Operative techniques for clinodactyly are varied and depend on the aetiology, amount of deformity and soft tissue involvement. They include:
- ablation or epiphyseolysis of the delta phalanx:
- when present in complicated syndactyly
- if carried out at an early stage (before the age of 6 years), destruction of the constraining convex side may allow the contralateral side to grow in an unrestrained manner; occasionally, this can result in the digit normalizing in position along the longitudinal axis with subsequent growth
- care must be taken not to damage the horizontal portion of the growth plate to allow for subsequent growth
- a modified procedure has been described with epiphyseolysis and then covering the ends of the split physis with a fat graft(1)
- closing wedge osteotomy:
- used for simple clinodactyly
- used when the phalanx length is normal
- a wedge of bone is removed from the convex side of the middle phalanx via a midlateral approach using a rongeur or oscillating saw
- a longitudinal K wire through the distal phalanx is used to hold the osteotomy site in a stable position and may be reinforced by an oblique K wire
- opening wedge osteotomy and bone graft:
- indicated for a deviated and relatively short digit where a closing wedge osteotomy would excessively shorten
- a cut is made on the concave side of the bone and a bone graft is inserted to lengthen and straighten the digit; again, a K wire is used to secure the position temporarily
- there is often a skin shortage in such digits on the concave side and as such, a Z-plasty lengthening procedure may be necessary to stop the constraining effects of the soft tissue on this side
- more difficult to accurately execute than a closing wedge osteotomy
- reversed wedge osteotomy:
- wedge of bone from longer convex cortex rotated about the desired long axis of the digit and inserted onto the contralateral side
- prone to early fusion of the graft with growth arrest
Ref: (1) Light TR, Ogden JA (1981). J Pediatr Orthop, 1: 299-305.