MADELUNGA DISEASE (O. W. Madelung, is mute. surgeon, 1846 — 1926; synonym: deformation of Madelunga, chronic incomplete dislocation of a brush) — the malformation of the distal end of a forearm and radiocarpal joint which is externally shown a vystoyaniye of a head of an ulna and shift of a brush in the palmar party that in total causes shtykoobrazny deformation of a radiocarpal joint. This deformation of an upper extremity is known long ago, but its first detailed description on the basis of the 12th a wedge, observations is brought in 1878 by Madelung in this connection this pathology received his name.
In orthopedic practice of M. meets quite often, but its specific weight among other diseases and deformations of a skeleton is not known. At female persons it is 4 times more often. In most cases defeat bilateral. Deformation develops owing to idiopathic disturbance of epiphyseal growth of a beam bone.
The first signs M. appear usually aged after 9 years, i.e. from the beginning most of rapid growth of long tubular bones. Progressing of deformation stops with the end of growth of bones. As a result of lag of a distal epiphysis of a beam bone in growth and the increasing relative shortening her radiocarpal joint turns the plane in the elbow party, the brush is displaced towards a palm, the head of an ulna acts under skin distalny lines of a joint. In process of increase of deformation in a radiocarpal joint at loading pains and restriction of its mobility, especially extension and supination of a forearm develop. Joint pains are explained, apparently, by stretching of a joint disk in a distal radioulnar joint. Than later the first symptoms of a disease at M. would appear., final deformation is less expressed to those.
Diagnosis M. it is based on comparison kliniko-rentgenol. data. Wedge. manifestations at the same time are rather characteristic. On roentgenograms the beam bone which is rather shortened and bent at the level of a distal metaphysis by camber to the back is defined. In a direct picture the epiphyseal line has the V-shaped form, premature closing of region of growth is quite often noted. The distal epiphysis of a beam bone is deformed, its joint surface is turned towards a palm. The ulna is rather extended, its head will stand distalny a joint (fig). All these symptoms are characteristic of M. also allow to differentiate it from other deformations of a forearm and a wrist joint — posttraumatic deformations, elbow talipomanus (see), an inborn incomplete dislocation in a radiocarpal joint.
Treatment M. it is necessary at emergence of pains in a radiocarpal joint or at the expressed its curvature. From conservative actions apply physiotherapeutic procedures, massage. At the expressed dysfunctions operational treatment is shown, a cut it is necessary to carry out only upon termination of growth of bones of a forearm. For the purpose of correction of deformation various techniques with an osteotomy of a beam bone and a resection of a head of an ulna are offered. The best results are received by lengthening of a beam bone with the help distraktsionno-compression devices (see).
Forecast is defined by terms of emergence and expressiveness of deformation, timeliness and correctness of treatment. Effective treatment allows to recover anatomy and function of a radiocarpal joint.
See also Radiocarpal joint .
Bibliography: Andrianov V. L., etc. Inborn deformations of upper extremities, M., 1972, bibliogr.; Sorkin A. 3. Diagnostic mistakes at pathology and malformations of the bone and joint device, M., 1969, bibliogr.; Lehrbuch der Orthopadie, hrsg. v. P. F. Mat-zen, B., 1967; Madelung O. W. Die spontane Subluxation der Hand nach vor-ne, Verh. dtsch. Ges. Chir., Bd 7, T. 2, S. 259, 1878.
AA. P. Mathis.