Biomechanical Analysis of Headless Compression Screw Versus Tension Band Wiring for Proximal Interphalangeal Joint Arthrodesis.

Autor:	Heineman N; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Do DH; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Ahn J; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Sammer DM; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Koehler DM; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: daniel.koehler@utsouthwestern.edu.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2024 Feb 26. Date of Electronic Publication: 2024 Feb 26.
DOI:	10.1016/j.jhsa.2024.01.007
Abstrakt:	Purpose: Proximal interphalangeal (PIP) joint arthrodesis is a procedure employed to address arthritis, instability, and deformity. Multiple fixation methods are available to maintain stability across the arthrodesis interval, including headless compression screws (HCSs), tension band wiring (TBW), plating, and Kirschner wire constructs. The purpose of this study was to compare the biomechanical properties of the HCS and TBW techniques. Methods: Thirty-two nonthumb digits from the paired upper limbs of four fresh frozen cadavers were divided into pairs, matching contralateral digits from the same specimen. One PIP joint of each pair was fused with an antegrade 3.5 mm HCS, and the second was fused with TBW using 0.035 in. Kirschner wires with 24-gauge dental wire. Each construct was then stressed to 10 N in the radial deviation, ulnar deviation, flexion, and extension planes, and stiffness (N/mm) was calculated. The fingers were stressed to failure in extension with the ultimate load and mode of failure recorded. Results: When stressed in extension, the HCS construct had a significantly greater mean stiffness than the TBW construct (16.4 N/mm vs 10.8 N/mm). The stiffness in all other planes of motion were similar between the two constructs. The mean ultimate load to failure in extension was 91.4 N for the HCS and 41.9 N for the TBW. The most common mode of failure was fracture of the dorsal lip of the proximal phalanx (13/16) for the HCS and bending of the K-wires (15/16) for TBW. Conclusions: 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. Clinical Relevance: Although the stiffness required to achieve successful PIP joint arthrodesis has not been well quantified, the HCS proved to be the most favorable construct with respect to initial strength and stability. Competing Interests: Conflict of Interest Dr Koehler is a paid educational consultant for Arthrex. No financial support was received from Arthrex during the conduct of the study. The HCS purchase order for the study was fully funded by the independent resident research grant from the University of Texas Southwestern Medical Center Hoffman fund. This is an institution-specific endowment to support and promote the completion of research by orthopedic residents in the training program. The funding provided financial support for the cadavers and equipment. No benefits in any form have been received or will be received by the other authors related directly to this article. (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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