One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly

Abstract

Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx's original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.

Keywords: camptodactyly; children; finger; osteotomy.

Figure 1

Clinical images of (a) a patient with idiopathic camptodactyly of a lesser digit and (b) a patient with syndromic camptodactyly involving multiple fingers.

Figure 2

The flow diagram of the inclusion/exclusion process.

Figure 3

Diagrams of a one-stage extension shortening osteotomy. A preoperative flexion contracture of the proximal phalanx was observed. After a longitudinal incision on the dorsal aspect of the index digits, the extensor digitorum tendon was exposed and split. The periosteum was incised and retracted using Hohmann retractors, both medially and laterally. Two transverse osteotomies between the shaft and the head of the proximal phalanx were performed. The antegrade insertion of a K-wire into the distal fragment was done through the PIP joint. The K-wire was advanced proximally across the osteotomy site to fix while maintaining the reduction.

Figure 4

The active arc of motion of the PIP joint, shown (a) preoperatively and (b) postoperatively.

Figure 5

The clinical image and radiographs of an arthrogryposis patient with syndromic camptodactyly show the flexion contractures from second to fifth finger with the left hand’s thumb-in palm deformity. Despite the restricted wrist motion with the lack of wrist crease, the patient did not present the flexion contracture of the wrist but complained of discomfort when grasping objects such as cups. After the correction of camptodactyly via one-stage extension shortening osteotomies, the hand function improved with the proper bony union.