining traits of MD.
What is the angle of Madelung deformity? ›The deformity is characterized by: dorsal and radial bowing of the radius. increased interosseous space. exaggerated palmar (up to 35°) and ulnar tilt (up to 60°) of the radiocarpal articulation.
What is the criteria for unstable distal radius? ›According to this definition, a distal radius fracture is unstable if three or more of the following factors are present: dorsal angulation exceeding 20°; dorsal comminution; intra-articular radiocarpal fracture; associated ulnar fracture; and age over 60 years.
What causes Madelung deformity in radiology? ›Differential Diagnosis
The Madelung-type deformity can occur due to trauma (from a fracture or repetitive microtrauma as seen in gymnasts' wrist) or tumors (including multiple hereditary exostoses and Ollier disease).
In children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures.
What is the acceptable reduction criteria for distal radius? ›Acceptable criteria for distal radius fractures include: Radial height: Less than 5 mm shortening. Radial inclination: Less than 5-degree change. Articular step off: Less than 2 mm.
What is the rule of 11 for distal radius fracture? ›Lateral Wrist
On the lateral view the distal radial articular surface normally points in a volar direction. Therefore if it is pointing dorsal it has already displaced by at least 11 degrees or more.