Abstract
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.
Materials and methods
Radiologic measurements on the distal and middle phalanx were performed to determine the optimal size of screw. Five hundred fingers from 50 adult Koreans without any abnormality on plain radiographs were selected and anteroposterior and lateral radiographs were obtained for measurements. For the distal phalanx, the narrowest diameter of the cortical bone was measured to determine the minimal diameter of the screw that would not penetrate the cortex. For the middle phalanx, the narrowest diameter of the medullary canal was measured to determine the appropriate size of the screw for fixation. Between May 2004 and December 2007, there were 23 fingers in 22 patients (6 male, 16 female) that had finger DIP joint or thumb IP joint arthrodesis performed with the acutrak fusion screws. At the final follow up, time to union, complications, clinical fusion angle, pinch power, visual analogue score (VAS) for pain and the Korean version of the disabilities of the arm, shoulder and hand (DASH) questionnaire were assessed.
Results
In the distal phalanx, the narrowest diameter of the cortex was 2.64 ± 0.51 mm for the little finger. In the middle phalanx, the narrowest diameter of the medullary canal was 1.83 ± 0.50 mm for the little finger and 4.17 ± 0.68 for the thumb. The mean time to union was 10 weeks (range 8–12). The mean clinical fusion angle of the DIP joint was 11.9° (range 0–20). The VAS pain score was 0.4 (range 0–3). Pinch power was 75% of the normal side. The average Korean DASH score was 5 points (range 0–8). We experienced one intraoperative fixation failure for thumb IP joint arthrodesis caused by a wide medullary canal of the proximal phalanx.
Conclusion
The acutrak fusion screw was a feasible and adequate tool for DIP arthrodesis, particularly in Koreans. However, meticulous attention to technique was important to avoid complications in some little fingers. If preoperative radiographs suggest the thumb has a wide medullary canal, alternate methods of fixation should be considered.
Similar content being viewed by others
References
Tomaino MM (2006) Distal interphalangeal joint arthrodesis with screw fixation: why and how. Hand Clin 22(2):207–210
Brutus JP, Palmer AK, Mosher JF, Harley BJ, Loftus JB (2006) Use of a headless compressive screw for distal interphalangeal joint arthrodesis in digits: clinical outcome and review of complications. J Hand Surg Am 31(1):85–89
Stern PJ, Fulton DB (1992) Distal interphalangeal joint arthrodesis: an analysis of complications. J Hand Surg Am 17(6):1139–1145
El-Hadidi S, Al-Kdah H (2003) Distal interphalangeal joint arthrodesis with Herbert screw. Hand Surg 8(1):21–24
Faithfull DK, Herbert TJ (1984) Small joint fusions of the hand using the Herbert bone screw. J Hand Surg Br 9(2):167–168
Ishizuki M, Ozawa H (2002) Distal interphalangeal joint arthrodesis using a minimally invasive technique with the Herbert screw. Tech Hand Up Extrem Surg 6(4):200–204
Gomez CL, Proubasta I, Escriba I, Itarte J, Caceres E (2003) Distal interphalangeal joint arthrodesis: treatment with Herbert screw. J South Orthop Assoc 12(3):154–159
Arata J, Ishikawa K, Soeda H, Kitayama T (2003) Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail. Scand J Plast Reconstr Surg Hand Surg 37(4):228–231
Drake ML, Segalman KA (2010) Complications of small joint arthroplasty. Hand Clin 26(2):205–212
Mikolyzk DK, Stern PJ (2011) Steinmann pin arthrodesis for salvage of failed small joint arthroplasty. J Hand Surg Am 36(8):1383–1387
Namdari S, Weiss AP (2009) Anatomically neutral silicone small joint arthroplasty for osteoarthritis. J Hand Surg Am 34(2):292–300
Wilgis EF (1997) Distal interphalangeal joint silicone interpositional arthroplasty of the hand. Clin Orthop Relat Res 342:38–41
Olivier LC, Gensigk F, Board TN, Kendoff D, Krehmeier U, Wolfhard U (2008) Arthrodesis of the distal interphalangeal joint: description of a new technique and clinical follow-up at 2 years. Arch Orthop Trauma Surg 128(3):307–311
Leibovic SJ (2007) Instructional course lecture: arthrodesis of the interphalangeal joints with headless compression screws. J Hand Surg Am 32(7):1113–1119
Mantovani G, Fukushima WY, Cho AB, Aita MA, Lino W Jr, Faria FN (2008) Alternative to the distal interphalangeal joint arthrodesis: lateral approach and plate fixation. J Hand Surg Am 33(1):31–34
Seitz WH Jr, Sellman DC, Scarcella JB, Froimson AI (1994) Compression arthrodesis of the small joints of the hand. Clin Orthop Relat Res 304:116–121
Sabbagh W, Grobbelaar AO, Clarke C, Smith PJ, Harrison DH (2001) Long-term results of digital arthrodesis with the Harrison–Nicolle peg. J Hand Surg Br 26(6):568–571
Faran KJ, Ichioka N, Trzeciak MA, Han S, Medige J, Moy OJ (1999) Effect of bone quality on the forces generated by compression screws. J Biomech 32(8):861–864
Toby EB, Butler TE, McCormack TJ, Jayaraman G (1997) A comparison of fixation screws for the scaphoid during application of cyclical bending loads. J Bone Joint Surg Am 79(8):1190–1197
Wyrsch B, Dawson J, Aufranc S, Weikert D, Milek M (1996) Distal interphalangeal joint arthrodesis comparing tension-band wire and Herbert screw: a biomechanical and dimensional analysis. J Hand Surg Am 21(3):438–443
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Song, JH., Lee, JY., Chung, YG. et al. Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses. Arch Orthop Trauma Surg 132, 663–669 (2012). https://doi.org/10.1007/s00402-011-1413-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-011-1413-3