Dimensional analysis of the distal phalanx with consideration of distal interphalangeal joint arthrodesis using a headless compression screw

Background

Headless compression screws have been used for arthrodesis of the distal interphalangeal joint with good clinical results. However, some distal phalanges are too small, thus precluding their use, or increasing complication rates.

Methods

In order to validate our digital measurements, radiographs of five cadaveric hands were obtained. The distal phalanges of these fingers were measured using our institution’s digital radiograph software. The cadavers were then dissected, and the actual phalanges were measured to confirm the accuracy of the digital measurements; 200 consecutive hand radiographs were then measured to obtain average width and heights of the narrowest measurements of the distal phalanx of each finger. Subgroup analysis of each finger for age and gender was completed.

Results and Conclusions

Females were routinely smaller than their male counterparts. No age-related differences were seen. A substantial number of fingers were found to be too small to allow for use of headless compression screws; 42 % of small finger distal phalanges are too small to accommodate 2.8-mm threads, and that number increases to 81 % with 3.2-mm threads and 97 % with 3.5-mm threads. Few distal phalanges, regardless of which finger, are large enough to accommodate 3.5-mm-diameter threads; 22% of female ring finger distal phalanges are smaller than 2.8 mm, and 66 % of ring fingers are smaller than 3.2 mm. Based on our measurements, a surprising number of distal phalanges are smaller than the trailing thread diameter of commonly commercially available headless screws. Care must be taken in selecting implants for distal interphalangeal (DIP) fusion.     

Distal interphalangeal joint arthrodesis: treatment with Herbert screw

From 1996 to 2000, 20 patients with a mean age of 53 underwent 20 arthrodeses with Herbert screws. There were 16 (80%) distal interphalangeal joint (DIP) and 4 (20%) thumb interphalangeal (IP) joint arthrodeses. Average follow-up was 25 months (range, 6-39 months). The diagnoses included rheumatoid arthritis in 10 patients, degenerative arthritis in 4, and post-traumatic arthritis in 6. Arthrodesis relieved pain and restored stability in all patients. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for DIP and 12 weeks for IP joint arthrodesis. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for distal interphalangeal joint arthrodesis and 12 weeks for interphalangeal joint of the thumb. There were three complications: one delayed union, one nonunion because of a short screw, and one dorsal skin necrosis with amputation. It was shown that distal interphalangeal joint arthrodesis with a Herbert screw is a technique with several advantages: good clinical results, high rates of fusion, early mobilization, and the screw does not need to be removed after the fusion heals. Potential complications may be avoided by using the Herbert mini-screw.     

Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

Introduction  

We performed radiologic measurement of the distal and middle phalanges in volunteers to determine the size of a headless compression screw suitable for distal interphalangeal (DIP) joint arthrodesis in Korean subjects and report on clinical results using an acutrak fusion screw.     

无头加压螺钉联合PHILOS钢板固定在胫距跟关节融合中的应用

目的探讨应用无头加压螺钉联合PHILOS钢板行胫距跟关节融合术治疗胫距、距下关节严重病变的临床疗效。方法笔者自2011-02—2014-02采用经外踝截骨入路、无头加压螺钉联合PHILOS钢板行胫距跟关节融合术治疗13例胫距、距下关节病变患者。所有患者均有足踝部疼痛,功能受限。术后功能评价采用美国骨科足踝协会(AOFAS)踝和后足评分系统。结果 1例失访,12例获得随访12~24个月,平均16.7个月。切口均一期愈合,术后平均11.3(8~16)周达骨性愈合。末次随访患者关节疼痛完全缓解,无内固定失败及融合失败等并发症发生,末次随访所有患者踝关节疼痛均得到明显缓解,无行走痛,步态基本正常。术前AOFAS评分为(48.75±6.8)分,末次随访AOFAS评分为(83.5±8.4)分,术后AOFAS评分优于术前,差异有统计学意义(t=18.790,P0.001)。2例出现足背外侧皮肤感觉减退,末次随访未恢复。结论经外踝截骨无头加压螺钉联合PHILOS钢板行胫距跟关节融合术,固定强度可靠,融合率高,是临床治疗踝关节和距下关节严重关节疾病的一种有效方法。     

Instructional Course Lecture. Arthrodesis of the interphalangeal joints with headless compression screws

Interphalangeal arthrodesis is a reliable method of pain relief for arthritic proximal and distal interphalangeal joints in the fingers. Indications include osteoarthritis, acute trauma, chronic reconstruction for trauma, rheumatoid and other inflammatory arthritides, and at the distal interphalangeal joint, chronic mallet finger deformity and unreconstructible flexor tendon defects. Solid arthrodesis imparts stability to the digital skeleton. Headless compression screws can be reproducibly inserted and are a good method to provide fixation adequate to accomplish interphalangeal arthrodesis. Surgical technique involves a dorsal incision and preparing the skeleton for good bony apposition. Exact technique for screw insertion depends on the specific screw used. Union rates range from 85% to 100% in published studies, with time to union of 7 to 10 weeks.     

Proximal interphalangeal joint arthrodesis with the Herbert screw

Numerous fixation techniques have been described to obtain successful proximal interphalangeal (PIP) joint arthrodesis. By use of the Herbert screw for compression, 50 (98%) out of 51 PIP joints were fused within 6 weeks. Biomechanically, PIP joint arthrodeses using the Herbert screw in cadaver joints were comparable to tension band arthrodeses evaluated by three-point bending. Herbert screw arthrodesis of the PIP joint achieves a high fusion rate with minimal external protection provided certain technical details are followed.     

Use of a headless compressive screw for distal interphalangeal joint arthrodesis in digits: clinical outcome and review of complications

PURPOSE: Arthrodesis of the distal interphalangeal joint (DIPJ) or thumb interphalangeal joints can be necessary to treat pain, deformity, or instability associated with arthritis. Compression and rigid fixation are thought to influence fusion rates and time to union favorably. The purpose of the study was to review the clinical outcome and complications associated with the use of a fully threaded headless compression screw for DIPJ arthrodesis. METHODS: Twenty-seven distal interphalangeal or thumb interphalangeal fusions were performed with an axial Mini-Acutrak screw in 22 patients. Charts, surgical reports, and preoperative and postoperative x-rays were reviewed to determine the incidence, time to union, and complications. The minimal follow-up period was 3 months. RESULTS: Twenty-three of the 27 arthrodeses achieved bony union. Complications included symptomatic nonunion (n=1, treated with secondary fusion), asymptomatic nonunion (n=2, left untreated), infection (n=4; 2 patients required implant removal that resulted in nonunion but declined revision) and nail bed injury (n=3). CONCLUSIONS: The Mini-Acutrak screw technique achieves healing rates that are comparable with but not superior to other techniques. Its main advantages are ease of execution, fully buried hardware, and early mobilization; however, the procedure is associated with complications and meticulous technique is required to avoid them. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Distal interphalangeal joint arthrodesis with screw fixation: why and how

Though DIP joint fusion can be successfully achieved with K-wires in both the osteoarthritic and rheumatoid patient, their use is often some-what of an inconvenience to the patient. They prohibit showering, may become infected, may back out and catch on clothing, and surely slowdown mobilization of the rest of the finger [1]. For optimal prehension, a modest amount of DIP joint flexion is required, however. Thus, one advantage of K-wires is that they allow fusion in 5 degrees to 10 degrees of flexion (Fig. 1). In the rheumatoid patient in particular, bone stock may be so com-promised that getting enough purchase with wires alone can be challenging. Since making the transition to the Herbert screw, hardware-related complications and patient dissatisfaction with obligatory postoperative functional limitations until union is achieved have been eliminated. Despite the fact that the fusion must occur without flexion-a necessity to ensure intramedullary placement of the screw-patients seem to adapt well (Fig. 2). One further potential disadvantage of screw fixation is the issue of size mismatch between phalanx and screw-especially in the small finger. Though cautious insertion is justified, precise technique allows use even in the small finger-a benefit when early motion is indicated; for example, when concomitant proximal interphalangeal (PIP) implant arthroplasty is performed in an adjacent digit. This device is contraindicated, obviously, if future PIP joint arthro-plasty is anticipated in the same finger (Fig. 3).     

Distal interphalangeal joint arthrodesis: An analysis of complications

One hundred thirty-nine patients underwent 181 arthrodeses of finger distal interphalangeal joints (144) and/or thumb interphalangeal joints (37). Techniques included (1) crossed Kirschner pins (111 joints), (2) interfragmentary wire and longitudinal Kirschner pin (43 joints), and (3) Herbert screw (27 joints). Each technique had a similar nonunion rate. There were 21 nonunions: 13 were pain free, 6 were successfully fused on the second attempt, 1 was painful (but the patient refused further surgery), and 1 was amputated. Inadequate bone stock, inadequate bone resection, premature pin removal, and infection appear to complicate the attainment of bony union. Twenty percent of the fusions had major complications (nonunion, malunion, deep infection, and osteomyelitis). Minor complications (dorsal skin necrosis, cold intolerance, proximal interphalangeal joint stiffness, paresthesias, superficial wound infection, and prominent hardware) occurred in 16% of the joints fused.     

Distal interphalangeal joint arthrodesis using a minimally invasive technique with the herbert screw

The authors performed six joint arthrodeses of the distal interphalangeal joint in five patients without surface preparation of the joint using the Herbert screw. After the surgery, the joint was not splinted and the finger could be used in daily living activities, provided the patient did not attempt powerful pinching or gripping maneuvers with the affected finger. Although bony union of the joint was delayed, firm bone union was ultimately obtained in all joints. If it is acceptable to position the arthrodesis of the distal interphalangeal joint with 0 degrees of flexion, this technique can be considered very useful. Although the omission of joint surface treatment in this technique prolongs the period before bony union of the joint is attained, patients feel no inconvenience in using their fingers in daily living activities.     

Herbert螺钉治疗腕舟骨骨折

2009年3月～2012年7月,笔者对8例腕舟骨新鲜骨折患者采用Herbert螺钉治疗,疗效满意,报道如下.     

Ipsilateral scaphoid and intra-articular radius fracture treated by Herbert screw fixation

The type and extent of a wrist lesion depends on the angulation of the hand, the force of impact and the age of the patient. We report on an unusual transscaphoidal subluxation fracture in combination with a shear fracture of the radius, caused by a low impact hyperextension trauma. To provide interfragmentary compression and a free mobility of the articular surfaces, two Herbert screws were used for osteosynthesis. The Herbert screw was designed originally for osteosynthesis of scaphoid fractures. As this implant can be buried completely within the bone, it allows fixation of other small articular fragments accordingly. This is demonstrated in the patient presented here who had a hyperextension trauma with unusual consequences. Received: 6 May 1997 / Accepted: 12 August 1997     

Herbert钉治疗Lisfranc关节骨折脱位

<正>2010年9月~2013年5月,我院收治13例Lisfranc损伤患者,给予切开复位、Herbert钉结合克氏针内定,效果满意,报道如下。1材料与方法1.1病例资料本组13例,男8例,女5例,年龄21~52岁。左侧7例,右侧6例。按Myerson分型:A型2例,B型4例,C型7例。按Myerson三柱分类:中柱损伤3例,中柱合并内侧柱损伤4例,三柱损伤6例。1.2手术方法硬膜外麻醉。足背第1、2跖骨基底作纵行切口,显露第1、2     

经皮Herbert螺钉治疗腕舟骨骨折

目的探讨Herbert螺钉及微创外科技术治疗腕舟骨骨折的临床疗效。方法应用Herbert螺钉微创治疗18例腕舟骨骨折。术前CT确诊骨折及分型;术中结节部小切口入路,采用克氏针闭合一次性穿入技术、Herbert螺钉加压髓内固定技术。结果 18例均获得随访,时间4～14个月,均骨性愈合。按Krimmer腕关节功能总体疗效评分:优13例,良3例,满意1例,差1例。结论应用Herbert螺钉及微创外科技术治疗腕舟骨骨折疗效满意。     

应用Herbert螺钉内固定治疗腕舟骨骨折

目的介绍用Herbert螺钉内固定治疗不稳定型腕舟骨骨折及腕舟骨骨折骨不连的疗效.方法 1992年12月至1996年12月,用Herbert螺钉内固定治疗不稳定型腕舟骨骨折20例,腕舟骨骨折骨不连14例.结果不稳定型腕舟骨骨折失访5例,15例术后平均随访12.8个月,骨折全部愈合;腕关节活动范围在106°～128°之间.腕舟骨骨折骨不连14例术后平均随访18.3个月,骨折愈合率为85.7%.结论 Herbert螺钉治疗腕舟骨骨折具有对骨折端的加压作用、固定稳固、可经关节面置入、无需取出等优点.     

切开复位Herbert螺钉内固定治疗股骨头骨折

正2007年1月~2014年10月,我科依据不同Pipkin分型选择切开复位Herbert螺钉内固定治疗15例股骨头骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男13例,女2例,年龄21~58岁。左侧6例,右侧9例。骨折按Pipkin分型:Ⅰ型3例,Ⅱ型8例,Ⅲ型3例,Ⅳ型1例。1例合并坐骨神经损伤。受伤至手术时间2~     

Herbert螺钉治疗Ⅲ型尺骨冠突骨折伴肘关节脱位

目的 探讨Herbert螺钉内固定对Ⅲ型尺骨冠突骨折伴肘关节脱位的治疗效果.方法 采用Herbert螺钉内固定治疗Ⅲ型尺骨冠突骨折伴肘关节脱位20例.结果 18例得到随访,随访时间7～28个月,平均16个月;骨折骨性愈合时间10～12周,平均11周;根据Morrey肘关节功能评定疗效：优12例（66.7%）,良5例（27.8%）,可1例（5.6%）,优良率为94.4%;均无深部感染、内固定松动或断裂、肘关节脱位及肘关节强直等并发症.结论 Herbert螺钉内固定治疗Ⅲ型尺骨冠突骨折伴肘关节脱位,手术创伤小、功能恢复好,是一种行之有效的手术方法.     

Herbert螺钉内固定治疗桡骨小头骨折15例

目的：观察随访用Herbert螺钉内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折的临床近期疗效。方法：2008年3月至2010年7月,采用切开复位Herbert螺钉内固定治疗15例MasonⅡ、Ⅲ型桡骨小头骨折,男6例,女9例;年龄18～55岁,平均32岁;左侧7例,右侧8例。受伤到入院时间3～10h。患者入院时肘部肿胀疼痛,肘关节活动受限,肘关节可闻骨擦音,X线片示桡骨小头骨折。对患者术后肘关节功能恢复观察采用Mayo肘部评分系统。结果：术后患者伤口愈合Ⅰ/甲,术后未见肘关节骨化性肌炎,随访6～15个月,依据Mayo肘部评分,优8例,良5例,可2例。Mayo评分（86.67±1.26）分,其中疼痛（53.33±9.76）分,关节活动度（27.33±4.58）分,关节稳定性（6.00±2.07）分;肘关节活动度70°～130°,平均（105±10）°,前臂旋转度100°～130°,平均（120±16）°。结论：用Herbert螺钉对MasonⅡ型及部分MasonⅢ型桡骨小头骨折固定,复位满意、固定可靠、方法简单,利于早期进行功能锻炼。