title: Early Results of Surgical Management of Camptodactyly.
abstract: BACKGROUND
  We hypothesize that surgery for moderate-to-severe camptodactyly (>50 degrees) results in modest gains in range of motion and improved digital position.
  
  
  METHODS
  A retrospective analysis of patients undergoing surgery for camptodactyly at a tertiary children's hospital between 2000 and 2014 was performed. Surgery was indicated for patients with persistent, functionally limiting flexion contractures despite observation, therapy, and splinting. Data were collected on demographics, clinical history and presentation, nonoperative management, surgery, and clinical follow-up, focusing on range of motion at the involved joint. Total passive motion (TPM) and total active motion (TAM) at the proximal interphalangeal (PIP) joint was calculated at presentation, preoperative visit, first postoperative visit out of the cast, and last follow-up visit. Average postoperative follow-up was 1.4 years.
  
  
  RESULTS
  In total, 31 digits in 22 patients were reviewed. There were 13 males; average age at surgery was 9.6 years. There were 7 type I (infantile), 8 type II (adolescent), and 7 type III (syndromic) patients. All cases involved the PIP joint; 55% involved the small finger. All patients underwent sequential release of contracted structures until maximal extension without compromising vascularity or joint stability was obtained. Z-plasty of the volar skin was performed in 68% of digits, flexor digitorum superficialis tenotomy in 77%, volar plate release in 58%, and collateral ligament release in 48%. All patients were casted postoperatively for an average of 31 days, and 71% of digits had temporary transarticular pin fixation. At initial presentation, mean TPM and TAM were 34 and 24 degrees, respectively. TPM and TAM were 32 and 19 degrees immediately preoperatively, 30 and 13 at the first postoperative visit, and 35 and 25 at the final follow-up. Furthermore, the position of PIP arc of motion was in a more extended position postoperatively. Average TPM arc of motion was from 50 to 82 degrees preoperatively and 28 to 63 degrees at final follow-up; average TAM arc of motion was 62 to 81 degrees preoperatively and 30 to 55 degrees at final follow-up. There were no clinically meaningful differences in results based on camptodactyly type, preoperative motion, or age at surgery. There were no cases of wound infection or dehiscence. Two patients with recurrent contractures opted for subsequent PIP arthrodesis.
  
  
  CONCLUSIONS
  Total motion of the PIP joint was similar both preoperatively and postoperatively following surgical release of camptodactyly. However postoperatively, the digit was in a more extended position over this arc of motion. For patients with functionally limiting flexion contractures, surgical release may be beneficial by providing a more extended position, for improved digital release, hygiene, and esthetics.
  
  
  METHODS
  Level IV.
authors.affiliation: *Harvard Combined Orthopaedic Residency Program †Department of Orthopaedic Surgery, Boston Children's Hospital ‡Harvard Medical School, Boston, MA.
authors.forename: Brady T
authors.initials: BT
authors.lastname: Evans
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waters
authors.forename: Donald S
authors.initials: DS
authors.lastname: Bae
mesh_terms: D002648:Child; D003286:Contracture / Q000601:surgery; D005260:Female; D005384:Finger Joint / Q000002:abnormalities / Q000601:surgery*; D006228:Hand Deformities, Congenital / Q000145:classification / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013165:Splints