Surgical Treatment of Clinodactyly Caused by Longitudinally Bracketed Diaphysis (“Delta Phalanx”)

Abstract

Clinodactyly in 10 fingers (9 patients) with longitudinally bracketed diaphysis (LBD) was treated surgically with various methods. In 4 cases with LBD in the middle phalanx of a triphalangeal thumb this phalanx was removed and the ligaments reconstructed. In the other 6 digits the LBD was in the base phalanx of a thumb or in the middle phalanx of some other digit. One of these was treated in infancy with transverse resection of the bracket. In 3 cases (4 digits) wedge osteotomy with reversal of the wedge was carried out. In the remaining case simple osteotomy was performed and a wedge-shaped bonegraft was interposed in the space created. Treatment in the last-mentioned case was unsuccessful because postoperatively the graft slipped out of position, but in all other cases the results achieved appear satisfactory.

Closing Wedge Osteotomy of Abnormal Middle Phalanx for Clinodactyly

“…[5][6][7][8][9] The choice of the surgical procedure depends on the underlying pathology, the amount of deformity, status of soft tissues, and the surgeon's preference. The various surgical options include closing wedge osteotomy, 7 opening wedge osteotomy, 6,10 reverse wedge osteotomy, 8 and physiolysis. 5,9 The treatment most often used is osteotomy of the middle phalanx to realign the digit.…”

Les clinodactylies : phalange delta et déformation de Kirner

“…Elle a été décrite par Carstam et Theander [24] comme une alternative plus simple à réaliser que l'ostéotomie d'ouverture (Fig. 11).…”

Correlative roentgenography and morphology of the longitudinal epiphyseal bracket

“…Carstam and Theander reported nine patients with ten involved digits [3,26]. In four cases, this was the middle phalanx of a triphalangeal thumb.…”

“…Flatt felt that this also was a misrepresentation, as the bone is usually trapezoidal [6]. Theander and Carstam introduced the term "longitudinally bracketed diaphysis" [3,26]. However, neither term is explicity correct.…”

“…Periosteum (PS) was only evident medially along the metaphyseal/diaphyseal segment n o t b e e n d e s c r i b e d p r e v i o u s l y . M o s t i m p o r t a n t , exc e p t f o r isolated, o f t e n i n c o m p l e t e , d e s c r i p t i o n s o f s u r g i c a l f i n d i n g s , the precise m o r p h o l o g y o f the L E B h a s n o t b e e n d e s c r i b e d p r e v i o u s l y [2,3,6,10,26,27]. W e h a v e r e c e n t l y h a d the o p p o r t u n i t y to s t u d y a d u p l i c a t e d m e t a t a r s a l w i t h a l o n g i t u d i n a l e p i p h y s e a l b r a c k e t .…”