Die Zugschraubenarthrodese von Fingergelenken

Abstract

Arthrodesis of proximal and distal interphalangeal joints. Joint destruction after primary or secondary arthritis accompanied by activity related pain. Joint instability interfering with pinch and not amenable to soft tissue procedures. Irreversible contracture in flexion or extension. Acute infection. Lack of bone stock. Unusually large medullary canal precluding safe anchorage of the screw. Supine, hand table. Roll of towel under fingers. Tourniquet at upper arm. Elastic band around base of finger in instances of DIP arthrodesis. Regional: plexus- or ring anaesthesia. Arthrodesis using the lagscrew principle. After resection of the destroyed joint surfaces compression of the fragments using screws of the Martin miniset and applying the lagscrew principle. The screw head will be countersunk. Immobilization on a plaster slab supporting forearm, operated and 1 neigh-bouring finger. Physiotherapy. Scew removal is usually not necessary. The screw head sinks into the medullary canal. Lack of sufficient stability. Lack of bony union. Infection. Gaping at site of arthrodesis. Detachment of the extensor tendon. Countersink hole of insufficient size. Between 1982 and 1992 51 patients had 54 lagscrew arthrodeses. 51 arthrodeses in 48 patients could be reexamined at the end of 1992. Average time of follow-up: 3 1/2 years (6 months to 10 years). No postoperative complication was observed and primary fusion was seen in every patient 4 to 13 weeks postoperatively. In 5 instances the screw had to be removed. The angle of arthrodesis varied between 10° and 54°, a vallue determined preoperatively to accommodate the individual needs. The pinch strength reached 75% of that of the finger of the opposite hand in 2/3 of the patients. Symptom-free were 44 patients, 4 had occasional pain (2 had activity related pain of the entire finger and 2 felt pain with changing weather). 86.8% of the patients assessed their result as good or excellent.