THE JOURNAL OF BONE AND JOINT SURGERY A Clinical and Cytogenetic Study

Madelung in 1879 described a painful deformity of the wrist which occurs in adolescence with no history of previous injury or infection. The distal growth plate of the radius, which is the primary site of the abnormality, has premature fusion of the antero-medial quadrant. As growth proceeds the characteristic deformity is produced which is now associated with the name of Madelung. The articular surface of the distal radius is tilted abnormally anteromedially, the ulna becomes disproportionately long and its distal epiphysis is distorted and subluxated posteriorly, and the lunate bone comes to lie deeply between the radius and ulna with consequent distortion of the proximal carpal row. Clinically the wrist has a characteristic appearance (Fig. 1). The lower end of the ulna is unduly prominent, and there may be quite marked shortening of the radius so that the carpal bones are deviated laterally. When the forearm and hand are viev ed from the side the wrist lies in a plane anterior to the forearm. This condition is part of an interesting group ofepiphysial growth disturbances, the other main sites being the proximal tibial epiphysis and the proximal femoral epiphysis.