Changes In angulation and phalangeal length of fingers and thumbs following surgical treatment for congenital clinodactyly

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