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PIP joint fusion

Surgeon-side topic for pip joint fusion. Backed by 432 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Proximal interphalangeal (PIP) joint arthrodesis is a reliable salvage option for failed PIP joint arthroplasty, offering fair to good subjective and functional outcomes despite not being completely free of complications [6]. The procedure carries low risks of nonunion and reoperation [4], and available arthrodesis techniques demonstrate similar fusion times, nonunion rates, and complication profiles [2]. While reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3], arthrodesis remains a viable alternative to total joint arthroplasty for PIP joint arthritis, with pyrolytic carbon hemiarthroplasty appearing as a promising option [22].

In complex reconstruction scenarios, combining PIP Swanson arthroplasty with DIP arthrodesis yields favourable outcomes regarding simultaneous bony union and flexibility [13]. Similarly, combining PIP joint arthroplasty with DIP arthrodesis produces 1-year outcomes comparable to PIP replacement alone [16], and preliminary results support this combination with surface replacement arthroplasty to increase range of motion [17]. For unstable PIP joint dorsal fracture-dislocations, fixation via a volar approach using mini plates and screws is technically feasible, allowing early active range of motion and providing good objective and subjective outcomes, though noteworthy complications occurred in 39% of patients [9]. Additionally, the superficialis sling for swan neck reconstruction may be performed with the PIP joint positioned in 20-30 degrees of flexion [1].

Anatomy & Pathophysiology

Kinematics and Functional Impact: Fusion of the index finger proximal interphalangeal (PIP) joint impairs the kinematics of precision pinch [7]. The relative motion concept harnesses normal functional anatomic relationships of the extensor digitorum communis and flexor digitorum profundus muscles to vary forces on finger joints [40]. Mean forearm shortening of 3 or 4 cm results in near-complete loss of flexor digitorum profundus simulated muscle force and tip-to-palm force in wrist-neutral and wrist-extension positions, respectively [33]. Stiffness of the PIP joint is a challenging problem that may be successfully treated under the guidance of a hand therapist [35].

Biomechanics of Adjacent Joints and Fixation: Patterns of peri-articular finger injuries differ greatly between the three finger joints due to falling mechanisms and local biomechanical forces [32]. Intramedullary fixation is a reviewed approach for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [34]. The nonaxial multiple small screws technique shows biomechanical stability comparable to the axial headless compression screw technique in distal interphalangeal joint and thumb interphalangeal joint arthrodesis [39]. Intercarpal arthrodeses render constant radiocarpal and midcarpal congruence during radioulnar deviation impossible in normal wrists [37], whereas wrist arthrodesis may only compromise select wrist functions [38]. Scaphotrapeziotrapezoid fusion alters load distribution patterns, suggesting significant biomechanical adaptations that support its use for scapholunate instability and the treatment of Kienbock's disease [47].

Measurement and Assessment: The Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction [48]. FlexRUMM is a reproducible tool for estimating the range of movement of the four ulnar digits [50]. Hand function is worsened by increasing deformity in Dupuytren's disease and improved by correction of the deformity [46].

Contracture Management and Reconstruction: A static cylinder finger splint is needed after use to consolidate tissue remodeling and preserve clinical results in the treatment of proximal interphalangeal joint flexion contractures [51]. A geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in digital artery-based V–Y advancement flaps for proximal interphalangeal joint flexion contracture [53]. Ultrasound-guided capsular hydrodilatation is a relatively simple and minimally invasive procedure that can rapidly reduce pain, swelling, and restore finger joint function in refractory post-trauma finger joint stiffness [54]. Hemi-resection of carpal and extensor resection reconstructed with wrist joint arthrodesis and palmaris longus tendon graft may be effective for achieving tumor resection with a negative margin while preserving hand function [45].

Thumb and Wrist Considerations: Greater fixation angle in palmar abduction results in more laxity of the thumb metacarpophalangeal joint following trapeziometacarpal arthrodesis [52]. Most activities of daily living tasks are performed significantly quicker by patients after proximal row carpectomy compared to wrist four-corner fusion [41].

Classification

Surgical Indication Classification: PIPJ implant arthroplasty is a good and reliable option for symptomatic degenerative, post-traumatic, and inflammatory arthritis given the proper clinical setting [5]. Conversely, reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Risks of nonunion and reoperation after PIPJ arthrodeses are low [4].

Arthrodesis Technique Classification: Available PIPJ arthrodesis techniques demonstrate similar fusion time, nonunion rate, and complication rate outcomes [2]. Biomechanically, fixation using a headless compression screw (HCS) results in a construct significantly stiffer in extension and greater than double the load to failure compared to tension band wiring (TBW) [61]. The PIP joint arthrodesis angle affects DIP joint extension [12]. For Swan neck reconstruction, a superficialis sling (flexor digitorum superficialis tenodesis) may be performed with the PIP joint positioned in 20-30 degrees of flexion [1].

Fracture-Dislocation Management Classification: Fixation of unstable PIP joint dorsal fracture-dislocations via a volar approach is technically feasible with mini plates and screws [9]. This approach allows early active range of motion and provides good objective and subjective outcomes, though noteworthy complications occurred in 39% of patients [9]. Extension-block pinning (EBP) offers a simple and innovative method to treat complex PIP joint injuries with reproducible outcomes [62]. Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate [30].

Combined Procedure Classification: The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [13]. 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]. Index finger PIP joint fusion is associated with impairment in the kinematics of precision pinch [7].

Contracture Management Classification: A simple staged procedure using a central slip facilitation device is a valid alternative for managing severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes [14]. Collagenase injection has been used for an MCP contracture after a PIP fusion [24].

Clinical Presentation

Patients presenting with PIP joint pathology often report a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains [55]. In cases of Swan Neck deformity, the Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for reconstruction is performed with the PIP joint positioned in 20-30 degrees of flexion [1]. Hyperextension of the PIP joint is corrected well with Volar Transfer of the Lateral Band With Transverse Retinacular Ligament, but the severe extension lag of the DIP joint remains uncorrected postoperatively [23]. PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis [43].

Arthritis and Arthroplasty: PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting [5]. PIPJ implant arthroplasty should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain [20]. Patients returned to work after a median of 8 weeks following PIP arthroplasty [8]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone [16].

Arthrodesis and Fusion: Risks of nonunion and reoperation after PIPJ arthrodeses are low [4]. Available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [2]. The PIP joint arthrodesis angle affects DIP joint extension [12]. Index finger PIP joint fusion is associated with impairment in the kinematics of precision pinch [7]. Patients' subjective and functional outcomes following arthrodesis as a salvage for failed PIP joint arthroplasty demonstrate fair to good results [6].

Instability and Trauma: 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 [9]. Noteworthy complications occurred in 39% of patients treated with volar plating for unstable PIP joint DFDs [9]. 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]. Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients [18].

Red-Flag Patterns: This is the first case in the literature demonstrating the use of collagenase injection for an MCP contracture after a PIP fusion [24]. Good and excellent clinical results in the majority of patients following radiolunate fusion do not depend on the fixation device [15].

Investigations

Other Considerations: Pre-operative planning must account for the specific functional implications of fusion. Index finger PIP joint fusion is associated with impairment in the kinematics of precision pinch [7], and the chosen arthrodesis angle affects DIP joint extension [12]. While available PIPJ arthrodesis techniques demonstrate similar fusion time, nonunion rate, and complication rate outcomes [2], the risks of nonunion and reoperation following arthrodesis remain low [4]. Conversely, reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [5]. Arthrodesis serves as a salvage for failed PIP joint arthroplasty, demonstrating fair to good subjective and functional outcomes, although achieving solid fusion is not completely reliable or without complication [6].

Surgical Technique Considerations: Specific technical modifications may be required based on bone quality and reconstruction goals. Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction may be performed with the PIP joint positioned in 20-30 degrees of flexion [1]. Plate-augmented tension band wiring arthrodesis for fusion of the MCP and PIP joints is an effective method, especially in the presence of osteopenia [29]. In the context of trigger digit management, a PIPJ-blocking orthosis is more effective than MCPJ-blocking orthosis in pain reduction and achieves better functional outcomes [31].

Treatment

Non-Operative

Passive manipulation serves as an alternative to surgical release for select PIP joint extension contractures [21]. External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results [25], and its use has been encouraging as a useful alternative [63].

Operative

Indications: Arthrodesis is preferred whenever possible if salvage procedures are indicated for severe periprosthetic joint infection [27]. Osteoarthritis represents the most common indication for arthrodesis of the distal interphalangeal and thumb interphalangeal joints [60]. PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [5]. Severe fixed flexion or instability of the proximal interphalangeal joint of the index finger should not be considered an absolute contraindication for pollicization [59]. Operative correction of Swan-Neck and Boutonniere deformities in the rheumatoid hand frequently reduces pain and increases function, though surgeons must remain reserved regarding long-term results [65].

Surgical Approach / Technique: 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 [9]. 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]. The smile incision and reverse shotgun approach may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary [36]. A simple staged procedure using a central slip facilitation device is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes [14]. The Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction may be performed with the PIP joint positioned in 20-30 degrees of flexion [1].

Implant Selection: Available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [2]. Plate-augmented tension band wiring arthrodesis for fusion of the MCP and PIP joints is an effective method, especially in the presence of osteopenia [29]. Augmenting 90/90 intraosseous wiring for PIP joint arthrodesis with 2 headless cannulated screws significantly increases stiffness in all directions as well as load to permanent deformation compared with 90/90 intraosseous wiring without cannulated screw augmentation [58]. Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis [22]. The results of lateral approach and plate fixation for distal interphalangeal joint arthrodesis are equivalent to traditional methods but with fewer major complications [19]. Care must be taken in selecting implants for distal interphalangeal joint arthrodesis, and alternative fixation techniques may be required [56].

Alignment / Balancing Strategy: Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone [16]. Preliminary results encourage considering combining distal interphalangeal joint arthrodesis with surface replacement arthroplasty of the proximal interphalangeal joint to increase range of motion following PIP joint arthroplasty [17]. The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [13].

Pain Management: Although most patients experienced significantly less pain after PIP joint arthroplasty for osteoarthritis, the pain reduction was considered clinically relevant in only 50% of patients [64]. Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after A1 pulley release for trigger fingers [26].

Adjuncts: Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Risks of nonunion and reoperation after PIPJ arthrodeses are low [4]. Noteworthy complications occurred in 39% of patients undergoing volar plating for unstable PIP joint dorsal fracture-dislocations [9]. Postoperative complications for distal interphalangeal and thumb interphalangeal joint arthrodesis occurred at a rate similar to that reported in the existing literature [60].

Revision: Arthrodesis should be preferred whenever possible if salvage procedures are indicated for severe periprosthetic joint infection [27].

Other Considerations: Patients returned to work after a median of 8 weeks following PIP arthroplasty [8]. Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict [44]. K-wires offer the easiest compatibility for combined DIP arthrodesis and PIP procedures [44]. Headless screws must ideally not reach proximal to the midpoint of the middle phalanx in combined DIP arthrodesis and PIP procedures [44].

Complications

Extensor-mechanism dysfunction: This is the most frequent cause of reoperation following primary nonconstrained PIP joint arthroplasties [3]. Younger age is a specific risk factor leading to higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting [28]. Revision arthroplasty of the PIP joint is associated with a 70% 5-year survival but carries a high incidence of complications [73].

Nonunion and Reoperation: Risks of nonunion and reoperation after PIPJ arthrodeses are low [4]. In contrast, reoperations following primary nonconstrained PIP joint arthroplasties are common [3]. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI for thumb carpometacarpal joint arthritis [84]. Complications were more frequent following arthrodesis compared with ligament reconstruction and tendon interposition for thumb carpometacarpal osteoarthritis, although most did not affect the overall outcome [72]. Achieving solid fusion with arthrodesis as a salvage for failed PIP joint arthroplasty is not completely reliable or without complication [6].

Infection (PJI): Arthrodesis as a salvage procedure shows higher complication and mortality rates compared to knee arthrodesis in severe periprosthetic joint infection, though above-knee amputation shows higher rates than knee arthrodesis [27]. Further surgical intervention after a failed prior 2-stage exchange arthroplasty has poor outcomes [82].

Other Considerations: Available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [2]. Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction may be performed with the PIP joint positioned in 20-30 degrees of flexion [1]. PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting [5]. Patients' subjective and functional outcomes following arthrodesis as a salvage for failed PIP joint arthroplasty demonstrate fair to good results [6]. Dynamic external fixation for PIPJ fracture treatment demonstrates improved functional outcomes, accelerated rehabilitation, and reduced complication rates compared to static external fixation and internal fixation [83]. Major complications occurred at roughly half the rate in the staged group compared to the single-stage group for fasciectomy in severe PIPJ contractures in Dupuytren disease, although the study was underpowered for complication analysis [75]. Cautious patient selection and consideration of potential complications are crucial for good outcomes in wrist arthrodesis and soft tissue rebalancing in the spastic hand [71]. 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 [81].

Recovery

Light activity (weeks): Patients typically return to work after a median of 8 weeks following PIP arthroplasty [8]. For patients undergoing PIP joint fusion, the Superficialis Sling procedure may be performed with the joint positioned in 20-30 degrees of flexion to facilitate early functional recovery [1].

Full activity (months): Available PIPJ arthrodesis techniques demonstrate similar fusion times, nonunion rates, and complication rates, allowing for predictable timelines across different surgical approaches [2]. The hook plate technique specifically enables patients to tolerate early range of motion exercises and achieve satisfactory clinical outcomes in both the PIP and DIP joints [42].

Complete recovery / outcome plateau (months): Risks of nonunion and reoperation after PIPJ arthrodeses are low [4]. Patients with severe recurrent PIP joint contractures due to Dupuytren's disease show high patient satisfaction and fairly rapid return to function with no requirement for revision surgery in the long term [57]. While patients' subjective and functional outcomes following arthrodesis as a salvage for failed PIP joint arthroplasty demonstrate fair to good results [6], those with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after A1 pulley release surgery [26].

Rehabilitation protocol: External fixation serves as a simple and effective treatment modality for chronic traumatic PIP joint contractures, yielding good predictable medium- to long-term results [25]. Passive manipulation remains an alternative to surgical release for select PIP joint extension contractures [21].

Functional milestones: Younger age is a predictor of higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting [28]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3].

Other Considerations: When deciding the timing of surgery for trigger finger patients, physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint [18]. In trigger digit management, PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcomes [31].

Key Evidence

  • [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 available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. (10.1177/1558944721998019)
  • [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. (10.1016/j.jhsa.2011.06.002)
  • [L3] Risks of nonunion and reoperation after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks. (10.1177/1558944720939196)
  • [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. (10.1177/17531934241265837)
  • [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)
  • [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)
  • [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. (10.1177/15589447221141485)
  • [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] 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)
  • [L5] The PIP joint arthrodesis angle affects DIP joint extension. (10.1016/j.jhsa.2017.04.002)
  • [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] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. (10.1177/1753193412439673)
  • [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] Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone. (10.1177/17531934231191255)
  • [L4] The authors state that their preliminary results encourage considering combining the two operations to increase range of motion following PIP joint arthroplasty, despite study limitations of small sample size and short follow-up. (10.1177/1753193420954371)
  • [L4] Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. (10.1016/j.jhsa.2018.06.023)
  • [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] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. (10.1177/15589447211030962)
  • [L4] Passive manipulation is an alternative to surgical release for select PIP joint extension contractures. (10.1016/j.jhsa.2022.01.023)
  • [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. (10.1016/j.jhsa.2014.12.016)
  • [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] This is the first case in the literature demonstrating the use of collagenase injection for an MCP contracture after a PIP fusion. (10.1016/j.jhsg.2023.07.018)
  • [L4] External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. (10.1016/j.jhsa.2013.07.007)
  • [L2] Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery. (10.1186/s12891-023-06130-5)
  • [L3] Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated. (10.1302/0301-620x.106b7.bjj-2023-0978.r2)
  • [L3] Younger age leads higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting. (10.5435/jaaos-d-17-00109)
  • [L4] Plate-augmented tension band wiring arthrodesis for fusion of the MCP and PIP joints is an effective method, especially in the presence of osteopenia. (10.1177/1753193421991762)
  • [L4] Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. (10.1016/j.jhsa.2021.11.007)
  • [L1] PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. (10.1016/j.jht.2018.02.007)
  • [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)
  • [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)
  • [L5] The article reviews the background, biomechanics, applications, techniques, outcomes, and costs of this approach for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis. (10.1016/j.jhsa.2023.08.011)
  • [L5] Stiffness of the PIP joint is a challenging problem that may be successfully treated under the guidance of a hand therapist. (10.1016/j.jhsa.2015.06.118)
  • [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)
  • [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)
  • [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] Most tasks were performed significantly quicker by the patients after proximal row carpectomy. (10.1177/1753193416638812)
  • [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] PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis. (10.1177/17531934221143690)
  • [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)
  • [Case_report] This method may be effective for not only achieving tumor resection with a negative margin but also preserving hand function. (10.1016/j.jhsg.2023.01.006)
  • [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] The Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction. (10.1016/j.jhsa.2008.10.028)
  • [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)
  • [L4] This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle. (10.1186/s12891-023-06158-7)
  • [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] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. (10.1016/j.jhsa.2023.01.025)
  • [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)
  • [L5] Augmenting 90/90 intraosseous wiring for PIP joint arthrodesis with 2 headless cannulated screws significantly increases stiffness in all directions as well as load to permanent deformation compared with 90/90 intraosseous wiring without cannulated screw augmentation. (10.1016/j.jhsa.2018.04.010)
  • [L4] Severe fixed flexion or instability of the proximal interphalangeal joint of the index finger should not be considered an absolute contraindication for pollicization. (10.1177/1753193415587242)
  • [L3] Osteoarthritis was the most common indication for arthrodesis and postoperative complications occurred at a rate similar to that reported in the existing literature. (10.1186/s12891-024-07361-w)
  • [L5] Arthrodesis of the PIP joint using a HCS resulted in a construct that was significantly stiffer in extension with greater than double the load to failure compared to TBW. (10.1016/j.jhsa.2024.01.007)
  • [L4] EBP offers a simple and innovative method to treat a complex injury of the PIP joint. (10.1177/15589447211066352)
  • [L5] The use of external fixation for treating PIP contracture has been encouraging and can be a useful alternative. (10.1016/j.jhsa.2013.03.014)
  • [L4] Although most patients experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% of patients. (10.1016/j.jhsa.2022.03.026)
  • [L5] Although operative correction frequently reduces pain and increases function, surgeons must remain reserved regarding long-term results. (10.5435/00124635-199903000-00002)
  • [L4] Cautious patient selection and consideration of potential complications are crucial for good outcomes. (10.1177/17531934231205548)
  • [L3] Although complications were more frequent following arthrodesis, most did not affect the overall outcome. (10.2106/00004623-200110000-00002)
  • [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)
  • [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)
  • [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)
  • [L3] Further surgical intervention after a failed prior 2-stage exchange arthroplasty has poor outcomes. (10.1016/j.arth.2016.10.008)
  • [L2] This comprehensive systematic review provides evidence supporting the efficacy of dynamic external fixation for PIPJ fracture treatment, demonstrating improved functional outcomes, accelerated rehabilitation, and reduced complication rates. (10.1186/s13018-025-05644-z)
  • [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)

See Also

References

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