Arthrodesis Flashcards
Describe the preferred position for thumb carpometacarpal joint (CMCJ) arthrodesis.
It is approximately 30 degrees of palmar abduction, 30 degrees of radial abduction, and 15 degrees of pronation. This allows effective thumb opposition.
Noted in Li et al. (2019) and Wheeless’ Textbook of Orthopaedics.
What is the recommended flexion angle for index finger proximal interphalangeal joint (PIPJ) arthrodesis?
The recommended angle is 20-40 degrees. This range supports precision grip and hand function.
Found by Yao et al. (2019) and Arauz et al. (2023).
What is the typical non-union rate for thumb CMCJ arthrodesis?
It ranges from 8-21%. Studies emphasize this variability.
Cited by Fulton and Stern (2001) and Hartigan et al. (2005).
What is a potential complication after distal interphalangeal joint (DIPJ) arthrodesis?
Nail matrix damage can occur due to its proximity to the surgical site.
Discussed in Stern et al. (1998) and Higgins et al. (2006).
Why is slight extension preferred in unilateral wrist fusion?
Slight extension (10-15 degrees) enhances grip strength and daily function, mimicking the wrist’s natural posture.
Per Tang et al. (2016) and Hurst et al. (1985).
What anatomical goal guides the positioning in thumb CMCJ arthrodesis?
The goal is to facilitate thumb opposition for grasping, achieved with 30 degrees palmar and radial abduction and 15 degrees pronation.
Per Li et al. (2019).
Why is 10 degrees of flexion not ideal for index finger PIPJ arthrodesis?
It impairs grip strength and precision tasks, being too straight. A 20-40 degree angle is optimal.
As per Yao et al. (2019) and Arauz et al. (2023).
What factors increase the non-union rate in thumb CMCJ arthrodesis?
High joint stress, mobility, and patient factors like bone quality contribute, with rates of 8-21% reported.
By Fulton and Stern (2001) and Hartigan et al. (2005).
How can nail matrix damage be minimized during DIPJ arthrodesis?
Careful dorsal incision planning and limited retraction near the matrix reduce risk.
As advised by Stern et al. (1998) and Higgins et al. (2006).
In what clinical scenario might ulnar deviation be added to wrist fusion positioning?
Slight ulnar deviation (0-10 degrees) may be used in degenerative joint disease to enhance function.
Unlike neutral alignment in rheumatoid arthritis, per Green’s Operative Hand Surgery (2017).
Why is pronation included in thumb CMCJ arthrodesis positioning?
Pronation (15 degrees) aids thumb opposition for pinching and grasping.
As described in Li et al. (2019) and Green’s Operative Hand Surgery (2017).
How does the recommended PIPJ flexion angle vary for the ring finger compared to the index finger?
The ring finger prefers 40-50 degrees of flexion versus 20-40 degrees for the index, maintaining a functional flexion cascade.
Per Green’s Operative Hand Surgery (2017).
What modern techniques help lower the non-union rate in thumb CMCJ arthrodesis?
Rigid fixation and bone grafting reduce rates, though they remain at 8-21%.
As per Hartigan et al. (2005) and Fulton and Stern (2001).
What postoperative sign might suggest nail matrix damage after DIPJ arthrodesis?
Nail deformities or growth issues may indicate damage.
As noted in Higgins et al. (2006) and Stern et al. (1998).
How does wrist fusion at 10-15 degrees of extension impact activities of daily living?
It improves writing, lifting, and grasping by aligning with the wrist’s natural posture.
According to Tang et al. (2016).
What misconception exists about wrist fusion positioning, and how is it corrected?
Some believe extension limits flexion tasks, but 10-15 degrees balances function effectively.
Per Tang et al. (2016) and Hurst et al. (1985).
What long-term issue might arise from nail matrix damage post-DIPJ arthrodesis?
Permanent nail deformities or growth impairment can occur, affecting aesthetics and function.
Per Higgins et al. (2006).
How might thumb CMCJ arthrodesis positioning adjust for a manual laborer?
Slightly higher abduction angles may enhance pinch strength, though 30 degrees palmar/radial abduction and 15 degrees pronation remain standard.
Per Li et al. (2019).
Why does thumb CMCJ arthrodesis have a higher non-union rate than expected historically?
High mobility and stress historically led to rates up to 50%, now reduced to 8-21% with modern techniques.
Per Fulton and Stern (2001).
