Tag Archives: arthritis

Limitations for Headless Compression Screws in Distal Interphalangeal Arthrodesis in Patients, Especially Women, with Small Fingers

Headless Compression Screws

LEFT: A well-placed and appropriately
sized headless compression screw in a
female patient.
RIGHT: An oversized and slightly dorsal
placed screw has cut out of the dorsal
cortex of the distal phalanx in this female,
putting her at risk of fingernail injury and
nonunion.

Arthrodesis of distal interphalangeal (DIP) joints using headless compression screws for internal fixation is often used to relieve arthritis-related pain, instability, and deformity. New findings highlight important limitations in the broad use of this hardware in female patients and others with smaller bones. In women, 65 percent of small fingers and approximately 25 percent of women’s index and ring finger distal phalanges were too small to safely accommodate the 2.8 millimeter trailing thread diameter of commonly used commercially available cannulated compression screws.1 By contrast, less than 8 percent of male distal phalanges were too small for such screws. The findings are based on analysis of distal phalanges height and width from digital radiographs of 200 hands from 200 patients at Penn State Hershey Bone and Joint Institute.1

The lead investigator, Michael Darowish, M.D., explains, “Achieving DIP arthrodesis safely with headless compression screws in patients with smaller bones, particularly women, has been a concern, but the true extent of the issue wasn’t objectively investigated until now. That more than half of all female patients undergoing DIP arthrodesis may be affected is probably much greater than most surgeons would have guessed.”

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Advantages of Total Ankle Replacement versus Pantalar Arthrodesis

Ankle Replacement

A) Preoperative anteroposterior X-ray
B) Lateral postoperative anteroposterior X-ray
C) Lateral X-ray with replacement

Patients suffering from severe arthritis of the ankle or foot, or patients with pes planus, or “flat foot,” commonly undergo fusion of the hind-foot joints (triple arthrodesis). When successful, such arthrodeses can eliminate or substantially decrease pain associated with weight-bearing activities.

“Patients can expect almost normal activity following hind-foot arthrodesis, although side-to-side motion is limited,” explains Paul Juliano, M.D., chief of foot and ankle orthopaedics at Penn State Hershey Bone and Joint Institute. “A potential negative consequence of this procedure is that the joints above and below the fused area take extra stress, and as a result, arthritis can progress in the ankle and the mid-foot,” explains Juliano.

Pantalar arthrodesis (the addition of an ankle arthrodesis to a previously performed hind-foot arthrodesis) has been traditionally performed as a salvage procedure, to alleviate severe pain and stabilize an unstable ankle or foot. Juliano notes, however, “While the pantalar arthrodesis can alleviate pain, it leaves the patient with something very similar to a ‘peg-leg’, with no ability to flex the foot forward and back or side-to-side. Functionality is poor. One could also expect arthritis and pain to progress in the knee and hip.” Continue reading

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