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DIP joint fusion

Surgeon-side topic for dip joint fusion. Backed by 431 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Dorsal plate fixation via a lateral approach for distal interphalangeal (DIP) joint arthrodesis yields results equivalent to traditional methods but with fewer major complications [1]. Alternative approaches, such as the smile incision and reverse shotgun technique, are suitable when more volar joint preparation and volar implant insertion sites are necessary [2]. For thumb IP joint fusion or finger DIP joint fusion, low-profile plate fixation through a dorsal approach can be performed safely [5].

Headless compression screws provide an acceptable rate of union and ease of operative technique for DIP joint arthrodesis [3], though caution is required to avoid screw prominence in the narrow aspects of the distal and middle phalanges [6]. The "Pepper-Pot" arthrodesis technique is easy to perform, maintains digital length, allows fine-tuning of arthrodesis position, and achieves fusion rates comparable to previously described techniques [9]. Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding simultaneous bony union and flexibility [4].

Arthrodesis serves as a salvage option for failed PIP joint arthroplasty, demonstrating fair to good subjective and functional outcomes, although achieving solid fusion is not completely reliable or without complication [7]. Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict [11]. K-wires offer the easiest compatibility for these combined procedures [11], whereas headless screws used in this setting must ideally not reach proximal to the midpoint of the middle phalanx [11].

Anatomy & Pathophysiology

Peri-articular finger injury patterns vary significantly across the three finger joints, a distinction driven by falling mechanisms and local biomechanical forces [24]. Impairment in precision pinch kinematics is specifically associated with index finger PIP joint fusion [25]. In the context of forearm length, a mean shortening of 3 or 4 cm results in near-complete loss of FDP simulated muscle force and tip-to-palm force in wrist-neutral and wrist-extension positions, respectively [26].

Regarding fixation and motion strategies, the NMSS technique demonstrates biomechanical stability comparable to the AHCS technique in DIPJ and thumb IPJ arthrodesis [36]. The relative motion concept leverages normal functional anatomic relationships of the EDC and FDP muscles to vary forces on finger joints, allowing immediate controlled active motion while reducing undesirable tension [38]. For refractory post-trauma finger joint stiffness, ultrasound-guided capsular hydrodilatation is a relatively simple and minimally invasive procedure that can rapidly reduce pain, swelling, and restore finger joint function [49].

In the thumb and wrist, greater fixation angle in palmar abduction results in more laxity of the thumb metacarpophalangeal joint following trapeziometacarpal arthrodesis [46]. Constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after intercarpal arthrodeses [34], though wrist arthrodesis may only compromise select wrist functions [35]. Altered load distribution patterns suggest significant biomechanical adaptations after scaphotrapeziotrapezoid fusion, supporting its use for scapholunate instability and the treatment of Kienbock's disease [42].

Dupuytren's disease function worsens with increasing deformity and improves with correction of the deformity [41]. FlexRUMM serves as a reproducible tool for estimating the range of movement of the four ulnar digits [44]. Finally, a static cylinder finger splint is needed after use to consolidate tissue remodeling and preserve clinical results in proximal interphalangeal joint flexion contractures [45].

Classification

Surgical Approach and Fixation: The Herbert headless compression screw provides an acceptable rate of union and ease of operative technique for DIP joint arthrodesis [3], though caution is required to avoid screw prominence in the narrow aspects of the distal and middle phalanges [6]. Lateral approach with plate fixation yields results equivalent to traditional methods but with fewer major complications [1], while dorsal plate fixation can be performed safely for DIP joint fusion of the fingers and thumb IP joint fusion through a dorsal approach [5]. The smile incision and reverse shotgun approach is a suitable surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary [2].

Combined Procedures: Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding simultaneous bony union and flexibility [4]. However, combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict [11]. K-wires offer the easiest compatibility for combined DIP arthrodesis and PIP procedures [11], whereas headless screws used in combined DIP arthrodesis and PIP procedures must ideally not reach proximal to the midpoint of the middle phalanx [11].

Risk Factors and Outcomes: Diabetes is a factor that increases the risk of postoperative complications in DIP and thumb IP joint arthrodeses [18], as is surgeon experience [18]. Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the DIP joint [12] and is accompanied by a decrease in range of motion of the DIP joint [12]; however, this decrease in range of motion associated with posttraumatic osteoarthritis does not clinically affect patient-reported outcome measures (PROMs) [12]. Hyperextension of the PIP joint is corrected well by volar transfer of the lateral band with transverse retinacular ligament, but severe extension lag of the DIP joint remains uncorrected postoperatively [14], and the PIP joint arthrodesis angle affects DIP joint extension [10].

Other Considerations: No specific named classification systems (e.g., Schatzker, Gustilo–Anderson) are defined in the provided evidence base for DIP joint fusion; the data focuses on surgical techniques, fixation modalities, and outcome predictors.

Clinical Presentation

DIP joint arthrodesis is indicated for severe painful osteoarthritis of both the PIP and DIP joints of the same digit [17], often serving as a salvage procedure for failed PIP joint arthroplasty. While arthrodesis as a salvage is not completely reliable or without complication, patients demonstrate fair to good subjective and functional outcomes [7]. Radiological osteoarthritis following a mallet finger fracture mimics the natural degenerative process in the DIP joint, accompanied by a decrease in range of motion, yet it does not clinically affect patient-reported outcome measures (PROMs) [12].

Inspection and palpation must account for specific deformities and surgical history. Severe extension lag of the DIP joint remains uncorrected postoperatively following volar transfer of the lateral band with transverse retinacular ligament for swan neck deformity correction [14]. The PIP joint arthrodesis angle affects DIP joint extension [10]. When planning surgical intervention, the Herbert headless compression screw provides an acceptable rate of union and ease of operative technique [3], though caution is required to avoid screw prominence in the narrow aspects of the distal and middle phalanges [6]. For cases requiring more volar joint preparation and volar implant insertion sites, the Smile incision and reverse shotgun approach is a suitable option [2].

Fixation and Approach: * Dorsal approach: IP joint fusion of the thumb or DIP joint fusion of the fingers can be performed safely with low-profile plate fixation [5]. * Volar approach: The Smile incision and reverse shotgun approach is suitable when more volar joint preparation and volar implant insertion sites are necessary [2]. * Screw fixation: The Herbert headless compression screw provides an acceptable rate of union and ease of operative technique [3].

Combined Procedures: * Simultaneous intervention: Simultaneous DIP arthrodesis and PIP Swanson arthroplasty results in favourable outcomes regarding bony union and flexibility [4]. * Indication: Simultaneous surgical intervention is recommended for severe painful osteoarthritis of both the PIP and DIP joints of the same digit [17].

Risk stratification identifies diabetes and surgeon experience as factors increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [18]. Despite these risks, DIP joint arthrodesis results are equivalent to traditional methods but with fewer major complications [1]. However, arthrodesis of the distal interphalangeal joint often leads to complications [31].

Investigations

Plain radiography: Radiological osteoarthritis following mallet finger fractures follows a natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion [12]. Despite these radiological changes, osteoarthritis after mallet finger fractures does not clinically affect patient-reported outcome measures (PROMs) [12]. The angle of proximal interphalangeal joint arthrodesis affects distal interphalangeal joint extension [10].

Other Considerations: Hyperextension of the PIP joint is corrected well by volar transfer of the lateral band with transverse retinacular ligament, but severe extension lag of the DIP joint remains uncorrected postoperatively [14]. Superficialis sling (flexor digitorum superficialis tenodesis) for swan neck reconstruction may be performed with the PIP joint positioned in 20-30 degrees of flexion [8]. Arthrodesis as a salvage for failed proximal interphalangeal joint arthroplasty is not completely reliable or without complication, though patients demonstrate fair to good subjective and functional outcomes [7]. Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding simultaneous bony union and flexibility [4].

Treatment

Operative

Indications: Simultaneous surgical intervention is recommended for severe painful osteoarthritis affecting both the PIP and DIP joints of the same digit [17]. Arthrodesis should be preferred whenever possible if salvage procedures are indicated for severe periprosthetic joint infection [16]. Operative correction of swan-neck and boutonniere deformities frequently reduces pain and increases function, though surgeons must remain reserved regarding long-term results [60].

Surgical Approach / Technique: The lateral approach with plate fixation yields results equivalent to traditional methods but with fewer major complications [1]. IP joint fusion of the thumb or DIP joint fusion of the fingers can be performed safely with low-profile plate fixation through a dorsal approach [5]. The smile incision and reverse shotgun approach is a suitable option when more volar joint preparation and more volar implant insertion sites are necessary [2]. The "Pepper-Pot" arthrodesis technique is easy to perform, maintains digital length, allows the surgeon to fine-tune the position of arthrodesis, and has fusion rates comparable to previously described techniques [9]. The superficialis sling (flexor digitorum superficialis tenodesis) for swan neck reconstruction may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion [8].

Implant Selection: The Herbert headless compression screw provides an acceptable rate of union and ease of operative technique for DIP joint arthrodesis [3]. Caution must be used when considering headless compression screws to avoid problems related to screw prominence in the narrow aspects of the distal and middle phalanges [6]. Care must be taken in selecting implants for DIP joint arthrodesis, and alternative fixation techniques may be required [52]. Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding simultaneous bony union and flexibility [4].

Adjuncts: Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict [11]. K-wires offer the easiest compatibility for combined DIP arthrodesis and PIP procedures [11]. Headless screws used in combined DIP arthrodesis and PIP procedures must ideally not reach proximal to the midpoint of the middle phalanx [11]. Fixation of unstable PIP joint dorsal fracture-dislocations via a volar approach is technically feasible with mini plates and screws, allowing early active range of motion and providing good objective and subjective outcomes, although noteworthy complications occurred in 39% of patients [19]. In most scenarios regarding wrist osteoarthritis, there is no single preferred option between arthrodesis or arthroplasty, complete or partial [64].

Complications

Infection (PJI): Arthrodesis is preferred over above-knee amputation for salvage in severe periprosthetic joint infection due to lower complication and mortality rates [16]. In the specific context of periprosthetic joint infection, knee arthrodesis with an external fixator carries a reduced risk of re-infection compared with the intramedullary nail strategy [83]. Pyarthrosis of the small joints of the hand can often be treated successfully with irrigation and debridement, though 27 patients required either arthrodesis or amputation despite multiple procedures [89].

Aseptic loosening: Revision proximal interphalangeal arthroplasty is associated with a high incidence of complications [71]. While total wrist arthroplasty declined despite positive early outcomes for fourth-generation implants, complications in total wrist arthrodesis occur frequently, most often due to incomplete bone fusion or hardware-related problems [82, 86].

Instability: Fusion surgery for recurrent shoulder instability in epileptic patients results in functional deficits that require comprehensive preoperative counseling [20]. Achieving solid fusion with arthrodesis as a salvage for failed PIP joint arthroplasty is not completely reliable and is not without complication [7].

Periprosthetic fracture: In patients with fused hips, neurovascular structures are located closer to the bone than on the normal side [21].

Stiffness / Arthrofibrosis: Cautious patient selection and consideration of potential complications are crucial for good outcomes in wrist arthrodesis and soft tissue rebalancing for the spastic hand [69].

Wound complications: The lateral approach and plate fixation for DIP joint arthrodesis results in fewer major complications compared to traditional methods [1]. Major complications occurred at roughly half the rate in the staged fasciectomy group compared to the single-stage group for severe PIPJ contractures in Dupuytren disease, although the study was underpowered for complication analysis [73]. Staged distraction osteogenesis followed by arthrodesis using internal fixation offers a high rate of union and reduced external fixation index without infection or wound dehiscence [87].

Other Considerations: The Herbert headless compression screw provides an acceptable rate of union for DIP joint arthrodesis [3], and the rate of fusion for thumb interphalangeal joint and finger DIP joint arthrodesis with a headless compression screw compares favorably with prior series using other methods of fixation [81]. Simultaneous anterograde screw arthrodesis of the DIP joint and silastic PIP joint replacement results in favorable outcomes regarding simultaneous bony union and flexibility [4]. Available proximal interphalangeal joint arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [84]. There is no difference in revision rate, nonunion, or prevalence of painful implant between locking and nonlocking dorsal plate fixation constructs for primary first MTP arthrodesis [76]. Complications are more frequent following thumb carpometacarpal arthrodesis compared with ligament reconstruction and tendon interposition, though most do not affect the overall outcome [67]; patients undergoing thumb carpometacarpal arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo ligament reconstruction and tendon interposition [77]. The most common reason for reoperation after four-corner arthrodesis is implant removal [85]. Few patients in a large consecutive series of open reduction and internal fixation of tarsometatarsal fracture dislocations failed to achieve union or required secondary arthrodesis [23]. There is a non-statistically significant difference in fusion rates between arthroscopic and open ankle arthrodesis techniques [66]. Pooled data analysis demonstrates a higher overall complication rate after ankle arthrodesis compared to total ankle arthroplasty [70], though intermediate results for second-generation total ankle arthroplasty are promising but should be interpreted with care due to the poor history of earlier prostheses and technical difficulties [79]. No conclusions can be made from pooled analysis comparing total ankle arthroplasty versus ankle arthrodesis due to limitations of primary studies in defining endpoints consistently, heterogeneous clinical indications, and imprecise surgical treatment definitions [80].

Recovery

Light activity (weeks): Patients typically return to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [30]. Early functional outcomes following pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint were good, with all children and parents satisfied [74]. Patients with severe recurrent proximal interphalangeal joint contractures in Dupuytren's disease show fairly rapid return to function following arthrodesis [53].

Full activity (months): A significant majority of elite athletes return to their elite level of sport post-operatively following first metatarsophalangeal arthrodesis [75]. The hook plate technique allows patients to tolerate early range of motion exercises [32]. Extension-block pinning for unstable dorsal proximal interphalangeal joint fracture-dislocations produces excellent functional outcomes with minimal long-term disability [78]. Functional recovery following osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint is generally acceptable, with a well-restored joint architecture [51].

Complete recovery / outcome plateau (months): The long-term outcomes of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren's disease show high patient satisfaction with no requirement for revision surgery [53]. Radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up despite radiographic progression [22]. Patients' subjective and functional outcomes following arthrodesis as a salvage for failed proximal interphalangeal joint arthroplasty demonstrate fair to good results [7].

Rehabilitation protocol: The hook plate technique allows patients to tolerate early range of motion exercises [32]. Clinicians and patients might consider early treatment with amputation or arthrodesis for periprosthetic joint infection with concomitant extensor mechanism disruption and soft-tissue defect [37]. Satisfactory results can be achieved with proper patient selection, meticulous technique, and joint fusion in an appropriate position for the patient's activities and expectations [47].

Functional milestones: Total wrist arthrodesis predictably restores grip strength and reduces disability in severe wartime wrist injuries [54]. Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function [50]. The lateral approach and plate fixation for distal interphalangeal joint arthrodesis yields results equivalent to traditional methods but with fewer major complications [1]. The hook plate technique produces satisfactory clinical outcomes in both the proximal interphalangeal and distal interphalangeal joints [32]. Good and excellent clinical results following radiolunate fusion do not depend on the fixation device [15].

Other Considerations: Patients with severe progressive collapsing foot deformity achieved greater radiographic correction than those with mild collapse after isolated ankle arthrodesis, but functional improvements did not differ between groups [88]. Short-term follow-up after conversion of ankle arthrodesis to total ankle arthroplasty demonstrated pain relief and improved function in a majority of patients [57]. Few patients failed to achieve union or required secondary arthrodesis in a large consecutive series of open reduction and internal fixation of tarsometatarsal fracture dislocations [23]. The functional return following releasing the entire A2 pulley after flexor tendon repair in zone 2C was similar to that in fingers with partial A2 pulley release [72]. The smile incision and reverse shotgun approach may be a good surgical option for distal interphalangeal joint arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary [2].

Key Evidence

  • [L4] The results obtained in this small series are equivalent to the traditional methods of DIP joint arthrodesis but with fewer major complications. (10.1016/j.jhsa.2007.09.004)
  • [L4] This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary. (10.1186/s12891-024-08016-6)
  • [L4] The Herbert screw provides an acceptable rate of union and ease of operative technique, making it a suitable procedure for DIP joint arthrodesis. (10.1007/s11552-010-9295-3)
  • [L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. (10.1177/17531934231215790)
  • [L4] An IP joint fusion of the thumb or DIP joint fusion of the fingers can be performed safely with a low-profile plate fixation through a dorsal approach. (10.1016/j.jhsa.2018.03.049)
  • [L4] Caution must be used when considering these screws for DIP joint arthrodesis, to avoid problems related to screw prominence in the narrow aspects of the distal and middle phalanges. (10.1016/j.jhsa.2014.02.007)
  • [L4] Although achieving solid fusion with arthrodesis is not completely reliable or without complication, patients' subjective and functional outcomes demonstrate fair to good results. (10.1016/j.jhsa.2010.10.030)
  • [L5] The procedure may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion. (10.1016/j.jhsa.2015.07.018)
  • [L4] The technique is easy to perform, maintains digital length, and allows the surgeon to fine-tune the position of arthrodesis, with fusion rates comparable to previously described techniques. (10.1054/jhsb.2002.0798)
  • [L5] The PIP joint arthrodesis angle affects DIP joint extension. (10.1016/j.jhsa.2017.04.002)
  • [L5] Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict; K-wires offer the easiest compatibility, while headless screws must ideally not reach proximal to the midpoint of the middle phalanx. (10.1016/j.jhsa.2024.08.006)
  • [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. (10.1016/j.jhsa.2023.03.027)
  • [L4] Hyperextension of the PIP joint is corrected well, but the severe extension lag of the DIP joint remains uncorrected postoperatively. (10.1177/15589447221127337)
  • [L4] Good and excellent clinical results in the majority of the patients following radiolunate fusion do not depend on the fixation device. (10.1177/1753193409342054)
  • [L3] Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated. (10.1302/0301-620x.106b7.bjj-2023-0978.r2)
  • [L3] The authors recommend simultaneous surgical intervention in case of severe painful OA of the PIP and DIP joints of the same digit. (10.1177/17531934231191255)
  • [L3] Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. (10.1186/s12891-024-07361-w)
  • [L4] Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws, allowing early active range of motion and providing good objective and subjective outcomes, although noteworthy complications occurred in 39% of patients. (10.1016/j.jhsa.2011.08.030)
  • [L4] Fusion surgery should be considered in this patient population, though patients must be comprehensively counselled preoperatively given the functional deficit that results from the procedure. (10.1302/0301-620x.96b11.33754)
  • [L4] In patients who have fused hips, neurovascular structures are located closer to the bone than on the normal side. (10.1016/j.arth.2024.05.011)
  • [L4] Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up. (10.1016/j.jhsa.2011.10.012)
  • [L3] In this large consecutive series, few patients failed to achieve union or required secondary arthrodesis. (10.5435/jaaos-d-23-00696)
  • [L4] The patterns of peri-articular finger injuries differ greatly between the three finger joints, explained by the mechanism of falling and local biomechanical forces. (10.1177/17531934251381203)
  • [L1] This study reports impairment in the kinematics of precision pinch associated with index finger PIP joint fusion. (10.1016/j.jhsa.2011.09.010)
  • [L5] Mean forearm shortening of 3 or 4 cm resulted in near-complete loss of FDP simulated muscle force and tip-to-palm force in wrist-neutral and wrist-extension positions, respectively. (10.1016/j.jhsa.2024.09.005)
  • [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. (10.1177/15589447221141485)
  • [L3] Arthrodesis of the distal interphalangeal joint often leads to complications. (10.1177/17531934221111641)
  • [L4] The hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints. (10.1016/j.jhsa.2023.09.004)
  • [L5] The study confirms that constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses. (10.1177/17531934231176004)
  • [L4] Our findings suggest that wrist arthrodesis may only compromise select wrist functions. (10.1177/1558944715626930)
  • [L4] The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. (10.1186/s12891-022-05473-9)
  • [L3] Clinicians and patients might consider early treatment with amputation or arthrodesis. (10.1016/j.arth.2024.05.084)
  • [L5] The relative motion concept harnesses normal functional anatomic relationships of the EDC and FDP muscles to vary forces on finger joints, allowing immediate controlled active motion while reducing undesirable tension. (10.1016/j.jht.2022.12.006)
  • [L3] Hand function is worsened by increasing deformity in Dupuytren's disease and improved by correction of the deformity. (10.1054/jhsb.2002.0776)
  • [L5] This altered load distribution pattern suggests significant biomechanical adaptations after the procedure and supports its use for scapholunate instability and the treatment of Kienbock's disease. (10.1177/17531934251374508)
  • [L4] FlexRUMM is a reproducible tool for estimating the range of movement of the four ulnar digits. (10.1177/17531934251340261)
  • [L4] A static cylinder finger splint is needed after use to consolidate tissue remodeling and preserve clinical results. (10.1016/j.jht.2009.04.001)
  • [L4] Greater fixation angle in palmar abduction resulted in more laxity of the joint. (10.1016/j.jhsa.2024.03.006)
  • [L5] Satisfactory results can be achieved with proper patient selection, meticulous technique, and joint fusion in an appropriate position for the patient's activities and expectations. (10.5435/jaaos-d-15-00033)
  • [L4] It is a relatively simple and minimally invasive procedure that can rapidly reduce pain, and swelling, and restore finger joint function. (10.1186/s13018-025-05893-y)
  • [L4] Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function. (10.1016/j.jhsa.2011.10.003)
  • [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. (10.1016/j.jhsa.2021.11.007)
  • [L4] Care must be taken in selecting implants for distal interphalangeal joint arthrodesis, and alternative fixation techniques may be required. (10.1007/s11552-014-9679-x)
  • [L4] The long-term outcomes show high patient satisfaction, fairly rapid return to function with no requirement for revision surgery. (10.1177/1753193420960309)
  • [L4] Total wrist arthrodesis remains the primary salvage solution for severe wartime wrist injuries, predictably restoring grip strength and reducing disability. (10.1177/17531934251337589)
  • [L4] Short-term follow-up after conversion of ankle arthrodesis to total ankle arthroplasty demonstrated pain relief and improved function in a majority of patients. (10.2106/jbjs.o.00396)
  • [L5] Although operative correction frequently reduces pain and increases function, surgeons must remain reserved regarding long-term results. (10.5435/00124635-199903000-00002)
  • [L5] Despite advancements in management, in most scenarios there is no single preferred option for wrist osteoarthritis. (10.1177/17531934241296758)
  • [L1] The meta-analysis found a non-statistically significant difference in fusion rates between arthroscopic and open techniques. (10.3390/jcm12103574)
  • [L3] Although complications were more frequent following arthrodesis, most did not affect the overall outcome. (10.2106/00004623-200110000-00002)
  • [L4] Cautious patient selection and consideration of potential complications are crucial for good outcomes. (10.1177/17531934231205548)
  • [L1] Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. (10.1186/s13018-017-0576-1)
  • [L3] Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. (10.1016/j.jhsa.2015.05.015)
  • [L4] The functional return was similar to that in fingers with partial A2 pulley release. (10.1177/1753193416646521)
  • [L3] Major complications occurred at roughly half the rate in the staged group, suggesting a potential safety advantage, although the study was underpowered for complication analysis. (10.1016/j.jhsa.2025.10.019)
  • [L4] The early functional outcomes were good and all children/parents were satisfied with the procedure. (10.1177/1753193415587242)
  • [L5] A significant majority of elite athletes return to their elite level of sport post-operatively, with improved clinical outcomes and pain reduction achieved in all patients. (10.1016/j.jisako.2025.100390)
  • [L3] There was no difference in revision rate, nonunion, or prevalence of painful implant between locking and nonlocking dorsal plate fixation for primary first MTP arthrodesis. (10.5435/jaaos-d-23-00185)
  • [L1] Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. (10.1016/j.jhsa.2024.10.018)
  • [L4] It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability. (10.1177/15589447211066352)
  • [L4] Intermediate results for second-generation total ankle arthroplasty are promising but should be interpreted with care due to the poor history of earlier prostheses and technical difficulties. (10.5435/jaaos-d-25-00638)
  • [Letter] No conclusions can be made from the pooled analysis due to limitations of primary studies in defining endpoints consistently, heterogeneous clinical indications for surgery, and imprecise surgical treatment definitions. (10.1186/s13018-019-1190-1)
  • [L4] Our rate of fusion compares favorably with prior series using other methods of fixation. (10.1016/j.jhsa.2013.09.040)
  • [L2] Total wrist arthroplasty declined despite reports of positive early outcomes for fourth-generation implants. (10.1016/j.jhsa.2023.11.009)
  • [L1] The available evidence from the aggregate published data suggests that knee arthrodesis with EF in the specific context of PJI has a reduced risk of re-infection in comparison with the IM nail strategy. (10.1186/s12891-018-2283-4)
  • [L4] The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. (10.1177/1558944721998019)
  • [L3] The most common reason for reoperation after 4-corner arthrodesis was implant removal. (10.1016/j.jhsg.2022.10.015)
  • [L5] Complications and reoperations occur frequently, most often due to incomplete bone fusion or hardware-related problems, and it remains unknown which implant type is best or if the carpometacarpal joint should be included. (10.1177/17531934241295343)
  • [L4] It offers a high rate of union, an opportunity to remove the frame early, and a reduced EFI without infection or wound dehiscence. (10.1302/0301-620x.100b6.bjj-2017-1188.r1)
  • [L2] Patients with severe PCFD achieved greater radiographic correction than those with mild collapse after isolated ankle arthrodesis, but functional improvements did not differ between groups. (10.1097/corr.0000000000003756)
  • [L3] Pyarthrosis can often be treated successfully with 1 or more I and D procedures, but 27 patients required either arthrodesis or amputation despite multiple I and D procedures. (10.1016/j.jhsa.2011.05.022)

See Also

References

[1] Alternative to the Distal Interphalangeal Joint Arthrodesis: Lateral Approach and Plate Fixation. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.09.004

[2] Smile incision and reverse shotgun approach in distal interphalangeal joint arthrodesis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08016-6

[3] Distal Interphalangeal Joint Arthrodesis with the Herbert Headless Compression Screw: Outcomes and Complications in 64 Consecutively Treated Joints. HAND. 2010. DOI: 10.1007/s11552-010-9295-3

[4] Simultaneous anterograde screw arthrodesis of distal interphalangeal joint and silastic proximal interphalangeal joint replacement for osteoarthritis. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231215790

[5] Dorsal Plate Fixation for Distal Interphalangeal Joint Arthrodesis of the Fingers and Thumb. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.03.049

[6] Distal Interphalangeal Joint Bony Dimensions Related to Headless Compression Screw Sizes. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.007

[7] Arthrodesis as a Salvage for Failed Proximal Interphalangeal Joint Arthroplasty. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.10.030

[8] Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.018

[9] “Pepper-Pot” Arthrodesis of the Small Joints of the Hand: Our Experience in 68 Cases. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0798

[10] Biomechanics and Pinch Force of the Index Finger Under Simulated Proximal Interphalangeal Arthrodesis. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.04.002

[11] Combined Distal Interphalangeal Joint Arthrodesis With Proximal Interphalangeal Joint Arthroplasty or Arthrodesis: Technical Considerations. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.08.006

[12] Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.03.027

[14] Volar Transfer of the Lateral Band With Transverse Retinacular Ligament for the Correction of Swan Neck Deformity. HAND. 2022. DOI: 10.1177/15589447221127337

[15] Radiolunate fusion in the rheumatoid wrist with Shapiro staples: clinical and radiological results of 22 cases. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409342054

[16] Above-knee amputation shows higher complication and mortality rates in line with lower functional outcome compared to knee arthrodesis in severe periprosthetic joint infection. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b7.bjj-2023-0978.r2

[17] Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231191255

[18] Arthrodesis of distal interphalangeal and thumb interphalangeal joint: a retrospective cohort study of 149 cases. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07361-w

[19] Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.08.030

[20] Glenohumeral arthrodesis for the treatment of recurrent shoulder instability in epileptic patients. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b11.33754

[21] Neurovascular Structural Deviations in Patients Who Have Fused Hips: Implications for Total Hip Arthroplasty. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.05.011

[22] Radiolunate and Radioscapholunate Arthrodeses as Treatments for Rheumatoid and Psoriatic Arthritis: Long-Term Follow-Up. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.012

[23] Open Reduction And Internal Fixation of Tarsometatarsal (Lisfranc) Fracture Dislocations—Is Arthrodesis Necessary?. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00696

[24] Is there a difference in the types of injuries occurring around each finger joint after a fall?. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251381203

[25] Influence of Index Finger Proximal Interphalangeal Joint Arthrodesis on Precision Pinch Kinematics. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.09.010

[26] The Effect of Forearm Shortening on Finger Flexion: A Biomechanical Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.005

[30] Type of Work and Preoperative Ability to Perform Work Affect Return to Usual Work Following Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis. HAND. 2022. DOI: 10.1177/15589447221141485

[31] Risk factors in distal interphalangeal joint arthrodesis in the hand: a retrospective study of 173 cases. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221111641

[32] The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.09.004

[34] The effect of intercarpal arthrodeses on wrist kinematics during radial and ulnar deviation: a cadaveric study using four-dimensional CT. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231176004

[35] Assessment of Wrist Function After Simulated Total Wrist Arthrodesis. HAND. 2016. DOI: 10.1177/1558944715626930

[36] Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05473-9

[37] Total Knee Arthroplasty Periprosthetic Joint Infection With Concomitant Extensor Mechanism Disruption and Soft-Tissue Defect: The Knee Arthroplasty Terrible Triad. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.05.084

[38] A commentary from the pioneers on the innovation of the relative motion concept: History, biologic considerations, and anatomic rationale. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.006

[41] Functional Benefit of Dupuytren’s Surgery. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0776

[42] Mechanical consequences of scaphotrapeziotrapezoid fusion studied by computational modelling. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251374508

[44] Assessment of digital range of motion using an artificial intelligence-assisted video tool. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251340261

[45] Alternative Splinting Approach for Proximal Interphalangeal Joint Flexion Contractures: No-profile Static-progressive Splinting and Cylinder Splint Combo. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2009.04.001

[46] Radial Collateral Ligament Laxity of Thumb Metacarpophalangeal Joint Following Trapeziometacarpal Arthrodesis. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.03.006

[47] Arthrodesis of the Metacarpophalangeal and Interphalangeal Joints of the Hand. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00033

[49] Efficacy of ultrasound-guided capsular hydrodilatation for refractory post-trauma finger joint stiffness in adult patients. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05893-y

[50] Role of Wrist Arthrodesis in Patients Receiving Double Free Muscle Transfers for Reconstruction Following Complete Brachial Plexus Paralysis. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.003

[51] Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.11.007

[52] Dimensional Analysis of the Distal Phalanx with Consideration of Distal Interphalangeal Joint Arthrodesis Using a Headless Compression Screw. HAND. 2014. DOI: 10.1007/s11552-014-9679-x

[53] Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420960309

[54] Warfare injuries to the wrist. Fusions and motion-preserving procedures. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251337589

[57] Conversion of Tibiotalar Arthrodesis to Total Ankle Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2015. DOI: 10.2106/jbjs.o.00396

[60] Operative Correction of Swan-Neck and Boutonniere Deformities in the Rheumatoid Hand. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199903000-00002

[64] Arthrodesis or arthroplasty, complete or partial: where are we at in the 21st century?. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241296758

[66] Arthroscopic vs. Open-Ankle Arthrodesis on Fusion Rate in Ankle Osteoarthritis Patients: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023. DOI: 10.3390/jcm12103574

[67] Thumb Carpometacarpal Osteoarthritis: Arthrodesis Compared with Ligament Reconstruction and Tendon Interposition. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200110000-00002

[69] Wrist arthrodesis and soft tissue rebalancing in the spastic hand. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231205548

[70] Total ankle arthroplasty versus ankle arthrodesis—a comparison of outcomes over the last decade. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0576-1

[71] Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.015

[72] Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416646521

[73] Single-Stage Versus Staged Fasciectomy for Severe PIPJ Contractures in Dupuytren Disease: A Retrospective Comparative Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.10.019

[74] Pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415587242

[75] Return to sport after first metatarsophalangeal arthrodesis in elite athletes. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100390

[76] Analysis of the Costs and Complications of First Metatarsophalangeal Joint Arthrodesis Comparing Locked and Non-locked Plate Fixation Constructs. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00185

[77] Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.10.018

[78] Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes. HAND. 2022. DOI: 10.1177/15589447211066352

[79] Clinical Outcomes and Safety Profile for Total Ankle Arthroplasty and Ankle Arthrodesis for Symptomatic Ankle Arthritis: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00638

[80] Response to review article published titled ‘Total ankle arthroplasty versus ankle arthrodesis - a comparison of outcomes over the last decade’. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1190-1

[81] Arthrodesis of the Thumb Interphalangeal Joint and Finger Distal Interphalangeal Joints With a Headless Compression Screw. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.09.040

[82] A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.11.009

[83] Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2283-4

[84] Proximal Interphalangeal Joint Arthrodesis Techniques: A Systematic Review. HAND. 2021. DOI: 10.1177/1558944721998019

[85] Factors Associated With Unplanned Reoperation After 4-Corner Arthrodesis: A Study of 478 Wrists. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.10.015

[86] Total wrist arthrodesis in patients with advanced osteoarthritis: current implants and outcomes. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241295343

[87] Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b6.bjj-2017-1188.r1

[88] Does Isolated Ankle Arthrodesis Affect Medial Column Alignment in Patients With Progressive Collapsing Foot Deformity and End-stage Ankle Osteoarthritis?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003756

[89] Pyarthrosis of the Small Joints of the Hand Resulting in Arthrodesis or Amputation. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.05.022

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