Camptodactyly: a unifying theory and approach to surgical treatment

Camptodactyly is an isolated congenital flexion deformity of the proximal interphalangeal (PIP) joint. Surgical experience with 16 patients (18 fingers) between June 1983 and December 1994 is reported. Skin, fascia (retinaculum cutis), tendon sheaths, flexor digitorum superficialis tendon, lumbricals and interossei (particularly the lateral bands), joint surfaces, neck of the proximal phalanx, and central slip insertion were involved in all cases, although the degree of involvement can vary. Surgery must address all of these structures. Postoperative splinting is important. Fifteen patients had good or excellent results after surgery, with a mean gain in motion of 57 degrees (range, 0 degrees-90 degrees). Surgery should be aimed at prevention of progressive deterioration and is probably not indicated in minor degrees of the deformity. Surgery should be reserved for patients with a preoperative PIP joint contracture of more than 60 degrees.