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Comparative Study of Distal Interphalangeal Joint Arthrodesis With and Without Joint Preparation
Taylor Gritzmaker, BS, BA
1, Catherine Rock, BS
1, Hisham M. Awan, MD
2, Jill Putnam, MD
2; Kanu S Goyal, MD
2(1)Ohio State University College of Medicine, Columbus, OH, (2)Ohio State University, Hand & Upper Extremity Center, Columbus, OH
IntroductionThis study compares patient characteristics, outcomes, and complications of prepared versus unprepared distal interphalangeal joint (DIPJ) arthrodesis. We hypothesize that although longer osseous union times may be noted, patients with increased risks and comorbidities may benefit from fewer incisions and lower infection risk, without significant alteration in satisfaction, complications, or use of the digit.
Methods A retrospective comparison between patients who underwent prepared and unprepared DIPJ arthrodesis was performed using IPJ Arthrodesis CTP codes. Demographics collected include age, sex, diagnosis, handedness, length of symptoms, pre-operative imaging findings, and smoking status. Post-operative information assessing healing around 3 weeks, 3 months, and 6 months was collected. Radiographic findings of osseous union, loss of fixation, and hardware failure were assessed. Complications including infection, nonunion, pain, dysesthesia, patient satisfaction, and use of digit were assessed.
Results12 unprepared DIPJ arthrodeses (8 patients) were identified. Most patients were noted to have multiple comorbidities such as dermatomyositis, contractures, smoking, and additional autoimmune conditions increasing infection susceptibility. Patient complications included 3 (25%) with infection, 2 (17%) with dysesthesia, 1 with weakness, and 1 unable to use the digit. 7 arthrodeses (58%) resulted in osseous union, 4 (33%) in fibrous union, and 1 nonunion. 5 fixations utilized headless compression screws and 7 utilized kirschner wires.
62 prepared DIPJ arthrodeses (52 patients) were identified. Complications included 8 (13%) with infection, 10 (16%) with dysesthesia, 2 (3%) with weakness, 4 (6%) unable to use digit, and 2 (3%) with hardware failure. One patient underwent hardware removal due to pain.
Differences between prepared and unprepared rates of nonunion, loss of fixation, and hardware failure were not statistically significant (p = 0.169, 0.051, 0.127 respectively).
Conclusions Unprepared DIPJ arthrodesis may be a viable option for patients with significant comorbidities who are poor candidates for open arthrodesis. Although higher rates of nonunion and fibrous union were noted in the unprepared group, differences in nonunion rate, loss of fixation, and hardware failure were not statistically significant. Patients with significant comorbidities may be lower demand and tolerate a fibrous union. Higher infection rates within the unprepared group could be attributed to autoimmune conditions and smoking status, increasing risk for infection. With a larger dataset, a more accurate comparison could be made to assess whether the outcomes of unprepared arthrodeses are satisfactory. Based on the study findings, the authors generally recommend prepared DIPJ arthrodesis but support unprepared arthrodesis for patients with significant comorbidities.
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