This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Surgical options

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Surgical options for camptodactyly must address the contracture at the proximal interphalangeal joint (PIPJ) and also the imbalance between flexor and extensor function around the joint. They include:

  • if joint is passively correctable:
    • approached via a midlateral incision on the digit with a zigzag incision on the palm
    • exploration of joint and release of any tendinous structures which might be tethering in flexion
    • release of joint contractures:
      • may mean addressing in isolation or combined the skin, fascia, tendon sheaths, intrinsic tendons, checkrein ligaments, collateral ligaments or volar plate:
        • skin contractures are addressed with Z-plasty lengthening or a skin graft
        • an anomalous lumbrical muscle is resected at its insertion but requires full exploration along its length; an abnormal insertion can be confirmed if pulling on the tendon does not result in PIPJ extension
        • palmar interosseous anomalies are not uncommon, particularly passing to the ring finger; needs partial division of the intermetacarpal ligament
        • flexor digitorum superficialis is assessed by traction on it proximal to the A1 pulley in the palm in both directions; anomalies causing failure of PIPJ flexion require division of either the origin or insertion depending on where the abnormality resides
      • Saffar procedure: release of all flexor structures in a subperiosteal plane on volar side of joint, collateral, accessory collateral and check rein ligaments
    • to counter lack of extension at central slip, either plicate the extensor or tendon transfer to the extensor apparatus:
      • options for tendon transfer include the lumbrical, flexor digitorum superficialis or extensor indicis proprius tendons
      • for the FDS tendon transfer:
        • independent function for the FDS to the little finger is required
        • the tendon is divided at the level of the A3 pulley in the digit and passed back into the palm
        • it is then passed distally and dorsally to be weaved into the lateral band and central slip at the level of the middle phalanx
        • if the FDS to the little finger is absent, the equivalent tendon to the ring finger can be used for the little finger
        • tension on the tendon transfer is adjusted to give about 70 degrees of MCPJ flexion and full interphalangeal joint extension
        • a K wire may be required to hold the position for three weeks
      • post-operative splintage
  • if joint is fixed in position or shows signs of bony derangement:
    • typically, salvage procedures are required and a minimal improvement can be expected
    • the approach may need to be changed to compensate for skin shortage; typically, z-plasty lengthening is carried out on the digits or, if there is a severe contracture, skin grafting may be required
    • dorsal closing wedge angulation osteotomy of the proximal phalanx to correct flexion and ulnar inclination; results in loss of full flexion and an impaired palmar grasp
    • rarely, arthrodesis with the joint in about 40 degrees of flexion

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.