Surgical Treatment for Kirner’s Deformity—Single Osteotomy through a Palmar Approach

Abstract

Background:Patients with Kirner’s deformity often seek medical attention for aesthetic improvement when they reach the age of approximately 10 years, when the deformity becomes evident. The operative technique described in textbooks is the palmar opening-wedge with multiple osteotomies through a mid-lateral incision, which is technically demanding. The purpose of this article was to introduce our surgical technique of a single transverse osteotomy through a palmar approach and to present the short-term outcomes of this technique.Methods:The surgical outcomes of 7 digits in 4 children were retrospectively reviewed. The deformed distal phalanx was approached with an oblique incision of the pulp, and the palmar cortex was incised at the apex of the curvature. The dorsal cortex was only partially incised and broken manually when correcting the deformity by a palmar opening-wedge. The dorsal aspect of the phalanx was not exposed, and the nail plate was left intact. The fragments were fixed with Kirschner wires.Results:There was no postoperative complication, and the osteotomy sites all healed uneventfully. None of the patients complained about scar pain or hypersensitivity of the finger pulp. The patients and their parents were satisfied with the aesthetic results.Conclusions:A single palmar opening-wedge osteotomy at the apex sufficiently corrected the main curvature, and the subtle curvature remaining at the tip of the phalanx did not affect the appearance. This technique is simple and easy; therefore, it is recommended as a reliable procedure for patients with Kirner’s deformity who are approaching puberty.

Recent Advancements in the Diagnosis and Treatment of Congenital Hand Differences

“…36 Patients present around 10 years of age, as the deformity progressively becomes more apparent and treatment is sought to improve appearance. 36 Nonsurgical measures are ineffective. The classic surgical treatment includes multiple osteotomies by mid-lateral finger incision, which can be technically challenging.…”

“…The classic surgical treatment includes multiple osteotomies by mid-lateral finger incision, which can be technically challenging. 36 Horii et al 36 introduced a novel technique of a single transverse osteotomy by using an oblique volar approach with good short-term outcomes (Table 4).…”

“…Kirner deformity is a radial and volar curvature of the distal phalanx of the small finger. 36 Patients present around 10 years of age, as the deformity progressively becomes more apparent and treatment is sought to improve appearance. 36 Nonsurgical measures are ineffective.…”