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.

Camptodactyly: From Embryological Basis to Surgical Treatment

“…The Korean authors considered the extension osteotomy a straightforward and effective technique for improving finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The authors highlighted the suitability of this simple procedure for surgery on multiple fingers in patients with syndromic camptodactyly [ 13 ].…”

“…Due to the contracture of PIPJ, secondary changes develop, such as adhesions of the dorsal apparatus and lateral bands, a deficient dorsal central slip extensor mechanism, volar plate contracture, and tightness of the collateral ligaments [ 1 , 9 , 10 , 11 ]. The long-term deformity can lead to bone changes in the proximal and middle phalanges and the joint surfaces of PIPJ [ 12 , 13 ].…”

Recent Advancements in the Diagnosis and Treatment of Congenital Hand Differences

“…Camptodactyly is a progressive flexion contracture of the PIP joint. 33,34 Camptodactyly is first treated nonsurgically until these measures fail and/or when the flexion contracture progresses to cause functional defi-ciencies. 34 Aggressive surgical management is then indicated but usually has not had ideal outcomes.…”

“…They found notable improvement in median flexion contracture and range of motion in digits that underwent early flexor digitorum superficialis release, followed by gentle passive manipulation. 34 Park et al 33 offered a new surgical approach for patients with syndromic camptodactyly with the use of a one-stage ostoperative: 85°N o significant differences were found between the preoperative and postoperative lengths of the distal phalanx DIPJ = distal interphalangeal joint, PIPJ = proximal interphalangeal joint extension shortening osteotomy of the proximal phalanx. Their approach lengthens volar structures, while also correcting the bony deformity.…”

“…Their approach lengthens volar structures, while also correcting the bony deformity. 33 Deveci and Arik presented a novel, minimally invasive external fixator to correct flexion contracture in camptodactyly and remodel the soft-tissue and neurovascular structures (Table 4). 35…”