Treatment of Symptomatic Distal Interphalangeal Joint Arthritis with Percutaneous Arthrodesis: a Novel Technique in Select Patients |
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Authors: | David E Ruchelsman Antony Hazel Chaitanya S Mudgal |
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Institution: | (1) Hand and Upper Extremity Service, Massachusetts General Hospital/Harvard Medical School, Yawkey Building 55 Fruit Street, Suite 2100, Boston, MA 02114, USA;(2) University of California-Irvine, 8624 Palo Verde Road, Irvine, CA 92617, USA |
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Abstract: | 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. |
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Keywords: | Arthritis Arthrodesis Distal interphalangeal joint Percutaneous hand surgery |
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