What is Clinodactyly?

Clinodactyly is a condition present from birth that causes a finger to curve beyond its typical joint connection. This usually happens when a finger bends at an angle more than 10 degrees. Curvatures less than 10 degrees are considered normal. The curvature occurs due to an irregular shape of one or more finger bones, causing them to not line up correctly with the surrounding finger joints. This irregular shape leads to uneven growth in a direction that deviates from the usual straight line of finger growth, resulting in a visibly curved finger.

What Causes Clinodactyly?

Clinodactyly can appear in different forms, including as a part of a syndrome, within families, or as a spontaneous occurrence. It is usually inherited from one parent and often affects the middle section of the little finger. Studies have also found it could affect the first section of the index finger and thumb.

Essentially, clinodactyly happens because one or more of the small bones in the fingers, called phalanges, develop an unusual trapezoidal or triangular shape. This results in a misalignment of the joint between these bones. The irregular shape also disrupts the typical growth pattern of the finger, making it grow in an angled direction instead of straight. This uneven growth leads to a visible curve in the finger.

Risk Factors and Frequency for Clinodactyly

Clinodactyly is a condition that we don’t fully know how often it occurs. It’s been recorded in between 1% and 19.5% of people. This condition tends to appear in both hands and is more common in boys and men. It’s also been linked to several syndromes like Rubinstein-Taybi syndrome, Cenani-Lenz syndactyly, Klinefelter syndrome, Turner syndrome, Fanconi anemia, and is seen in roughly 25% of children with Down syndrome. Clinodactyly can be seen in newborns, but it usually becomes more obvious in later childhood as the child grows. Folks usually seek treatment because the bent digit looks unusual, but this bend doesn’t usually cause any problems with using the digit. This is because the affected digit can move to the side, which stops the bend from interfering with the digit’s full range of movement.

Signs and Symptoms of Clinodactyly

An examination of a person’s medical history and physical state can help doctors understand if a finger’s curve is affected. It’s essential to determine if the deformity impacts either the thumb-side fingers or if it’s compromising the ability to pinch due to the deformity. The doctor will also check the range of motion in the fingers. Your medical history will help reveal if the deformity was present from birth or occurred after an injury, and whether it’s stable or getting worse over time.

Testing for Clinodactyly

X-ray images can help diagnose clinodactyly, a condition where your fingers might bend towards your thumb or little finger. These X-rays show a curve towards either the thumb side or the little finger side of the hand. Often, the middle bone of the finger appearing on the X-ray may be shorter, usually more towards the thumb side. Sometimes, the X-ray might show a specific growth plate pattern in the finger bone or a distinctive bone shape. Additionally, clinodactyly might be picked up during a prenatal ultrasound occasionally.

Treatment Options for Clinodactyly

Most cases of clinodactyly, a condition where the fingers or toes bend inward, can be managed without any invasive treatments. Applying a splint to the affected finger or toe has generally been found to ineffective and is not suggested. The condition usually poses no functional problems for patients and is primarily a cosmetic concern. Surgery for aesthetic reasons is not recommended because it could lead to complications such as scarring and stiffness in the finger or toe. However, surgery could be an option for severe cases of clinodactyly that cause noticeable bending and shortening, especially if the thumb or fingers on the side of the hand closest to the thumb are affected. These severe cases can potentially interfere with the ability to pinch or grasp objects.

If the condition is causing a significant deformity that limits the ability to pinch or involves the thumb-side fingers, there are different surgical techniques available. The most commonly used surgical procedure for clinodactyly correction is corrective osteotomy, a type of surgery that involves cutting and resetting the bone. This surgery is typically reserved for patients whose bones are fully grown. Performing osteotomy in growing children can be challenging due to risks of damaging the growth plate – a part of the bone that promotes growth, or not achieving the desired correction. Several types of this surgery exist, including opening or closing wedge osteotomy, reverse wedge osteotomy, and removing the growth plate bracket and inserting a fat graft.

In severe cases where the surgery makes the finger or toe longer or shorter, there may be a lack of soft tissue which must be addressed. Usually, this loss of soft tissue on the curved side can be managed with a corrective surgical procedure known as a “Z”-plasty. If there’s a bigger deficit of soft tissue, skin flaps may be needed to provide enough skin coverage.

In patients whose bones are still growing, a procedure called “Vicker’s physiolysis” can be used as an alternative. This procedure involves removing the abnormal part of the growth plate on the shorter side of the affected finger or toe and placing fat tissue in the space created. After removing the abnormal growth plate and placing the fat tissue, the normal part of the growth plate can improve the deformity over one to two years. Compared to the osteotomy procedure, Vicker’s physiolysis has been shown to work well in patients with initial deformities less than 55 degrees and requires fewer follow-up surgeries.

When a doctor is trying to make a diagnosis, they might think about other conditions that could cause similar symptoms. For example, if a child’s finger is curved (a condition known as clinodactyly), the doctor may need to consider other possibilities. These include injuries to the growth plate of the bone, tumors, infections, and a type of bone infection called osteomyelitis.

Clinodactyly is also related to other health conditions. These include Rubinstein-Taybi Syndrome, Cenani-Lenz Syndactyly Syndrome, and Down Syndrome. In fact, up to 25% of children who have Down Syndrome might also have clinodactyly.

What to expect with Clinodactyly

The anticipated result of surgical intervention is to correct the deformity.

Possible Complications When Diagnosed with Clinodactyly

After surgery to correct a deformity, some complications can occur. These include stiffness, an over or under correction of the deformity, an interruption in bone growth, skin issues, and infections.

Common complications:

  • Stiffness
  • Over correction of deformity
  • Under correction of deformity
  • Interruption in bone growth
  • Skin issues
  • Infections

Preventing Clinodactyly

It’s crucial to have a thorough conversation with the patient and their family, explaining the potential risks and benefits of surgery. Surgery should generally be considered for patients experiencing problems with normal function, rather than those with aesthetic or cosmetic concerns.

Frequently asked questions

Clinodactyly is a condition present from birth that causes a finger to curve beyond its typical joint connection.

Clinodactyly is recorded in between 1% and 19.5% of people.

Signs and symptoms of Clinodactyly may include: - A noticeable curve or bend in one or more fingers, particularly the pinky finger. - Difficulty in fully straightening the affected finger(s). - Limited range of motion in the affected finger(s). - Pain or discomfort in the affected finger(s) when attempting to straighten or move them. - Difficulty in gripping or pinching objects due to the deformity. - In some cases, the curve may be more severe and noticeable, causing cosmetic concerns. - The deformity may be present from birth or develop later in life due to an injury or other factors. - The severity of the curve can vary, with some cases being mild and others more pronounced. - The deformity may remain stable over time or progressively worsen. - Clinodactyly can affect either the thumb-side fingers or all fingers.

Clinodactyly is usually inherited from one parent.

The doctor needs to rule out the following conditions when diagnosing Clinodactyly: - Injuries to the growth plate of the bone - Tumors - Infections - Osteomyelitis - Rubinstein-Taybi Syndrome - Cenani-Lenz Syndactyly Syndrome - Down Syndrome

The text does not mention any specific tests that are needed for diagnosing clinodactyly. However, X-ray images can be helpful in diagnosing the condition by showing the curve towards either the thumb side or the little finger side of the hand, as well as any specific growth plate patterns or distinctive bone shapes. Prenatal ultrasound may occasionally pick up clinodactyly as well.

Clinodactyly can be managed without invasive treatments in most cases. Applying a splint to the affected finger or toe is generally ineffective and not recommended. Surgery is not recommended for aesthetic reasons, as it can lead to complications. However, surgery may be an option for severe cases that cause noticeable bending and shortening, especially if it affects the thumb or fingers closest to the thumb. Corrective osteotomy is the most commonly used surgical procedure, involving cutting and resetting the bone. Other surgical techniques include "Z"-plasty for addressing soft tissue loss and Vicker's physiolysis for patients whose bones are still growing.

The side effects when treating Clinodactyly include stiffness, over correction of the deformity, under correction of the deformity, interruption in bone growth, skin issues, and infections.

The prognosis for Clinodactyly is that surgical intervention can correct the deformity.

You should see an orthopedic doctor for Clinodactyly.

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