Aggressive paediatric camptodactyly: The evolution of a proposed treatment algorithm

Area of Science:

• Orthopedics
• Pediatric Surgery
• Hand Surgery

Background:

• Congenital camptodactyly often requires surgical intervention for severe proximal interphalangeal joint (PIPJ) contractures.
• Traditional treatment avoids surgery until non-operative methods fail and contractures reach 60° or more.
• Early intervention may prevent the need for more aggressive procedures in established cases.

Purpose of the Study:

• To evaluate the efficacy of early flexor digitorum superficialis (FDS) release and gentle passive manipulation (GPM) in correcting severe congenital camptodactyly.
• To determine if this early intervention can avoid more aggressive surgical techniques typically used in adolescents.
• To assess outcomes in young children with significant PIPJ contractures.

Main Methods:

• A multi-center case series detailing surgical technique and treatment algorithm for congenital camptodactyly.
• Data collected included patient demographics, syndromic associations, affected digits, age at onset and surgery, and pre/post-operative joint measurements.
• Analysis focused on proximal interphalangeal joint (PIPJ) contracture and range of motion following FDS release and GPM.

Main Results:

• Fifteen operations were performed on 24 digits across 12 patients, with surgery occurring at a median of 3 months post-referral.
• Significant improvements were observed in median PIPJ contracture (90° to 0°) and range of motion (0° to 90°) at a median 2.5-year follow-up (p<0.001 for both).
• 87.5% of digits achieved excellent/good outcomes based on the Siegert grade, with 12.5% fair outcomes.

Conclusions:

• Early flexor digitorum superficialis (FDS) release and gentle passive manipulation (GPM) effectively correct severe proximal interphalangeal joint (PIPJ) contractures in young children with congenital camptodactyly.
• This early intervention strategy shows promising results, improving joint function and potentially avoiding more complex surgeries.
• Additional procedures may be necessary for syndromic cases, multiple digital involvement, or older children with failed prior surgeries.