title: An obliquely placed headless compression screw for distal interphalangeal joint arthrodesis.
abstract: OBJECTIVE
  To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits.
  
  
  METHODS
  A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. After the resection of synovium and joint cartilage by a dorsal approach, a 0.88-mm diameter guide wire was inserted at the ulnar side of the proximal phalanx in the thumb and radial side of the middle phalanx in the other digits from proximal to distal to fix the joint obliquely. We verified its position under fluoroscopic control and placed the cannulated screw from proximal to distal over the guide wire.
  
  
  RESULTS
  Intraoperative rigid fixation was obtained except for 1 case, which required additional K-wire fixation. The overall union rate was 96%. Average time to fusion was 11 weeks (range, 8-30 wk), with 76% achieving union within 3 months. There were 2 complications, 1 nonunion and 1 late infection. Other complications such as dorsal skin necrosis, nail deformity, and paresthesia did not occur.
  
  
  CONCLUSIONS
  Efforts to avoid invasion of the nailbed can be technically demanding. We believe that our proximal to distal technique with oblique placement of the headless compression screw is a straightforward and effective method with a relatively low risk of complication.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University; and the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: iwatakuji@gmail.com.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Matsumura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001863:Bone Screws; D015331:Cohort Studies; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Arthrodesis; distal interphalangeal joint; headless compression screw