Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

Abstract

Purpose To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation.

Patients and methods Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient’s characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated.

Results Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0–9) and 25.8 (range: 2–38) to 0.4 (range: 0–2) and 3.4 (range: 0–10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58–114) with three non-union.

Conclusion Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.

Zusammenfassung

Ziel Ziel der Untersuchung war die Evaluierung der klinischen und radiologischen Ergebnisse nach Versteifung kleiner Fingerendgelenke unter ausschließlicher Verwendung von K-Drähten.

Patienten und Methoden Zwischen Januar 2000 und Dezember 2018 wurden bei 21 Patienten (9 Männer und 12 Frauen mit einem mittleren Alter von 52,1 Jahren) 28 Arthrodesen kleiner Fingerendgelenke durchgeführt. Angaben bzgl. des Alters und Geschlechts der Patienten, des betroffenen Fingers sowie der Anzahl und Größe der verwendeten K-Drähte wurden den Patientenakten entnommen. Der Durchmesser der Endglieder sowie deren Markraumes wurde jeweils an der engsten Stelle auf präoperativ gefertigten Röntgenbildern ausgemessen. Die Zeit bis zur knöchernen Heilung sowie der Arthrodesenwinkel wurde anhand von postoperativen Röntgenserienaufnahmen bestimmt. Präoperativ und bei der letzten Nachuntersuchung wurden die Schmerzen mittels der visuellen Analogskala (VAS) und der Quick-DASH-Score erhoben. Des Weiteren wurden Komplikationen erfasst.

Ergebnisse Die durchschnittliche Nachbeobachtungszeit betrug 11,4 Monate. Der kleine Finger war am häufigsten betroffen (n = 12; 42,9 %). Der engste Durchmesser der distalen Phalanx betrug 2,8 mm (SD 0,5), des Markraumes 1,2 mm (SD 0,4). Bei sieben Arthrodesen wurde 1 K-Draht, bei 20 (71,4 %) 2 Drähte und einmal 3 Drähte verwand. Die meisten K-Drähte wiesen einen Durchmesser von 1,1 inches (n = 24; 48 %) bzw. 0,9 inches (n = 21; 42 %) auf. Schmerzen und Quick-DASH-Score verbesserten sich von durchschnittlich präoperativ 6,1 (0 – 9) resp. 25,8 (2–38) bis zur letzten Nachuntersuchung auf 0,4 (0–2) resp. 3,4 (0–10,2). Bei 25 (89,3 %) der 28 Endgelenke kam es zur knöchernen Heilung, 3mal entwickelte sich eine Pseudarthrose.

Schlussfolgerung Die Versteifung kleiner Fingerendgelenke unter ausschließlicher Verwendung von K-Drähten hat eine hohe Erfolgsrate, weshalb wir sie für Patienten mit kleinen Endgliedern empfehlen, bei denen die Gefahr besteht, dass es bei Verwendung dickerer Implantate zu Problemen kommen kann. Allerdings ist die lange Zeitdauer bis zur knöchernen Durchbauung zu bedenken.

Key words

Distal interphalangeal joint arthrodesis - small distal interphalangeal joints - K-wire fixation

Schlüsselwörter

Versteifung des distalen Interphalangealgelenks - kleine distale Interphalangealgelenke - K-Drahtfixation

Publication History

Received: 05 November 2020

Accepted: 21 July 2021

Article published online:
28 September 2021

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