gms | German Medical Science

Objectives: Arthrodesis of the proximal interphalangeal joint of the finger is an established procedure for advanced osteoarthritis. Since there are different techniques of fusion it seems necessary to evaluate the results. In a systematic review it was analyzed whether different arthrodesis methods of the PIP joint show (1) different numbers of non-unions, (2) different times to consolidation, and (3) do they differ in their complications?

Method: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases included PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies included reported outcomes of the arthrodesis with a defined technique and radiological consolidation. Complication rates and types were recorded.

6.162 articles could be identified, 159 full-texts were assessed and 64 studies included.

Results and Conclusion: A total of 1.923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n=743, 14 studies), Tension-band (n=313, 15 studies) and compression screws (n=233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate showed the interosseous wiring with 8.6%.

All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is the tendency in the more recent literature of the use of compression techniques. A direct comparison of different techniques of arthrodesis is not possible because of the variable quality of published studies, different indications for joint fusion as well as varying definitions of consolidation (radiological versus clinical).