Interphalangeal joint fusion of thumb
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Arthrodesis of the interphalangeal joint of the thumb is a widely performed procedure in hand surgery.
The most common indication is degenerative arthritis and occasionally post traumatic or inflammatory arthritides.
A variety of other indications exist. These include severe articular disruption from trauma, irreparable tendon injury, loss of function from neurological conditions and reconstruction following tumour resection.
A range of techniques have been described to fuse the interphalangeal joint of the thumb. These include dorsally placed low profile plates and intramedullary compression screws. Each technique has its unique advantages. Fusion rates overall are reported at 80-100%. Tension band wiring is a tried and tested, cost effective method that that remains in wide use today. The principle of tension band wiring is to convert a distracting force into a compressive one.
Most fusions of the thumb interphalangeal joint are set at between 0-30 degrees. It is important to come to an agreement with the patient after consideration of their occupation and desired function. In this example case, the patients unique functional needs demanded that his joint be fused in a degree of flexion that would be difficult to achieve with an intramedullary device.
Author: Tahseen Chaudhry FRCS (Tr and Orth), Consultant Hand and Peripheral Nerve Surgeon
Institution: The Queen Elizabeth Hospital, Birmingham, UK.
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