Beruflich Dokumente
Kultur Dokumente
Hersch, AH, De Marinus, F, Stecher R. On the inheritance and development of clinodaclyly. Am. J Human Gen., 1953;
5: 257-268.
Fujita H, Iio K, Yamamoto K. Brachymesophalangea and clinodac- tyly of the fifth finger in Japanese children. Acta
Paediatr Jpn 1964; 31:26 –30.
Classification
• 3 types
• Clinodactyly secondary to
epiphyseal injury (fracture,
frostbite…)
Burke F, Flatt AE. Clinodactyly. A Review of a Series of Cases. The Hand 1979; 11(3):269-280
Poznanski AK et al. Clinodactyly, Camptodactyly, Kirner’s Deformity, and Other Crooked Fingers. Radiology 1969; 93:
573-582.
Clinodactyly in Apert Clinodactyly in a tri-
Syndrome phalangeal thumb
Norat F et al. Les clinodactylies : phalange delta et déformation de Kirner. Chirurgie de la main 27S (2008) S165–S173
« Familial » clinodactyly
Hersch, AH, De Marinus, F, Stecher R. On the inheritance and development of clinodaclyly. Am. J Human Gen., 1953;
5: 257-268.
Clinodactyly in art
• Characterized by an anomalous
epiphysis (C-shaped) that is
oriented longitudinally along the
short side of the affected bone
leading to progressive angulation
of the digit toward the convex side
Burke F, Flatt AE. Clinodactyly. A Review of a Series of Cases. The Hand 1979; 11(3):269-280
Rare cases
Buck-Gramcko D, Ogino T. Congenital malformations of the hand: non- classificable cases. Hand Surg 1996;1:45–61
Rare cases
Al-Qattan MM. Congenital sporadic clinodactyly of the index finger. Ann Plast Surg 2007;59:682– 687.
Norat F et al. Les clinodactylies : phalange delta et déformation de Kirner. Chirurgie de la main 27S (2008) S165–S173
Flatt’s series of 50 cases
• 28 females, 22 males
Burke F, Flatt AE. Clinodactyly. A Review of a Series of Cases. The Hand 1979; 11(3):269-280
Clinical presentation
Burke F, Flatt AE. Clinodactyly. A Review of a Series of Cases. The Hand 1979; 11(3):269-280
Poznanski AK et al. Clinodactyly, Camptodactyly, Kirner’s Deformity, and Other Crooked Fingers. Radiology 1969; 93:
573-582.
Indications for treatment
• Minor deformity
• Those with marked angulation of the small finger at the DIP joint can
accommodate by abduction of the metacarpophalangeal joint.
Carstam N, Theander G. Surgical treatment of clinodactyly caused by longitudinally bracketed diaphysis (‘‘delta
phalanx’’). Scand J Plast Reconstr Surg 1975;9:199–202.
Jones GB. Delta phalanx. J Bone Joint Surg Br 1964;46:226–8.
Wood VE, Flatt AE. Congenital triangular bones in the hand. J Hand Surg Am 1977;2:179–93.
Closing wedge osteotomy
Ali M, Jackson T, Rayan GM. Closing Wedge Osteotomy of Abnormal Middle Phalanx for Clinodactyly. J Hand Surg
2009;34A:914–918
Closing wedge osteotomy
• Dorsolateral longitudinal incision over the
convex side of the finger.
Ali M, Jackson T, Rayan GM. Closing Wedge Osteotomy of Abnormal Middle Phalanx for Clinodactyly. J Hand Surg
2009;34A:914–918
Closing wedge osteotomy
• Angular deformity improve
from 33° preop to 9° postop
(X-rays correction from 29°
to 5°)
6 years old boy, 6 months FU
• DIP joint arc of motion
decreased from 84° prior to
surgery to 81° after surgery,
Goldfarb CA, Wall LB. Osteotomy for clinodactyly. J Hand Surg Am. 2015;40(6):1220-1224
Opening wedge osteotomy
• A single 0.045-inch Kirschner
wire is placed retrograde in the
distal phalanx, slightly radial to
midline.
Goldfarb CA, Wall LB. Osteotomy for clinodactyly. J Hand Surg Am. 2015;40(6):1220-1224
Opening wedge osteotomy
• 13 fingers in 9 patients treated Preop Postop
between 2003 and 2011.
Clinical 34°
• Average age at surgery was 7° (0-35°)
angle (20-45°)
nine years. FU was 25 months
Piper SL, Goldfarb CA, Wall LB. Outcomes of Opening Wedge Osteotomy to Correct Angular Deformity in little finger
Clinodactyly J Hand Surg Am. 2015;40(5):908-913
Others
• Realignement
Carstam N, Theander G. Surgical treatment of clinodactyly caused by longitudinally bracketed diaphysis (‘‘delta
phalanx’’). Scand J Plast Reconstr Surg 1975;9:199–202.
Surgical techniques
The limiting factor is tightness of all the soft tissues, and Z-
plasty of the skin does little to help (Jones, 1964).
The extensor mechanism and the neurovascular structures
are at risk
• Physiolysis (Vickers)
Vickers D. Clinodactyly of the little finger: a simple operative technique for reversal of the growth abnormality. J Hand
Surg Br 1987;12:335–42.
Physiolysis
Vickers D. Clinodactyly of the little finger. A simple operative technique for reversal of the growth abnormality. J Hand
Surg Br 1987; 12B(3):335-342
Vickers’s Physiolysis
• 22 patients (27 fingers) over a 13 years period with 7,4 years FU
• Final angulation was 8° (79% correction) obtained in most cases within 1 year
Medina J, Lorea P, Elliot D,Foucher G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. J Hand Surg
Am. 2016;41(6):123-127
Vickers’s Physiolysis
• 14 patients (24 fingers) over a 6
years period with 54 months FU
El Sayed L, Salon A, Glorion C, Guéro S. Physiolysis for correction of clinodactyly with delta phalanx: Early
improvement. Hand Surgery and Rehabilitation 38 (2019) 125–128
Other series
• Al Qattan, in 10 index fingers using closing wedge osteotomy recommended that
Vickers physiolysis should be used early and that closing or open wedge
osteotomy should be followed later. He obtained a mean correction from 44° to
13°.
• Gillis compared 21 patients (30 digits) with Vickers’s technique and 6 patients
(11 digits)with osteotomy
• The use of osteotomy may lead to more revision cases, while the Vickers
procedure has minimal complications and need for revision. The Vickers
physiolysis procedure is more effective in those with angulation less than 55°
Al-Qattan MM. Congenital sporadic clinodactyly of the index finger. Ann Plast Surg 2007;59:682– 687.
Gillis JA. Comparison of Vickers Physiolysis Versus Osteotomy for Primary Correction of Clinodactyly. Abstract ASSH
2018
Conclusion