Quantitative results of epiphysiodesis in young children with macrodactyly

Abstract

Background: Macrodactyly is a very rare congenital anomaly of single or multiple digits of the hands or feet involving bone and all soft tissue components. A treatment protocol has not been elucidated due to its rarity and variety of clinical manifestation. Moreover, there is a paucity of quantitative data regarding postoperative results in the long-term follow-up. Methods: A retrospective chart review was performed for 13 patients with isolated macrodactyly who were treated with epiphysiodesis at our institution over a 15-year period. The relative size of macrodactyly was estimated by calculating the length and diameter of the involved digit compared with those of their normal counterpart on radiology. The relative size of each phalanx was measured preoperatively and postoperatively at 6 months, 1 year, 2 years, and in the long-term (7.63 years on average [range, 3.5–15 years]). The preoperative clinical feature of macrodactyly and the effect of epiphysiodesis on growth were investigated. Results: Among 13 patients, there were 2 boys and 11 girls. Feet were more frequently involved (8 cases) than the hands (5 cases). The mean age at the first epiphysiodesis procedure was 4.23 years (range, 1–11 years). The mean follow-up period was 5.38 years (range, 1–16 years). Preoperatively, the relative size of the affected digit increased from the metacarpal/metatarsal bone to the distal phalanx in both length and diameter. Epiphysiodesis effectively regulated longitudinal growth from 6 months postoperatively to the long-term follow-up, but it did not control appositional growth. Compared with the preoperative state, the relative length of the operated phalanges decreased to 0.9267 at 6 months (p = 0.0476), 0.8916 at 1 year (p = 0.0048), 0.8688 at 2 years (p = 0.0018), and 0.8353 at the long-term follow-up (p = 0.0006). Conclusions: Epiphysiodesis is an effective surgical method to control longitudinal growth of macrodactyly in young patients when growth potential remains. This information may assist hand surgeons in determining the treatment plan and providing counseling to patients.