Distal interphalangeal joint arthrodesis

Distal interphalangeal (DIP) joint arthrodesis is indicated in patients with intractable pain or instability after failure of nonoperative management.

Many patients with DIP arthritis present with mucous cysts. Cyst excision may correct a nail deformity, skin changes, or a draining wound, but it will not improve joint pain.

Fusion is a reliable option when pain causes functional limitations.

Patients may present with stiffness, pain, instability, or an angular deformity ( Fig. 43.1 ).

Subluxation, dislocation, or osteophytes may be present at the joint.

Inspect for mucous cysts and changes in the nail bed.

Assess range of motion (ROM) and pinch strength.

Joint destruction and intractable tenderness are clear indications for joint fusion.

Obtain standard anteroposterior (AP) and lateral radiographs of the affected digits ( Fig. 43.2 ).

Assess the surrounding bone quality; poor bone stock makes fusion more difficult.