This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Operative techniques

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.