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Oliveira MDCSD, Figueiredo FS, Aguiar DP. Conservative Treatment of Camptodactyly with use of Orthoses: A Retrospective Cohort. Rev Bras Ortop 2024; 59:e564-e571. [PMID: 39239571 PMCID: PMC11374391 DOI: 10.1055/s-0044-1786199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/15/2024] [Indexed: 09/07/2024] Open
Abstract
Objective To evaluate the outcomes of conservative treatment using static orthoses manufactured by the Occupational Therapy Sector of our institution in participants with camptodactyly types I, II, and III in their rigid or flexible forms, to describe the demographic and clinical data, and to analyze the number of dropouts during the treatment period. Methods The Ethics in Human Research Committee approved the project under protocol number CAAE 20300419.3.0000.5273. All medical records used in the research were made available by our institution. In the present retrospective study, we did not use the informed consent form due to the impossibility of contacting the high number of participants. The study included medical records of 38 participants treated at the Occupational Therapy Outpatient Clinic from 2013 to 2019. Results Of the 54 fingers treated with orthoses, 38 were completely corrected. The rates of correction were as follows: type I in its rigid form - 100% type I in its flexible form - 81.2%; type II in its rigid form - 0%; type II in its flexible form - 100%; type III in its rigid form - 47.6%; and type III in its flexible form - 100%. Of the 93 fingers included in this study, 42% abandoned the treatment. Conclusion Static orthoses are a safe alternative to surgical procedures, with low execution complexity for camptodactyly treatment.
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Affiliation(s)
| | | | - Diego Pinheiro Aguiar
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brasil
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Kloc J, Dzula B, Varga I, Klein M, Steno B. Camptodactyly: From Embryological Basis to Surgical Treatment. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050966. [PMID: 37241199 DOI: 10.3390/medicina59050966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Jan Kloc
- Department of Orthopaedic Surgery, Faculty Hospital of J.A. Reiman, Holleho 14, 080-01 Presov, Slovakia
| | - Boris Dzula
- Department of Orthopaedic Surgery, Faculty Hospital of J.A. Reiman, Holleho 14, 080-01 Presov, Slovakia
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813-72 Bratislava, Slovakia
| | - Martin Klein
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813-72 Bratislava, Slovakia
| | - Boris Steno
- II. Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813-72 Bratislava, Slovakia
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Miranda BH, Talwar C, Horwitz MD, Smith PJ. Aggressive paediatric camptodactyly: the evolution of a proposed treatment algorithm. J Plast Reconstr Aesthet Surg 2022; 75:1907-1915. [DOI: 10.1016/j.bjps.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
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Morimoto Y, Sogabe Y, Kawabata A, Takamatsu K. Digital artery perforator flap transfer for volar soft tissue defect due to dissociation from joint contracture in camptodactyly. JPRAS Open 2020; 27:48-52. [PMID: 33319010 PMCID: PMC7726480 DOI: 10.1016/j.jpra.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022] Open
Abstract
Camptodactyly is a condition defined by persistent flexion contracture of the proximal interphalangeal joints of the hand. Surgical treatment requires flaps for the dissection of the skin and the resulting soft tissue defect, soft tissue release, and sometimes reconstruction of the extension mechanism. Z-plasty and transposition flap have been reported as methods used in soft tissue defects. In this case, covering the defects of the digits was necessary for keeping the wound clean; thus, we should select a surgical method that facilitates stable and reliable blood flow of the flap. The digital artery perforator flap is pedicled and its transfer does not require the dissection of neurovascular bundles; therefore, it can be used safety and relatively easily. We considered the digital artery perforator flap to be a useful technique in terms of securing stable and reliable blood flow and not twisting the skin. Thus, we performed a digital artery perforator flap transfer for a volar soft tissue defect due to dissociation from proximal interphalangeal joint contracture in camptodactyly.
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Park BK, Kim HW, Park H, Park MJ, Hong KB, Park KB. One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly. J Clin Med 2020; 9:jcm9113731. [PMID: 33233749 PMCID: PMC7699896 DOI: 10.3390/jcm9113731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023] Open
Abstract
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.
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Affiliation(s)
- Byoung Kyu Park
- Graduate School, Yonsei University College of Medicine, Seoul 03722, Korea;
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Korea
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.W.K.); (K.-B.H.)
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Min Jung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Kee-Bum Hong
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.W.K.); (K.-B.H.)
| | - Kun Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.W.K.); (K.-B.H.)
- Correspondence: ; Tel.: +82-2-2228-2180
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Wang AMQ, Kim M, Ho ES, Davidge KM. Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review. Hand (N Y) 2020; 15:761-770. [PMID: 30897950 PMCID: PMC7850255 DOI: 10.1177/1558944719834654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a "Weak" global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.
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Affiliation(s)
| | - Min Kim
- University of Toronto, ON, Canada
| | - Emily S. Ho
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kristen M. Davidge
- University of Toronto, ON, Canada,The Hospital for Sick Children, Toronto, ON, Canada,Kristen M. Davidge, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8.
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Abstract
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.
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Affiliation(s)
- Sarah M Yannascoli
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
| | - Charles A Goldfarb
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA.
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