Tuesday, June 4, 2013

Clinodactyly Minimally Invasive Treatment

Clinodactyly is defined as a deviation of a finger.  Most commonly, it involves the 5th finger curved towards the ring finger but can also involve the thumb or any other finger.  We have reviewed clinodactyly previously http://congenitalhand.wustl.edu/2013/01/clinodactyly.html

In an established clinodactyly in an older child, treatment is based on functional limitations.  Therapy has never been proven successful and typically surgery is indicated.  As previously discussed, osteotomy, or cutting the bone, is the accepted surgery although all different kinds of osteotomies can be considered.

In younger children there is another choice for the treatment of clinodactyly, a physiolysis.  This procedure is simple in that it divides the abnormal growth plate to allow resumption of normal growth.  We reviewed this technique in a previously written journal article http://www.ncbi.nlm.nih.gov/pubmed/20216055 .  The procedure was first reported http://www.ncbi.nlm.nih.gov/pubmed/3437200 in 1987 by David Vickers from Australia and the best report of a number of kids is from Quebec Canada in 2002 http://www.ncbi.nlm.nih.gov/pubmed/12132092

We prefer to perform this procedure in younger children (ideally less than 3 but up to 5 or 6 years of age)- this gives maximal time for growth to allow gradual deformity correction.  One nice thing about this procedure is that it has a quick recovery and doe not require pinning or prolonged immobilization.  And it works, although it takes time to see correction.





Severe clinodactyly in a 1 year old.




While a bit difficult to see, clinodactyly identified with needle prior to procedure.




Severe clinodactyly treated with physiolysis.  The knife is dividing and excising a portion of the abnormal growth plate.

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