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DIP Arthrodesis 26860

 

DIP arthritis DIP arthritis xray

DIP arthritis lateral xray

DIP arthrodesis xray

DIP arthrodesis xray

synonyms:DIP Fusion, DIP arthrodesis, distal interphalangeal joint fusion, distal interphalangeal joint arthrodesis

DIP Fusion CPT

DIP Fusion Indications

  • DIP joint pain, deformity and funtional loss secondary to arthritis(osteo/inflammatory/post-traumatic/post-infectious).
  • Chronic tendon rupture
  • Burns

DIP Fusion Contraindications

  • Active infection
  • Occupation or hobby which maintenance of DIP motion

DIP Fusion Alternatives

DIP Fusion Planning / Special Considerations

  • Fixation options: K-wires, tension bands, intraosseous wiring, headless bone screws(Herbert, Acutrak, EBI VPC, Synthes; generally must be 3.0mm or small screw), plates
  • DIP joint is generally fused in full extension.
  • PIP joint IF, MF fused 15-30°.
  • PIP joint RF, SF fused at 30-45° .

DIP Fusion Technique

  • Pre-operative antibiotics, +/- regional block
  • Digital block anesthesia +/- intravenous sedation.
  • Supine position. All bony prominences well padded.
  • Prep and drape in standard sterile fashion.
  • Penrose drain used as a tourniquet.
  • Dorsal H, transverse or Y-incision.
  • Extensor mechanism is exposed and incised transversely exposeing the DIP joint.
  • Release collateral ligaments if needed.
  • Use small oscillatin saw to make the joint surfaces flat.
  • Predrill middle phalanx centrally with a k-wire.
  • Under c-arm guidance drill 0.062-inch double tipped K-wire from proximal to distal centrally in the distal phalanz.
  • Reduce joint and drive K-wire into middle phalanx centrally.
  • Verify placement with fluoroscopy.
  • Drill per screw manufacture recommendations.
  • Place appropriate screw.
  • Verify reduction and screw placement with fluoroscopy.
  • Irrigate.
  • Close in layers.

DIP Fusion Complications

  • Pin-tract infection.
  • Deep infection/osteomyelitis.
  • Painful hardware.
  • Nonunion.
  • Cold intolerance.

DIP Fusion Follow-up care

  • Post-Op: bulky hand dressing with volar splint. Keep elevated.
  • 10-14 Days: Wound check, Stack splint applied. Active and passive PIP ROM encouraged.
  • 6 Weeks: review xrays for signs of union.
  • 3 Months: return to full activities if pain free and union evident by xray.

DIP Fusion Outcomes

DIP Fusion Review References

  • Greens Hand Surgery
  • Master Techniques in Orthopaedic Surgery-The Hand