gms | German Medical Science

Objectives/Interrogation: The authors have hypothesized that an alternative technique for arthrodesis of the DIPJ of the fingers or IPJ of the thumb using pre-tensioned implants for intramedullary fixation can provide a high rate of satisfactory union and anatomic position with a minimal complication rate.

Methods: Twenty-one distal interphalangeal joint arthrodesis and 11 thumb interphalangeal joint arthrodesis were performed in 16 patients (10 women and 6 men). Age range between 6 and 79 years with a mean age of 62 years. In five patients a single joint arthrodesis was performed whereas in 11 patients more than one arthrodesis was performed. All patients included in this study were followed for a minimum of two years.

Results and Conclusions: The mean time to healing was eight weeks with a range of six to ten weeks. By ten weeks, healing was noted in 31 of 32 digits. The healing was eight weeks with range of 6-10 weeks. By ten weeks there was healing noted in 31 of 32 digits. Only one patient with a delayed union after ten weeks demonstrated a fibrous union that was stable and non-tender. In all cases patients reported no pain at the arthrodesis site by three months postoperatively. There have been no hardware related problems and in no case was the hardware removed. The one patient with delayed union after ten weeks appeared to have formed a fibrous union which was stable and non-tender. All patients described complete absence of pain at the site of arthrodesis and complained of no significant pain or dysfunction by three months post-operatively. There have been no hardware problems and in no case was hardware removed. Functional pinch & grip strength was 80% of normal.

The surgical technique for arthrodesis of the distal joint of the fingers and thumb is straight forward. The technique employed in this series utilizes instrumentation which further simplify the surgical procedure, affords excellent apposition of bone, and intramedullary fixation of the arthrodesed joint. Variability in angle of the implants affords the surgeon the ability to place the fused joint in neutral 15 or 25 degrees of flexion as is needed for patient function. The absence of any hardware related problems, lack of infection and high rate of union, & excellent function indicates this to be a viable and attractive option for arthrodesis of the distal joints in the hand.