Madelung deformity

Madelung deformity is a rare congenital hand difference caused by a distal radial growth arrest. Patient workup includes assessing pain, range of motion (ROM), grip strength, and aesthetic deformity. Surgical treatment involves lengthening the radius, shortening the ulna, or a combination of both. Unfortunately, patients are significantly impacted in their physical, mental, and social health, even after corrective surgical treatment. Advancing our assessment of the wrist through novel imaging techniques allows us to increase our understanding of this rare condition. New 3D quantifications show the lunate fossa in patients to be more concave and irregular, and the angle between the scaphoid, lunate, and triquetrum to be decreased. Four-dimensional analyses show significantly reduced movement patterns of the lunate and the triquetrum, while scaphoid bone mobility remains normal. The latter raises the question of whether the abnormal carpal kinematics are caused by the distorted skeletal configuration, or the anomalous radiolunate and radiotriquetral ligaments previously discovered in patients’ wrists. The development of a statistical shape model allows us to visualize anatomical shape variations and quantify these variations by representing them as ‘modes’ of variation. Over 80% of variation in the distal radius can be explained with the five largest modes: ulnar-sided collapse, coronal width, sigmoid notch axial rotation, volar tilt, and lunate fossa angle. Using the findings above, we developed a new surgical technique: radioscapholunate arthrodesis and construction of a neo-distal radioulnar joint. As both functional and clinical post-operative outcomes seem satisfactory, this new technique could provide a viable treatment option for a subset of symptomatic patients