J Wrist Surg 2018; 07(03): 227-231
DOI: 10.1055/s-0037-1612636
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Reliable is the Radiographic Diagnosis of Mild Madelung Deformity?

Sebastian Farr
1   Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
Thierry G. Guitton
2   Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
David Ring
3   Dell Medical School, The University of Texas at Austin, Austin, Texas
Science of Variation Group › Author Affiliations
Funding None.
Further Information

Publication History

20 September 2017

20 November 2017

Publication Date:
14 December 2017 (online)


Background Patients with Madelung deformity exhibit a spectrum of mild to severe deformity and distortion of wrist geometry. It may be difficult to reliably distinguish mild Madelung deformity from normal.

Purpose This study thus tested the reliability of the diagnosis of mild Madelung deformity on a single posteroanterior (PA) radiograph.

Materials and Methods An online survey was sent to hand and wrist surgeons of the Science of Variation Study Group for evaluation of 25 PA wrist radiographs comprising five adults with suspected mild Madelung deformity and 20 radiographs without any evident wrist pathology. Interobserver agreement was evaluated both via average percent agreement and Fleiss' kappa. To evaluate the relationship of rater characteristics and accuracy, a linear regression model was computed.

Results The interobserver agreement among the 69 participating surgeons was low (Κ = 0.12). The overall sensitivity, specificity, and accuracy were 0.30, 0.86, and 0.75, respectively. The mean confidence was 7.4 ± 0.4 for mild Madelung and 7.8 ± 0.5 for normal (p = 0.112). The observers' confidence level was the only factor which had a mild but significant effect on the accuracy of the ratings.

Conclusion The diagnosis of mild Madelung deformity on a single PA radiograph is unreliable.

Level of Evidence The level of evidence is II, diagnostic study.


Ethical approval was waived by the local ethics committee since this article does not contain any studies with human or animal subjects.

  • References

  • 1 McCarroll Jr HR, James MA, Newmeyer III WL, Manske PR. Madelung's deformity: diagnostic thresholds of radiographic measurements. J Hand Surg Am 2010; 35 (05) 807-812
  • 2 Tuder D, Frome B, Green DP. Radiographic spectrum of severity in Madelung's deformity. J Hand Surg Am 2008; 33 (06) 900-904
  • 3 McCarroll HR, James MA, Newmeyer III WL, Manske PR. Madelung's deformity: quantitative radiographic comparison with normal wrists. J Hand Surg Eur Vol 2008; 33 (05) 632-635
  • 4 McCarroll Jr HR, James MA, Newmeyer III WL, Molitor F, Manske PR. Madelung's deformity: quantitative assessment of x-ray deformity. J Hand Surg Am 2005; 30 (06) 1211-1220
  • 5 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378-382
  • 6 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174