Paediatric
Madelung deformity
Wrist · growth
What it is
Madelung deformity is a growth disturbance of the growth plate of the radius, on the inner side of the wrist. That part stops growing normally while the rest of the forearm keeps growing. The radius gradually tilts, and the end of the ulna becomes prominent at the back of the wrist. A thick, abnormal ligament is often found on the palm side, tethering the bone like a stay.
It usually becomes apparent in later childhood or adolescence, and more often in girls. It can occur on its own or as part of a wider condition affecting bone growth, which is why further assessment is sometimes arranged.
Symptoms
The first sign is often a bump at the back of the wrist on the little-finger side, and a wrist that looks tilted. Loss of movement follows — particularly rotating the forearm to turn the palm up, and bending the wrist backwards.
Pain is not always present early; it tends to come with activity or at the end of the day. Many young people first come because of the shape of the wrist, and the limitation is found on examination.
Non-operative treatment
Where the deformity is mild and causes neither pain nor limitation, watching it is the right approach: examination and X-rays at intervals during growth are enough to follow how it changes.
Physiotherapy or occupational therapy helps maintain movement, and adapting certain sporting or school activities reduces discomfort. Many mild cases never need surgery.
Surgical treatment
In a child who still has growth remaining, releasing the abnormal ligament together with the closed part of the growth plate can allow the radius to resume more even growth and limit progression.
Once growth is complete, correction is done by osteotomy: the radius is cut and realigned, sometimes with shortening of the ulna, to straighten the wrist and improve rotation. The choice depends on age, severity and — above all — on how much it actually interferes.
Recovery expectations
The wrist is held in a cast or splint for several weeks, after which therapy gradually restores movement and strength.
Correcting the alignment is reliable. The gain in forearm rotation is more variable and depends a great deal on the state of the joints beforehand. Return to sport follows once bone healing is confirmed on X-ray.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.