Finger Joint Fusion

What is Finger Joint Fusion?

Finger joint fusion, or finger arthrodesis, is a surgical procedure to address severe pain, instability, or deformity in the finger joints. This procedure involves permanently joining or fusing two or more finger bones (phalanges), eliminating the joint space between them.

Who is Suitable for Finger Joint Fusion?

Finger joint fusion is typically recommended for individuals who experience severe pain, loss of function, or instability in their finger joints. This procedure may be considered for the following conditions:

• Severe Arthritis
• Joint Instability
• Joint Deformity
• Failed Non-surgical Treatments

What are the Benefits of Finger Joint Fusion?

Here are some of the key advantages of Finger Joint Fusion:

• Pain Relief: Finger joint fusion eliminates the painful joint space and the rubbing of bone surfaces, providing significant pain relief.
• Increased Joint Stability: Fusion of the finger joints restores stability to the affected area. This particularly benefits individuals with joint instability caused by ligament damage or previous injuries. Improved stability allows for better gripping, grasping, and overall hand function.
• Improved Function: Finger joint fusion can significantly enhance hand function. Although the fused joint no longer bends, the neighbouring joints compensate to provide a functional range of motion. Patients often experience improved grip strength and better overall hand dexterity.
• Correction of Deformities: Finger joint fusion can correct deformities, such as mallet finger or swan-neck deformity, which can cause pain and impair hand function. By realigning the bones and fusing them in a corrected position, the procedure helps restore a more normal finger alignment.
• Long-Term Durability: Finger joint fusion is a reliable and durable surgical procedure. Once the fusion is complete and the bones have fully healed, the joint remains stable and pain-free for the long term. This can provide lasting relief and improved quality of life.

Types of Finger Joint Fusion

Different approaches and techniques exist for performing finger joint fusion, depending on the joint involved and the patient's condition. Here are some common types of finger joint fusion:

• Thumb Interphalangeal (IP) Joint Fusion: This procedure involves fusing the joint between the two phalanges of a finger. IP joint fusion is frequently performed for severe arthritis or joint instability affecting this specific joint.
• Proximal Interphalangeal (PIP) Joint Fusion: PIP joint fusion involves fusing the joint between the proximal and middle phalanges of a finger. This procedure is commonly used to address advanced arthritis or deformities affecting the PIP joint.
• Distal Interphalangeal (DIP) Joint Fusion: DIP joint fusion fuses the joint between the middle and distal phalanges of a finger. It is typically performed for severe arthritis or deformities affecting the DIP joint.

Alternative Options to Finger Joint Fusion

Before considering finger joint fusion, exploring alternative treatment options is essential, especially for individuals who may not be suitable candidates for surgery or wish to explore non-surgical options. Here are some alternative options that can be considered:

• Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or disease-modifying antirheumatic drugs (DMARDs)
• Splinting and Bracing
• Physical Therapy
• Corticosteroid injections
• Joint Replacement

What to Do Before a Finger Joint Fusion?

Before undergoing finger joint fusion surgery, certain steps should be taken to ensure a successful procedure and recovery. Here are some important considerations:

• Schedule a consultation with an experienced orthopaedic surgeon specialising in hand and finger surgery. The surgeon will evaluate your condition, review your medical history, and conduct any necessary imaging or tests to determine if finger joint fusion is the right treatment for you.
• Have a detailed discussion with your surgeon regarding the expected outcomes of the surgery, including the level of pain relief, improvement in function, and any potential risks or complications associated with the procedure.
• Your surgeon may order preoperative tests, such as blood work, X-rays, or other imaging studies, to assess your overall health and ensure that you are a suitable candidate for surgery. Following your surgeon's preoperative instructions, such as fasting before the procedure, is important.
• Inform your surgeon about your medications, supplements, or herbal remedies. Some medications may need to be adjusted or temporarily discontinued before the surgery.
• Make any necessary lifestyle adjustments in preparation for the surgery. This may include quitting smoking, maintaining a healthy diet, and ensuring you have a support system in place for post-operative care.
• Discuss the post-operative care plan with your surgeon. Arrange for someone to drive you home after the surgery and help with daily activities during the initial recovery period. Prepare your home environment to accommodate your needs during the healing process.

Finger Joint Fusion Surgery

During a finger joint fusion surgery, the following general steps are typically involved:

• Anaesthesia: Before the procedure, anaesthesia will be administered to ensure you are comfortable and pain-free throughout the surgery.
• Incision: The surgeon will make an incision over the affected finger joint to access the joint space. The length and location of the incision may vary depending on the joint being fused.
• Joint Preparation: The damaged cartilage and any remaining joint tissue within the joint space are carefully removed to expose the bone surfaces that will be fused. This is done using specialised surgical instruments.
• Bone Fusion: The exposed bone surfaces are aligned and held together using screws, plates, or other fixation devices. This promotes bone healing and fusion over time. In some cases, bone grafts or substitutes may aid the fusion process.
• Closure: Once the bone fusion is completed, the incision is closed with sutures. Sterile dressings are applied to protect the surgical site and aid in healing.  A splint may also be used.

What to Expect After a Finger Joint Fusion?

After the surgery, you will be taken to the recovery area. Pain medication and instructions on wound care, activity restrictions, and follow-up appointments will be provided. Hand therapy may be recommended to aid in the recovery and rehabilitation process.

Finger Joint Fusion Recovery Plan

To facilitate a smooth recovery after finger joint fusion surgery, it's important to follow a comprehensive recovery plan. Here are some general guidelines that may be included in your recovery plan:

• Wound Care: Keep the surgical site clean and dry, and follow any dressing change protocols provided.
• Pain Management: Take pain medications as your surgeon prescribes to manage postoperative pain. If you experience severe or increasing pain, notify your surgeon.
• Hand and Finger Exercises: Engage in prescribed finger and hand exercises as your surgeon or hand therapist recommends. These exercises will minimise swelling and promote recovery.
• Activity Modification: Adhere to the activity restrictions provided by your surgeon. Avoid activities that may stress the healing joint, such as heavy lifting or repetitive gripping. Gradually reintroduce activities as advised by your surgeon or hand therapist.
• Lifestyle Modifications: Make necessary lifestyle modifications to support your recovery. This may include temporarily adapting your work duties, arranging for assistance with daily tasks, and modifying your environment to ensure safety and comfort.
• Healthy Choices: Maintain a healthy lifestyle by following a balanced diet, staying hydrated, getting adequate rest and sleep, and refraining from smoking or using tobacco products. These factors can contribute to a faster and smoother recovery.

Finger Joint Fusion Prognosis

The prognosis after finger joint fusion surgery is generally positive. The procedure aims to alleviate pain, restore stability, and improve hand function.

Individuals with more advanced arthritis or joint deformities may experience greater pain relief and function improvement than those with less severe conditions. Patient compliance and active participation in the rehabilitation process are crucial to achieving the best outcomes.

Certain health factors, such as diabetes or compromised immune function, may affect the healing process and potentially influence the prognosis. Consistent and appropriate engagement in rehabilitation exercises can enhance the functional abilities of the finger and hand.

Choosing a qualified and experienced surgeon with a strong hand and finger surgery background is crucial for achieving favourable outcomes.

Finger Joint Fusion Risks

While finger joint fusion surgery is generally safe and effective, there are potential risks and complications associated with the procedure. It's important to be aware of these risks and discuss them with your surgeon. Some possible risks include:

• Infection: There is a risk of developing a surgical site infection after finger joint fusion surgery. This can occur despite taking appropriate precautions. Signs of infection may include increased pain, redness, swelling, warmth, or drainage from the surgical site.
• Delayed or Non-union: In some cases, the bones may not fully fuse, resulting in delayed or non-union. Poor bone quality and inadequate immobilisation during healing can contribute to this complication.
• Nerve or Blood Vessel Damage: There is a slight risk of damage to nearby nerves or blood vessels during the surgical procedure. This can lead to numbness, tingling, or circulation problems in the affected finger or hand.
• Joint Stiffness: While finger joint fusion can improve pain and stability, it may result in some loss of finger flexibility. The fused joint will no longer bend, and neighbouring joints may compensate for the reduced range of motion.
• Hardware Complications: If screws or plates are used to stabilise the joint during fusion, there is a small risk of hardware-related complications, such as loosening, irritation, or the need for hardware removal in the future.

What if Finger Joint Fusion is Delayed?

If finger joint fusion is delayed, it can result in ongoing pain, joint instability, and further deterioration of joint function. Delaying the procedure may allow the underlying condition, such as arthritis or deformity, to progress, making subsequent surgery more complex and potentially compromising the outcome.

While there may be valid reasons for delaying finger joint fusion, such as exploring non-surgical treatments or addressing other health concerns, it's important to consult an orthopaedic surgeon to understand the potential consequences and develop an appropriate treatment plan.