Madelung Deformity: A Current Concepts Review

Madelung deformity is a rare congenital wrist deformity characterized by growth disturbance of the volar-ulnar aspect of the distal radial physis, leading to progressive wrist deformity, pain, and stiffness. Madelung deformity is frequently associated with genetic conditions such as Leri-Weill dyschondrosteosis and Turner syndrome, and more recently, mutations in the GNAS gene have been implicated. Diagnosis is based on clinical findings and radiographic criteria, with plain radiographs demonstrating characteristic volar-ulnar radial curvature, positive ulnar variance, and carpal subluxation. Advanced imaging modalities enhance the characterization of complex deformities and aid in surgical planning. In skeletally immature patients, radial physiolysis with Vickers ligament release can prevent deformity progression. For skeletally mature patients with pain and functional limitations, corrective osteotomies of the distal radius, often combined with ulnar procedures, are the mainstay of treatment. Advances in three-dimensional surgical planning and custom cutting guides have improved the precision and reproducibility of complex reconstructions. Long-term outcome data remain limited and heterogeneous because of variability in patient presentation and surgical techniques, although many studies report improvements in pain, function, and radiographic alignment. Continued emphasis on standardized outcome reporting and collaborative research will improve evidence-based care and patient counseling for this complex deformity.