DIP AND PIP JOINT ARTHRITIS

Question 1

Aetiology of PIP and DIP joint arthritis

Answer 1

1. Primary OA = most common
2. Inflammatory
3. Post-traumatic

Question 2

Erosive OA of the DIP joints

Answer 2

1. Most common in middle-aged females
2. Generally self-limiting
3. Generally asymptomatic
   * * Exclude systemic polyarthropathy like RA **

Question 3

Surgical options for DIPJ arthritis

Answer 3

Fusion is the only option
Headless compression screws have highest union rate Nonunion rate = 10%
DIPJ arthroplasty is not performed

Question 4

Position of DIPJ fusion

Answer 4

0-5deg per Symes
Per Orthobullets:
IF and MF = extension
RF and LF = 10-20deg flexion

Question 5

Surgical options for PIPJ arthritis

Answer 5

1. Arthrodesis

2. Silicone arthroplasty

Question 6

PIPJ arthrodesis:
2 indications
Technique

Answer 6

1. Indications
   - severe arthritis of border digits (IF and LF)
   - severe arthritis of central digits (MF and RF) with deformity/ instability/ poor bone stock
2. Technique
   - options are headless compression screw, plate or TBW
   - headless compression screws have highest union rate
   - goal = to recreate normal cascade of fingers

Question 7

Position of PIPJ fusion

Answer 7

Increasing flexion from IF to LF
40 to 55deg per Symes
30 to 45deg per Orthobullets

Question 8

PIPJ arthroplasty:
Indication
Technique

Answer 8

1. Indication = severe arthritis of central digits (MF and RF) if no deformity/ instability/ good bone stock
2. Technique
   - RCL must to be intact to allow pinch
   - volar approach = better ROM and lower revision rate

Question 9

3 features of nail plate involvement with mucous cysts

Answer 9

1. Loss of normal gloss
2. Splitting/ ridging of nail plate
3. Nail plate deformity

Question 10

3 complications of mucous cyst progression

Answer 10

1. Overlying skin breakdown
2. Chronic draining sinus
3. Septic arthritis

Question 11

Surgical management of mucous cysts

Answer 11

Cyst excision and osteophyte resection
Osteophyte resection is a must to prevent recurrence
May require local rotational flap for skin coverage