Orthopedics - Oleksa A.P. 2006

Congenital malformations of the upper extremity
Congenital hand deformities
Congenital contractures of the fingers

Congenital finger contractures are extremely rare. They can be either flexion or extension contractures. Flexion contractures typically affect the distal interphalangeal joint of the little finger. Occasionally, deviation of the distal phalanx toward the radial side (clinodactyly) may occur. Clinical examination reveals either floating movements or their absence in the interphalangeal joints of otherwise normally developed fingers.

Flexion contractures are treated conservatively, starting in early childhood.

Class="center">

Fig. 127. Macrodactyly of the second toe with adectomia of the third toe (Matzen/Matzen, 1990).

Paraffin-ozokerite Applications and passive-active mobilization of the finger joints are applied. The achieved correction is fixed using a volar plaster splint, which is replaced step-by-step. Once full extension of the finger is achieved, a corrective splint is worn at night for an extended period.

Congenital extension contracture, which may involve all JOINTS OF THE finger, is treated using a similar approach. The primary goal is to stretch the extensors and progressively apply corrective plaster splints while holding the finger Phalanges in a flexed position.

In untreated children, contractures become so rigid that surgical intervention is required. The Procedure involves lengthening the finger extensor tendons and performing a capsulotomy of the interphalangeal joints, followed by immobilization of the finger in a semi-flexed position using a plaster splint. Nowadays, interphalangeal joint arthroplasty is available, but joint replacement should be delayed until skeletal maturity is reached, i.e., in adults.