Congenital Clinodactyly of the Thumb.

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.