34th Annual Scientific Meeting proceedings

Objectives:

To compare placement of two 5.5mm cortical transarticular screws necessary to realize a proximal interphalangeal joint (PIPJ)  arthrodesis using a 3D titanium printed aiming device, with the standard AO-described method.

Methods:

An aiming device was designed from PIPJ CT-scan images, to comply and reproduce the gold standard of trans-articular screw placement in PIPJ arthrodesis.

Forty cadaveric limbs were randomly implanted with the aiming device or in a standard fashion technique, equally distributed between a 1st year ECVS resident and an experienced surgeon. Time to complete the procedure and number of radiographs were recorded. A point score was attributed according to the accuracy of the placement of the screws in the second phalanx. Grades for symmetry and homogeneity of the construct were given to the final constructs by a blinded ECVS diplomate on anonymized radiographs.

Results:

For the unexperienced surgeon, the use of the aiming device significantly reduced the time of the procedure by 25%(p<0,01), the number of radiographs taken to 3.6 (p<0,001), significantly increased the number of accurate insertion points to 1.4 (p<0,05), and increased the grades attributed to the symmetry and homogeneity of the construct (p<0,05).  However, for the senior surgeon, results were non-significant concerning the time, the insertion points, and the radiographic grades (p>0,05 for each), but significantly reduced the number of radiographs taken to 1.18 (p<0,01) with the use of the aiming device.

Conclusions:

In our study, feasibility, accuracy, and repeatability of trans articular screw placement in a PIPJ arthrodesis procedure were increased with the aiming device for the unexperienced surgeon, compared to the standard technique.