Lesser digital arthrodesis.

Abstract

Arthrodesis at the proximal interphalangeal joint is a surgical procedure useful when dealing with semireducible or nonreducible contractures of the lesser digits. When arthrodesis of the proximal interphalangeal joint is performed, there is conversion of the retrograde dorsal buckling force of the long extensor tendon to a plantargrade straightening force of the flexor tendon. This occurs as a result of the rigid strut created at the arthrodesis site. If metatarsal equinus is present, arthrodesis can help reduce this deformity and eliminate plantar pressure contributing to submetatarsal tyloma. An arthroplasty procedure does not resist deforming forces and is more useful in correcting painful deformities where flexibility is desired postoperatively. It is therefore important, even in "simple" digital surgery, to understand the etiology of the pathology and identify and structure the goals of the surgery. The end-to-end arthrodesis offers the advantage of being easy to perform, relatively free of complication, and able to maintain the length of the digit. A fixation device, such as a Kirschner wire or monofilament wire, may be needed to maintain the correction. Its inherent complications have been described. It can be relatively unstable. The peg in hole arthrodesis offers the advantage of better stability which does not necessarily require internal fixation. There is also rapid bone healing due to the side-to-side configuration of the arthrodesis site. The procedure is more complicated and time consuming to perform than an end-to-end procedure. There is more shortening in the peg in hole. Taking these factors into account, the surgeon should choose the procedure which best meets the preoperative criteria and expected postoperative results.