Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Clinodactyly

Basics
Description

  • Clinodactyly presents as a painless bent finger with angulation in a radial or ulnar direction .
  • It is most commonly the little finger bent in a radial direction.
  • Most often, the finger has a short, delta-shaped middle phalanx.
  • This condition may be associated with mental retardation, especially when clinodactyly is severe.
  • Synonym: Bent finger
General Prevention
No evidence suggests that the deformity may be prevented or its natural history changed by intervention.
 
Epidemiology
  • Detected at birth
  • More common in males, in whom it is usually bilateral
Incidence
<19.5% in otherwise normal children; least common in Caucasians.
 
Risk Factors
  • In children with Down syndrome, the incidence of clinodactyly is 35-70% .
  • It also is seen in children with many other syndromes, especially Kline-Felter and trisomy 18.
Genetics
  • The condition is autosomal dominant, with variable expressivity.
  • Some cases are sporadic.
Etiology
Abnormal shape of the underlying phalanx develops as a result of asymmetrical longitudinal growth.
 
Associated Conditions
  • Symphalangism
  • Brachydactyly (short fingers)
  • Trisomies
  • Treacher Collins syndrome
  • Silver syndrome
  • Holt-Oram syndrome
  • Prader-Willi syndrome
Diagnosis
Signs and Symptoms
  • The finger (usually the little finger) is curved in a radial or ulnar direction.
  • Deviation can occur at the PIP joint, middle phalanx, or DIP joint
  • It is most common in the DIP joint.
  • This condition is painless.
Physical Exam
  • The angle of deviation of a finger at the PIP joint, the middle phalanx, or the DIP joint should be measured.
  • Active and passive motion at each joint should be recorded.
  • The remainder of the skeleton also should be inspected.
Tests
Lab
Chromosome analysis should be undertaken if an underlying syndrome is suspected.
 
Imaging
  • Conventional plain radiography of the affected finger is recommended, especially when considering surgical correction.
  • <10° of angulation is within normal limits .
Pathological Findings
Maldevelopment of 1 of the phalanges causes an angulation of the joint surface.
 
Differential Diagnosis
  • Delta phalanx (a wedge-shaped phalanx with a sloped joint surface)
  • Malunion after fractures
Treatment
General Measures
  • Most cases are cosmetic problems.
  • Slight deformity does not need surgical correction.
  • Because nonoperative treatment, including manipulation and casting, usually is futile, and patients find such modalities difficult to tolerate, treatment choices are no intervention or surgery.
  • Surgical correction can be considered for substantial deformity persisting after the age of 6 years.
  • Surgical procedures are elective because the problem is mainly cosmetic.
Activity
No restrictions on activity
 
Special Therapy
Physical Therapy
Therapy may be helpful for regaining motion after surgery.
 
Surgery
  • Surgical procedures include osteotomy and growth plate reconstruction with a free-fat graft.
  • For a child <6 years old, a fat-graft placement should be performed after resection of the midportion of the continuous epiphysis and underlying physis (growth plate).
  • After age 6, a simple closing osteotomy can be done easily and with few complications.
Follow-up
Prognosis
The prognosis is good, with no evidence of degenerative joint disease.
 
Patient Monitoring
Patients may monitor the angulation of the finger and return for surgical treatment if it becomes unacceptable.
 
Miscellaneous
Codes
ICD9-CM
759.59 Clinodactyly
 
Patient Teaching
Educating patients about the excellent prognosis and benign nature of the condition is helpful.
 
FAQ
Q: Is splinting helpful?
A: No. The deformity can be corrected only by surgical intervention.
 
Q: Is surgery recommended for all patients?
A: No. Most patients do not have a functional deficit. Surgery for cosmetic improvement alone should be avoided because of the risks of scarring and stiffness.
 
Q: How is clinodactyly different from camptodactyly?
A: Clinodactyly is angulation of the digit in a radioulnar plane distal to the MCP joint, versus camptodactyly, which is angulation in an AP plane.
 
Q: What is the preferred treatment for clinodactyly?
A: No treatment is required for mild to moderate clinodactyly. More severe clinodactyly requires realignment of the digit through osteotomy.

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