Non-union rates and complications after elective interphalangeal joint arthrodesis of the hand: a cohort study of 366 arthrodeses in 289 patients
DOI:
https://doi.org/10.2340/17453674.2026.46627Keywords:
Arthrodesis, Bone, Hand, OsteoarthrosisAbstract
Background and purpose: Interphalangeal joint arthrodesis of the hand is a common procedure, but data on outcomes and complications is limited. We aimed to determine the non-union rate, evaluate risk factors for non-union, and investigate the frequency and distribution of complications across different fixation methods.
Methods: We retrospectively reviewed all interphalangeal joint arthrodeses performed between 2014 and 2022. Union and non-union were defined clinically and/or radiographically. Potential risk factors for non-union were evaluated by logistic regression with cluster-robust standard errors accounting for clustering of multiple arthrodeses within patients.
Results: After exclusions, 366 arthrodeses in 289 patients with ≥ 2 years of follow-up were analyzed. The median age was 63 years (interquartile range [IQR] 57–72) among women and 58 years (IQR 41–69) among men. Non-union occurred in 20 of 366 arthrodeses (5.5%, 95% confidence interval [CI] 3.6–8.3). Men had higher odds of non-union than women, but the difference was not statistically significant (OR 2.43, CI 0.98–6.01); no other characteristic was associated with non-union. Hardware-related complications were frequent, particularly following fixation with K-wires and cerclage, and resulted in hardware removal in 47% of cases. Other complications included superficial infections in 7% of cases, deep infections in 4%, and malunion in 4%.
Conclusion: Elective interphalangeal joint arthrodesis was associated with a non-union rate of 5.5% (CI 3.6–8.3) and few major complications; however, hardware-related problems were frequent and commonly hardware removal was required.
Downloads
References
Straszewski A, Wolf J. Osteoarthritis of the interphalangeal and metacarpophalangeal joints of the hand. In: Plastic surgery. New York: DeckerMed; 2020. doi: 10.2310/PS.10083. DOI: https://doi.org/10.2310/PS.10083
Silvano P, Pantzar-Castilla E, Lundqvist E. Arthrodesis of distal interphalangeal and thumb interphalangeal joint: a retrospective cohort study of 149 cases. BMC Musculoskelet Disord 2024; 25(1): 258. doi: 10.1186/s12891-024-07361-w. DOI: https://doi.org/10.1186/s12891-024-07361-w
Heinonen A, Leppänen O, Huhtala H, Karjalainen T, Jokihaara J. Factors influencing bone union in finger distal interphalangeal and thumb interphalangeal joint arthrodesis. J Hand Surg Asian Pac Vol 2020; 25(02): 184-91. doi: 10.1142/S2424835520500216. DOI: https://doi.org/10.1142/S2424835520500216
Beldner S, Polatsch D B. Arthrodesis of the metacarpophalangeal and interphalangeal joints of the hand: current concepts. J Am Acad Orthop Surg 2016; 24(5): 290-7. doi: 10.5435/JAAOS-D-15-00033. DOI: https://doi.org/10.5435/JAAOS-D-15-00033
Runkel A, Bonaventura B, Sundermann B, Zajonc H, Eisenhardt S, Leibig N. Risk factors in distal interphalangeal joint arthrodesis in the hand: a retrospective study of 173 cases. J Hand Surg Eur Vol 2022; 47(9): 907-14. doi: 10.1177/17531934221111641. DOI: https://doi.org/10.1177/17531934221111641
Faulkner H, An V, Lawson R D, Graham D J, Sivakumar B S. Proximal interphalangeal joint arthrodesis techniques: a systematic review. Hand (N Y) 2023; 18(1): 74-9. doi: 10.1177/1558944721998019. DOI: https://doi.org/10.1177/1558944721998019
Dickson D R, Mehta S S, Nuttall D, Ng C Y. A systematic review of distal interphalangeal joint arthrodesis. J Hand Microsurg 2014; 6(2): 74-84. doi: 10.1007/s12593-014-0163-1. DOI: https://doi.org/10.1007/s12593-014-0163-1
Millrose M, Gesslein M, Ittermann T, Kim S, Vonderlind H C, Ruettermann M. Arthrodesis of the proximal interphalangeal joint of the finger: a systematic review. EFORT Open Rev 2022; 7(1): 49-58. doi: 10.1530/EOR-21-0102. DOI: https://doi.org/10.1530/EOR-21-0102
Rigot S K, Diaz-Garcia R, Debski R E, Fowler J. Biomechanical analysis of internal fixation methods for distal interphalangeal joint arthrodesis. Hand (N Y) 2016; 11(2): 221-6. doi: 10.1177/1558944715627211. DOI: https://doi.org/10.1177/1558944715627211
Vedel J-C, Jorgensen R W, Jensen C H. Arthrodesis of the distal interphalangeal joint and the thumb interphalangeal joint: a retrospective comparison of Kirschner wires and the Acutrak 2 headless compression screw. Open Orthop J 2019; 13: 166-9. doi: 10.2174/1874325001913010166. DOI: https://doi.org/10.2174/1874325001913010166
Woo S H, Kwak S H, Jang H S, Kim D H, Seo J H, Lee S H. Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. BMC Musculoskelet Disord 2022; 23(1): 504. doi: 10.1186/s12891-022-05473-9. DOI: https://doi.org/10.1186/s12891-022-05473-9
Heineman N, Do D H, Ahn J, Sammer D M, Koehler D M. Biomechanical analysis of headless compression screw versus tension band wiring for proximal interphalangeal joint arthrodesis. J Hand Surg Am 2025; 50(5): 625.e1-625.e8. doi: 10.1016/j.jhsa.2024.01.007. DOI: https://doi.org/10.1016/j.jhsa.2024.01.007
De Almeida Y K, Athlani L, Dap F, Dautel G. Distal interphalangeal joint arthrodesis using the X-Fuse implant: a retrospective study of 54 fingers with 24 months’ follow-up. Hand Surg Rehabil 2019; 38(3): 186-90. doi: 10.1016/j.hansur.2019.01.001. DOI: https://doi.org/10.1016/j.hansur.2019.01.001
Barabas P, Pavličný R. Arthrodesis of the distal interphalangeal joint of the finger using an intramedullary implant. Acta Chir Orthop Traumatol Cech 2024; 91(5): 282-8. doi: 10.55095/achot2024/047. DOI: https://doi.org/10.55095/achot2024/047
Renault A, Maximen J, Ebalard M, Mevel G, Ropars M, Dreano T. Arthrodesis of distal interphalangeal joints using X-Fuse implant: a five-year retrospective study of 64 fingers. Acta Orthop Belg 2025; 91(1): 77-83. doi: 10.52628/91.1.13284. DOI: https://doi.org/10.52628/91.1.13284
Satteson E S, Langford M A, Li Z. The management of complications of small joint arthrodesis and arthroplasty. Hand Clin 2015; 31(2): 243-66. doi: 10.1016/j.hcl.2015.01.002. DOI: https://doi.org/10.1016/j.hcl.2015.01.002
Additional Files
Published
How to Cite
License
Copyright (c) 2026 Karl Lindberg, Hanna Sand-Uhlén, Martin Clementson, Magnus Tägil, Deepak Bushan Raina, Elisabeth Brogren
This work is licensed under a Creative Commons Attribution 4.0 International License.
PlumX (by Elsevier) is an altmetrics platform that tracks and visualizes the online attention, usage, captures, citations, and social media engagement.
