Congenital Differences-Osteotomy for Clinodactyly

Osteotomy for Clinodactyly

Pdf Summary

Clinodactyly is a finger deviation in the coronal plane, most commonly affecting the little finger. Although it usually doesn't cause functional limitations, it can cause difficulties with certain tasks, such as playing musical instruments. Surgical options for clinodactyly include physiolysis for young patients and osteotomy for older patients. An opening wedge osteotomy is often used to correct the coronal deformity and increase finger length. This surgical technique has high success rates and rare complications, although some patients may experience stiffness in the distal interphalangeal joint. Clinodactyly is commonly bilateral and may be autosomal dominant. It can be an isolated anomaly or part of a syndrome or chromosomal abnormality. Bar resection and osteotomy are two surgical options for clinodactyly. Bar resection involves removing the tethering bracket to allow gradual correction with growth and is most effective in children under 6 years old. Osteotomy, specifically the opening wedge technique, is performed in older children and corrects both the length and deviation of the abnormal phalanx with less technical complexity. Surgery is indicated in patients with a marked clinical deformity that interferes with function, typically manifesting as difficulty playing musical instruments or typing on a keyboard. The opening wedge osteotomy is not preferred for younger children due to technical challenges and alternative options like bar resection. The surgical technique involves careful protection of the extensor mechanism, identification of the PIP and DIP joints, creation of the opening wedge osteotomy, and stabilization with Kirschner wires. Postoperative care includes wearing a protective orthosis, followed by gradual rehabilitation and removal of pins. Complications are rare but can include infection, nerve or artery injury, extensor mechanism injury, incomplete correction of deformity, loss of initial correction, and stiffness in the DIP joint.

Keywords

Clinodactyly

finger deviation

coronal plane

surgical options

osteotomy

opening wedge osteotomy

complications

stiffness

DIP joint

extensor mechanism