Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review

Background:

Camptodactyly is a common condition estimated to affect 1% of the population. The treatment for camptodactyly remains controversial, with a diverse range of surgical and conservative management approaches proposed. The ambiguity in the literature regarding the definition of camptodactyly, high variability in both conservative and surgical treatments, and lack of consistency in outcomes evaluation lead to significant challenges when guiding patients and their families through selecting management strategies.

Purpose:

The aim of this systematic review is to improve patient care and decision making in camptodactyly management, through clarifying the definition of camptodactyly and indications for treatment, summarizing treatment outcomes for camptodactyly patients, and defining risks of treatment including complications, pain and burden of care.

Methods:

A systematic review was conducted, which included randomized control trials, prospective and retrospective cohort studies, case-control studies, case series and case reports on outcomes following the surgical and/or conservative management of idiopathic camptodactyly in children aged 0 to 18 years. The literature was searched using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database (EMBASE), Allied and Complementary Medicine (AMED) and Cumulative Index of Nursing and Allied Health Literature (CINAHL). The primary outcome evaluated was post-treatment flexion contracture, and the secondary outcomes were indications for surgery, post-treatment complications, functional limitations and patient satisfaction.

Results:

Database searching generated 947 records, with 805 screened after duplicates removed, and 57 full-text articles reviewed. A total of 16 articles describing the conservative and/or surgical treatment of camptodactyly were included in the final review, with seven case series and nine retrospective cohort studies, and no prospective studies or randomized controlled trials. There was lack of consistency on the definition of camptodactyly as it related to the etiology of the flexion deformity. All 16 studies received a “Weak” global rating and demonstrated low quality evidence that showed a reduction in flexion contracture in most patients after treatment (from pre-treatment averages of 20° to 85° to post-treatment averages of 5° to 37°). Only one study performed statistical analysis of the change in flexion contracture of the proximal interphalangeal joint (PIPJ) after treatment and found the improvement after passive stretch exercises to be statistically significant. There was general agreement that surgery should be considered for severe flexion contracture of more than 30°, or failure to respond to conservative management. Surgical treatment generally led to more complications compared to conservative management. Only one study reported on functional limitations and one study reported on patient-reported outcomes.

Conclusions:

The current literature on camptodactyly management is weak, and the evidence on the effectiveness of surgical and conservative treatment is inconclusive. Given the complexity of treatment options available, future research may consider the development of decision aids to guide patients and families through selecting management strategies, and promote shared decision making.