Mateusz Gładysz FESSH prep

FESSH prep Congenital hand Joint and digit affected in camptodactyly, plane and cause of clinodactyly, the delta phalanx epiphysis, reversibility of radiographic changes in camptodactyly, quality of the treatment evidence

Camptodactyly and clinodactyly

Last reviewed v1.0

FESSH-079Congenital hand●○○ basic

Regarding camptodactyly and clinodactyly:

  1. 1.In skeletally immature patients with camptodactyly, bony changes at the proximal phalangeal head persist after the contracture has been corrected.

  2. 2.Camptodactyly is a flexion contracture of the proximal interphalangeal joint, and the little finger is the digit most often affected.

  3. 3.Clinodactyly is a congenital angulation of a finger in the radioulnar plane, and an abnormal middle phalanx is a recognised cause.

  4. 4.In a delta phalanx, an abnormal epiphysis restricts longitudinal growth on one side of the phalanx, so the angulation tends to progress with growth.

  5. 5.Comparative studies show that surgical release of camptodactyly gives better results than splinting and stretching.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-079
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In skeletally immature patients with camptodactyly, bony changes at the proximal phalangeal head persist after the contracture has been corrected.

    False

    Hong and colleagues showed that a stretching programme improved the contracture and helped to restore the roundness and concentricity of the proximal phalangeal head in infantile camptodactyly (48 fingers). In Netscher and colleagues' series of skeletally immature patients with advanced radiographic changes, soft-tissue release led to substantial improvement or full restoration of articular congruency in 15 of the 16 joints that were not fused.

    • Hong SW, Kim J, Kwon OS, Lee MH, Gong HS, Baek GH. Radiographic Remodeling of the Proximal Phalangeal Head Using a Stretching Exercise in Patients With Camptodactyly. J Hand Surg Am. 2020;45(5):e1-e10. PMID 31005462
    • Netscher DT, Hamilton KL, Paz L. Soft-Tissue Surgery for Camptodactyly Corrects Skeletal Changes. Plast Reconstr Surg. 2015;136(5):1028-1035. PMID 26505704

  2. 2. Camptodactyly is a flexion contracture of the proximal interphalangeal joint, and the little finger is the digit most often affected.

    True

    In Evans and colleagues' surgical series of 31 digits in 22 patients, every case involved the proximal interphalangeal joint and 55% involved the small finger. The deformity lies in the flexion–extension plane, unlike clinodactyly.

    • Evans BT, Waters PM, Bae DS. Early Results of Surgical Management of Camptodactyly. J Pediatr Orthop. 2017;37(5):e317-e320. PMID 28277466

  3. 3. Clinodactyly is a congenital angulation of a finger in the radioulnar plane, and an abnormal middle phalanx is a recognised cause.

    True

    El Sayed and colleagues describe congenital clinodactyly with a delta phalanx as a finger deviation caused by a middle phalanx abnormality, and Medina and colleagues' series consisted of fingers with radial clinodactyly. The deviation is sideways, in contrast to the flexion deformity of camptodactyly.

    • El Sayed L, Salon A, Glorion C, Guero S. Physiolysis for correction of clinodactyly with delta phalanx: Early improvement. Hand Surg Rehabil. 2019;38(2):125-128. PMID 30782503
    • Medina JA, Lorea P, Elliot D, Foucher G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. J Hand Surg Am. 2016;41(6):e123-7. PMID 26972556

  4. 4. In a delta phalanx, an abnormal epiphysis restricts longitudinal growth on one side of the phalanx, so the angulation tends to progress with growth.

    True

    Medina and colleagues describe the central part of the abnormal epiphysis as the portion that restricts longitudinal growth on one side and induces progressive deviation. Physiolysis removes it and fills the defect with fat; in their series the mean angle fell from 38° before surgery to 8° after at least 6 years of growth.

    • Medina JA, Lorea P, Elliot D, Foucher G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. J Hand Surg Am. 2016;41(6):e123-7. PMID 26972556

  5. 5. Comparative studies show that surgical release of camptodactyly gives better results than splinting and stretching.

    False

    A systematic review of 16 studies (7 case series and 9 retrospective cohorts) rated all of them as weak, low-quality evidence. Operative and non-operative treatment both reduced the contracture in most patients, surgery led to more complications, and there was general agreement that surgery should be reserved for contractures over 30° or failure of conservative treatment.

    • Wang AMQ, Kim M, Ho ES, Davidge KM. Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review. Hand (N Y). 2020;15(6):761-770. PMID 30897950