Middle Phalangectomy for the Correction of Toe Clinodactyly With Longitudinal Epiphyseal Bracket in Young Children

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ABSTRACT

Toe clinodactyly is often owed to the presence of a longitudinal epiphyseal bracket. We developed middle phalangectomy as a simple surgical solution for correction of toe clinodactyly because of longitudinal epiphyseal bracket in childhood. Ten children (ages 1–5 years) were operated on by the same surgeon between October 2007 and May 2012 (n = 15 feet). The same surgical technique was used in all the cases. A clinical evaluation included the appearance of the foot, the parents’ level of satisfaction, and the presence or absence of bothersome symptoms (such as pain and discomfort when wearing footwear). A radiological evaluation under weight-bearing conditions enabled us to 1) rate the achievement of a natural-looking toe parabola and 2) detect the recurrence of clinodactyly (defined as an angle of >40° between 2 adjacent phalanges). The mean follow-up period was 5.4 (range 3.3 to 8.1) years. Nine sets of parents (90%) were satisfied with the results of the procedure. None had difficulties wearing boots, and only 1 child (10%) had residual pain during sports activities. Clinodactyly recurred in 3 feet in 3 patients (20% of feet, 30% of patients). Two (20%) of the latter patients underwent repeat surgery and achieved a lasting, satisfactory outcome. Middle phalangectomy is an appropriate procedure for the treatment of toe clinodactyly because of longitudinal epiphyseal bracket in young children. However, the patients’ long-term outcomes (notably once bone growth has ended) must be assessed.

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Patients and Methods

This preliminary, single-center, retrospective study was based on prospectively collected clinical and radiographic data. Patients were aged between 1 and 5 years and presented with unilateral or bilateral clinodactyly of ≥1 toes (Fig. 1). All operations were performed by the same surgeon and followed the same procedure. Before surgery, the presence of a longitudinal epiphyseal bracket was confirmed on posterior-anterior and latero-lateral radiographs (Fig. 2).

Results

Ten children (8 [80%] boys and 2 [20%] girls) underwent longitudinal epiphyseal bracket excision between October 2007 and May 2012. The mean age at the time of surgery was 4.1 (range 1 to 5) years, and the mean follow-up duration was 5.4 (range 3.3 to 8.1) years. Five (50%) patients had unilateral clinodactyly, and 5 (50%) had bilateral clinodactyly. In all, 15 feet were treated surgically (Table). The fourth toe was involved in 7 patients (70%), the third toe was involved in 2 patients (20%),

Discussion

In the present study, we evaluated middle phalangectomy as a therapeutic option for the correction of toe clinodactyly because of longitudinal epiphyseal bracket in young children. Even though this was a retrospective study of a small number of cases (10 patients and 15 feet), all the children were evaluated clinically and radiologically at last follow-up visit. Furthermore, previous reports in this field did not feature a greater number of participants than in the present series (1, 10). Our

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