Changes In angulation and phalangeal length of fingers and thumbs following surgical treatment for congenital clinodactyly
Gordon, Alanna Alexandra
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INTRODUCTION: Congenital clinodactyly is a condition characterized by the deviation of a digit or digits in the coronal plane. Angulation is often due to the presence of a delta phalanx. There is a scarcity of long-term data regarding the results of surgical treatment for clinodactyly, particularly with respect to postoperative phalangeal growth and risk factors for recurrent deformity. METHODS: Our retrospective study involved the analysis of data from medical records of patients who had corrective surgery for congenital clinodactyly. We also measured radiographs to quantify the angle of deviation and the longitudinal lengths of the surgically corrected phalanx and corresponding metacarpal. Clinodactyly was defined as radiographic angulation of 10° or greater in the coronal plane. Recurrence was defined as a final angulation of 10° or greater as well as an increase of at least 10° compared with the immediate postoperative measurement. The primary ratio was defined as the ratio of the length of the primary ossification center of the surgically corrected phalanx to the length of the primary ossification center of the corresponding metacarpal. The secondary ratio was the ratio of the length of the primary and secondary ossification centers together of the corrected phalanx to those of the metacarpal. Comparisons were made between preoperative, postoperative, and most-recent follow-up values. Postoperative data was restricted to radiographs taken within three months after surgery. Final follow-up data was initially permitted if radiographs were taken at least one year after surgery. Additional analysis was performed of patients with a minimum of two years clinical and radiographic follow-up. RESULTS: There was a significant decrease in angulation with surgery and a significant increase in angulation postoperatively (p<0.001; p<0.01). Overall, the mean preoperative and final digital angulation was 40.4° and 17.4°, respectively, when a two-year minimum between the time of surgery and final follow-up measurements was implemented. This resulted in a significant average correction of 23.3° (p<0.001). The postoperative change in angulation was found to be significantly different depending on the surgical technique used. Digits corrected with reverse wedge osteotomies showed little to no change in angulation during the postoperative period. However, digits corrected with closing wedge osteotomies showed a significant increase in angulation between the immediate postoperative and final follow-up measurements (p=0.007). The rate of recurrence was 43.2% (95% CI: 28.7-58.9% with a one year minimum for follow-up; 95% CI: 27.5-60.4% with a two year minimum for follow-up). Postoperative changes in angulation or recurrence were not significantly associated with gender, patient age at the time of surgery, the type of digit corrected, coexisting congenital syndromes, or the presence of additional hand abnormalities. The primary ratio decreased significantly with surgery, from 0.35 preoperatively to 0.27 postoperatively (p=0.03). The primary ratio then increased significantly over time to 0.40 when there was a two-year minimum between the time of surgery and final follow-up. There was an insignificant change in primary ratio from immediately after surgery to final follow-up when data as early as one year postoperatively was included. The secondary ratio did not change significantly with surgery or during the postoperative period regardless of whether one or two-year time restrictions were in place. The mean secondary ratio was 0.29 before surgery, 0.25 immediately after surgery, and 0.33 at the time of final follow-up at least two years after surgery. CONCLUSIONS: Surgery to correct clinodactyly effectively decreases angulation of the digit, despite the risk of recurrent deformity over time. Our study did not identify any factors associated with recurrence. However, there was a significant difference in the change in angulation between the immediate postoperative and final follow-up measurements depending on the surgical technique used. Surgery to correct clinodactyly does not hinder postoperative growth of the corrected phalanx.