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Case of the Week 350

What's the most likely diagnosis?

  • 23 year-old female with pain in both wrists

Frontal radiographs of each wrist

  1. Barton fractures
  2. Negative ulnar variance
  3. Madelung deformity
  4. Fong disease
  5. Scapho-lunate advanced collapse

Additional Image - Lateral radiographs of each wrist


Additional Images



Lateral radiographs of each wrist




3. Madelung Deformity



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Madelung Deformity

General Considerations

  • Arrest of epiphyseal growth of the ulnar (medial) and volar (anterior) portions of the distal radius
  • Leads to shortening of the radius and relative overgrowth of the ulna
  • Inherited as an autosomal dominant due to mutation on X chromosome and has variable penetrance
  • Overwhelmingly occurs in females
  • Rare congenital deformity that does not usually manifest until 10-14 years
  • May also be seen as an acquired consequence of trauma to the growth plate (e.g. Salter V fracture)

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