Opening Wedge Osteotomy for Valgus Deformity of the Little Finger after Proximal Phalangeal Fracture in Children: Two Case Reports

Abstract

In the treatment of posttraumatic valgus deformity of the pediatric little finger, it is usually difficult to achieve accurate correction of angular and rotational deformity using closing wedge osteotomy. We report two cases of valgus deformity of the little finger (both 11-year-old female patients) successfully treated using opening wedge osteotomy followed by intramedullary semirigid fixation with a single Kirschner wire. A wire tip inserted from the retrocondylar fossa of the proximal phalangeal head was advanced along the radial side of the intramedullary cortex after gradual opening of the osteotomy site. If needed, further fine adjustment of the rotational alignment can be performed even after K-wire insertion. Postoperatively, the gap between the little and ring fingers in the fully extended and adducted position and the finger overlapping in the fully flexed position were completely resolved. The flexibility of the pediatric bone and sagittal clearance between the wire and the inner wall of the proximal phalangeal medullary cavity allow fine adjustment of the rotational alignment even after wire insertion.

Figure 1

Surgical procedure. (a) Insert a K-wire until just distal to the preplanned osteotomy line (a dotted line). (b) Advance the tip of the K-wire along the radial side of the intramedullary cortex after gradual opening of the osteotomy site.

Figure 2

Preoperative photographs of the affected hand in Case 1. (a) Making a fist was difficult due to finger overlapping. (b) Passive finger flexion under general anesthesia revealed marked rotation of the little finger.

Figure 3

Preoperative imaging in Case 1. (a) Plain radiographic anteroposterior view of the right little finger. The distal articular surface of the proximal phalanx of the little finger was tilted in the ulnar direction. (b) Plain radiographic lateral view of the right little finger. (c) Three-dimensional computed tomography of the proximal phalanx of the right little finger.

Figure 4

Photographs of Case 1 taken 1 year postoperatively. (a) Dorsal view. (b) Palmar view of the clenched fist. The alignment of the little finger was good. Because of the retained extension contracture of the metacarpophalangeal joint, the tip of the little finger could not touch the palm. (c) Lateral view.

Figure 5

Postoperative radiographs of Case 1. (a, b) Images taken immediately after the surgery. (c, d) Images taken 1 year postoperatively.

Figure 6

Preoperative photographs of Case 2. (a) There was a gap between the left ring and little fingers in the fully extended and adducted position. (b) The left little finger was partially covered by the ring finger in the fully flexed position.

Figure 7

Radiographs of Case 2. (a, b) Preoperative radiography of the left little finger. (c, d) Images taken immediately after the surgery. (e, f) Images taken 3 months postoperatively.

Figure 8

Photographs of Case 2 taken 1 year and 2 months postoperatively. The valgus deformity and overlapping of the left little finger had completely resolved.