Correction of Clinodactyly by Early Physiolysis: 6-Year Results.

PURPOSE: To review results at least 6 years after physiolysis for treatment of the delta phalanx associated with clinodactyly. METHODS: We present 22 cases of clinodactyly treated with physiolysis in which we removed the central part of the epiphysis, which is the portion restricting longitudinal growth unilaterally and inducing progressive finger deviation, and placed a fat graft in the resultant defect. RESULTS: This retrospective study reports the results of early physiolysis in 27 fingers with radial clinodactyly, including 17 fingers from 17 patients previously reported and 10 little fingers from 5 additional patients. All patients had a minimum follow-up of 6 years. Mean preoperative angle was 38° (range, 25° to 47°). At final follow-up, mean angle was 8° (range, 0° to 24°), a mean correction of 79%. Twelve fingers in 9 patients had more than 10° of deformity at final follow-up, whereas 15 fingers in 13 patients had a residual deformity of less than 10°, which is effectively full correction of a clinodactyly. No patient required a closing wedge osteotomy later for insufficient correction. CONCLUSIONS: These accumulative findings confirm our previous preliminary report. Early physiolysis is a quick and simple procedure that allows for growth and partial but often adequate correction of the clinodactyly. The correction occurs slowly over a period of years, which can be seen as a disadvantage, and requires careful counseling of the parents. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Camptodactyly as a spectrum of congenital deficiencies: a treatment algorithm based on clinical examination.

BACKGROUND: Camptodactyly is a frequent congenital hand disorder, but its cause and treatment remain a matter of controversy. Although it is difficult to establish the primary cause of camptodactyly, careful clinical examination allows the assessment of all the structures involved (e.g., skin, subcutaneous fascia, flexor tendons, extensor tendon, intrinsic muscles, and joints). The purpose of the study was to assess the validity of an algorithm based on the clinical examination in planning the operation. METHODS: An algorithm based on clinical examination and the authors' 27-year experience was designed to determine and customize the surgery for each case according to the function of the anatomical structures involved. The authors compared the results of surgical treatment in two groups of patients with camptodactyly of the fifth finger operated on before (group 1, 33 patients) or after use of the algorithm (group 2, 35 patients). All patients had more than 1 year of follow-up (range, 21 to 47 months). RESULTS: There were significantly fewer failures in group 2 (14 percent versus 45.5 percent, p < 0.01). The improvement, after an extensive liberation in stiff early cases (type Ia), gave better results than previous attempts but did not reach significance (84 percent versus 66 percent). Similarly, for types Ib (early and correctable) and IIb (late and correctable) camptodactyly, the surgical results were improved, with 91 percent and 90 percent improvement, respectively, in group 2 versus 50 percent and 44 percent in group 1 (not significant). CONCLUSION: A selective surgical indication, based on careful clinical examination, improves the results of camptodactyly treatment by correcting the involved anatomical components.

Radial shift of the ulnar fingers: a new technique for special cases of longitudinal central deficiency.

Treatment of central longitudinal deficiencies is well defined, with different techniques established for the classical clefts. However, none of these techniques is easily applied to the treatment of very deep clefts accompanied by a significant divergence of the metacarpal bones. In such cases, the results of current techniques are disappointing. We propose a new technique of "Translocation in the Radial direction of the Ulnar Finger(s)" (TRUF) by intra-carpal osteotomy. The results are illustrated in three clinical cases. The TRUF operation allowed closing of the cleft, alignment of the metacarpal bones and preservation of carpometacarpal mobility. When necessary, a metacarpal synostosis may be treated at the same procedure.

Principalization of pollicization of the index finger in congenital absence of the thumb.

After reviewing our experience with pollicization in congenital cases of thumb hypoplasia or aplasia, we found that classic techniques have several weak points concerning function and appearance. Abduction is frequently inadequate, and adduction is quite weak. Esthetically the thumb has a slender aspect, the web fold is absent, and the commissure looks more like a cleft. We tried to prioritize the issues to propose some technical modifications for improvement of function and appearance.

Vascularizaçäo da articulaçäo interfalangiana proximal / Proximal interphalangeal join vascularization

Os autores apresentam os resultados da dissecçao cadavérica de 100 dígitos. Analisam a vascularizaçao da articulaçao interfalangiana proximal (IFP), através de estudo microscópico, em que foram utilizados látex colorido e poliéster CPLS 1108 adicionado ao carbonato de chumbo; este foi injetado equitativamente 50 veces na artéria colateral radial e ulnal de cada dígito, após a ligadura da artéria colateral oposta ao nível da articulaçao interfalangiana distal (IFD). Na maior parte dos casos, três ramos vascularizam a IFP, com dois sistemas: um proximal e um distal em relaçao à IFP. Os resultados foram: grupo I (2º e 5º quirodáctilos) - a ligadura dos ramos distais ou proximais à artéria acarretou a ausência de coloraçao, respectivamente, dos elementos distais ou proximais à IFP; grupo II (3º e 4º quirodáctilos) - a ligadura dos ramos distais ou proximais à artéria ocasionou coloraçao quantitativamente superior à do grupo I. Este estudo da vascularizaçao da IFP demonstrou diferenças importantes segundo o dígito em estudo e a precariedade do sistema radial do 2º quirodáctilo e ulnal do 5º, proporcionando nova forma de pensar na escolha da via de abordagem cirúrgica dessa articulaçao.

Estudo prospectivo randomizado da força Pós-operatória após diferentes técnicas de liberaçäo do túnel do carpo / Postoperative strenght after surgical release of the carpal tunnel: randomized prospective study

A síndrome do túnel do carpo é patologia freqüente e, na maioria das vezes, necessita tratamento cirúrgico. Estudo prospectivo randomizado de 300 intervençoes utilizou quatro técnicas diferentes: secçao clássica, plastia simples, zetaplastia e secçao endoscópica. Foram analisados aspectos quanto ao sexo, idade, profissao, dor e a força pré e pós-operatória. A zetaplastia apresentou melhores resultados, comparativamente, que a secçao clássica e plastia simples. A secçao endoscópica mostrou-se, aparentemente, superior quanto à força pós-operatória no primeiro mês, igualando-se à plastia em Z a partir do terceiro mês.