Congenital Clinodactyly of the Thumb.
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Date
2014-05-21
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Abstract
Aims: To present five patients with thumb clinodactyly and the results of surgical
treatment in two patients who were followed till skeletal maturity.
Case Presentation: Four patients (five thumbs) exhibited an ulnar interphalangeal
angulation and were all associated with a triphalangeal thumb, while in only one patient a
radial deviation associated with a longitudinal epiphyseal bracket of the proximal phalanx
was noted.
Three patients (four thumbs) received primary surgical treatment for thumb polydactyly. A
three-phalangeal thumb was retained in all. Two of these thumbs were also treated
surgically for clinodactyly. Removal of the accessory delta phalanx and reconstruction of
the soft tissues was performed in a 3-year-old girl. Follow-up at 18 years of age revealed
reduced size of the thumb, limitation of flexion and a secondary radial interphalangeal
deviation. A closing wedge osteotomy of the shaft of the proximal phalanx, leaving the
delta phalanx undisturbed, was performed in a 12-year-old girl. Follow-up at 18 years of
age revealed no loss of thumb alignment but not improved function.
Discussion: The aim of surgical reconstruction of thumb clinodactyly is to create a
painless thumb of adequate mobility, stability, alignment and size. Removal of an
angulated middle phalanx in a very young child should be associated with a ligament
reconstruction from the soft tissues. In an older child or adult, an osteotomy of the shaft of
the proximal phalanx or fusion of the oblique joint and realignment with bone resection
may be indicated. The real value of a surgical procedure may be evaluated only when the
satisfactory result remains unimpaired beyond skeletal maturity.
Conclusion: Surgical reconstruction of thumb clinodactyly may require specific
challenges and techniques to obtain a painless, properly aligned, stable thumb with
improved function that will retain the satisfactory result beyond skeletal maturity.
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Keywords
Thumb, congenital, clinodactyly, triphalangeal
Citation
Sferopoulos Nikolaos K. Congenital Clinodactyly of the Thumb. British Journal of Medicine and Medical Research. 2014 May; 4(15): 2874-2883.