This is a follow up to my recent post on clinodactyly which included a description of treatment of the bracketed epiphysis in the younger patient. When the patient is older, there is less chance of correction through growth (or no chance if the growth plates are closed (typically around 12 years of age).
In these patients, the simplicity of the excision of the bracketed epiphysis is no longer an option. These patients and families need to consider cutting the bone to realign it (an osteotomy). This is a much bigger surgery and requires metal pins to hold the realigned bone in place for 6 weeks while the bone heals (ie, heals like a fractured bone). Then the pins can be removed. This surgery is a good one and can create a much better aligned finger. But it does have a few shortcomings. First, the bone is never exactly the shape of other bones (ie, not a perfect rectangle). And second, the joint (the DIP joint) can be stiff although over time this will improve. My main goal in counseling families is the they understand the nature of the surgery, the healing process and the time it may take to regain motion (and the therapy required).
In this patient, the deformity was affecting his ability to play the violin. The clinical pictures demonstrate the deformity. The after surgery pictures and single xray show the correction. The pictures with pins are from after the correction.
