• This is caused by an asymmetric growth arrest of volar and ulnar aspect of distal radial physis, resulting in increased volar and ulnar tilt.
• Several possible causes:

- An abnormal band between the radius and lunate called Vickers ligament.
- premature fusion ulnar half of distal radial epiphysis
- Associated with:

1. Multiple epiphyseal dysplasia
2. Ollier’s disease
3. post traumatic
4. post infective growth arrest

• adolescence girls, often bilateral

X-rays

• + ulnar variance
• Lunate subsidence
• increased radial inclination
• prominent ulna due to subluxation of radius (rather than an ulna problem)

Rx

• release of Vickers ligament
• excision of physeal bar and dermo-fat graft insertion
• radial lengthening
• correction residual deformity

Pathological Vickers ligament in Madelung’s deformity (1). Release of physeal bar and Vickers ligament (2) and Restoration of radial growth (3)

[Image is courtesy of Paediatric Orthopaedics by Matthew Nixon Lulu publishing 2012]

Madelung’s Deformity correction

Pathology

• osteochondromas of ulna inhibits ulna growth
• radius grows normally, bows round ulna
• rado-capitellar dislocation

Clinical features

• ulnar deviation of hand
• prominent radial head
• loss of supination

Treatment

• debridement of ostoechondroma
• restoration of ulnar length
• span elbow to allow RH reduction

Pseudo-Madelung’s deformity. Ulna growth arrest following ulna osteochondromas. Ulna distraction to lenghthen the ulna with or without excising the osteochondroma [Image is courtesy of Paediatric Orthopaedics by Matthew Nixon Lulu publishing 2012]