. Annals of surgery. the radiusnot so much in the direction of the diaphysis as of the epiphysiswhich is always present. This is also Madelungs has been, however, constantly found in the later obser-vations a bending of the diaphysis and Stetten agrees withDelbet, that the chief cause of the deformity is the throwing MADELUNGS DEFORMITY OF WRIST. 335 forward of the articular plane of the radius sufficient indegree to make an apparent dislocation. This was true of ourcases. The radio-ulnar articulation is much more widelyseparated than normal, thus giving- artificial and exaggeratedm
. Annals of surgery. the radiusnot so much in the direction of the diaphysis as of the epiphysiswhich is always present. This is also Madelungs has been, however, constantly found in the later obser-vations a bending of the diaphysis and Stetten agrees withDelbet, that the chief cause of the deformity is the throwing MADELUNGS DEFORMITY OF WRIST. 335 forward of the articular plane of the radius sufficient indegree to make an apparent dislocation. This was true of ourcases. The radio-ulnar articulation is much more widelyseparated than normal, thus giving- artificial and exaggeratedmovements of the carpal bones and of the hand (Figs. 3 and4). Our cases did not seem to be as pronounced as Made-lungs, as shown by Figs. 5 and 6. The etiology and pathology of this peculiar deformityare, therefore, not entirely explained. We may, however,from our study of these cases, draw the following conclusions: First. They occur in people usually of the lower class,many of whom show evidences of rickets. Fig, Showing relation of end of radius to carpal and metacarpal. Second. There is a dystrophy and atrophy in the carpalbones, cartilages, and epiphyses, with an occasional hyper-trophy of the dorsal side, and the diaphysis of the radius iscurved anteriorly. This corresponds to Delbets descriptionof the spontaneous subluxations of adolescence. Third. Radical treatment is only indicated for cosmeticpurposes. Symptoms must be controlled by palliative means. Fourth, Heredity, female sex, and occupations are pre-disposing factors to this disease. Treatment.—While sometimes osteotomy may be justifiablewhen the deformity is very great, yet it is not indicated exceptfor cosmetic effects and then it is questionable in its plaster casts, splints, etc., are useless. After about 236 A. C. STOKES. the age of twenty-five all symptomatology disappears. There-fore, palliative treatment is indicated up to that age, or to thedisappearance of the symptoms. The treatm
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
