Physiolysis for correction of clinodactyly in children

Congenital clinodactyly is a lateral deviation of a finger frequently caused by an abnormal middle phalanx (trapezoidal or triangular delta phalanx). The physis extends longitudinally on the short side of the middle phalanx. Resection of the abnormal longitudinal physis and fat graft interposition (physiolysis) has been reported to correct the lateral finger deviation in growing children. We reviewed 35 fingers that had a physiolysis procedure. The age at surgery varied from 2.9 to 10.9 years (mean, 6.6 y), the preoperative angulation was 20° to 29° in 9 fingers, 30° to 39° in 16 fingers, and 40° or more in 10 fingers. Thirty-one fingers presented a trapezoidal phalanx and 4 fingers a triangular phalanx. Ten fingers had a second surgery using the same procedure. Follow-up time ranged from 1.2 to 5.3 years (mean, 3.2 y). After 1 procedure the degree of correction varied from 0° to 30° (mean, 11.1°). The residual angulation was <15° in 8 fingers, 15° to 19° in 4 fingers, 20° to 29° in 15 fingers, 30° to 39°in 6 fingers, and ≥40° in 2 fingers. Correction obtained in the trapezoidal phalanges was better (mean 12.5°) than in the triangular phalanges (mean, 2.8°). The fingers presenting a more severe preoperative deformity (angulation ≥40°) had a better correction (mean, 20°) compared with fingers with a lesser deformity (mean, 7.5°). The correction was also better in children who had surgery before 6 years of age (mean, 17.9°) compared with older children (mean, 6.5°). A second physiolysis procedure was not beneficial in 8 of 10 fingers reoperated and 2 premature fusions of the proximal transverse physis were found among these 10 fingers. There were no other complications. The physiolysis procedure is simple and effective, particularly in children presenting with a trapezoidal phalanx who have surgery before 6 years of age. (J Hand Surg 2002;27A:659–665. Copyright © 2002 by the American Society for Surgery of the Hand.)