A Systematic Review of Distal Interphalangeal Joint Arthrodesis

Arthrodesis of the distal interphalangeal joint of the hand is a reliable procedure for creating a painless stable joint. Numerous techniques are described within the literature for varying indications. We undertook a systematic review of all studies published within the English literature to provide a comparison of the different techniques. The published studies were predominantly of Level IV evidence. The most commonly employed techniques were Kirschner wire, headless compression screw and cerclage wires. There was no difference in infection rates. Headless compression screws appear to have increased union rates but are associated with complications not seen with other well-established and cheaper techniques. The screw diameter is often similar to or larger than the joint itself, which can result in penetration. Furthermore, they limit the available angle for achieving fusion. Other than in terms of union, there is insufficient evidence to show the headless compression screw is superior to other techniques.     

Treatment of Symptomatic Distal Interphalangeal Joint Arthritis with Percutaneous Arthrodesis: a Novel Technique in Select Patients

Arthrodesis of the distal interphalangeal (DIP) joint is a reliable means of achieving pain relief in a symptomatic DIP joint afflicted by a variety of degenerative, inflammatory, or posttraumatic conditions. Successful arthrodesis is more reproducible when rigid compression of the joint is achieved. The emergence of an increasing number of commercially available headless or variable pitch compression screws reflects the growing trend among hand surgeons to utilize rigid stabilization of the DIP joint so that motion at more proximal levels can be initiated immediately without affecting arthrodesis rates. Successful closed percutaneous DIP arthrodesis can be achieved in a patient with hypertrophic osteoarthropathy, passively correctable deformity, and patients at increased risk for perioperative soft tissue complications associated with open arthrodesis. We present a novel percutaneous DIP fusion technique utilizing a cannulated headless compression screw in a select group of patients. The sagittal plane diameters of the distal and middle phalanges are templated. Cannulated headless compression screws, 2.4 and 3.0 mm, with short or long terminal threads at the leading end of the screw are selected based upon patient-specific anatomic considerations. Pain-free status and radiographic fusion were achieved in both patients (gout arthropathy, n = 1; posttraumatic arthritis, n = 1) at an average of 6 weeks postoperatively. Our current indications, along with pearls and pitfalls with this technique, are reviewed. In select patients, this percutaneous DIP joint arthrodesis is advantageous in comparison with open fusion techniques.     

Proximal Interphalangeal Joint Replacement with Surface Replacement Arthroplasty (SR–PIP): Functional Results and Complications

The purpose of the study was to investigate patients with proximal interphalangeal (PIP) joint replacements regarding postoperative function, pain, complications and incidence of reoperations. From 2000 to 2007, 23 patients (11 male, 12 female) with an average age of 47 years (19–72 years) who had symptomatic posttraumatic (15) or idiopathic arthritis (nine) in 24 PIP joints underwent unconstrained PIP joint replacements (formerly AVANTA, now Small Bone Innovations^TM). All 23 patients were instructed in special hand exercises starting the first postoperative day. Thirteen of 23 patients had previous operations. The median history of pain was 12 months (2–120). Fourteen of 24 prostheses needed reoperations (58%): teno-arthrolysis (9×), PIP tenodesis (one in three with swan neck deformity) and explantation (four with infections/loosening). The four explantations resulted in a PIP joint arthrodesis in all cases. Twenty-two patients were available for follow-up at an average of 27 months (4–73 months) postoperatively. The median postoperative pinch grip was 7.6 lbs (4–28 lbs), and the disabilities of the arm, shoulder and hand score was 24 (1–58). The active range of motion of the PIP joint was 33° preoperatively (min 0°, max 75°) and 54° postoperatively (min 0°, max 90°). On the Visual Analogue Pain Scale (VAS, range 0–10), seven patients had mild (VAS 1–3) and four moderate pain (VAS 4–7) in the finger on exercise. Seventy percent were overall satisfied with operation and functional results. The results of surface replacement arthroplasty of the PIP joint are overall satisfying; however, postoperative complications and incidence of reoperations are noticeable and should be mentioned to the patients in the preoperative setting.     

Dorsal Dislocation of the Distal Interphalangeal Joint and Volar Dislocation of the Metacarpophalangeal Joint in the Same Finger: A Case Report

Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare entity. Sixty-four cases of distal and proximal interphalangeal joint double dislocations have been previously reported. Five cases of metacarpophalangeal and interphalangeal double dislocations of the thumb have also been reported. Only one case has been reported in the English literature regarding simultaneous dislocations of the distal interphalangeal and metacarpophalangeal joints in the nonthumb digit. The directions of the dislocation were the same; both were dorsal. We report, to our knowledge, the first ever case of a double dislocation a non-thumb digit in opposing directions—volar at the metacarpophalangeal joint and dorsal at the distal interphalangeal joint.     

The rheumatoid metacarpophalangeal joint

Rheumatoid metacarpophalangeal joint deformities remain an important cause of disability. Surgical intervention in carefully selected patients improves function and prolongs independence. This article discusses the commonly used reconstructive techniques and their benefits. Case selection through a combined clinic with rheumatologists and hand therapists is recommended.