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Purpose: Surgical treatment of camptodactyly and indications for surgery are controversial. However, a logical stepwise release of restraining soft tissues in the digits of children with severe camptodactyly predictably leads to correction. Provided surgery is done before reaching skeletal maturity, the affected joints remodel following surgical correction, and normal articulation is restored – even in those who have developed radiographic PIP joint articular changes.

Methods: We retrospectively reviewed 16 fingers in 8 children who underwent surgery for dysfunctional camptodactyly. The mean preoperative flexion contracture was 60° (range, 35-105°). Of these, 12 fingers could be assessed for radiographic articular changes as they belonged to children old enough to have fully ossified joint surfaces. (The other digits were in children who were too young.) Clinical and radiographic outcomes were measured prior to and following surgery.

Results: Our surgical procedure involved a stepwise release of volar skin and fascia with transposition flap and skin graft for the skin deficit, flexor digitorum superficialis (FDS) tenotomy, and volar plate release. No patient lost flexion, and 12 of 14 reached full active PIP extension; and the two remaining digits extended to 10 and 30°, respectively. Two digits had extensive articular damage requiring PIP arthrodesis. All of their affected articular surfaces had either reverted to normal or were markedly improved at an average follow-up of 17.2 months (range, 3-32 months).

Articular changes occur in severe camptodactyly with flattening of the head of the proximal phalanx and a dorsally riding proximal phalanx on the base of the middle phalanx. These are remodeling articular changes in response to the soft tissue imbalance. The joint remodels back to normal once soft tissue constraints have been corrected.

Conclusions: Even in patients with severe radiographic changes, surgery can effectively restore function in digits affected by camptodactyly. Indeed, we believe that once radiographic articular changes become apparent, surgical correction is an appropriate and effective treatment to prevent articular damage. Provided correction is performed before skeletal maturity is reached, these radiographic changes will reverse.