Avaliação do tratamento da camptodactilia: análise retrospectiva de 40 dígitos

Camptodactyly: From Embryological Basis to Surgical Treatment

Camptodactyly is a relatively rare hand deformity presenting as the proximal interphalangeal joint's nontraumatic and progressive flexion contracture. Most cases are limited to the fifth finger. The severity and type of camptodactyly should be considered to optimize treatment. Since many structures at the finger base can be involved in the pathogenesis of the deformity, surgical treatment for this particular type of deformity is challenging. This paper aims to bring insight into camptodactyly's pathogenesis and treatment options. We discuss the indication and pitfalls of surgical treatment options for particular camptodactyly types and present a case of a fourteen-year-old boy who was admitted to our department with proximal interphalangeal joint flexion contracture of the left fifth digit.

Treatment of camptodactyly with a new progressive correction device

The aim of this study was to introduce a new progressive correction device and present treatment results in camptodactyly patients. Eight patients (11 fingers) were treated for camptodactyly by an external fixator between February 2019 and April 2020. Mean follow-up was 28.7 ± 3.3 months (range, 24-35 months). Operative times and treatment complications were recorded. Pre- and post-operative flexion contracture, total active range of motion (TAM) and esthetic satisfaction were evaluated at final follow-up. Esthetic satisfaction was rated by the patient on a 1-5 point scale. Seven patients were male, and 1 female. Mean age was 21.6 ± 8.5 years (range, 15-42 years). Mean surgery time was 14.9 ± 2.4 min (range, 10-18 min). Mean preoperative flexion contracture was 85.9 ± 7° (range, 75-95°), and mean postoperative flexion contracture was 4 ± 3° (range, 0-10°). Transient proximal interphalangeal joint swelling was seen in 1 case and pin tract infection in 1. TAM was perfect in 5 fingers and good in 6. Patients were either very satisfied (n = 5) or satisfied (n = 3) with the esthetic appearance of each operated finger. Camptodactyly could be managed with a hinged external fixator simply and effectively with gratifying results in selected patients. LEVEL OF EVIDENCE: Level IV, case series.

One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly

Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx’s original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.

Orthopedic findings in arthrogryposis and congenital Zika syndrome: A case series

BACKGROUND

Congenital arthrogryposis (CA) consists of congenital joint contractures that affect at least two joints in different parts of the body. Approximately, 80% of CA cases are neurogenic, with changes to the formation, structure or functioning of the central and/or peripheral nervous systems. Most abnormalities are triggered either by motoneurons decreased activation in the corticospinal tract or by direct motoneurons injury. There had been few reports in the literature correlating congenital infection in humans with arthrogryposis until 2015. CA has recently been described associated with congenital Zika syndrome (CZS).

METHODS

The objective of this study was to investigate and describe accurately the arthrogrypotic alterations in infants diagnosed with CZS and thus, suggest a possible pattern of orthopedic impairment. A total of 198 medical records of infants with CZS were evaluated. According to inclusion and exclusion criteria, 17 infants were included in the present study. Arthrogrypotic joints were orthopedically evaluated in four segments: right, left, upper, and lower limbs. All the four segments were assessed independently.

RESULTS

Flexed wrists were the most frequently observed manifestation, associated with ulnar deviation (35.29%). Deformities were also commonly found in the third and fourth fingers (64.70%). Hip dislocation was found in 58.82% of the patients and talipes equinovarus and equinovalgus ankles were found in 29.41 and 23.52%.

CONCLUSION

There was a particular pattern of joint impairment related to CZS and arthogrypotic alterations of infants evaluated in this study.

Treating Congenital Proximal Interphalangeal Joint Contracture

The management of congenital proximal interphalangeal joint deformity, also known as camptodactyly, is challenging. There are numerous theories on the cause of this abnormal finger posture, leading to variations in classification, definition, and treatment approaches. This article assesses the previous literature and provides clarity and guidance for the practical treatment of camptodactyly.