In the last few weeks, we have discussed a bent (flexed) finger or camptodactyly and a stiff finger (symphalangism). In the post, I will review a crooked finger or clinodactyly. There are a large number of different presentations of clinodactyly but the most common, by far, is a deviated little finger. It most commonly present in both little fingers and, typically, is not a functional issue. However, on some occasions the curvature of the fingers can limit typing abilities or playing a musical instrument. And, of course, the curvature may be problematic from an aesthetic or cosmetic standpoint.
Clinodactyly is typically an isolated condition without other medical or bony issues. But it can be associated with brachydactyly (short fingers), Down syndrome, Turner syndrome, and others. It can be Autosomal Dominant (passed from parent to child) or random inheritance.
Many families simply desire to understand the diagnosis. For these families, we provide information an encourage follow- up clinical examination and X-rays. Therapy and splinting have not proven helpful in the treatment of clinodactyly. If there are functional challenges, there are two primary interventions.
The first, and my preferred, is only appropriate for younger children with plenty of growth remaining. In patients 7 years or younger, in patients with a clear bracketed epiphysis to explain the clinodactyly, an excision of the abnormal growth plate is the treatment of choice. Excuse my block drawing picture but I believe it gets across the point- the middle bone (the middle phalanx) has an abnormal growth plate, shaped almost like a “C”. The inner part of the growth plate (long axis) tethers growth and leads to increasing deformity. And, the simple concept for treatment is to remove a portion of this abnormal growth plate to allow a return of growth (and indeed, extra growth which allows the finger to straighten over time.
Bracketed Epiphysis
Excision of bracketed epiphysis
These three pictures show the deformity before surgery as well as the xray. The bracketed epiphysis is not as clear in this xray (compared to my block images) because the xray is not perfectly in line with the bony abnormality. An MRI would show it more clearly (but is not necessary).
The other option is an osteotomy of the middle phalanx. We do this at older ages (typically in adolescence) once the growth plates can no longer create enough growth to make up for the deformity. This too is a good surgery and will be the subject of another post.