Outcomes of opening wedge osteotomy to correct angular deformity in little finger clinodactyly

Abstract

Purpose: To evaluate the outcomes and complications in a series of children with clinodactyly treated with opening wedge osteotomy of the abnormal phalanx.

Methods: We performed a retrospective review of all children with clinodactyly treated at our institution with opening wedge osteotomy of the abnormal middle phalanx between 2003 and 2013. Patients with concomitant pathology or prior surgery in the affected finger were excluded. Preoperative and postoperative clinical angle, radiographic angle, digital range of motion, and pain were compared and complications were recorded.

Results: We included 13 digits in 9 patients. All had greater than 20° of preoperative clinical angulation (mean, 36°). Mean age at time of surgery was 11 years; mean duration of follow-up was 25 months (range, 12-43 mo). All digits had significant improvement (mean, 32°) in clinical and radiographic angles after surgery. This improvement was maintained at final follow-up in 12 digits. Six patients had pain preoperatively and no patient had pain postoperatively. One digit had a recurrent deformity at final follow-up and 3 digits developed stiffness at the distal interphalangeal joint.

Conclusions: Opening wedge osteotomy is an effective treatment for angulation in children with clinodactyly. We counsel families regarding the risk of distal interphalangeal joint stiffness.

Type of study/level of evidence: Therapeutic IV.

Keywords: Clinodactyly; opening wedge; osteotomy; surgery.

Figure 1

Clinodactyly. Top left; radial angulation of the small finger due to an abnormal middle phalanx. Top right; scissoring as a result of the angulation. Bottom left; a PA radiograph shows the abnormal trapezoidal shaped middle phalanx. Bottom right; a lateral view of the small finger shows no sagittal plane deformity.

Figure 2

Opening wedge osteotomy of the middle phalanx. A. The distal and proximal interphalangeal joint lines are palpated and marked, and a V-shaped incision is made with its apex over the lateral aspect of the digit, creating a medially based flap. B. The extensor mechanism is mobilized and protected after raising the full thickness skin and subcutaneous flap. C. An osteotomy is made at the concave aspect of the middle of the middle phalanx. D. The osteotomy is opened to the extent needed to obtain neutral alignment of the finger, and 2 K-wires are driven across. E. The skin is then closed.

Figure 3

K-wire placement during the opening wedge osteotomy. A 1.1 mm K-wire is driven through the distal phalanx across the distal interphalangeal joint, and a .9 mm K-wire is driven through the proximal interphalangeal joint. These stabilize the joints and allow for opening of the osteotomy (Left). After opening the osteotomy, the 1.1 mm K-wire is driven across the osteotomy, a second .9 mm K-wire wire is driven across the osteotomy for rotational stability, and the K-wire stabilizing the proximal interphalangeal joint is removed (Right).