Operative techniques

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.