Purpose: Arthrodesis of the distal interphalangeal and thumb interphalangeal joints is indicated for the treatment of arthritic joints. While several techniques have been recommended, the use of headless compression screws has grown in popularity over recent years. Rates of union reported in the literature vary widely, ranging from 85% to 100%. Most studies are based on small series, ranging from six joints in the smallest report to 27 joints in the largest. The purpose of this study was to review the complications associated with distal interphalangeal joint arthrodesis using the Herbert headless compression screw in a large, consecutively treated case series.

Methods: The charts, surgical reports, and x-rays for all consecutive patients undergoing distal interphalangeal or thumb interphalangeal 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: Distal interphalangeal or thumb interphalangeal fusion with a Herbert headless compression screw was attempted in 67 joints in 54 patients. In 3 joints the screw was not used due to inadequate bone size and screw purchase. In the remaining 64 joints that were treated with the Herbert screw, a total of 86% (n = 55) ultimately went on to union. A normal, uncomplicated union occurred in 81% (n = 52) while delayed union occurred in 5% (n = 3). Screw removal was required in 12% (n = 8) with the most common indications being painful hardware (n = 5), pseudoarthrosis (n = 2), and infection (n = 1).

Conclusions: Fusion of the distal interphalangeal joint with the Herbert screw can be achieved at rates that are comparable to other techniques and other headless compressive screws; however, union rates are lower than those reported by previous, smaller studies and overall complication rates are considerable. Notwithstanding, the Herbert screw provides an acceptable rate of union and ease of operative technique, making it a suitable procedure for distal interphalangeal joint arthrodesis.