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Camptodactyly

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Topic updated on 06/06/14 9:34pm
Introduction
  • Congenital digital flexion deformity that usually occurs in the PIP joint of the small finger
  • Epidemiology
    • prevalence
      • less than 1%
    • location
      • can be unilateral or bilateral
        • if bilateral, can be symmetric or assymetric
  • Pathophysiology
    • typically caused by either
      • abnormal lumbrical insertion/origin   
      • abnormal (adherent, hypoplastic) FDS insertion 
      • other less common causes include
        • abnormal central slip
        • abnormal extensor hood
        • abnormal volar plate
        • skin, subcutaneous tissue, or dermis contracture
  • Genetics
    • most often sporadic
    • can be familial with possible autosomal dominant inheritance with variable penetrance
  • Associated conditons
    • can be associated with more widespread developmental dysmorphology syndromes
Classification
 
Camptodactyly Classification
Type I  • Presents in infancy and affects males and females equally
 • Most common form
Type II  • Presents in adolescence
 • Affects girls more often than boys

Type III  • Multiple digits involved
 • More severe form
 • Usually associated with a syndrome

Kirner's Deformity  • Specific deformity of small finger distal phalanx with volar-radial curvature (apex dorsal-ulnar)
 •  Often affects preadolescent girls
 •  Often bilateral
 •  Usually no functional deficits

 
Presentation
  • Symptoms
    • often goes unnoticed as usually only affects small finger and is very rarely associated with any significant compromise in function
    • typically painless and without motor/sensory deficits
  • Physical exam
    • flexion deformity of small finger PIP joint
      • flexible (correctable) or fixed (non-correctable) deformity
      • progressively worsens over time if untreated
      • may rapidly worsen during growth spurts
    • normal strength, sensation, perfusion
    • usually normal DIP and MCP joint alignment, however compensatory contractures can develop
    • no swelling, erythema, or warmth; not associated with inflammation
Imaging
  • Radiographs
    • often normal, especially in early stages
    • later stages: possible decrease in P1 head convexity; possible volar subluxation and flattening of base of P2
Treatment
  • Nonoperative
    • passive stretching, splinting
      • indications
        • nonoperative treatment is favored in most cases
        • best for PIP contracture < 30 degrees
      • technique
        • passive stretching + static splinting
      • outcomes
        • variable outcomes
        • best outcomes with early intervention
  • Operative
    • FDS tenotomy +/- FDS transfer
      • indications
        • reserved for cases of progressive deformity leading to functional impairment
      • technique
        • must address all abnormal anatomy
        • passive (correctable) deformities
          • FDS tenotomy, or
          • FDS transfer to radial lateral band if full active PIP extension can be achieved with MCP flexion
    • osteotomy vs. arthrodesis
      • indications
        • severe fixed deformities
      • outcomes
        • variable outcomes

 

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