Comparison of Vickers' Physiolysis With Osteotomy for Primary Correction of Clinodactyly

Abstract

Background: The purpose of this study was to compare the Vickers physiolysis procedure with osteotomy for correction of digital clinodactyly and determine which method provides better correction at final follow-up or whether the patient's age, preoperative angulation, or presence of syndactyly affects final outcomes. Methods: All patients of skeletal immaturity who underwent surgical correction of clinodactyly were evaluated with clinical examination and radiographs to determine the percentage and absolute change in the degree of clinodactyly pre- versus postoperatively, in addition to stratification based on the degree of deformity, age, and presence of syndactyly. Results: Vickers' physiolysis and osteotomy were undertaken in 30 and 11 digits, respectively. The angulation significantly improved from 43.0° to 23.9°, with a 46.2% correction of deformity in the Vickers group at 46.3 months. The angulation decreased from 39.2° to 22.4° in the osteotomy group, with a 55.3% correction of deformity at 55.3 months. There was better correction in those with isolated clinodactyly compared with those with concomitant syndactyly and better percentage of correction in patients with lesser deformity in the Vickers group. There were more reoperations in the osteotomy group. Conclusions: The use of osteotomy may lead to more revision cases, whereas the Vickers procedure has minimal complications and need for revision. The Vickers physiolysis procedure is more effective in those with angulation <55°.

Keywords: anatomy; congential; diagnosis; digits; hand; pediatric; specialty; surgery.

Figure 1.

Different phenotypic appearances of clinodactyly: (a) isolated small finger, (b) ring finger with metacarpal synostosis, (c) index finger with type A postaxial polydactyly, and (d) small finger with complete syndactyly of long, ring, and small digits.

Figure 2.

Sample radiographs demonstrating measurement of clinodactyly angulation divergence: (a) preoperative appearance and (b) postoperative appearance after Vickers’ physiolysis.

Figure 3.

Radiographic (top row) and clinical results (bottom row) after the Vickers physiolysis treatment for clinodactyly of the left index finger: (a) preoperative, (b) 11 months postoperative, and (c) 30 months postoperative.

Figure 4.

Radiographic (top row) and clinical results (bottom row) after Vickers’ physiolysis and syndactyly release for a patient with concomitant clinodactyly of the little finger and syndactyly of the long, ring, and little finger: (a) pre–syndactyly release, (b) appearance post–syndactyly release and pre–clinodactyly correction, and (c) 34 months after Vickers’ physiolysis for correction of the little finger clinodactyly.