Middle phalangectomy with shortening fusion of the fifth finger in Dupuytren's digital hooks.

Severe contracture of the little finger due to Dupuytren's disease continues to be a therapeutic problem. Fifth finger amputation, which is sometimes the only solution, has a major negative impact on function and appearance, and exposes the patient to adjacent digital hook aggravation. Middle phalangectomy with finger shortening fusion is an alternative surgical solution. The aim of this study was to report on a continuous series of 36 cases treated with this approach. This was a retrospective series of 33 patients (26 males and 7 females) operated from 1994 to 2015. All patients had severe contracture of their little finger and 30 had prior surgery. The combined extension lag was 143° (75-270), with considerable functional deficit and poor appearance. The surgical technique consisted of a dorsal approach, a more or less extensive excision of the middle phalanx, and arthrodesis with alignment of the remaining bone segments, while preserving the fingertip/nail complex. The following outcomes were determined when the patients were reviewed: functional discomfort and use, appearance, residual pain, pulp sensitivity, recurrence of contracture and overall satisfaction. Six patients were dead and two were lost to follow-up. Twenty-five patients (27 cases) were reviewed at a mean follow-up of 64 months (12-280). There were no post-operative complications. Twenty-two patients (24 cases) were satisfied or very satisfied. The resulting appearance was graded at 7.13/10 (1-10). Pain on a 10-point Visual Analog Scale was 0.46 (0-5). Cold intolerance was found in 9 cases (33.3%) and decreased fingertip sensitivity in 3 cases (11.1%). The hand could be flattened in 21 cases; in the other cases, it could not be flattened due to contracture in another finger. Wearing gloves was again possible in 26 cases. Fusion was achieved in 18 of the 21 cases evaluated with X-rays at the last follow-up (85.7%). All the other cases had a non-union with no clinical repercussions. There were 5 local recurrences at the level of the little finger. Finger shortening through a dorsal approach seems to provide satisfactory outcomes in patients with Dupuytren's disease who have severe contracture of the little finger. This technique results in an acceptable looking functional finger, which has sensation and no significant morbidity.