Outcomes of the Surgical Management of Clinodactyly: A Systematic Review.

Abstract

Purpose: This systematic review evaluated outcomes of surgical management for congenital clinodactyly, focusing on physiolysis and osteotomy.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, registered on the International Prospective register of Systematic Reviews (PROSPERO). MEDLINE and EMBASE were searched for studies reporting operative management of congenital clinodactyly published up to December 2025. Data extraction and bias assessment (Newcastle-Ottawa Scale) were performed independently by two reviewers. Outcomes were analyzed descriptively.

Results: Of 818 studies screened, 8 were included, comprising 119 patients (165 digits). Physiolysis was performed in 76% of cases and osteotomy in 24%. The mean age of the physiolysis group was 6.1 years (0.6-12.3) and 7.2 years (0.6-16.4) for the osteotomy group. Mean preoperative angulation was 41°, improving to 21° after surgery. All techniques demonstrated angular improvement; however, no clear criteria exist for guiding the choice of procedure alongside disparity in the threshold for surgical intervention, with some studies quoting >20° to 25° as an indication. The overall complication rate was 7.3%, and reoperation was required in 9% of cases; reoperations were most frequently following physiolysis. Outcome reporting was inconsistent, with variable definitions of success and limited distinction between clinical and radiological measures. There were no studies using validated patient-reported outcome measures; limited qualitative feedback suggested generally high levels of patient or parental satisfaction despite residual deformity.

Conclusions: Both techniques achieve reduction in angulation; however, standardized indications and robust outcome measures are needed to guide practice. Outcome reporting was heterogeneous, and most notably, there is a complete absence of validated patient-reported outcome measures across all included studies, despite generally high reported satisfaction, representing a major gap in patient-centered outcome assessment.

Type of study/level of evidence: Therapeutic IIIa.