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Clinodactyly (Bent Finger)

Clinodactyly (Bent Finger)

Clinodactyly is a congenital condition in which one or more fingers are abnormally curved or bent sideways, typically in the direction of the adjacent fingers. The term originates from the Greek words “klinein” (to bend) and “daktylos” (finger). This deformity most often affects the little finger, but it can also involve other digits. While usually mild and painless, clinodactyly may occasionally interfere with hand function or cause cosmetic concerns.

Causes of Clinodactyly

The condition develops due to structural abnormalities in the bones of the finger. The most common cause is an abnormally shaped middle phalanx (the middle bone of the finger), which may be wedge-shaped or trapezoid in form. This abnormal growth results in sideways angulation of the finger.

Key causes include:

1. Congenital (present at birth):

  • Often occurs as an isolated condition without other health problems.
  • Sometimes associated with genetic syndromes such as Down syndrome, Turner syndrome, Klinefelter syndrome, or other chromosomal abnormalities.

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2. Hereditary factors:

  • Clinodactyly may run in families and follow autosomal dominant inheritance patterns.

3. Acquired causes (rare):

  • Can result from injury, malunited fractures, or growth plate disturbances during childhood.

Types of Clinodactyly

1. Mild Clinodactyly:

  • Finger is slightly curved with little to no functional limitation.
  • Usually a cosmetic concern only.

2. Moderate to Severe Clinodactyly:

  • Significant angulation (more than 20–30 degrees).
  • May cause fingers to overlap or cross each other, leading to functional impairment in gripping or writing.

3. Isolated Clinodactyly vs. Syndromic Clinodactyly:

  • Isolated: Appears alone without any other abnormalities.
  • Syndromic: Occurs as part of a larger syndrome (e.g., Down syndrome).

Clinical Features

The presentation of clinodactyly depends on the severity of the deformity:

  • Visible curvature: The finger, most commonly the little finger, bends sideways toward the ring finger.
  • Painless deformity: Most cases are not painful.
  • Finger overlap: In moderate to severe cases, the bent finger may overlap or push against neighboring fingers.
  • Functional difficulty: Severe angulation may interfere with grasping, writing, or handling small objects.
  • Cosmetic concerns: Many families seek medical advice because of the appearance of the hand rather than functional problems.

Diagnosis

1. Physical examination:

  • Observation of the bent finger and assessment of the degree of angulation.
  • Measurement of the angle to determine severity.

2. Imaging tests:

  • X-rays: Reveal the abnormal wedge-shaped bone (middle phalanx) and help in planning treatment.
  • Growth plate evaluation in children helps predict progression.

3. Genetic assessment:

  • If clinodactyly occurs with other abnormalities, genetic testing may be recommended to check for associated syndromes.

Treatment and Management

Treatment of clinodactyly depends on the severity of the deformity, functional impairment, and cosmetic concerns.

1. Observation (Non-surgical management):

  • Mild cases that do not interfere with function usually require no treatment.
  • Regular follow-up may be advised to monitor progression, especially in children.
  • Splints and physiotherapy generally do not correct the deformity but may improve flexibility.

2. Surgical treatment:

  • Osteotomy: The most common procedure, where the bone is cut and realigned to straighten the finger.
  • Closing wedge osteotomy: A wedge-shaped piece of bone is removed to correct the angle.
  • Opening wedge osteotomy: Space is created in the bone and filled with graft material to restore alignment.
  • Physiotherapy after surgery: Essential for regaining motion and strength.

Complications

While clinodactyly itself is usually harmless, untreated severe deformities or complications of treatment can cause problems such as:

  • Limited grip strength or finger function.
  • Overlap of fingers leading to difficulty in daily tasks.
  • Recurrence of deformity after surgery.
  • Joint stiffness, pain, or reduced mobility following corrective procedures.

Prognosis

The outlook for clinodactyly is generally very good.

  • Mild cases: Remain stable throughout life and rarely need intervention.
  • Severe cases: Surgical correction is usually successful in improving both function and appearance.
  • Syndromic cases: Prognosis depends on the overall health condition and presence of other associated anomalies.

Conclusion

Clinodactyly, commonly known as a bent finger, is a congenital condition characterized by sideways curvature of a finger, most often the little finger. It usually arises from an abnormal wedge-shaped bone and may be inherited or occur as part of a genetic syndrome. In most cases, clinodactyly is mild, painless, and does not interfere with function. However, severe cases may require surgical correction to restore alignment and improve function. With early diagnosis, appropriate management, and reassurance, individuals with clinodactyly can lead normal, functional lives without significant limitations.

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