Dorsal Plate Fixation for Distal Interphalangeal Joint Arthrodesis of the Fingers and Thumb
Anand Patel, BS, MD; Dhanur Damodar, BA, MD; Seth D Dodds, MD
University of Miami, Miami, FL
Introduction: Arthrodesis is generally the most accepted surgical option for treatment of degenerative and traumatic conditions involving the DIP joint of the fingers or the IP joint of the thumb. Ideal position of arthrodesis is thought to be slightly flexed in order to improve power, fine pinch, and grip post fusion. However, surgeons commonly ignore this recommendation in favor of using a convenient straight intra-medullary implant which obligates the joint to be positioned in neutral extension. We propose a novel technique that allows the surgeon to fuse the most distal interphalangeal joints in flexion to improve functionality using dorsal plate fixation.
Materials and Methods:
We retrospectively reviewed six patients that were treated with thumb IP or finger DIP arthrodesis via dorsal plate fixation. An H shaped incision is made to access the DIP joint and a full thickness fasciocutaneous flap is elevated proximally. Extensor tendon is incised transversely, 5mm proximal to the joint. Soft tissue attachments between the overlying skin and the underlying terminal extensor tendon are preserved to maintain a robust soft tissue envelop for closure. Next, collateral ligaments of the joint are released and articular cartilage is debrided. Two sides of the arthrodesis are positioned in appropriate flexion and held with a K wire. A low profile mini "grid" or "bicolumnar" plate is contoured to the bone at the desired degree of joint flexion and screws are placed in compression mode to achieve fixation. All patients were followed with clinical examinations and intermittent radiographs in clinic.
Our case series included six patients with an average age of 45.5. 3 patients had the procedure performed on the thumb, and the other three on index, middle and ring finger respectively. 5/6 patients were followed for over 1 year with the last patient being only 6 months post surgery. Average flexion for the thumb was 28.3° degrees compared to 11.6° degrees for the fingers. 100% of patients healed their wounds without any complications and went onto union. 2 out of 6 patients elected to undergo plate removal while another reported cold intolerance over the fusion site but did not pursue hardware removal when offered.
Low profile plate fixation through dorsal approach for distal joint arthrodesis is an excellent option. It allows for a more functional position of fusion without violating the volar/distal aspect of the distal phalanx, and provides secure internal fixation that does not require post op immobilization.
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