Comparing outcomes of conservative rehabilitation protocols for camptodactyly in pediatric patients: A retrospective cohort study
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Liam Young1, Joshua Baek1, Dalia Ebeda2
1Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Background:
Camptodactyly is a flexion contracture of the proximal interphalangeal joint initially presenting during early (Type I) or later (Type II) in childhood. Commonly, the contracture occurs in the small finger but may affect multiple digits with or without association to distal arthrogryposis. Conservative management is widely recommended as the primary form of treatment for camptodactyly; however, little is known about how treatment approaches differ for camptodactyly with and without association to distal arthrogryposis.
Purpose:
To compare the outcomes of conservative management for proximal interphalangeal joint contracture of children with camptodactyly and distal arthrogryposis.
Study Design:
Retrospective cohort design.
Methods:
The Hospital for Sick Children (SickKids) database was reviewed to identify children diagnosed with camptodactyly or distal arthrogryposis. Diagnostic and outcomes data were extracted from health records. The primary analysis was paired comparison of the degree of proximal interphalangeal joint extension passive range of motion of affected digits pre- and post-treatment. Secondary analyses were outcome comparisons of the mean difference in proximal interphalangeal joint between Type I and Type II camptodactyly.
Results:
Of 280 children reviewed, 95 (M:F, 47:48) were included in the study. Sixty-five (68%) were diagnosed with camptodactyly and 30 (32%) distal arthrogryposis; 55 (59%) had Type I and 38 (41%) had Type II camptodactyly. Significant reduction in proximal interphalangeal joint contractures were found in children with camptodactyly following conservative treatment, but were not significant in children with distal arthrogryposis. No significant difference was found between Type I and Type II. Contractures in children with distal arthrogryposis were found to have higher association with skin and soft tissue deficiencies than children with camptodactyly.
Conclusions:
Camptodactyly and distal arthrogryposis may require different hand therapy treatment. Conservative management is indicated in both conditions; however, interweaving interdisciplinary collaboration to provide conservative and surgical intervention is recommended for children with distal arthrogryposis.