An obliquely placed headless compression screw for distal interphalangeal joint arthrodesis

Takuji Iwamoto, Noboru Matsumura, Kazuki Satou, Shigeki Momohara, Yoshiaki Toyama, Toshiyasu Nakamura

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits. Methods A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. After the resection of synovium and joint cartilage by a dorsal approach, a 0.88-mm diameter guide wire was inserted at the ulnar side of the proximal phalanx in the thumb and radial side of the middle phalanx in the other digits from proximal to distal to fix the joint obliquely. We verified its position under fluoroscopic control and placed the cannulated screw from proximal to distal over the guide wire. Results Intraoperative rigid fixation was obtained except for 1 case, which required additional K-wire fixation. The overall union rate was 96%. Average time to fusion was 11 weeks (range, 8-30 wk), with 76% achieving union within 3 months. There were 2 complications, 1 nonunion and 1 late infection. Other complications such as dorsal skin necrosis, nail deformity, and paresthesia did not occur. Conclusions Efforts to avoid invasion of the nailbed can be technically demanding. We believe that our proximal to distal technique with oblique placement of the headless compression screw is a straightforward and effective method with a relatively low risk of complication. Type of study/level of evidence Therapeutic IV.

Original languageEnglish
Pages (from-to)2360-2364
Number of pages5
JournalJournal of Hand Surgery
Volume38
Issue number12
DOIs
Publication statusPublished - 2013 Dec

Fingerprint

Arthrodesis
Joints
Thumb
Synovial Membrane
Paresthesia
Nails
Cartilage
Necrosis
Skin
Infection

Keywords

  • Arthrodesis
  • distal interphalangeal joint
  • headless compression screw

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

An obliquely placed headless compression screw for distal interphalangeal joint arthrodesis. / Iwamoto, Takuji; Matsumura, Noboru; Satou, Kazuki; Momohara, Shigeki; Toyama, Yoshiaki; Nakamura, Toshiyasu.

In: Journal of Hand Surgery, Vol. 38, No. 12, 12.2013, p. 2360-2364.

Research output: Contribution to journalArticle

Iwamoto, Takuji ; Matsumura, Noboru ; Satou, Kazuki ; Momohara, Shigeki ; Toyama, Yoshiaki ; Nakamura, Toshiyasu. / An obliquely placed headless compression screw for distal interphalangeal joint arthrodesis. In: Journal of Hand Surgery. 2013 ; Vol. 38, No. 12. pp. 2360-2364.
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AB - Purpose To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits. Methods A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. After the resection of synovium and joint cartilage by a dorsal approach, a 0.88-mm diameter guide wire was inserted at the ulnar side of the proximal phalanx in the thumb and radial side of the middle phalanx in the other digits from proximal to distal to fix the joint obliquely. We verified its position under fluoroscopic control and placed the cannulated screw from proximal to distal over the guide wire. Results Intraoperative rigid fixation was obtained except for 1 case, which required additional K-wire fixation. The overall union rate was 96%. Average time to fusion was 11 weeks (range, 8-30 wk), with 76% achieving union within 3 months. There were 2 complications, 1 nonunion and 1 late infection. Other complications such as dorsal skin necrosis, nail deformity, and paresthesia did not occur. Conclusions Efforts to avoid invasion of the nailbed can be technically demanding. We believe that our proximal to distal technique with oblique placement of the headless compression screw is a straightforward and effective method with a relatively low risk of complication. Type of study/level of evidence Therapeutic IV.

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