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Modified Manktelow Step-Cut Osteotomy for Rotational Malunion of the Long Fingers: Tips and Pearls From a 7-Patient
Marie Marant1, Remy Lavigne2, Pierre-Emmanuel Chammas2
1Paris Saint Joseph Hospital Group, France.
Background:
Rotational malunion of the long fingers is poorly tolerated because even minor degrees of deformity may produce clinically relevant digital overlap, impaired grip, and aesthetic concerns. The modified Manktelow step-cut osteotomy is a reproducible technique that allows controlled derotation of metacarpal and proximal phalangeal malunions while preserving a broad cancellous contact surface for stable fixation and early mobilization.
Method:
This article describes the indications, surgical planning, technical steps, and practical pearls for performing this osteotomy. We also report our clinical experience in 7 patients treated for symptomatic rotational malunion of the long fingers.
Results:
The mean preoperative rotational deformity was 20°. Complete correction was achieved in 5 patients, and the 2 remaining patients had improved but mild residual deformity. Mean total active motion improved postoperatively, and no complications, revision procedures, hardware failures, or nonunions were observed. Key technical points include careful preoperative assessment of digital overlap, intraoperative verification of derotation using the tenodesis effect, preservation of the volar cortex until controlled closure of the dorsal resection gap, and stable screw fixation with minimal hardware.
Conclusion:
The modified Manktelow step-cut osteotomy is a useful and reliable option for selected rotational malunions of the long fingers, particularly when accurate correction and early mobilization are desired.
Insights
The modified Manktelow step-cut osteotomy effectively corrects rotational malunion in long fingers, improving function and aesthetics. This technique provides stable fixation for early patient mobilization with excellent outcomes.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Skeletal Reconstruction
Background:
- Rotational malunion of long fingers causes significant functional and aesthetic issues.
- Even minor deformities lead to digital overlap and impaired grip.
- The modified Manktelow step-cut osteotomy offers controlled derotation for these malunions.
Purpose of the Study:
- To describe the indications, surgical technique, and clinical outcomes of the modified Manktelow step-cut osteotomy.
- To evaluate the efficacy of this osteotomy in correcting rotational malunions of the long fingers.
- To share practical insights for performing the procedure.
Main Methods:
- Detailed description of the modified Manktelow step-cut osteotomy technique.
- Surgical planning and technical steps are outlined.
- Clinical experience with 7 patients treated for rotational malunion is reported.
Main Results:
- Mean preoperative rotational deformity of 20° was addressed.
- Complete correction achieved in 5 patients; mild residual deformity in 2.
- Improved total active motion postoperatively with no complications or nonunions.
Conclusions:
- The modified Manktelow step-cut osteotomy is a reliable option for correcting rotational malunions in long fingers.
- It allows for accurate correction and facilitates early mobilization.
- This technique is particularly useful for selected cases requiring precise deformity correction.
