Millrose Michael, Ittermann Till, Vonderlind Hans Christoph, Willauschus Maximilian, Rüther Johannes, Bail Hermann-Josef, Geßlein Markus
Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany.
Department of Orthopedics and Traumatology, Paracelsus Medical University, 90419 Nuremberg, Germany.
J Clin Med. 2025 Jun 21;14(13):4420. doi: 10.3390/jcm14134420.
Proximal interphalangeal joint (PIJ) arthrodesis is a common surgical intervention for patients with PIJ osteoarthritis or trauma-related joint destruction. The objective of this study was to evaluate the biomechanical stability of various arthrodesis techniques under forces comparable to activities of daily living (ADL) to assess their suitability for early active movement protocols. In this in vitro study, composite cylinders simulating PIJ arthrodesis were subjected to standardized fusion angles of 40° using different fixation techniques, including crossed K-wires, compression screws, cerclage wires, tension band wiring, anatomical fixation plates, and locking grid plates. Forces representing ADLs such as typing, holding a pencil, carrying weight, and opening a jar were applied using a universal testing machine in a four-point bending setup. Micromotion and gap clearance were calculated and analyzed. Techniques involving compression, such as compression screws, tension bands, and cerclage wires, exhibited lower micromotion and gap clearance under forces up to 17 N, suggesting potential suitability for early active movement protocols. In contrast, fixation plates demonstrated structural failure or excessive clearance during early active motion ADLs. K-wires showed intermediate results with moderate gap clearance and micromotion. Compression-based fixation techniques for PIJ arthrodesis may permit early active movement without external stabilization, while fixation plates are prone to failure under ADL forces. Further dynamic biomechanical testing and clinical studies are recommended to confirm these findings.
近端指间关节（PIJ）融合术是治疗PIJ骨关节炎或创伤相关关节破坏患者的常见外科手术。本研究的目的是评估在与日常生活活动（ADL）相当的力作用下，各种融合技术的生物力学稳定性，以评估它们对早期主动运动方案的适用性。在这项体外研究中，模拟PIJ融合术的复合圆柱体采用不同的固定技术，包括交叉克氏针、加压螺钉、环扎钢丝、张力带钢丝、解剖固定板和锁定网格板，使其达到40°的标准化融合角度。使用万能试验机在四点弯曲装置中施加代表打字、握笔、负重和打开罐子等ADL的力。计算并分析微动和间隙。涉及加压的技术，如加压螺钉、张力带和环扎钢丝，在高达17 N的力作用下表现出较低的微动和间隙，表明可能适用于早期主动运动方案。相比之下，固定板在早期主动运动ADL期间表现出结构失效或间隙过大。克氏针的结果介于两者之间，间隙和微动适中。用于PIJ融合术的基于加压的固定技术可能允许早期主动运动而无需外部稳定，而固定板在ADL力作用下容易失效。建议进一步进行动态生物力学测试和临床研究以证实这些发现。
