Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review

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  • 1 Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
  • | 2 Department of Orthopaedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
  • | 3 Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany
  • | 4 Department of Trauma and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
  • | 5 Department of Trauma Surgery, Helios Kliniken Schwerin, Schwerin, Germany
  • | 6 Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • | 7 Institute for Hand- and Plastic Surgery, Oldenburg, Germany

Correspondence should be addressed to M Millrose; Email: michael.millrose@klinikum-gap.de
Open access

  • Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results.

  • Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally.

  • The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies.

  • A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring.

  • All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Abstract

  • Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results.

  • Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally.

  • The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies.

  • A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring.

  • All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Introduction

Osteoarthritis of the proximal interphalangeal (PIP) joint, either primary or secondary, limits the range of motion and causes pain with or without instability, leading to significant global hand function impairment (1). Typical aetiologies leading to secondary osteoarthritis are posttraumatic changes, chronic instability or inflammatory diseases, for example rheumatoid arthritis or scleroderma. Operative treatment options include denervation, different arthroplasties, prosthesis or arthrodesis. The aim of arthrodeses is pain reduction in combination with a sufficient global hand function (2). With distinctive deformation of the joint and/or preexisting instability, there is a tendency to recommend arthrodesis because an unstable prothesis is prone to failure. In these cases, the fusion of the joint provides reliable results.

In posttraumatic osteoarthritis, especially of the radial digits with an instability not exceeding 30°, a prothesis could provide excellent results (3, 4). If more than one joint is affected, especially in patients with rheumatoid arthritis, and only a moderate instability exists, silicone arthroplasty is still the method of choice (5).

Arthrodesis of the PIP joint is an established technique for advanced osteoarthritis or when other reconstruction methods have failed. Different techniques for arthrodesis of the PIP joint have been described and their main difference is if there is compression on the arthrodesis or not (6). There is no clear indication in the current literature as to which technique shows the most promising results in terms of union. Typical major complications of PIP joint arthrodesis are non-union and mal-union; minor complications are superficial infections (61).

The aim of this first systematic review was to clarify the following questions: Do different arthrodesis methods of the PIP joint for primary and secondary causes of osteoarthritis or destruction of the joint show (i) different numbers of non-unions? (primary outcome) and (ii) different times to consolidation? (secondary outcome). The different complications of each technique were additionally included but not further evaluated.

Methods

Search methods

The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (7). Two reviewers (MM and HV) independently selected studies for inclusion. Disagreements were solved by discussion with a senior author (MR).

The search was conducted from January 1, 1946, to April 28, 2020, in the following databases: PubMed, Medline, Embase, Google Scholar and Cochrane Library by the main author. We initially searched without any language or publication type restrictions. The search algorithm is shown in Table 1.

Table 1

The respective search string of the different included databases.

DatabaseSearch string
Pubmed(((proximal interphalangeal joint[Title/Abstract]) OR (pij[Title/Abstract]) OR (pip-joint[Title/Abstract]) OR (finger[Title/Abstract]) OR (digital[Title/Abstract]) OR (pipj[Title/Abstract]) OR (proximal interphalangeal[Title/Abstract])) AND ((arthrodesis[Title/Abstract]) OR (fusion[Title/Abstract]))) NOT equine[Title/Abstract]
Embase(‘proximal interphalangeal joint’/exp OR pij:ab,ti OR ‘pip joint’:ab,ti OR ‘proximal interphalangeal joint’:ti,ab OR ‘digital’:ab,ti OR ‘finger’:ab,ti) AND (‘arthrodesis’:ti,ab OR ‘fusion’:ab,ti) AND [embase]/lim
Cochrane Library(pij OR pip joint OR pip-joint OR proximal-interpalangeal-joint OR proximal interphalangeal joint OR digital OR finger) AND (arthrodesis OR fusion)
Google Scholarallintitle: (“pij” OR “pip joint” OR “proximal interphalangeal joint” OR “digital” OR “finger”) AND (“arthrodesis” OR “fusion”)

Selection criteria

Full-text reports (original articles, randomized controlled trials, controlled clinical trials, retrospective or prospective observational studies, case series and technical descriptions) concerning PIP joint arthrodesis were screened.

Reference lists from included studies and reviews were screened for additional studies and included. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. Clinical studies with an evidence level of I–IV were included. As there were studies which compared arthrodeses to other techniques of joint salvage, those reporting of five or less arthrodeses were also included.

Studies lacking original data, studies whose data were not doubtlessly concerning the PIP joint as well as studies whose full-text were not available were excluded. Doctoral theses were also excluded.

The search flowchart according to the PRISMA guidelines is depicted in Fig. 1. Initially, 6162 articles were identified. Thirteen additional records from reference lists were included. After removing 1914 duplicates, 4261 articles remained. By screening titles and abstracts, a further 4102 studies were excluded.

Figure 1
Figure 1

This PRISMA flowchart shows the numbers of articles identified as well as the inclusion and exclusion steps.

Citation: EFORT Open Reviews 7, 1; 10.1530/EOR-21-0102

The full text of 159 articles was thoroughly assessed and evaluated for reporting the number of treated PIP joints, the technique used and the primary endpoint of consolidation. The 64 studies depicted in Table 2 were finally included, and data were extracted from these based on the inclusion criteria. Six studies that focused on diseases of connective tissue, for example rheumatoid arthritis, were mentioned separately from other indications.

Table 2

Studies of arthrodeses of the PIP joint of the finger with different techniques.

ReferenceYearLoEMINORS scoreTechniqueArthrodeses, nNon-union, nConsolidation (t)FingerIMM (t)PROM (type, data)Complications (Y/N)
Al-Qattan (9)12016IV11Interosseus + K-wire505 weeks5× DIINRNRN
Allende & Engelem (10)21980IV8Tension-band1604–6 weeks5× DII, 3× DIII, 4× DIV, 3× DVSplint for discomfortNRY – Lateral deviation; infection
Arata et al. (11)2003IV9Bioabsorbale rod107.9 weeksNR3–4 weeksNRN
Ayres et al. (12)1988IV10Herbert screw5116 weeksNR2 weeksNRY – 4× fracture dorsal cortex, 2× pain
Bansky & Racz (13)2005IV3Plate20NR2× DIINRNRN
Baruch & Kahanovich (14)31980IV4Angulated bone peg50NRNR3 weeksNRN
Biskop (15)41985IV11Tension-band25012 weeks7× DII, 5× DIII, 9× DIV, 4× DVNRY – 2× inflammation
Breyer et al. (16)2015III10Tension-band2429.4 weeksNR2–3 weeksNRY – 5× superficial infection
Compression screw2919.8 weeksNR2–3 weeksNRY – 1× superficial infection, 1× deep infection
Buechler & Aiken (17)1987IV10Bone graft and plate25245–90 days5× DII, 13 DIII, 6 DIV, 1 DVNRNRY – 1× infection
Buck-Gramcko & Oehme (18)51988III6Interosseus + K-wire84NR7 weeksNRNRTAMY – 22× superficial infection, 3× osteoporotic fracture, three hardware failure
Lag screw6NR8.1 weeksNRNRTAMY – 4× fracture dorsal cortex, 2× rotation, 1× tissue defect
Tension-band20NR8.2 weeksNRNRTAM
K-wires8NR10.6 weeksNRNRTAM
Burton et al. (19)1986IV12K-wires3409.2 weeksNR3–4 weeksNRY – 2× delayed union, 1× arterial spasm
Carroll & Hill (20)1969IV6Cup/cone + K-wire23096–8 weeksNR6–8 weeksNRY – 4× rotational error
Faithfull & Herbert (21)1984IV4Herbert screw50NRNRNRN
Goth & Konigsberger (22)1996IV9Lag screw2307.5 weeksNR2 weeksPS-100°N
Harrison & Nicolle (23)1974IV2Harrison–Nicolle peg351NRNR2 weeksNRY – 1× infection
Herzog (24)1961IV5Bone peg1108–12 weeksNR5 weeksNRN
Hoffmann & Rossack (25)1975IV6External fixation100NRNR5 daysNRN
Høgh & Jensen (26)61982IV9Interosseus + K-wire23NR8 weeksNR6 weeksNRY – 1× infection, 1× pain with amputation
Hohendorff et al. (27)2016IV9Tension-band161NR5× DII 4× DIII, 1× DIV, 6× DV6 weeksPain VAS, DASH, PSY – 1× infection
Jones et al. (28)2011III8K-wires219 months1× DII, 1× DIVNRMHOQY – 2× malunion
Tension-band10310 weeks4× DII, 4× DIII, 2× DIVNR
Plate111× DVNR
Khuri (29)1986IV8Tension-band1006–8 weeks4× DII, 2× DIV, 4× DV7–10 daysNRN
Kowalski & Manske (30)1988IV10K-wires606–12 weeks2× DII, 2× DIV, 2× DV6 weeksNRN
Kvasnička (31)2019IV8External fixation206.9 weeksNRNRNRN
Leibovic et al. (32)1994III10K-wires992110 weeks49× DII, 63× DIII, 51× DIV, 61× DVNRNRY – 3x superficial infection, 1× osteomyelitis, 2× CRPS
Tension-band66311 weeks
Herbert screw3509 weeks
Plate4212 weeks
Leonard & Capen (33)1979IV8External fixation2148 weeks3× DII, 2× DIII, 6× DIV, 10× DV8 weeksNRNR
Lewis et al. (34)1986IV8Cup/cone60NRNR8 weeksNRN
Lister (35)1978IV8Interosseus + K-wire1629.6 weeksNRNRN
Martin (36)71981III10Lag screw8997.1 weeksNRNRNRY – 80× superficial infection, six fracture of dorsal cortex, 8× osteomyelitis, two breakage of wire
K-wires84239.25 weeksNRNRNR
Tension-band19110.3 weeksNRNRNR
Interosseus + K-wire4010.7 weeksNRNRNR
Plate106.2 weeksNRNRNR
McGlynn et al. (37)1988IV8K-wires2806–12 weeksNR11× none, 14× 3–6 weeks, 3× 8–10 weeksNRY – 2× superficial infection
Mikolyzk & Stern (38)2011IV7Interosseus + Steinmann Pin50NR1× DII, 3× DII, 1× DV6 weeksNRN
Moberg (39)1960III6K-wires151NRNRNRNRNR
Bone peg5026 weeksNR6 weeksNR
Netscher & Hamilton (40)2012IV6Bone peg + K-wires106 weeks1× DIV6 weeksNRN
Newman et al. (41)2018IV2Compression screw60NRNRNRNRN
Novoa-Parra et al. (42)2018IV10Compression screw608 weeks3× DIV, 3× DVDASH, pain VASN
Ono et al. (43)2019IV8Plate118 weeks1× DIINRROM, GripN
Pellegrini & Burton (44)1990IV7K-wires101NR5× DII, 2× DIII, 3× DIVNRGrip, pinchN
Pfeiffer & Nigst (45)1970IV6Lag screw706 weeksNRNRN
Popova & Yankov (46)1980IV6Staples1006–8 weeksNR4 weeksNRN
Pribyl et al. (47)1996IV9K-wires3909 weeks9× DII, 6× DIII, 14× DIV, 10× DV8 weeksNRY – 2× superficial infection, 1× mal-union
Prokes & Lutonsky (48)2005IV7External fixation906.7 weeksNRNRN
Reill & Renne (49)1973IV5Lag screw200NRNRNRNRN
Robertson (50)1964IV2Interosseus wiring110NRNR6NRN
Sabbagh et al. (51)2001IV10Harrison–Nicolle peg201NRNR2 weeksNRY – 1× superficial infection, 1× deep infection
Sanderson et al. (52)1991IV9Harrison–Nicolle peg362NRNR2 weeksNRN
Savvidou & Kutz (53)2013IV12X-Fuse208–12 weeks2× DV3 weeksDASHN
Seitz et al. (54)1994IV8External fixation704–6 weeksNRNRN
Stahl & Rozen (55)72001IV9Tension-band4107–14 weeks12× DII, 10× DIII, 8× DIV, 11× DV4–6 daysNRY – 2× superficial infection, 3× pain
Strzyzewski et al. (56)1971IV7External fixation100NRNR6 weeksNRN
Tan et al. (57)2017III12Interosseus + K-wire2112 weeks1× DIV, 1× DV1 weeksROM, DASHNR
Lag screw1013 weeks1× DIV1 weeks
Taylor & Spencer (58)1994IV8Harrison–Nicolle peg93NR2× DII, 2× DIII, 3× DIV, 2× DVNRNRY – 1× mal-union
Teoh et al. (59)1994IV8Lag screw908.2 weeks2× DII, 1× DIII, 2× DIV, 4× DVNRN
Uhl & Schneider (60)1992IV8Tension-band32112 weeks3× DII, 6× DIII, 10× DIV, 13× DV1 weekNRY – 1× infection
Vitale et al. (61)4,82015III10Tension-band91NRNRNRGrip, pinch, pain VAS, MHOQY – 1× pain, 1× tendon adhesion
Plate30NRNRNR
Compression screw20NRNRNR
ReferenceYearLoEMINORS scoreTechniqueArthrodeses, nNon-union, nConsolidation (t)FingerIMM (t)PROM (type, data)Complications (Y/N)
Vorderwinkler et al. (62)42011III8Tension-band60NRNRNRNRN
External fixation10NRNRNRNRN
Wexler et al. (63)1977IV8External fixation3124–6 weeksNR1 weekNRY – 5× infection
Wright & McMurtry (64)1983IV10Plate3506 weeksNRNRN
Wuestner et al. (65)1986IV6PDS peg206 weeks1× DII, 1× DIV2–3 weeksNRNR
Zolotov (66)2004IV6Tension-band60NR1× DII, 1× DIII, 2× DIV, 2× DV2–3 weeksNRN
Indication rheumatoid inflammatory diseases
 Belsky et al. (67)91982IV7K-wires500NRNRNRNRN
 Bracey et al. (68)101980IV12Plate240NRNRNRN
 Gilbart et al. (69)112004IV13Tension-band130NR1× DII, 3× DIII, 4× DIV, 5× DVNRNRY – 3× local irritation
 Granowitz & Vainio (70)101966IV9K-wires12286 weeks19× DII, 29× DIII, 43× DIV, 31× DVNRY – 3× infection
 Jones et al. (71)111987IV10Interosseus + K-wire5336–8 weeksNR6 weeksNRN
 Lipscomb et al. (72)111969IV6K-wires1605–8 weeks3× DII, 4× DIII, 4× DIV, 5× DVNRNRY – 5× superficial infection

1 1x only Kwire; 2Unclear description of complications, might have occurred ad thumb; 31x additional Kwires; 4Personal communication with author; 5Non-union not differentiated between PIP- and other arthrodesis as well as techniques; 6Non-union and complication not differentiated between PIP- and other arthrodeses; 7Complications not differentiated between PIP- and other arthrodesis; 8Complications not differentiated between different methods; 9Psoriac arthritis; 10Rheumatoid arthritis; 11Systematic sclerosis.

DASH, disabilities of Arm, Shoulder and Hand Questionnaire; DII, index finger; DIII, long finger; DIV, ring finger; DV, little finger; IMM, immobilization; LoE, level of evidence; MHOQ, Michigan Hand Outcomes Questionnaire; nr, not reported; PROM, patient-reported outcome measure; PS, palm spacing; ROM, range of movement; TAM, total active movement; VAS, visual analogue scale.

Data extraction

Data were extracted from the included studies by two authors independently (MM and HV) according to a predefined data extraction sheet. The level of evidence, quality and risk of bias assessed with the standardized critical appraisal instrument, Methodological Index for Non-Randomized Studies (MINORS) score, where applicable, were recorded (8). The methodological quality score MINORS shows a mean of 8 with a global ideal score of 16. Fifty-five articles had level IV evidence, and nine articles had level III evidence. Nearly all studies were retrospective data analysis. We extracted the number of PIP joint arthrodesis, the technique used, time of immobilization, number of non-unions, time to radiological consolidation, and the incidence and type of complications. All patients regardless of their age with arthrodesis were included in this review.

Results

Included studies

A total of 1923 arthrodeses of the PIP joint could be extracted from the included papers (Table 2). The main indications for the arthrodesis of the PIP joint were primary or secondary osteoarthritis, joint infection or traumatic destruction. Included are six studies that consisted only of patients with rheumatic disease, for example rheumatoid arthritis or systemic sclerosis. These results are presented separately in Table 2.

Surgical techniques

Twelve different surgical techniques were described. Four of these techniques with compression at the arthrodesis site: interosseus wiring with/without K-wire, tension-band, cannulated screw as well as a lag screw – combined a total of 805 arthrodeses. The plate, external fixation and K-wire might hold some applied compression during the arthrodesis but do not hold any compression potential themselves. The most frequently used techniques were, with the number of arthrodesis in descending order, K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The included studies cover a time span of 74 years of publication, and that there is an obvious trend towards techniques with compression of the arthrodesis, especially with compression screws.

Non-unions and mean consolidation times

Non-unions were reported in all studies. Two studies included other finger joints besides the PIP and did not report the exact numbers of non-unions concerning the fused joint. In these cases, the studies were only included for the consolidation time, for they reported that explicitly. The lowest non-union rate in compression techniques was 3.9% with the compression screw. Interestingly, the non-union rate for the peg fixations (without compression) was even lower 3.6%. The highest non-union rate showed the interosseous wiring with 8.6% (Table 3).

Table 3

Amount of non-union joint arthrodeses because of osteoarthritis by technique – only studies which described the number of non-unions of the PIP joint with respective technique were included.

TechniqueStudies (n)Individuals (n)Non-union (n(%))
Tension-band1429312 (4.1)
K-wires1373564 (8.7)
Compression screw1228211 (3.9)
Interosseus wiring81059 (8.6)
Pin fixation91026 (5.9)
Peg fixation81656 (3.6)
Plate6934 (4.3)
Total701775112 (6.3)

Table 4 depicts the mean consolidation times. Further information on how non-uniions were stratified by technique is presented in the Supplementary information and the results are presented in supplementary figures 1 and 2.

Table 4

Consolidation time by technique – only studies included with joints affected by osteoarthritis. The table depicts the consolidation times (mean ± s.d.) in weeks. Again, there were no statistically significant differences between any analyzed technique in comparison to K-wires. Also, we made a comparison of compression vs non-compression techniques of the mean consolidation time, without statistically significant difference (P = 0.830).

TechniqueStudies (n)Individuals (n)Consolidation times (weeks)
Tension-band102639.5 ± 2.2
K-wires116688.6 ± 1.5
Compression screw92557.7 ± 1.3
Interosseus wiring71878.5 ± 2.4
Pin fixation7826.9 ± 1.7
Peg fixation3637.3 ± 2.3
Plate3649.2 ± 3.0
Total5015828.2 ± 2.0

Complications

Four studies did not describe complications. All others either stated that they had no complications or did not describe them in detail. Most complications besides the non-unions were infections (mostly superficial), pain caused by the implant or mal-unions. The consequences of these complications, that is, if revisionary surgery had to be performed or if superficial infections could be treated by antibiotics, were not reported.

Discussion

A wide range of different surgical techniques for achieving fusion of the PIP joint have been published. Moberg already stated in 1960 that ‘the prime requisite of a good digital arthrodesis is a painless and stable union in proper position occurring in a reasonable space of time’ (39). Nevertheless, a proper comparison, although needed, proves to be difficult because of the variable quality of published studies, different indications for joint fusion, varying definitions of consolidation (radiological vs clinical) as well as lacking important data in large but older studies, where a personal communication with the author is no longer possible (73).

The two main groups of joint fusion techniques which can be differentiated, are techniques with and without compression of the arthrodesis site respectively (6). The most important advantage of the compression is the assumed shorter consolidation time because of higher primary stability, consolidation by primam intentionem with fewer non-unions as well as early functional occupational therapy (60, 64). In this systematic review, the assumption that techniques with compression are more reliable, as demonstrated by Leibovic in 1994, could not be clearly proven (32). One possible reason might be that the compression techniques are surgically more difficult and might tend to non-union if there are no ideal operative results. For example, there is the possibility that a tension-band fusion does not apply the compression to the whole arthrodesis site and therefore renders it unstable. The compression screw however might be easier and more forgiving to implant than tension-band or intraosseus wiring. That might be the reason why the superiority of this implant in contrast to K-wires is evident in different studies in the literature (32, 36).

Nevertheless, in the studies included in this systematic review, there is a trend towards techniques with compression over the course of time, especially towards compression screws (41, 42). With further development of the implants, the diameter of the screws got progressively smaller, as 8 mm diameter screws are commercially available now. Thus, these days they can be used in small bones too.

Newer implants like the Apex IP fusion device so far lack any evidence that they are easier to implant or provide a better outcome, maybe because they have not been available in the market long enough (42).

The most reported complications besides the primary outcome of non-unions were infection, mostly superficial. As there is typically very little soft tissue around the PIP joint, protruding implants, like a tension-band, can cause irritation and subsequently a superficial infection. This emphasizes the need for a proper handling of soft tissues (36).

Rheumatoid arthritis and connective tissue diseases

Rheumatoid inflammatory diseases commonly affect the joint, especially the PIP joint, which may lead to contractures and deviations that are both disabling as well as cosmetically unacceptable (74). These diseases could affect the quality of the bones and therefore the stability of arthrodeses as well as the healing of soft tissues. The referenced papers by Gilbart et al. (69), Jones et al. (71)and Lipscomb et al. (72) relate to patients with systemic sclerosis. From a pragmatic point of view, one might state that if something works for this challenging group of patients it will probably work for a patient with osteoarthritis. Interestingly and somewhat counterintuitively, Lipscomb et al. (72) found quicker healing compared to other studies dealing with posttraumatic osteoarthritis.

Biomechanical properties and primary stability

The primary stability of different fusion techniques or implants could provide an interesting insight into the ability of the implant itself to withstand the forces of early function therapy as well as a short or even no immobilization. There are only few papers that have tried to compare the results of different biomechanical studies (75, 76). Therefore, it seems reasonable to conduct a biomechanical study for comparing the different implants and techniques of interphalangeal arthrodesis so that postsurgical treatment can be standardized.

Strengths and limitations

There are several limitations of the existing literature as well as of this study. In order to do a reasonable meta-analysis and statistical evaluation of the different techniques, randomized controlled trials (RCT) are required. On the topic of arthrodesis of the PIP joint, there is no RCT published at all. Therefore, we did a qualitative systematic review with only descriptive data pooling of the different studies with respect to their published technique for greater clearness instead of a meta-analysis. Another limitation is that the literature review for this systematic review showed that there are predominantly studies with an evidence level IV, with a heterogenous MINORS score but a satisfying mean of 8. As the risk of bias as depicted in the MINORS score exists, one might suspect that the published technique makes the apparent effect appear better than it is. There were nine evidence level III studies which could be included. Nevertheless, these results imply a lack of good quality data to statistically compare the different techniques and to achieve recommendations.

Especially the complications of different techniques, which we extracted from the studies, were reported very heterogeneously with no clear evidence on how to avoid them or of their consequences.

Strengths of this systematic review is its novelty and uniqueness, since there are no systematic reviews with a high quality, like PRISMA methodology. It includes a very long-time span of nearly 74 years and covers the most extensive databases. A very large number of abstracts were screened to achieve the most complete systematic review.

Conclusion

The compression screw shows superior results with respect to non-unions in comparison to K-wires. There is a tendency of more published techniques with compression in the last 10 years which might implicate a shift towards compression techniques. Given the limited evidence of the available studies on arthrodesis of the PIP joint, there is a lack of clear indications for other special techniques. The three most often used techniques are K-wires, tension-band and compression screws. The K-wires still have their place in acute trauma with soft tissue defects or replantation. Only large multi-center RCTs can answer the question on which technique for arthrodesis of the PIP joint is the best.

Supplementary materials

This is linked to the online version of the paper at https://doi.org/10.1530/EOR-21-0102.

ICMJE Conflict of Interest Statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the work reported here.

Funding Statement

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author contribution statement

H-C Vonderlind and M Ruettermann: both authors contributed equally to this manuscript.

Acknowledgements

The authors would like to thank Stefanie Karpik for her support in preparing and correcting the manuscript with respect to spelling and grammar.

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  • 8

    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ Journal of Surgery 2003 73 712716. (https://doi.org/10.1046/j.1445-2197.2003.02748.x)

    • Search Google Scholar
    • Export Citation
  • 9

    Al-Qattan MM Pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint. Journal of Hand Surgery, European Volume 2016 41 295300. (https://doi.org/10.1177/1753193415587242)

    • Search Google Scholar
    • Export Citation
  • 10

    Allende BT, Engelem JC. Tension-band arthrodesis in the finger joints. Journal of Hand Surgery 1980 5 269271. (https://doi.org/10.1016/s0363-5023(8080012-8)

    • Search Google Scholar
    • Export Citation
  • 11

    Arata J, Ishikawa K, Sawabe K, Soeda H, Kitayama T. Osteosynthesis in digital replantation using bioabsorbable rods. Annals of Plastic Surgery 2003 50 350353. (https://doi.org/10.1097/01.SAP.0000041482.24205.D7)

    • Search Google Scholar
    • Export Citation
  • 12

    Ayres JR, Goldstrohm GL, Miller GJ, Dell PC. Proximal interphalangeal joint arthrodesis with the Herbert screw. Journal of Hand Surgery 1988 13 600603. (https://doi.org/10.1016/s0363-5023(8880105-9)

    • Search Google Scholar
    • Export Citation
  • 13

    Bansky R, Racz N. The use of titanium miniplates in arthrodesis of the interphalangeal joints and a metacarpal neck fracture. Bratislavske Lekarske Listy 2005 106 287290.

    • Search Google Scholar
    • Export Citation
  • 14

    Baruch A, Kahanovich S. Angulated bone peg. Plastic and Reconstructive Surgery 1980 66 471473. (https://doi.org/10.1097/00006534-198066030-00033)

    • Search Google Scholar
    • Export Citation
  • 15

    Biskop M, Neumann HW. Tension-wire arthrodesis of the proximal interphalangeal joint in chronic polyarthritis. Beiträge zur Orthopadie und Traumatologie 1985 32 2225.

    • Search Google Scholar
    • Export Citation
  • 16

    Breyer JM, Vergara P, Parra L, Sotelo P, Bifani A, Andrade F. Metacarpophalangeal and interphalangeal joint arthrodesis: a comparative study between tension band and compression screw fixation. Journal of Hand Surgery, European Volume 2015 40 374378. (https://doi.org/10.1177/1753193413514362)

    • Search Google Scholar
    • Export Citation
  • 17

    Buechler U, Aiken MA. Arthrodesis of the proximal interphalangeal joint by solid bone grafting and plate fixation in extensive injuries to the dorsal aspect of the finger. Journal of Hand Surgery 1988 13 589594. (https://doi.org/10.1016/s0363-5023(8880103-5)

    • Search Google Scholar
    • Export Citation
  • 18

    Buck-Gramcko D, Oehme S. Finger joint arthrodeses with intraosseous wire suture and Kirschner wire. A comparative study of 309 operations. Handchirurgie, Mikrochirurgie, Plastische Chirurgie 1988 20 99106.

    • Search Google Scholar
    • Export Citation
  • 19

    Burton RI, Margles SW, Lunseth PA. Small-joint arthrodesis in the hand. Journal of Hand Surgery 1986 11 678682. (https://doi.org/10.1016/s0363-5023(8680011-9)

    • Search Google Scholar
    • Export Citation
  • 20

    Carroll RE, Hill NA. Small joint arthrodesis in hand reconstruction. Journal of Bone and Joint Surgery: American Volume 1969 51 12191221. (https://doi.org/10.2106/00004623-196951060-00020)

    • Search Google Scholar
    • Export Citation
  • 21

    Faithfull DK, Herbert TJ. Small joint fusions of the hand using the Herbert Bone Screw. Journal of Hand Surgery 1984 9 167168. (https://doi.org/10.1016/S0266-7681(8480021-2)

    • Search Google Scholar
    • Export Citation
  • 22

    Goth D, Konigsberger H. Arthrodesis of finger joints using the Lagscrew principle. Operative Orthopädie und Traumatologie 1996 8 118128. (https://doi.org/10.1007/BF02512776)

    • Search Google Scholar
    • Export Citation
  • 23

    Harrison SH, Nicolle FV. A new intramedullary bone peg for digital arthrodesis. British Journal of Plastic Surgery 1974 27 240241. (https://doi.org/10.1016/s0007-1226(7490081-2)

    • Search Google Scholar
    • Export Citation
  • 24

    Herzog KH Indication and technic of finger arthrodesis. Langenbecks Archiv fur Klinische Chirurgie Vereinigt mit Deutsche Zeitschrift Fur Chirurgie 1961 297 172178.

    • Search Google Scholar
    • Export Citation
  • 25

    Hoffmann P, Rossak K. 2 Kirschner wires as simplified external fixation devices in finger joint arthrosis. Handchirurgie 1975 7 9193.

  • 26

    Høgh J, Jensen PO. Compression-arthrodesis of finger joints using Kirschner wires and cerclage. Hand 1982 14 149152. (https://doi.org/10.1016/s0072-968x(8280006-5)

    • Search Google Scholar
    • Export Citation
  • 27

    Hohendorff B, Franke J, Spies CK, Mueller LP, Ries C. Arthrodesis of the proximal interphalangeal joint of fingers with tension band wire. Operative Orthopädie und Traumatologie 2017 29 385394. (https://doi.org/10.1007/s00064-016-0471-7)

    • Search Google Scholar
    • Export Citation
  • 28

    Jones Jr DB, Ackerman DB, Sammer DM, Rizzo M. Arthrodesis as a salvage for failed proximal interphalangeal joint arthroplasty. Journal of Hand Surgery 2011 36 259264. (https://doi.org/10.1016/j.jhsa.2010.10.030)

    • Search Google Scholar
    • Export Citation
  • 29

    Khuri SM Tension band arthrodesis in the hand. Journal of Hand Surgery 1986 11 4145. (https://doi.org/10.1016/s0363-5023(8680099-5)

  • 30

    Kowalski MF, Manske PR. Arthrodesis of digital joints in children. Journal of Hand Surgery 1988 13 874879. (https://doi.org/10.1016/0363-5023(8890263-8)

    • Search Google Scholar
    • Export Citation
  • 31

    Kvasnička J Arthrodesis of interphalangeal joints of the hand by an external fixator in managing conditions resulting from septic arthritis. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2019 86 358361.

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  • 32

    Leibovic SJ, Strickland JW. Arthrodesis of the proximal interphalangeal joint of the finger: comparison of the use of the Herbert screw with other fixation methods. Journal of Hand Surgery 1994 19 181188. (https://doi.org/10.1016/0363-5023(9490002-7)

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  • 33

    Leonard MH, Capen DA. Compression arthrodesis of finger joints. Clinical Orthopaedics and Related Research 1979 145 193198. (https://doi.org/10.1097/00003086-197911000-00029)

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  • 34

    Lewis RC, Nordyke MD, Tenny JR. The tenon method of small joint arthrodesis in the hand. Journal of Hand Surgery 1986 11 567569. (https://doi.org/10.1016/s0363-5023(8680201-5)

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  • 35

    Lister G Intraosseous wiring of the digital skeleton. Journal of Hand Surgery 1978 3 427435. (https://doi.org/10.1016/s0363-5023(7880135-x)

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  • 36

    Martin L Arthrodeses of the thumb and long finger joints. Handchirurgie 1981 13 221230.

  • 37

    McGlynn JT, Smith RA, Bogumill GP. Arthrodesis of small joint of the hand: a rapid and effective technique. Journal of Hand Surgery 1988 13 595599. (https://doi.org/10.1016/s0363-5023(8880104-7)

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  • 38

    Mikolyzk DK, Stern PJ. Steinmann pin arthrodesis for salvage of failed small joint arthroplasty. Journal of Hand Surgery 2011 36 13831387. (https://doi.org/10.1016/j.jhsa.2011.05.027)

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  • 39

    Moberg E Arthrodesis of finger joints. Surgical Clinics of North America 1960 40 465470. (https://doi.org/10.1016/s0039-6109(1636053-4)

  • 40

    Netscher DT, Hamilton KL. Interphalangeal joint salvage arthrodesis using the lister tubercle as bone graft. Journal of Hand Surgery 2012 37 21452149. (https://doi.org/10.1016/j.jhsa.2012.05.043)

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  • 41

    Newman EA, Orbay MC, Nunez Jr FA, Nunez Sr F. Minimally invasive proximal interphalangeal joint arthrodesis using headless screw: surgical technique. Techniques in Hand and Upper Extremity Surgery 2018 22 3942. (https://doi.org/10.1097/BTH.0000000000000189)

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  • 42

    Novoa-Parra CD, Montaner-Alonso D, Pérez-Correa JI, Morales-Rodríguez J, Rodrigo-Pérez JL, Morales-Suarez-Varela M. Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren’s disease. Revista Espanola de Cirugia Ortopedica y Traumatologia 2018 62 216221. (https://doi.org/10.1016/j.recot.2017.10.012)

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  • 43

    Ono R, Komura S, Hirakawa A, Hirose H, Tsugita M, Masuda T, Ito Y, Akiyama H. Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases. Archives of Orthopaedic and Trauma Surgery 2019 139 10251031. (https://doi.org/10.1007/s00402-019-03197-5)

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  • 44

    Pellegrini Jr VD, Burton RI. Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion? Journal of Hand Surgery 1990 15 194209. (https://doi.org/10.1016/0363-5023(9090096-a)

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  • 45

    Pfeiffer KM, Nigst H. Finger joint arthrodesis with surgical screws. Handchirurgie 1970 2 149151.

  • 46

    Popova B, Yankov E. Arthrodesis of the interphalangeal joints of fingers using an inverted U-shaped staple. Ortopediya i Travmatologiya 1980 17 6066.

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  • 47

    Pribyl CR, Omer GE, McGinty L. Effectiveness of the chevron arthrodesis in small joints of the hand. Journal of Hand Surgery 1996 21 10521058. (https://doi.org/10.1016/S0363-5023(9680315-7)

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  • 48

    Prokes L, Lutonský M. Arthrodesis of interphalangeal joints by means of external frame fixation. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2005 72 111115.

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  • 49

    Reill P, Renné J. Indication and technic of finger joint arthrodesis for middle and distal joints using the AO-screw. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 1973 111 475478.

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  • 50

    Robertson DC The fusion of interphalangeal joints. Canadian Journal of Surgery 1964 7 433437.

  • 51

    Sabbagh W, Grobbelaar AO, Clarke C, Smith PJ, Harrison DH. Long-term results of digital arthrodesis with the Harrison-Nicolle peg. Journal of Hand Surgery 2001 26 568571. (https://doi.org/10.1054/jhsb.2001.0649)

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  • 52

    Sanderson PL, Morris MA, Fahmy NR. A long-term review of the Harrison-Nicolle peg in digital arthrodesis. Journal of Hand Surgery 1991 16 283285. (https://doi.org/10.1016/0266-7681(9190055-s)

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  • 53

    Savvidou C, Kutz J. Interphalangeal and thumb metacarpophalangeal arthrodesis with an intramedullary implant. Annals of Plastic Surgery 2013 70 3437. (https://doi.org/10.1097/SAP.0b013e31821d0757)

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  • 54

    Seitz Jr WH, Sellman DC, Scarcella JB, Froimson AI. Compression arthrodesis of the small joints of the hand. Clinical Orthopaedics and Related Research 1994 304 116121. (https://doi.org/10.1097/00003086-199407000-00019)

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  • 55

    Stahl S, Rozen N. Tension-band arthrodesis of the small joints of the hand. Orthopedics 2001 24 981983. (https://doi.org/10.3928/0147-7447-20011001-19)

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  • 56

    Strzyzewski H, Woźny W, Jurczyk A. Value of compression arthrodesis of finger joints. Chirurgia Narzadow Ruchu i Ortopedia Polska 1971 36 741745.

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  • 57

    Tan M, Ho SWL, Sechachalam S. Acute arthrodesis of interphalangeal joints of the hand in traumatic injuries. Journal of Hand and Microsurgery 2018 10 15. (https://doi.org/10.1055/s-0037-1608691)

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  • 58

    Taylor MF, Spencer JD. Complications of the use of the Harrison-Nicolle intramedullary Peg in digital arthrodesis. Journal of Hand Surgery 1994 19 205207. (https://doi.org/10.1016/0266-7681(9490167-8)

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  • 59

    Teoh LC, Yeo SJ, Singh I. Interphalangeal joint arthrodesis with oblique placement of an AO lag screw. Journal of Hand Surgery 1994 19 208211. (https://doi.org/10.1016/0266-7681(9490168-6)

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  • 60

    Uhl RL, Schneider LH. Tension band arthrodesis of finger joints: a retrospective review of 76 consecutive cases. Journal of Hand Surgery 1992 17 518522. (https://doi.org/10.1016/0363-5023(9290365-v)

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  • 61

    Vitale MA, Fruth KM, Rizzo M, Moran SL, Kakar S. Prosthetic arthroplasty versus arthrodesis for osteoarthritis and posttraumatic arthritis of the index finger proximal interphalangeal joint. Journal of Hand Surgery 2015 40 19371948. (https://doi.org/10.1016/j.jhsa.2015.05.021)

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  • 62

    Vorderwinkler KP, Muehldorfer M, Pillukat T, van Schoonhoven J. Treatment of bacterial infection in the interphalangeal joints of the hand. Operative Orthopädie und Traumatologie 2011 23 192203. (https://doi.org/10.1007/s00064-011-0024-z)

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  • 63

    Wexler MR, Rousso M, Weinberg H. Arthrodesis of finger joints by dynamic external compression using dorsoventral Kirschner wires and rubber bands. Plastic and Reconstructive Surgery 1977 60 882885. (https://doi.org/10.1097/00006534-197712000-00006)

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  • 64

    Wright CS, McMurtry RY. AO arthrodesis in the hand. Journal of Hand Surgery 1983 8 932935. (https://doi.org/10.1016/s0363-5023(8380099-9)

  • 65

    Wuestner MC, Partecke BD, Buck-Gramcko D. Resorbable PDS splints in fracture stabilization and for arthrodeses of the hand. Handchirurgie, Mikrochirurgie, Plastische Chirurgie 1986 18 298301.

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  • 66

    Zolotov AS Finger joint fusion with the aid of an aluminum template. Techniques in Hand and Upper Extremity Surgery 2004 8 193196. (https://doi.org/10.1097/01.bth.0000134707.51560.cc)

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  • 67

    Belsky MR, Feldon P, Millender LH, Nalebuff EA, Phillips C. Hand involvement in psoriatic arthritis. Journal of Hand Surgery 1982 7 203207. (https://doi.org/10.1016/s0363-5023(8280090-7)

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  • 68

    Bracey DJ, McMurtry RY, Walton D. Arthrodesis in the rheumatoid hand using the AO technique. Orthopedic Reviews 1980 9 6569.

  • 69

    Gilbart MK, Jolles BM, Lee P, Bogoch ER. Surgery of the hand in severe systemic sclerosis. Journal of Hand Surgery 2004 29 599603. (https://doi.org/10.1016/j.jhsb.2004.03.013)

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  • 70

    Granowitz S, Vainio K. Proximal interphalangeal joint arthrodesis in rheumatoid arthritis. A follow-up study of 122 operations. Acta Orthopaedica Scandinavica 1966 37 301310. (https://doi.org/10.3109/17453676608989418)

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  • 71

    Jones NF, Imbriglia JE, Steen VD, Medsger TA. Surgery for scleroderma of the hand. Journal of Hand Surgery 1987 12 391400. (https://doi.org/10.1016/s0363-5023(8780012-6)

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  • 72

    Lipscomb PR, Simons GW, Winkelmann RK. Surgery for sclerodactylia of the hand. Experience with six cases. Journal of Bone and Joint Surgery: American Volume 1969 51 11121117. (https://doi.org/10.2106/00004623-196951060-00006)

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  • 73

    Vonderlind HC, Eisenschenk A, Juergensen I, Kim S, Millrose M. Arthrodesis of the proximal interphalangeal joint – a review. Handchirurgie, Mikrochirurgie, Plastische Chirurgie 2019 51 618. (https://doi.org/10.1055/a-0833-8729)

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    Nalebuff EA Surgery in patients with systemic sclerosis of the hand. Clinical Orthopaedics and Related Research 1999 366 9197. (https://doi.org/10.1097/00003086-199909000-00012)

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  • 75

    Vonderlind HC, Zach A, Eichenauer F, Kim S, Eisenschenk A, Millrose M. Proximal interphalangeal joint arthrodesis using a compression wire: a comparative biomechanical study. Hand Surgery and Rehabilitation 2019 38 307311. (https://doi.org/10.1016/j.hansur.2019.07.002)

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  • 76

    Millrose M, Zach A, Kim S, Güthoff C, Eisenschenk A, Vonderlind HC. Biomechanical comparison of the proximal interphalangeal joint arthrodesis using a compression wire. Archives of Orthopaedic and Trauma Surgery 2019 139 577581. (https://doi.org/10.1007/s00402-019-03119-5)

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  • 1

    Murray PM Treatment of the osteoarthritic hand and thumb. In Green’s Operative Hand Surgery, 7th ed ., pp. 345372. Eds Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Philadelphia: Elsevier Inc., 2017.

    • Search Google Scholar
    • Export Citation
  • 2

    Herren D The proximal interphalangeal joint: arthritis and deformity. EFORT Open Reviews 2019 4 254262. (https://doi.org/10.1302/2058-5241.4.180042)

    • Search Google Scholar
    • Export Citation
  • 3

    Schindele SF, Hensler S, Audigé L, Marks M, Herren DB. A modular surface gliding implant (CapFlex-PIP) for proximal interphalangeal joint osteoarthritis: a prospective case series. Journal of Hand Surgery 2015 40 334340. (https://doi.org/10.1016/j.jhsa.2014.10.047)

    • Search Google Scholar
    • Export Citation
  • 4

    Reischenboeck V, Marks M, Herren DB, Schindele S. Surface replacing arthroplasty of the proximal interphalangeal joint using the CapFlex-PIP implant: a prospective study with 5-year outcomes. Journal of Hand Surgery, European Volume 2021 46 496503. (https://doi.org/10.1177/1753193420977244)

    • Search Google Scholar
    • Export Citation
  • 5

    Boeckstyns MEH My personal experience with arthroplasties in the hand and wrist over the past four decades. Journal of Hand Surgery, European Volume 2019 44 129137. (https://doi.org/10.1177/1753193418817172)

    • Search Google Scholar
    • Export Citation
  • 6

    Jones BF, Stern PJ. Interphalangeal joint arthrodesis. Hand Clinics 1994 10 267275. (https://doi.org/10.1016/S0749-0712(2101289-0)

  • 7

    Moher D, Liberati A, Tetzlaff J, Altman DG & PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. International Journal of Surgery 2010 8 336341. (https://doi.org/10.1016/j.ijsu.2010.02.007)

    • Search Google Scholar
    • Export Citation
  • 8

    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ Journal of Surgery 2003 73 712716. (https://doi.org/10.1046/j.1445-2197.2003.02748.x)

    • Search Google Scholar
    • Export Citation
  • 9

    Al-Qattan MM Pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint. Journal of Hand Surgery, European Volume 2016 41 295300. (https://doi.org/10.1177/1753193415587242)

    • Search Google Scholar
    • Export Citation
  • 10

    Allende BT, Engelem JC. Tension-band arthrodesis in the finger joints. Journal of Hand Surgery 1980 5 269271. (https://doi.org/10.1016/s0363-5023(8080012-8)

    • Search Google Scholar
    • Export Citation
  • 11

    Arata J, Ishikawa K, Sawabe K, Soeda H, Kitayama T. Osteosynthesis in digital replantation using bioabsorbable rods. Annals of Plastic Surgery 2003 50 350353. (https://doi.org/10.1097/01.SAP.0000041482.24205.D7)

    • Search Google Scholar
    • Export Citation
  • 12

    Ayres JR, Goldstrohm GL, Miller GJ, Dell PC. Proximal interphalangeal joint arthrodesis with the Herbert screw. Journal of Hand Surgery 1988 13 600603. (https://doi.org/10.1016/s0363-5023(8880105-9)

    • Search Google Scholar
    • Export Citation
  • 13

    Bansky R, Racz N. The use of titanium miniplates in arthrodesis of the interphalangeal joints and a metacarpal neck fracture. Bratislavske Lekarske Listy 2005 106 287290.

    • Search Google Scholar
    • Export Citation
  • 14

    Baruch A, Kahanovich S. Angulated bone peg. Plastic and Reconstructive Surgery 1980 66 471473. (https://doi.org/10.1097/00006534-198066030-00033)

    • Search Google Scholar
    • Export Citation
  • 15

    Biskop M, Neumann HW. Tension-wire arthrodesis of the proximal interphalangeal joint in chronic polyarthritis. Beiträge zur Orthopadie und Traumatologie 1985 32 2225.

    • Search Google Scholar
    • Export Citation
  • 16

    Breyer JM, Vergara P, Parra L, Sotelo P, Bifani A, Andrade F. Metacarpophalangeal and interphalangeal joint arthrodesis: a comparative study between tension band and compression screw fixation. Journal of Hand Surgery, European Volume 2015 40 374378. (https://doi.org/10.1177/1753193413514362)

    • Search Google Scholar
    • Export Citation
  • 17

    Buechler U, Aiken MA. Arthrodesis of the proximal interphalangeal joint by solid bone grafting and plate fixation in extensive injuries to the dorsal aspect of the finger. Journal of Hand Surgery 1988 13 589594. (https://doi.org/10.1016/s0363-5023(8880103-5)

    • Search Google Scholar
    • Export Citation
  • 18

    Buck-Gramcko D, Oehme S. Finger joint arthrodeses with intraosseous wire suture and Kirschner wire. A comparative study of 309 operations. Handchirurgie, Mikrochirurgie, Plastische Chirurgie 1988 20 99106.

    • Search Google Scholar
    • Export Citation
  • 19

    Burton RI, Margles SW, Lunseth PA. Small-joint arthrodesis in the hand. Journal of Hand Surgery 1986 11 678682. (https://doi.org/10.1016/s0363-5023(8680011-9)

    • Search Google Scholar
    • Export Citation
  • 20

    Carroll RE, Hill NA. Small joint arthrodesis in hand reconstruction. Journal of Bone and Joint Surgery: American Volume 1969 51 12191221. (https://doi.org/10.2106/00004623-196951060-00020)

    • Search Google Scholar
    • Export Citation
  • 21

    Faithfull DK, Herbert TJ. Small joint fusions of the hand using the Herbert Bone Screw. Journal of Hand Surgery 1984 9 167168. (https://doi.org/10.1016/S0266-7681(8480021-2)

    • Search Google Scholar
    • Export Citation
  • 22

    Goth D, Konigsberger H. Arthrodesis of finger joints using the Lagscrew principle. Operative Orthopädie und Traumatologie 1996 8 118128. (https://doi.org/10.1007/BF02512776)

    • Search Google Scholar
    • Export Citation
  • 23

    Harrison SH, Nicolle FV. A new intramedullary bone peg for digital arthrodesis. British Journal of Plastic Surgery 1974 27 240241. (https://doi.org/10.1016/s0007-1226(7490081-2)

    • Search Google Scholar
    • Export Citation
  • 24

    Herzog KH Indication and technic of finger arthrodesis. Langenbecks Archiv fur Klinische Chirurgie Vereinigt mit Deutsche Zeitschrift Fur Chirurgie 1961 297 172178.

    • Search Google Scholar
    • Export Citation
  • 25

    Hoffmann P, Rossak K. 2 Kirschner wires as simplified external fixation devices in finger joint arthrosis. Handchirurgie 1975 7 9193.

  • 26

    Høgh J, Jensen PO. Compression-arthrodesis of finger joints using Kirschner wires and cerclage. Hand 1982 14 149152. (https://doi.org/10.1016/s0072-968x(8280006-5)

    • Search Google Scholar
    • Export Citation
  • 27

    Hohendorff B, Franke J, Spies CK, Mueller LP, Ries C. Arthrodesis of the proximal interphalangeal joint of fingers with tension band wire. Operative Orthopädie und Traumatologie 2017 29 385394. (https://doi.org/10.1007/s00064-016-0471-7)

    • Search Google Scholar
    • Export Citation
  • 28

    Jones Jr DB, Ackerman DB, Sammer DM, Rizzo M. Arthrodesis as a salvage for failed proximal interphalangeal joint arthroplasty. Journal of Hand Surgery 2011 36 259264. (https://doi.org/10.1016/j.jhsa.2010.10.030)

    • Search Google Scholar
    • Export Citation
  • 29

    Khuri SM Tension band arthrodesis in the hand. Journal of Hand Surgery 1986 11 4145. (https://doi.org/10.1016/s0363-5023(8680099-5)

  • 30

    Kowalski MF, Manske PR. Arthrodesis of digital joints in children. Journal of Hand Surgery 1988 13 874879. (https://doi.org/10.1016/0363-5023(8890263-8)

    • Search Google Scholar
    • Export Citation
  • 31

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