Clinodactyly is a congenital anomaly accompanied by a curvature of the fingers or a change in their position relative to the axis of the limb. The lesion is symmetrical, it is more often detected on the hands, the little fingers or the little fingers and ring fingers suffer. The diagnosis is made on the basis of a survey, examination data, and radiography results. In most cases, pathology does not affect the functionality of the brush and does not need correction. With a pronounced curvature, osteotomy is indicated.
Q74.0 Other congenital anomalies of the upper limb(s), including the shoulder girdle
Clinodactyly is an extremely common abnormality of finger development. It is found in every 6-7 people in the population, blurred forms prevail. As a rule, the defect is observed in isolation or combined with other small developmental anomalies. It can be detected in some aneuploid syndromes and gene mutations. It exists from birth, progresses until the end of puberty. Men suffer more often than women.
There are three variants of finger curvature. The first is an independent disease with autosomal dominant transmission. The second is the formation as a result of spontaneous mutation. The third is the manifestation of chromosomal and gene diseases in the composition. It is often detected with such aneuploidies as Down syndrome, Turner syndrome and Klinefelter syndrome. May be present in Edwards syndrome. It is determined in patients with the following genetic disorders:
- Russell-Silver syndrome;
- Roberts syndrome;
- Feingold syndrome;
- Cornelia de Lange syndrome;
- Fanconi anemia.
The inclusion of clinodactyly in the number of signs of severe congenital diseases allows for early diagnosis of such pathologies. If an anomaly is detected on the ultrasound of the fetus, the pregnant woman is sent for consultation to a geneticist, if there are indications, a karyotype study is performed. Sometimes clinodactyly is combined with other nonsyndromic malformations of the fingers, for example, brachydactyly or polydactyly. A rare variant of pathology – curvature of the first toes is observed in fibrodysplasia.
The cause of the curvature of the fingers is a violation of the growth of the middle phalanx mainly in its distal part. Due to uneven growth, the phalanx acquires a C-shaped shape, the bone looks like a triangle or trapezoid. At an early age, the deformity is hardly noticeable, the peak of the progression of clinodactyly occurs during puberty. After the growth is completed, the curvature does not worsen.
There are 3 degrees of clinodactyly:
- 1 – the angle of curvature does not exceed 10-15 degrees, the proportions of the finger are not changed;
- 2 – the distal phalanx is deflected by 15-20 degrees, the finger is shortened;
- 3 – the angle of inclination is more than 20 degrees, pronounced deformation of the finger is detected.
The only sign of an isolated pathology is the curvature of the end sections of the fifth or fourth and fifth fingers. Most patients do not complain, the functions of the brushes are completely preserved. With clinodactyly of the 3rd degree, there may be movement restrictions in the distal interphalangeal joint, an indistinct violation of the grip, more noticeable when two fingers of each hand are affected. There are no complications.
The diagnosis of clinodactyly is made by an orthopedic doctor. If signs of congenital syndromic pathologies are detected, patients are referred for consultations to specialists of the appropriate profile. In the process of diagnosis, the following procedures are carried out:
- Survey. The doctor studies personal and family history data reflecting the presence of a similar malformation in relatives and the progression of clinodactyly during puberty.
- External inspection. The specialist evaluates the degree of curvature of the fingers and the safety of the functions of the hand.
- Finger x-ray. The images show the curvature of the axis of the affected fingers, wedge-shaped deformation of the middle phalanges.
- CT or MRI of the hand. Rarely required. They can be prescribed for examination of young children with severe clinodactyly, combined malformations.
Pathology treatment is only surgical. It is performed in combination with other anomalies of the fingers and hand, complaints of a patient with grade 3 clinodactyly on the limitation of the function of the hand. Most often, the reason for the operation is the patient’s dissatisfaction with the appearance of the brush. Depending on the age and severity of the deformity, the following osteotomy options are performed:
Closed wedge-shaped. The curved phalanx is separated by an osteotome through a small incision. The position of the fragments is changed, the fragments are fixed with spokes. The technique is more often used in children. The advantage of this method is minimally invasive, the disadvantages are a possible reduction in the length of the finger and the need for repeated correction as the patient grows.
Open wedge-shaped. A Z-shaped incision is made in the zone of the middle phalanx. After osteotomy, a bone autograft is installed between the fragments from the shortened side of the phalanx. The resulting flaps are moved, the wound is sutured. The advantage of the method is the preservation of the length of the finger, the disadvantages are higher traumatism, the need to take a graft from the iliac crest or fibula.
Converted. Perform the same incision as in the previous case. On the long side of the phalanx, a bone wedge is excised, and then it is placed between the fragments on the short side. The wound is closed with displaced flaps. The disadvantages of the method include labor intensity and a sufficiently high injury rate. The advantage is considered to be the preservation of the length of the phalanx in the absence of the need to use a graft. The operation is more often performed in adults.
In the postoperative period, bandages are performed, analgesics and antibiotics are prescribed. The rehabilitation program includes physiotherapy procedures, therapeutic gymnastics, massage.
The prognosis is favorable. After reaching adulthood, the pathology does not progress, the function of the hand in the absolute majority of patients is preserved in full. The outcome after surgery in patients with severe clinodactyly is good. If the doctor’s recommendations are followed and the brush is developed in a timely manner, the appearance and functionality of the limb are fully restored.
Due to the congenital nature and favorable course, prevention of isolated clinodactyly is impossible and not required. The detection of this stigma of embryogenesis during ultrasound screening of the fetus is a reason to exclude mutations, especially in the absence of close relatives with clinodactyly.
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