KnotesFree Orthopaedic & FRCS notes, viva stations and higher order SBAs

Madelung deformity

High YieldHand & WristthinKbox SBA

Definition

A developmental deformity due to abnormal growth of the volar-ulnar distal radial physis causing volar and ulnar tilt of the distal radius.

Clinical features

  • Wrist deformity
  • Pain or reduced motion
  • Prominent distal ulna
  • Reduced grip strength

Associations

  • Often bilateral
  • May be associated with Leri-Weill dyschondrosteosis and SHOX abnormalities

Imaging

  • Increased radial inclination and volar tilt
  • Carpal malalignment with lunate subsidence
  • Relative ulnar overgrowth

Treatment

  • Observation if mild and asymptomatic
  • Physiotherapy and activity modification for symptoms
  • Corrective osteotomy, epiphysiolysis of Vickers ligament, or ulnar procedures in selected patients

Diagram

Madelung deformity

Written/reviewed by Kishore Puthezhath

Professor of Orthopaedics and Consultant Paediatric Orthopaedic Surgeon

FRCS (Tr & Orth) revision resource

Reviewed: September 2026