Bilateral proximal delta phalanges of hand: a rare case report with review of literature

Keerthi Kocherla, Prasada Rao Kocherla, Vasantha Kumari Kocherla


Delta phalanx or longitudinal bracketed epiphysis is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. It results from a defective secondary ossification that extends longitudinally along the diaphysis and brackets the diaphysis and metaphysis, causing restricted longitudinal growth and resultant angular deformities. Although rare, longitudinal epiphyseal bracket most commonly manifests in the hands as clinodactyly and in the feet as hallux varus. We report a case of 18 year old male patient with isolated bilateral multiple proximal delta phalanges of hand.


Delta phalanx, Longitudinal bracketed epiphysis, Short proximal phalanges, Clinodactyly, Hallux varus

Full Text:



Johnson JM, Higgins TJ, Lemos D. Appearance of the delta phalanx (longitudinally bracketed epiphysis) with MR imaging. Pediatr Radiol. 2011;41:394-6.

Yucel A, Kuru I, Bozan ME, Acar M, Solak M. Radiographic evaluation and unusual bone formations in different genetic patterns in synpolydactyly. Skeletal Radiol. 2005;34:468-76.

Elliott AM, Evans JA, Chudley AE, Reed MH. The duplicated longitudinal epiphysis or “kissing delta phalanx”: evolution and variation in three different disorders. Skeletal Radiol. 2004;33:345-51.

Calif E, Stahl S. Complex bilateral polysyndactyly featuring a triplet of delta phalanges in a syndactylised digit. Eur Radiol. 2002;12:140-2.

Vickers DW. Delta Phalanx and Madelung’s deformity. In: Berger RA, Weiss APC, eds. Hand Surgery. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2004: 1497-1512.

Mahboubi S, Davidson R. MR imaging in longitudinal epiphyseal bracket in children. Pediatr Radiol. 1999;29:259-61.

Ogden JA, Light TR, Conlogue GJ. Correlative roentgenography and morphology of the longitudinal epiphyseal bracket. Skeletal Radiol. 1981;6:109-17.

Lai MM, Spencer JD, Montandon JA, Berry AC. Triphalangeal thumb with delta phalanx in a case of Klinefelter syndrome. J Med Genet. 1991;28(7):497-8.

Taybi H, Lachman RS. Delta phalanges. In: Taybi H, Lachman RS, eds. Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias. 4th ed. St. Louis: Mosby; 1996a: 1027.

Taybi H, Lachman RS. In: Apert syndrome, Down syndrome, Klinefelter syndrome. Taybi H, Lachman RS, eds. Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias. 4th ed. St. Louis: Mosby; 1996b: 73.

Neil MJ, Conacher C. Bilateral Delta phalanx of the proximal phalanges of the great toes. A report on an affected family. J Bone Joint Surg Br. 1984;66(1):77-80.

Wood BP, Reading GP. Case report 30: longitudinally bracketed diaphysis (“Delta phalanx” anomaly). Skeletal Radiol. 1977;1:259-60.