Distal Interphalangeal Joint Arthrodesis with the Herbert Headless Compression Screw: Outcomes and Complications in 64 Consecutively Treated Joints

Abstract

Background Arthrodesis of the distal interphalangeal (DIP) joint is indicated for the treatment of arthritis. While several techniques have been recommended, the use of headless compression screws has grown in popularity. Rates of union reported vary widely, ranging from 80% to 100%, with most studies based on small series. The purpose of this study was to review the outcomes and complications associated with DIP joint arthrodesis using the Herbert headless compression screw in a large case series. Methods The medical charts, surgical reports, and X-rays for patients undergoing DIP joint arthrodesis with a Herbert screw between January 1996 and May 2006 were retrospectively reviewed to determine the frequency and types of complications. All operations were performed by the senior author at a single institution. Results Of 64 joints in 51 patients that were treated with the Herbert screw, a total of 95% ( n=61) went on to union. Union within 3 months occurred in 89% ( n=57) while delayed union (between 3 and 6 months) occurred in 6% ( n=4). Nonunion requiring subsequent revision arthrodesis occurred in 5% ( n=3). Screw removal for symptomatic hardware was required in 8% ( n=5). Conclusions Fusion of the DIP joint with the Herbert screw can be achieved at rates that are comparable to other techniques and other headless compressive screws. However, while complications do occur, the Herbert screw provides an acceptable rate of union and ease of operative technique, making it a suitable procedure for DIP joint arthrodesis.