Department of Orthopedic Surgery, St. Vincent' Hospital, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon 442-723, Korea.
Arch Orthop Trauma Surg. 2012 May;132(5):663-9. doi: 10.1007/s00402-011-1413-3. Epub 2011 Oct 20.
We performed radiologic measurement of the distal and middle phalanges in volunteers to determine the size of a headless compression screw suitable for distal interphalangeal (DIP) joint arthrodesis in Korean subjects and report on clinical results using an acutrak fusion screw.
Radiologic measurements on the distal and middle phalanx were performed to determine the optimal size of screw. Five hundred fingers from 50 adult Koreans without any abnormality on plain radiographs were selected and anteroposterior and lateral radiographs were obtained for measurements. For the distal phalanx, the narrowest diameter of the cortical bone was measured to determine the minimal diameter of the screw that would not penetrate the cortex. For the middle phalanx, the narrowest diameter of the medullary canal was measured to determine the appropriate size of the screw for fixation. Between May 2004 and December 2007, there were 23 fingers in 22 patients (6 male, 16 female) that had finger DIP joint or thumb IP joint arthrodesis performed with the acutrak fusion screws. At the final follow up, time to union, complications, clinical fusion angle, pinch power, visual analogue score (VAS) for pain and the Korean version of the disabilities of the arm, shoulder and hand (DASH) questionnaire were assessed.
In the distal phalanx, the narrowest diameter of the cortex was 2.64 ± 0.51 mm for the little finger. In the middle phalanx, the narrowest diameter of the medullary canal was 1.83 ± 0.50 mm for the little finger and 4.17 ± 0.68 for the thumb. The mean time to union was 10 weeks (range 8-12). The mean clinical fusion angle of the DIP joint was 11.9° (range 0-20). The VAS pain score was 0.4 (range 0-3). Pinch power was 75% of the normal side. The average Korean DASH score was 5 points (range 0-8). We experienced one intraoperative fixation failure for thumb IP joint arthrodesis caused by a wide medullary canal of the proximal phalanx.
The acutrak fusion screw was a feasible and adequate tool for DIP arthrodesis, particularly in Koreans. However, meticulous attention to technique was important to avoid complications in some little fingers. If preoperative radiographs suggest the thumb has a wide medullary canal, alternate methods of fixation should be considered.
我们对志愿者的远节和中节指骨进行了影像学测量，以确定适用于韩国人远节指间关节 (DIP) 融合的无头加压螺钉的大小，并报告使用 Acutrak 融合螺钉的临床结果。
对远节和中节指骨进行影像学测量，以确定螺钉的最佳尺寸。选择 50 名无任何异常的成年韩国人 500 根手指进行平片检查，并获取前后位和侧位 X 线片进行测量。对于远节指骨，测量皮质骨的最小直径，以确定不会穿透皮质的螺钉的最小直径。对于中节指骨，测量髓腔的最小直径，以确定固定用螺钉的合适尺寸。2004 年 5 月至 2007 年 12 月，有 22 例患者（6 例男性，16 例女性）的 23 根手指接受 Acutrak 融合螺钉进行 DIP 关节或拇指 IP 关节融合术。在最终随访时，评估了融合时间、并发症、临床融合角度、捏力、疼痛视觉模拟评分 (VAS) 和韩国版手臂、肩部和手残疾问卷 (DASH)。
远节指骨中，小指的皮质最窄直径为 2.64±0.51mm。中节指骨中，小指的髓腔最窄直径为 1.83±0.50mm，拇指为 4.17±0.68mm。平均融合时间为 10 周（8-12 周）。DIP 关节的平均临床融合角度为 11.9°（0-20°）。VAS 疼痛评分为 0.4（0-3）。捏力为健侧的 75%。平均韩国 DASH 评分为 5 分（0-8 分）。我们在一例拇指 IP 关节融合术中遇到 1 例术中固定失败，原因是近节指骨的髓腔较宽。
Acutrak 融合螺钉是一种可行且足够的 DIP 融合工具，特别是在韩国人。然而，为避免一些小指出现并发症，需要仔细注意技术。如果术前 X 线片提示拇指髓腔较宽，应考虑其他固定方法。
