主诉 病史

主诉：发现双小指屈曲挛缩畸形8年。 现病史：患儿G6P2足月剖腹产，出生体重不详，无窒息抢救史，Appgar评分不详。生后母乳喂养，按时添加辅食，生后三月时会抬头。患儿出生时即发现双小指屈曲挛缩，当时即诊断“双小指屈曲挛缩”，门诊随诊。现为手术治疗来我院，拟“双小指屈曲畸形”收治入院手术。         患儿发病以来一般情况好，胃纳好，二便正常，无明显体重减轻史。

查体 辅查

查体：患者双小指可见屈曲挛缩，不能伸直。感觉正常。其余指均正常。 4.X-ray：双小指屈曲畸形

诊断 处理

诊断：小指屈曲畸形取左小指掌侧Z形切口，切开皮肤、皮下组织、筋膜，暴露屈指肌腱，切开掌腱板及关节囊；    - 纠正挛缩畸形，1枚直径1.0mm克氏针贯穿指骨固定； 此畸形主要为关节挛缩导致。    - 透视下见骨折对位好，内固定好，    - 右侧手术同左侧   

随访 讨论

Camptodactyly

Introduction Congenital digital flexion deformity that usually occurs in the PIP joint of the small finger Epidemiology prevalence less than 1% location unilateral (33%) or bilateral (66%) if bilateral, can be symmetric or asymmetric Pathophysiology typically caused by either abnormal lumbrical insertion/origin abnormal (adherent, hypoplastic) FDS insertion other less common causes include abnormal central slip abnormal extensor hood abnormal volar plate skin, subcutaneous tissue, or dermis contracture Genetics most often sporadic can be inherited with autosomal dominant inheritance with incomplete penetrance/variable expressivity Associated conditons can be associated with more widespread developmental dysmorphology syndromes Classification   •If full PIP extension can be achieved actively with MCP held in flexion, digit can be explored and abnormal tendon transferred to radial lateral band Benson Classification Type Characteristics Treatment Type I  • Isolated anomaly of little finger, presents in infancy and affects males and females equally  • Most common form Stretching/splinting Type II  • Same clinical features as Type I, presents in adolescence  • Affects girls more often than boys From abnormal lumbrical insertion, abnormal FDS origin or insertion If full PIP extension can be achieved actively with MCP held in flexion, digit can be explored and abnormal FDS tendon transferred to radial lateral band Type III • Severe contractures, multiple digits involved, presents at birth  • Usually associated with a syndrome Non-operative (unless functional deficit exists after skeletal maturity), then consider corrective osteotomy/fusion Kirner's Deformity • Specific deformity of small finger distal phalanx with volar-radial curvature (apex dorsal-ulnar)  • Often affects preadolescent girls  • Often bilateral  • Usually no functional deficits   Presentation Symptoms often goes unnotice