Use of a headless compressive screw for distal interphalangeal joint arthrodesis in digits: clinical outcome and review of complications.

PURPOSE: Arthrodesis of the distal interphalangeal joint (DIPJ) or thumb interphalangeal joints can be necessary to treat pain, deformity, or instability associated with arthritis. Compression and rigid fixation are thought to influence fusion rates and time to union favorably. The purpose of the study was to review the clinical outcome and complications associated with the use of a fully threaded headless compression screw for DIPJ arthrodesis.

METHODS

Twenty-seven distal interphalangeal or thumb interphalangeal fusions were performed with an axial Mini-Acutrak screw in 22 patients. Charts, surgical reports, and preoperative and postoperative x-rays were reviewed to determine the incidence, time to union, and complications. The minimal follow-up period was 3 months.

RESULTS

Twenty-three of the 27 arthrodeses achieved bony union. Complications included symptomatic nonunion (n=1, treated with secondary fusion), asymptomatic nonunion (n=2, left untreated), infection (n=4; 2 patients required implant removal that resulted in nonunion but declined revision) and nail bed injury (n=3).

CONCLUSIONS

The Mini-Acutrak screw technique achieves healing rates that are comparable with but not superior to other techniques. Its main advantages are ease of execution, fully buried hardware, and early mobilization; however, the procedure is associated with complications and meticulous technique is required to avoid them.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.