Master of Science / Department of Clinical Sciences / James D. Lillich / Objective - To compare the biomechanical characteristics of the currently recommended (CR) technique and a less invasive (LI) surgical approach for arthrodesis of the proximal interphalangeal joint (PIPJ). Additionally, to describe a technique for cartilage removal and disruption of the subchondral bone. Study design - Randomized paired limb design for biomechanical comparison. Cartilage removal and subchondral bone disruption was accomplished using an orthopedic drill bit. Sample Population – 76 cadaver limbs. Methods - Cadaver PIPJs were drilled using a 3.5mm, 4.5mm or 5.5mm drill bit. Articular surfaces were digitally photographed and analyzed. Other paired PIPJs were arthrodesed using either the CR or the LI surgical technique. Implants consisted of a 3-hole DCP and two 5.5mm transarticular screws. Constructs were tested to failure in dorso-palmar/plantar and latero-medial in single cycle 3-point bending. The maximum load and yield load was measured and composite stiffness was calculated and statistically compared. Results - The LI technique had significantly greater mean yield load (11.3 ± 2.8 kN vs. 7.68 ± 1.1 kN, P=0.008) and mean maximum load (13.5 ± 3.1 kN vs. 10.1 ± 1.94 kN, P= 0.02) under latero-medial bending. Under dorso-palmar/plantar bending there was no statistical difference between the surgical approaches (P=0.5). The 4.5mm drill bit removed 42% ± 7.3 of the cartilage and disrupted subchondral bone. The LI technique had a decreased surgical time (19 ± 3 min.) when compared with the CR (31 ± 3 min.) technique. Conclusion – The LI technique results in a stronger composite as measured in 3-point bending, loaded to failure. Clinical Relevance – The LI surgical technique may be considered for clinical cases requiring arthrodesis of the PIPJ as there is no reduction in composite strength.

The in vitro comparison of monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique and application of 2 abaxial transarticular lag screws combined with either an axial 4.5mm narrow 3-hole LC-DCP with 5.5mm cortical screws a 4.5mm narrow 3-hole LCP with 5.0mm locking screws. Limbs were tested for cyclic fatigue at 20,0000cycles and then in single-cycle to failure under 3-point, dorsopalmar bending. There were no significant differences in stiffness and single-cycle to failure values between the LCP and LC-DCP constructs, with or without PIPJ collateral ligament transaction. There was no interaction between the open and closed techniques, nor between plate types on force or stiffness at failure.