Compression arthrodesis of the small joints of the hand.

A number of techniques for achieving small joint arthrodesis in the hand combine various forms of internal fixation with external cast or splint immobilization. Rates of arthrodesis in most cases are quite high. However, the prolonged period of adjacent joint immobilization from casting can extend rehabilitation time and limit hand function during healing. Compression arthrodesis has been used effectively in a number of larger joints, such as the knee and ankle. Miniaturization of existing external fixation compression devices now enables the application of this principle to the small joints of the hand. A series of 20 metacarpophalangeal and interphalangeal joints underwent arthrodesis in which a miniature external fixation/compression frame was used. Nineteen of 20 joints demonstrated complete primary arthrodesis within 6 weeks; one fibrous union developed in a distal interphalangeal joint and no postoperative deformities occurred. Complete stabilization was provided by the fixator, thus allowing immediate postoperative adjacent joint function.