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A compression arthrodesis device for small joints of the hands
A Compression Arthrodesis Device for Small Joints o] the Hands--J. W. Tupper
A COMPRESSION A R T H R O D E S I S D E V I C E F O R S M A L L JOINTS OF T H E H A N D S
J. W. TUPPER, Oakland, California Intimate bone-to-bone contact and rigid immobilisation are the two mechanical requirements necessary for a successful arthrodesis. These requirements are difficult to meet in the distal interphalangeal joints because of the small amount of suitable bone in the distal phalanx. In other joints such as the metacarpophalangeal or the carpo-metacarpal joints of the thumb, a graft is sometimes necessary to secure fusion by conventional means. Compression is a proven technique for obtaining fusion in large joints where an external device may be used, or as an aid in obtaining union in long bone fractures. In the hand, many surgeons do not wish to leave pins protruding through the skin for a protracted period of time, and because of this the following apparatus has been devised. (Figs. 1 and 2). The screw portion is an orthodontic traction screw obtainable from the dental supply house, and the eye wires may be easily fashioned by the surgeon from .035 Kirschner-wires. TECHNIQUE FOR DISTAL INTERPHALANGEAL $O!NTS
A transverse incision dorsally over the joint is joined by two mid-lateral incisions, making short, proximal and distal flaps. The incision is carried through the extensor tendon and the collateral ligaments, allowing full visualisation of the joint. The cartilage and sub-chondral cortex are then removed in the manner desired by the surgeon, allowing for a good fit between the two cancellous surfaces. An axial Kirschner-wire is then passed through the distal joint to maintain alignment at the proper angle desired. Using a Kirschner-wire as a drill, pass two eye wires on each side of the joint. The straight end of the wire is cut flush with the bone with an end cutter. The threaded wires are then passed from distal to proximal in this fashion, and the nuts on the proximal end tightened until fixation ts quite secure. A pre-set ordinary pin vice may be used as a wrench. In somewhat similar fashion, the device may be used for fusion of other joints and for obtaining healing in un-united fractures of the phalanges. Figs. 3, 4, 5 and 6 illustrate examples of the use of the method. RESULTS
Twenty-three procedures have been carried out in twenty patients. The average fusion time has been 2.9 months. There have been three failures, one in the distal interphalangeal joint, one in the interphalangeal joint of the thumb, and one in the carpometacarpal joint of the thumb. In two cases, the device was improperly inserted, loosened, and required tightening to secure fusion. The fusion times for these two cases were counted after the tightening procedure. A graft was used in only one case, a wrist fusion from radius to metacarpal. CONCLUSION It is not suggested that this is necessarily the best technique in all cases, but it is an addition to the general armamentarium of the surgeon and is particularly useful in cases with previous failures. 62
Vol. 4
No, 1
1972
A. Compression Arthrodesis Device for Small Joints of the Hands--J. W. Tupper
Fig. 1. Model of compression device used to fuse distal joint of finger.
Fig. 2. Eye w i r e s , compression screw, and end wrench.
Fig. 3a. N o n - u n i o n of previous fusion attempt, metacarpophalangeal joint of the thumb.
Fig. 3b. Compression fusion device in place.
Fig. 3c. Final fusion.
Fig. 4a, Non-union proximal phalanx.
Fig. 4b. Compression device in place.
Fig. 4e. Final fusion.
Vol. 4
No. 1
1972
63
A Compression Arthrodesis Device for Small Joints of the Hands--J. W. Tupper
Fig. 5a. Compression Fig. 5b. Lateral view. fusion device used to fuse lunate triquetrum and hamate in case of recurrent dislocation of the l u n a t e AP view.
64
Fig. 5c. Final fusion,
Fig. 6. Compression device for carpo - metafusion of carpal.
Vol. 4
No. 1
1972
A COMPRESSION A R T H R O D E S I S D E V I C E F O R S M A L L JOINTS OF T H E H A N D S
J. W. TUPPER, Oakland, California Intimate bone-to-bone contact and rigid immobilisation are the two mechanical requirements necessary for a successful arthrodesis. These requirements are difficult to meet in the distal interphalangeal joints because of the small amount of suitable bone in the distal phalanx. In other joints such as the metacarpophalangeal or the carpo-metacarpal joints of the thumb, a graft is sometimes necessary to secure fusion by conventional means. Compression is a proven technique for obtaining fusion in large joints where an external device may be used, or as an aid in obtaining union in long bone fractures. In the hand, many surgeons do not wish to leave pins protruding through the skin for a protracted period of time, and because of this the following apparatus has been devised. (Figs. 1 and 2). The screw portion is an orthodontic traction screw obtainable from the dental supply house, and the eye wires may be easily fashioned by the surgeon from .035 Kirschner-wires. TECHNIQUE FOR DISTAL INTERPHALANGEAL $O!NTS
A transverse incision dorsally over the joint is joined by two mid-lateral incisions, making short, proximal and distal flaps. The incision is carried through the extensor tendon and the collateral ligaments, allowing full visualisation of the joint. The cartilage and sub-chondral cortex are then removed in the manner desired by the surgeon, allowing for a good fit between the two cancellous surfaces. An axial Kirschner-wire is then passed through the distal joint to maintain alignment at the proper angle desired. Using a Kirschner-wire as a drill, pass two eye wires on each side of the joint. The straight end of the wire is cut flush with the bone with an end cutter. The threaded wires are then passed from distal to proximal in this fashion, and the nuts on the proximal end tightened until fixation ts quite secure. A pre-set ordinary pin vice may be used as a wrench. In somewhat similar fashion, the device may be used for fusion of other joints and for obtaining healing in un-united fractures of the phalanges. Figs. 3, 4, 5 and 6 illustrate examples of the use of the method. RESULTS
Twenty-three procedures have been carried out in twenty patients. The average fusion time has been 2.9 months. There have been three failures, one in the distal interphalangeal joint, one in the interphalangeal joint of the thumb, and one in the carpometacarpal joint of the thumb. In two cases, the device was improperly inserted, loosened, and required tightening to secure fusion. The fusion times for these two cases were counted after the tightening procedure. A graft was used in only one case, a wrist fusion from radius to metacarpal. CONCLUSION It is not suggested that this is necessarily the best technique in all cases, but it is an addition to the general armamentarium of the surgeon and is particularly useful in cases with previous failures. 62
Vol. 4
No, 1
1972
A. Compression Arthrodesis Device for Small Joints of the Hands--J. W. Tupper
Fig. 1. Model of compression device used to fuse distal joint of finger.
Fig. 2. Eye w i r e s , compression screw, and end wrench.
Fig. 3a. N o n - u n i o n of previous fusion attempt, metacarpophalangeal joint of the thumb.
Fig. 3b. Compression fusion device in place.
Fig. 3c. Final fusion.
Fig. 4a, Non-union proximal phalanx.
Fig. 4b. Compression device in place.
Fig. 4e. Final fusion.
Vol. 4
No. 1
1972
63
A Compression Arthrodesis Device for Small Joints of the Hands--J. W. Tupper
Fig. 5a. Compression Fig. 5b. Lateral view. fusion device used to fuse lunate triquetrum and hamate in case of recurrent dislocation of the l u n a t e AP view.
64
Fig. 5c. Final fusion,
Fig. 6. Compression device for carpo - metafusion of carpal.
Vol. 4
No. 1
1972