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Distal Interphalangeal Joint Arthrodesis: Review and Comparative Analysis of Various Techniques
Sofia Restrepo, BA
1, Tantien Nguyen, BS
2, Joshua U. Hancock, BS
2, Rachel E Becker, DO
3, Victor T. Hung, M.D.
4, Tien Nguyen, BS
2, Alfred Hess, MD
5; Michael C Doarn, MD
6(1)Morsani College of Medicine, University of South Florida, Tampa, FL, (2)Foundation For Orthopaedic Research and Education, Tampa, FL, (3)Cleveland Clinic, Cleveland, OH, (4)Foundation for Orthopaedic Research and Education, Tampa, FL, (5)Florida Orthopaedic Institute, Tampa, FL, (6)Hand and Upper Extremity Surgery, Florida Orthopaedic Insititue, Tampa, FL
INTRODUCTIONOsteoarthritis (OA), characterized by cartilage loss, bone changes, and inflammation, commonly affects hand joints-particularly the distal interphalangeal joint (DIPJ), with ~35% showing radiographic signs by age 40. For refractory cases, DIPJ arthrodesis is used, traditionally employing headless compression screws (HCS) (high fusion rates but hardware-related risks). A smaller fully threaded pin (FTP) offers similar compression with limited evidence, prompting this study to assess FTP's viability as a new standard.
METHODSA retrospective review analyzed patients undergoing DIPJ arthrodesis with HCS or FTP at a single tertiary institution. Surgeons were fellowship trained. Patients were identified via CPT code 26860 (Jan 2020-Oct 2024) and included if >18 years old, with exclusion criteria of inadequate follow-up or trauma-related surgeries. Of 124 patients, 15 received FTP and 109 HCS, with equal left/right distribution. Primary outcome was QuickDASH score; secondary outcomes included operative time, tourniquet time, complications, and reoperation rates to assess FTP efficacy versus HCS.
RESULTSFTP vs. HCS comparisons showed significant baseline QuickDASH differences (56.47 vs. 45.23, p=0.0249) and greater improvement post-surgery with FTP (30.15 vs. 13.31, p=0.0157). Final QuickDASH scores trended lower for FTP (near-significance). FTP also demonstrated shorter operative times (p=0.0333), while tourniquet times, complications, reoperation rates, and follow-up duration showed no significant differences between groups.
DISCUSSION AND CONCLUSIONDIPJ OA severely impacts quality of life through pain, stiffness, and deformity. While HCS remains standard for arthrodesis due to high fusion rates, its large size risks malunion and soft tissue injury. This study evaluated the FTP as an alternative, finding superior functional outcomes (via QuickDASH improvement) and shorter operative times compared to HCS, with no differences in tourniquet time, complications, reoperations, or follow-up duration. These results position FTP as a preferable option for DIPJ arthrodesis.
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