A case of medelung deformity in a 13-year-old Iranian girl

Abstract

Blood cell count and the blood chemistry analysis were normal. Her familiar history was positive for grandmother’s deformity similar to her own, with being less symptomatic. The postero-anterior wrist X-rays (Figure 1) illustrated typical Madelung deformity changes on her both wrists which is characterized by shortening of radius bone , in comparison with the ulna, radially curved radius, a disparity of the distal radioulnar joint plus a triangular-shaped carpus. The lateral X-ray (Figure 2) showed major changes on the right wrist: dorsal dislocation of the ulnar and an exaggerated volar tilt of the radioulnar joint in a way which caused palmar carpal displacement and an anterior translation of the hand and the wrist. She wa candidate for closed wedge osteotomy performed on the right side of left distal radius with Vicker’s ligament release, and an ulnar shortening osteotomy with plate fixation (Figure 3). No intra and postoperative complications were occurred. Osteotomies were protected with dorsal forearm plaster splint for 3 weeks. Postoperative management depends on what is done. Casting immobilization might be necessary for some weeks after the osteotomy of the radius or ulna. Physiotherapy might be needed in children not able to regain range of motion on their own after 2-3 months without restrictions. In our case no physiotherapy was needed. After 2 months, there was no pain, a good aesthetic and mobility improvement of the right wrist mainly in prone-supination. The radiographic images (Figure 3) illustrated improving alignment and healing of the bone.