Surgical Treatment for Kirner’s Deformity—Single Osteotomy through a Palmar Approach

Background: Patients with Kirner's deformity often seek medical attention for aesthetic improvement when they reach the age of approximately 10 years, when the deformity becomes evident. The operative technique described in textbooks is the palmar opening-wedge with multiple osteotomies through a mid-lateral incision, which is technically demanding. The purpose of this article was to introduce our surgical technique of a single transverse osteotomy through a palmar approach and to present the short-term outcomes of this technique. Methods: The surgical outcomes of 7 digits in 4 children were retrospectively reviewed. The deformed distal phalanx was approached with an oblique incision of the pulp, and the palmar cortex was incised at the apex of the curvature. The dorsal cortex was only partially incised and broken manually when correcting the deformity by a palmar opening-wedge. The dorsal aspect of the phalanx was not exposed, and the nail plate was left intact. The fragments were fixed with Kirschner wires. Results: There was no postoperative complication, and the osteotomy sites all healed uneventfully. None of the patients complained about scar pain or hypersensitivity of the finger pulp. The patients and their parents were satisfied with the aesthetic results. Conclusions: A single palmar opening-wedge osteotomy at the apex sufficiently corrected the main curvature, and the subtle curvature remaining at the tip of the phalanx did not affect the appearance. This technique is simple and easy; therefore, it is recommended as a reliable procedure for patients with Kirner's deformity who are approaching puberty. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 26 February 2018. Received for publication September 8, 2017; accepted December 21, 2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Shukuki Koh, MD, Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3–35 Michishita-cho, Nakamura-ku, Nagoya 453–8511, Japan, E-mail: skoh@nagoya-1st.jrc.or.jp Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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