Clinodactyly thumb: causes, treatment, pictures of pinky after surgery
Clinodactyly — congenital anomaly of fingers
The hands are the body part that is always in sight. Any changes and strain on the hands or on the fingers is very noticeable.
Such anomalies are many. Often they represent only a cosmetic defect but can sometimes interfere with full functioning person: to work, to learn, to communicate.
Among the most common deviations in the development of the hands is clinodactyly.
The definition of anomaly
Clinodactyly is a common congenital anomaly of the bones of the fingers. Data on the prevalence of the disease in different statistical sources is very vary, from 1% to 19%.
Most clinodactyly affects the Pinkies or ring fingers, but there are cases of changes in the other fingers.
The disease affects both hands symmetrically. When this pathology is offset from the axis of the finger laterally at the level of the middle phalanx on the limb. The fingers are bent medial or lateral, noted violations in the synovial proportions.
Sometimes in children, this defect goes unnoticed, because the deformation varies in degree and continues until puberty. Its peak anomaly reaches the age of 18-20 years and usually no longer progressing.
Diagnosis of the disease is by external examination and radiological investigation. It is important to differentiate clinodactyly from similar diseases – camptodactyly, which is due to the muscle-tendon pathology.
Classification and physiology of the process
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The disease usually does not cause pain or discomfort and treat it if when the finger is very strongly deviates from the axis and this causes severe discomfort and difficulty in everyday life.
There are several types of clinodactyly:
- Type I. the Proportions of the normal finger, the deflection angle is small (10-15 degrees).
- Type II. The proportions of the finger is changed (shortening), the angle of deflection is negligible (no more than 10-15 degrees).
- Type III. Strong curvature, tilt angle greater than 20 degrees.
The deformation occurs due to changes of the growth zone (epiphysis) of the middle phalanx. Normally, the pineal gland located at the base of the bone and is a flat plate.
If clinodactyly zone of growth around the middle phalanx from the proximal to the distal bone of the finger, forming the letter S.
Due to this deformation the growth of the middle phalanx is uneven and resembles a trapezoid or a triangle, because of this, it is called a Delta phalanx.
The reasons for the development of pathology
Clinodactyly can occur as an isolated disease or in combination with other disabilities. It can develop for three reasons.
As an independent hereditary disease transmitted in an autosomal dominant pattern. In this case, someone of the relatives definitely detected such anomalies. They can vary in severity (e.g., the mother of the second type, and the daughter of the third).
As one of the more serious diseases of genetic origin. It can be syndromes associated with changes in sets of chromosomes (aneuploid syndromes):
- down syndrome (clinodactyly in 60% of cases);
- Klinefelter syndrome;
- trisomy in the 18th pair of chromosomes;
- Turner’s syndrome.
Syndromes related to gene mutations:
- Roberts syndrome;
- syndrome Russell-silver;
- the Fanconi anemia;
- Cornelia de Lange syndrome;
- syndrome Feingold;
- or other asyndrome anomalies (brachydactyly).
Can manifest as a sporadic disease. This means that there was a spontaneous mutation of the gene, which led to the defect. Or clinically the disease was manifested for the first time, because it has recessive inheritance.
Clinodactyly can be detected through routine ultrasound screening during pregnancy. In the presence of such deviations the pregnant woman may be referred to the genetics consultation and, if necessary, carried out to determine the karyotype of the child to exclude chromosomal abnormalities.
Surgery is the only way
Clinodactyly is a problem that can be solved only by surgery. When a small child, many parents are not always ready to carry out the operation, but it is wrong because it is in childhood when it is best tolerated operation and better results.
Eliminate the defect in the teenage and in adulthood. This malformation of the fingers does not lead to disability and does not prevent the person.
With the exception of clinodactyly third type, when the angle of curvature is very large and leads to disruption of organ function – joint is limited in motion, difficult grasping movements.
There are several methods to solve this problem:
- A closed wedge osteotomy of abnormal phalanges. The easiest way, but it may require correction in the future does not preserve the length of the finger. This files most often carried out in children. For fixation of phalanges in the correct position using two pins and a plaster cast which is removed after 4-5 weeks. The skin is a small scar.
- Open wedge osteotomy of the phalanx, with its short side and insert part of the iliac crest. Complicated operation for carrying a small child because you want to use the bone material for transplantation, but the baby him a little. In addition, the operation suggested corrective Z — plasty, i.e., excision of the triangular flaps of skin to improve the appearance of your finger. The length of the finger is preserved.
- Reversed wedge osteotomy. The most rational choice of surgical intervention for adults with clinodactyly. Technically demanding operation. Excised a wedge-shaped piece of bone with the broad side of a phalanx and it is inserted on the narrow side. Also accompanied by a plastic counter triangular patches. Length is preserved.
- Resection of the middle part of the growth zone of the Delta phalanx and the establishment of a educated period a fat graft. This method allows to normalize the function of the pineal gland. It does not require prolonged immobilization, which is very important for a young child. The method used in America for children up to 6 years, the ideal age of the child must be under 3 years.
Results of surgical treatment of clinodactyly little finger you can see by comparing the photo above, hands before and after the intervention.
It pays to carry out the operation in early childhood. Before surgery in young children is recommended to wear a special clip-on braces, which hold the finger with the defect in the desired position.
Since this is a genetic disorder associated with abnormalities of the bony structures, then the conservative therapy it is not exposed.
The only solution is surgery. However, it is not always necessary since often, the curvature is almost imperceptible and does not prevent man from living fully. In severe cases, it is necessary to correct the situation promptly.
Experts select the most appropriate solution to the problem. After the operation the result is visible immediately. The curvature is eliminated almost completely. The skin may remain small scars from the surgery. It is best to deal with this problem in early childhood.