Arthrodesis of the Distal Interphalangeal Joint and the Thumb Interphalangeal Joint: A Retrospective Comparison of Kirschner Wires and the Acutrak 2 Headless Compression Screw

Abstract

Background: Headless compression screws have become first choice for achieving arthrodesis in the distal interphalangeal joint and thumb interphalangeal joint. Only few comparisons between headless compression screws and other methods have been published. Objective: To assess healing and complication rate after arthrodesis of the distal interphalangeal joint or the thumb interphalangeal joint using a headless compression screw or Kirschner wires. Methods: A retrospective analysis of 148 consecutive primary fusions performed with the Acutrak 2 headless compression screw (n=107) or K-wires (n=41) was conducted. Healing was assessed clinically and radiographically at 6 to 8 weeks postoperatively. Results: In 89% of cases fusion had been achieved at 6 to 8 weeks postoperatively using the headless compression screw. 7 cases healed after 8 weeks. Secondary surgery with screw removal was required in 11 cases due to screw prominence, infection or non-union. In 71% of cases fusion had been achieved at 6 to 8 weeks postoperatively using Kirschner wires showing a lower fusion rate at this stage as compared to the headless compression screw group (p<0.05). 9 joints in the Kirschner wire group fused at some point after 8 weeks of follow up yielding a total fusion rate of 93% which was similar to 96% in the headless compression screw group (p>0.05). One infection occurred in the Kirschner wire group. Conclusion: Arthrodesis can be achieved with either a headless compression screw or Kirschner wires both showing equivalent total fusion rates though fusion may occur earlier using a headless compression screw.