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A Stepwise Surgical Approach Resolves Camptodactyly
Kristy L. Hamilton, BA; David T. Netscher, MD
Department of Orthopedic Surgery and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX

Introduction: Camptodacyly is common, but its treatment remains controversial. Multiple deforming forces have been implicated in the pathogenesis: skin and fascia, flexor tendons, lumbricals and interossei, retinacular ligaments, extensor deficiency, and articular deformity. A logical clinical assessment helps create a stepwise surgical plan.

Technique: Preoperative assessment determines:

  1. Degree of flexion deformity with MP joint both flexed and extended. This will demonstrate soft tissue pterygium as well as relative extrinsic flexor versus volar plate tightness.
  2. PIP extensor lag by Bouvier blocking to assess extensor mechanism attenuation.
  3. DIP extension with PIP flexed (Boutonniere deformity).

Corresponding stepwise treatment steps potentially involve (Figure 1):

  1. Volar skin and fascia release with flap and skin graft
  2. FDS tenotomy
  3. Sliding volar plate release
  4. Correction of extension lag:
    • If mild, postoperative extension block splinting
    • If severe, intrinsic transfer using the released FDS
  5. Fowler extensor tenotomy

Methods: 22 consecutive fingers in 12 children (5 female, 8 male) had surgery at a mean age of 8 years (range, 9 months 15 years) between February 2009 and February 2013. Involved fingers were the little (14), ring (3), middle (3), and index (2) with PIP in 20 digits and DIP in 2. Mean preoperative flexion was 62° (range, 35-105°). Preoperative and postoperative range of motion was measured. Of those operated, all had soft tissue release and flap, all had FDS tenotomy, 16 had volar plate release, 2 had intrinsic transfers, and 2 had Fowler release.

Results: Mean postoperative flexion resolved to 4° (range, 0-25°) at mean follow-up of 13 months (range, 3-32 months). Mean PIP joint range of motion was 88° (range, 50-100°). 19 of 22 could achieve full active PIP extension (Figure 2). The other three had residual contractures of 15, 20, and 25°, respectively. Two digits had such extensive preoperative articular damage that the only surgical option was arthrodesis.

Conclusions: This stepwise surgical approach effectively treats severe camptodactyly and appears to confirm our suspected pathogenesis of the disorder. Lumbricals and interossei did not seem to be involved. Presentation will include video of the clinical assessment, surgical technique and postoperative management. Figure 1

Figure 2

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