Risk factors in distal interphalangeal joint arthrodesis in the hand: a retrospective study of 173 cases

Abstract

In this retrospective study we aimed to analyse the risk factors for complications after different methods of distal interphalangeal arthrodesis in the hand. Forty-four per cent were treated with K-wire/cerclage fixation, 46% with X-fuse® implants (Stryker GmbH, Selzach, Switzerland) and 10% with headless compression screws (HBS®-screw, KLS Martin Group, Tuttlingen, Germany). The median follow-up was 16 weeks (range 6–224). The overall complication incidence was 44% (minor complications 29% and major 15%). The logistic regression showed that osteoarthritis, revisional arthrodesis and smoking had a negative impact on the total complication incidence. A Cox-regression analysis showed that HBS®-screw arthrodesis was associated with a significantly lower incidence of major complications compared with K-wire/cerclage and X-Fuse®-arthrodesis. Revisional arthrodesis was five times more frequently connected with major complications than primary surgery. Smokers were three times more likely to experience major complications than non-smokers. We conclude that arthrodesis of the distal interphalangeal joint often leads to complications. Risk factors must be kept in mind. Level of evidence: III

Comparative Finite Element (FE) Analysis of the Mechanical Behavior in an Innovative Nitinol Staple for Arthrodesis in Distal Interphalangeal Joint

“…In cases of joint deformity or pre-existing instability, joint surgery is often recommended to obtain optimal results. [5][6][7][8] On the other hand, posttraumatic degenerative arthritis, especially in the presence of instability, sometimes requires the use of a prosthesis. 9 DIP joint destruction is caused by inflammatory or degenerative processes, sometimes also by posttraumatic injury, and can be easily diagnosed through clinical examination and radiographic examination.…”

Arthrodesis of distal interphalangeal and thumb interphalangeal joint: a retrospective cohort study of 149 cases

“…There is no consensus on which method should be used [5][6][7][8]. Fixation with a headless compression screw has been associated with slightly higher bone union rates, but it increases the risk of certain minor complications that do not affect the outcome (e.g., wound healing problems, dysesthesia, and long-lasting postoperative pain) [9]. A systematic literature review of 32 studies covering 1125 cases of DIP joint arthrodeses reported overall complication frequencies of 19% for headless compression screws and 13% for K-wires, while the results on bone union frequency ranged from 91-96% for the different methods [5].…”

“…A systematic literature review of 32 studies covering 1125 cases of DIP joint arthrodeses reported overall complication frequencies of 19% for headless compression screws and 13% for K-wires, while the results on bone union frequency ranged from 91-96% for the different methods [5]. Moreover, a recent retrospective study suggested that the choice of surgical technique will affect the outcome, as headless compressions screw arthrodesis was associated with a signi cantly lower rate of major complications when compared with K-wire/cerclage [9].…”

“…Several studies have highlighted the signi cant variation in complication rate regarding the different methods [9,10]. It is therefore important to have a standardized de nition of complications and their documentation in order to avoid systematic error.…”

“…All methods can lead to non-union, hardware migration, loosening, skin necrosis, permanent stiffness of the proximal interphalangeal (PIP) joint, paresthesia, and osteomyelitis [11]. A retrospective study including 173 DIP joint and thumb IP joint arthrodeses concluded that arthrodesis of these joints is often associated with complications [9], reporting an overall complication frequency of 44% (minor complications 29%, major complications 15%). Minor complications were de ned as prolonged pain (8%), dysesthesia (14%), and wound healing problems (7%), and major complications as osteomyelitis (15%), nonunion (6%), implant failure (4%), and malalignment (1%).…”