To the Editor.—
I refer to a CLINICAL NOTE on "Clubbing Secondary to an Arteriovenous Fistula Used for Hemodialysis" (240:142, 1978). I am a clinician who becomes concerned when symptoms and signs are not defined as precisely as possible. Reading that article and looking at Fig 1,I believe those fingers are spatulous but are not really clubbed. To appreciate true clubbing, one should look at the profile of the fingers. The old method of looking at the angle between the plane of the nail and the plane of the distal phalanx is not accepted anymore. Sly and colleagues1 have done some elegant and simple clinical studies to define true digital clubbing.
Athreya BH. Spatulous Fingers vs Clubbed Fingers. JAMA. 1978;240(20):2152. doi:10.1001/jama.1978.03290200030003