Biomechanical Analysis of Internal Fixation Methods for Distal Interphalangeal Joint Arthrodesis

Abstract

Background: The biomechanical performance of distal interphalangeal joint (DIPJ) fixation techniques in response to cyclic and load-to-failure bending loads is generally unknown. The purpose of this study is to assess the performance of 4 commonly used techniques for DIP arthrodesis. Methods: Phalanges were fixed by one of the following techniques: (1) 2 parallel Kirschner wires (K-wires), (2) 1 longitudinal K-wire and 1 oblique K-wire, (3) an Acutrak® 2 Micro headless compression screw, or (4) 90-90 wiring. The phalanges were loaded in cantilever bending on the palmar side of the phalange for 3000 cycles, then loaded-to-failure. Results: The 90-90 wiring was significantly worse than the other 3 methods in 9 of 10 parameters analyzed. Both K-wire methods and the screw produced similar results in nearly all parameters. Conclusions: Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion.

Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

“…In biomechanical test loading, cantilever bending on the palmar side of the phalange for 3000 cycles, then loaded-to-failure depending on fixation devices, parallel or crossed K-wires have similar stability except in maximum load applied at failure than screw [25]. This also offers the benefit of a short operative time compared with other methods.…”

Comparison of Screw Quantity and Placement of Metacarpal Fracture Fixation: A Biomechanical Study

“…19,20 Similar loading protocols have been used in previous literature. 21,22 Each specimen was first preloaded to 10 N and then loaded 1-40 N, 1-70 N, and 1-100 N in 3 successive phases. Each phase is representative of physiologic postoperative conditions: (1) active flexion with some resistance; (2) strong composite grasp; and (3) firm fingertip pinch.…”

Die Arthrodese des Fingerendgelenkes: eine Literaturanalyse

“…In einer biomechanischen Untersuchung zur Stabilität bei zyklischer und Maximalbelastung verschiedener Formen von Biegebelastungen untersuchten Rigot und Mitarb. 2016 zwei gekreuzte K-Drähte, zwei parallele K-Drähte, eine kopflose Kompressionsschraube und das Ninety-ninety-intraosseous-wiring miteinander [111]. Unter zyklischer Belastung zeigten sich keine statistisch signifikant unterschiedlichen Stabilitätswerte.…”

“…Das Ninety-ninety-intraosseous-wiring zeigte in annährend allen Kategorien die geringsten Stabilitätswerte. Da die Autoren vor allem die Belastung gegenüber zyklischer Belastung als klinisch relevant werteten, empfahlen sie, dass auch ökonomische Faktoren und die Komplikationsprofile bei der Wahl einer Arthrodesetechnik berücksichtigt werden sollten [111].…”