The key investigation in clinodactyly is radiography. This reveals the alignment and bony configuration of the affected digit. The distal interphalangeal joint surface is typically inclined radially and the cause of this may be found in the middle phalanx for the digits or the proximal phalanx for the thumb. These latter bones often exhibit a delta phalanx that brackets the phalanx longitudinally to give a 'C' shape. Generally, this is only seen after ossification has commenced and it may be necessary to take repeat films if the child presents in infancy. Alternatively, a magnetic resonance scan can show the abnormal epiphysis at an early stage.
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