Saturday, January 12, 2013

Clinodactyly



I have previously posted on clinodactyly but recently performed several surgeries so I though adding a few more pictures and thoughts might be helpful.  There are two types of clinodactyly: isolated and associated with a syndrome.  Isolated clinodactyly is common in the general population but is very well tolerated and usually ignored.  In fact, many people are not even aware that they have a clinodactyly, especially if it is mild.  It is most common in the small finger but can be seen in any digit.  When the pinky is involved, it can cause an appearance problem or it can be a functional problem.  It tends to be most noted in adolescence.  Functional difficulties are most commonly seen in those patients that play a musical instrument.  Here is a single example of an isolated case of small finger syndactyly in a flute player with functional limitations. The family and patient are happy.


Isolated small finger clinodactyly
Clinodactyly after correction.



Clinodactyly associated with a syndrome is most common in Aperts syndrome- also called acrocephalosyndactyly due to facial anomalies and syndactyly in the hand- and Rubenstein Taybi syndrome.  In both of these conditions, the clinodactyly affects the thumb and can interfere with function especially in the severe cases.  These cases are more severe than the isolated cases and therefore are treated at a younger age.  Here are 2 examples.

Clinodactyly in Rubenstein Taybi before surgery.  The after surgery x-ray and pictures are below.




A more severe clinodactyly in Rubenstein Taybi.
X-ray show the abnormal phalanx (rounded) and the deformity in clinodactyly.


Clinodactyly after correction.
Clinodactyly after correction.  The opening wedge osteotomy is visible (as a "hole") in the phalanx which allowed straightening of the digit.

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