Updated: 10/12/2016

Symphalangism

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Introduction
  • Congenital digital stiffness that comes in two forms 
    • hereditary symphalangism 
    • nonherediatry symphalangism
  • Epidemiology
    • location
      • more common in ulnar digits
  • Pathophysiology
    • failure of IP joint to differentiate during development
  • Genetics
    • inheritance pattern (hereditary type)
      • autosomal dominant
  • Associated conditions
    • syndactyly (nonhereditary type) 
    • Apert's syndrome (nonhereditary type) 
    • Poland's syndrome (nonhereditary type) 
    • correctable hearing loss (hereditary type)
Presentation
  • Physical exam
    • inspection
      • absence of flexion and extension creases
    • motion
      • stiff digits
Imaging
  • Radiographs
    • IP joint space may appear narrow 
Treatment
  • Nonoperative
    • observation
      • no indication for surgery in children
  • Operative
    • capsulectomy
      • outcome
        • limited success
    • IP joint arthroplasty
      • outcome
        • limited success
    • angular osteotomy 
      • indications
        • rarely needed due to adequate digital function
    • arthrodesis
      • indications
        • may be considered during adolesence to improve function and cosmesis
        • rarely needed due to adequate digital function
 

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