Qiu Yan Wang, Presenter: Nothing to Disclose

Paul S. Babyn MD, Abstract Co-Author: Nothing to Disclose

Jennifer Stimec MD, Abstract Co-Author: Nothing to Disclose

Madelung's deformity(MD) is an uncommon spontaneous forward subluxation of hand. Using recently established quantitative adult measurement, our goal was to establish the normal range of measurement in skeletally immature children and illustrate the spectrum of changes in pediatric MD.

All MD cases were collected from our database over a 16-year period. Inclusion criteria were with available wrist radiographs. Excluded cases with trauma, infection, inflammation or tumor of the wrist. Gender and age-matched control were found in the same database who had normal radiographs after trauma and otherwise healthy. Measurement for ulnar tilt(UT), lunate subsidence(LS), lunate fossa angle(LFA) and palmar carpal displacement(PCD) was done according to McCarroll’s work. Forearm was measured as proposed by Zebala on available radiographs. Entire radius was considered involved if radial bowing(RB)>10º on lateral view or radiocapitellar joint space(RCJS)>4 mm. Carpal angle(CA) was also measured.

Both study and control comprised of 27 cases (5M, 22F), 7-17y, mean(M) 13y. Range in control for UT was 7.9-30.5º(M 20.4º), LS -7.1-0 mm(M-3.5mm), LFA 5.8-37.2º(M 20.1º) and PCD 5.6-19.0mm(M 12.6mm), comparing to UT in MD 9.3-77.8º(M 36.5), LS -8-11.1 mm(M1.6mm), LFA 4.8-96.5º(M 47.9) and PCD -24.2-32.6mm(M 18.4 mm). Measurements were greater in study than those in control except for LOR, LOU and CA. The differences were significant except for RCJS measured on front view. Inter- and intrareader agreement ranged 0.49-1.0(M 0.88). Eight of 16 cases with bilateral radiographs demonstrated asymmetry involvement. Values for UT, LFA and PCD were greater and CA was smaller on left than on the right. The differences were significant. Half of 12 cases with follow-up showed progression of the deformity, including increase in UT, LS, LFA, PCD and decrease in CA. The rest were stable in an interval of 2-31 month(M 15m). Among the 13 cases with forearm radiographs 8 cases had entire forearm involvement.

It is practical using proposed adult measurement in pediatric MD. MD has a spectrum of severity and overlap with normal but UT>30º, LS>0, LFA>37º, PCD>19 mm and CA<104º only occurred in MD. Deformity on the left may be more severe than on the right. Part of MD may progress with aging.

This quantitative method maybe helpful in early diagnosis for subtle MD, follow-up progression or post-therapy.   

Wang, Q, Babyn, P, Stimec, J, Pediatric Madelung's Deformity and Quantitative Comparison with Normal Group.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002684.html