Camptodactyly as a spectrum of congenital deficiencies: a treatment algorithm based on clinical examination.

BACKGROUND: Camptodactyly is a frequent congenital hand disorder, but its cause and treatment remain a matter of controversy. Although it is difficult to establish the primary cause of camptodactyly, careful clinical examination allows the assessment of all the structures involved (e.g., skin, subcutaneous fascia, flexor tendons, extensor tendon, intrinsic muscles, and joints). The purpose of the study was to assess the validity of an algorithm based on the clinical examination in planning the operation.

METHODS: An algorithm based on clinical examination and the authors' 27-year experience was designed to determine and customize the surgery for each case according to the function of the anatomical structures involved. The authors compared the results of surgical treatment in two groups of patients with camptodactyly of the fifth finger operated on before (group 1, 33 patients) or after use of the algorithm (group 2, 35 patients). All patients had more than 1 year of follow-up (range, 21 to 47 months).

RESULTS: There were significantly fewer failures in group 2 (14 percent versus 45.5 percent, p < 0.01). The improvement, after an extensive liberation in stiff early cases (type Ia), gave better results than previous attempts but did not reach significance (84 percent versus 66 percent). Similarly, for types Ib (early and correctable) and IIb (late and correctable) camptodactyly, the surgical results were improved, with 91 percent and 90 percent improvement, respectively, in group 2 versus 50 percent and 44 percent in group 1 (not significant).

CONCLUSION: A selective surgical indication, based on careful clinical examination, improves the results of camptodactyly treatment by correcting the involved anatomical components.