What are the treatment options for clinodactyly?

Treatment Options for Clinodactyly

For clinodactyly with angulation greater than 25 degrees causing functional limitation, surgical correction is indicated, with the choice of procedure determined by skeletal maturity: physiolysis (epiphyseal bar resection with fat interposition) for children aged 3-6 years with open growth plates, and osteotomy for older children and adolescents with closed growth plates.

Observation vs. Surgical Intervention

• Most cases of clinodactyly are treated nonoperatively, as the deformity is rarely functionally limiting 1, 2
• Surgical correction should be reserved for patients with functional limitations, typically associated with angulation greater than 25 degrees 1, 3
• Functional limitations may include difficulties with specific tasks such as playing musical instruments or other fine motor activities 2
• The American Academy of Pediatrics guidelines indicate that congenital malformations of the limbs, including clinodactyly, should be referred to a pediatric plastic surgeon for evaluation 4

Surgical Options Based on Age and Skeletal Maturity

For Younger Children (3-6 Years Old with Open Growth Plates)

Physiolysis (Epiphyseal Bar Resection with Fat Interposition):

• This procedure is most appropriate for children aged 3 to 6 years with radial deviation of at least 25 degrees 3
• The technique involves resection of the longitudinal epiphyseal bracket on the radial side of the middle phalanx with fat graft interposition 3, 5
• This approach uses the child's remaining growth potential to correct the axial deviation 5
• The procedure is technically simple and requires neither postoperative pin fixation nor immobilization 3
• Expected correction is approximately 44% of the initial deformity (mean improvement of 17 degrees from a preoperative average of 37 degrees) 5
• Results show similar improvement regardless of whether surgery is performed before or after age 3, though there is wider dispersion of results in younger children 5
• The procedure reliably diminishes the extent of deformity with minimal complications 3

For Older Children and Adolescents (Closed Growth Plates)

Osteotomy Techniques:

• Opening Wedge Osteotomy: This technique corrects the coronal deformity while simultaneously increasing finger length 1, 2
• Closing Wedge Osteotomy: This approach provides adequate correction for moderate (15-30 degrees) and severe (>30 degrees) deformities 6
• Closing wedge osteotomy with K-wire fixation corrects angular deformity from an average of 33 degrees preoperatively to 9 degrees postoperatively (radiographic correction from 29 degrees to 5 degrees) 6
• Surgical results are satisfying with rare complications, though some stiffness of the distal interphalangeal joint may occur 2
• The procedure provides improved hand function and high parental satisfaction 6

Expected Outcomes and Range of Motion

• Full active range of motion is typically maintained in all joints of treated fingers following physiolysis 5
• After closing wedge osteotomy, distal interphalangeal joint arc of motion shows minimal change (84 degrees preoperatively to 81 degrees postoperatively), while proximal interphalangeal joint motion remains unchanged 6
• All patients demonstrate zero finger-palm distance postoperatively 5
• Appearance of all fingers improves after surgical correction 6

Potential Complications and Considerations

• Complications are rare with both physiolysis and osteotomy techniques 2, 5
• Incidental radiographic findings after physiolysis may include premature fusion of the proximal radial epiphyseal plates (observed in 2 of 43 fingers) or sinuous-shaped proximal radial epiphyseal plates (12 of 43 fingers) 5
• Some patients may experience stiffness of the distal interphalangeal joint following opening wedge osteotomy 2
• The age group of 7 to 10 years shows large variability in corrective potential, making surgical timing critical 5

Clinical Algorithm

1. Measure angular deformity: If <25 degrees without functional limitation → observe
2. If ≥25 degrees with functional limitation:
   • Age 3-6 years with open growth plates → Physiolysis with fat interposition
   • Age >6 years or closed growth plates → Osteotomy (opening or closing wedge)
3. Refer to pediatric plastic surgeon for surgical planning and execution 4