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HANDSURGERY Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses Joo-Hyoun Song Joo-Yup Lee Yang-Guk Chung Il-Jung Park Received: 1 August 2011 / Published online: 20 October 2011 Ó Springer-Verlag 2011 Abstract Introduction We performed radiologic measurement of the distal and middle phalanges in volunteers to determine the size of a headless compression screw suitable for distal interphalangeal (DIP) joint arthrodesis in Korean subjects and report on clinical results using an acutrak fusion screw. Materials and methods Radiologic measurements on the distal and middle phalanx were performed to determine the optimal size of screw. Five hundred fingers from 50 adult Koreans without any abnormality on plain radiographs were selected and anteroposterior and lateral radiographs were obtained for measurements. For the distal phalanx, the narrowest diameter of the cortical bone was measured to determine the minimal diameter of the screw that would not penetrate the cortex. For the middle phalanx, the nar- rowest diameter of the medullary canal was measured to determine the appropriate size of the screw for fixation. Between May 2004 and December 2007, there were 23 fingers in 22 patients (6 male, 16 female) that had finger DIP joint or thumb IP joint arthrodesis performed with the acutrak fusion screws. At the final follow up, time to union, complications, clinical fusion angle, pinch power, visual analogue score (VAS) for pain and the Korean version of the disabilities of the arm, shoulder and hand (DASH) questionnaire were assessed. Results In the distal phalanx, the narrowest diameter of the cortex was 2.64 ± 0.51 mm for the little finger. In the middle phalanx, the narrowest diameter of the medullary canal was 1.83 ± 0.50 mm for the little finger and 4.17 ± 0.68 for the thumb. The mean time to union was 10 weeks (range 8–12). The mean clinical fusion angle of the DIP joint was 11.9° (range 0–20). The VAS pain score was 0.4 (range 0–3). Pinch power was 75% of the normal side. The average Korean DASH score was 5 points (range 0–8). We experienced one intraoperative fixation failure for thumb IP joint arthrodesis caused by a wide medullary canal of the proximal phalanx. Conclusion The acutrak fusion screw was a feasible and adequate tool for DIP arthrodesis, particularly in Koreans. However, meticulous attention to technique was important to avoid complications in some little fingers. If preopera- tive radiographs suggest the thumb has a wide medullary canal, alternate methods of fixation should be considered. Keywords Distal interphalangeal joint Á Arthrodesis Á Headless compression screw Introduction Arthrodesis of the finger distal interphalangeal (DIP) joint or thumb interphalangeal (IP) joint is a commonly per- formed procedure for the treatment of severe arthritis accompanying pain, instability and deformity. In addition, it can be performed for chronic mallet deformity, chronic flexor digitorum profundus avulsions, or for nonunion in J.-H. Song Á J.-Y. Lee Department of Orthopedic Surgery, St. Vincent’ Hospital, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon 442-723, Korea Y.-G. Chung Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea I.-J. Park (&) Department of Orthopedic Surgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon 420-717, Korea e-mail: [email protected] 123 Arch Orthop Trauma Surg (2012) 132:663–669 DOI 10.1007/s00402-011-1413-3

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Page 1: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

HANDSURGERY

Distal interphalangeal joint arthrodesis with a headlesscompression screw: morphometric and functional analyses

Joo-Hyoun Song • Joo-Yup Lee • Yang-Guk Chung •

Il-Jung Park

Received: 1 August 2011 / Published online: 20 October 2011

� Springer-Verlag 2011

Abstract

Introduction We performed radiologic measurement of

the distal and middle phalanges in volunteers to determine

the size of a headless compression screw suitable for distal

interphalangeal (DIP) joint arthrodesis in Korean subjects

and report on clinical results using an acutrak fusion screw.

Materials and methods Radiologic measurements on the

distal and middle phalanx were performed to determine the

optimal size of screw. Five hundred fingers from 50 adult

Koreans without any abnormality on plain radiographs

were selected and anteroposterior and lateral radiographs

were obtained for measurements. For the distal phalanx,

the narrowest diameter of the cortical bone was measured

to determine the minimal diameter of the screw that would

not penetrate the cortex. For the middle phalanx, the nar-

rowest diameter of the medullary canal was measured to

determine the appropriate size of the screw for fixation.

Between May 2004 and December 2007, there were 23

fingers in 22 patients (6 male, 16 female) that had finger

DIP joint or thumb IP joint arthrodesis performed with the

acutrak fusion screws. At the final follow up, time to union,

complications, clinical fusion angle, pinch power, visual

analogue score (VAS) for pain and the Korean version of

the disabilities of the arm, shoulder and hand (DASH)

questionnaire were assessed.

Results In the distal phalanx, the narrowest diameter of

the cortex was 2.64 ± 0.51 mm for the little finger. In the

middle phalanx, the narrowest diameter of the medullary

canal was 1.83 ± 0.50 mm for the little finger and

4.17 ± 0.68 for the thumb. The mean time to union was

10 weeks (range 8–12). The mean clinical fusion angle of

the DIP joint was 11.9� (range 0–20). The VAS pain score

was 0.4 (range 0–3). Pinch power was 75% of the normal

side. The average Korean DASH score was 5 points (range

0–8). We experienced one intraoperative fixation failure for

thumb IP joint arthrodesis caused by a wide medullary

canal of the proximal phalanx.

Conclusion The acutrak fusion screw was a feasible and

adequate tool for DIP arthrodesis, particularly in Koreans.

However, meticulous attention to technique was important

to avoid complications in some little fingers. If preopera-

tive radiographs suggest the thumb has a wide medullary

canal, alternate methods of fixation should be considered.

Keywords Distal interphalangeal joint � Arthrodesis �Headless compression screw

Introduction

Arthrodesis of the finger distal interphalangeal (DIP) joint

or thumb interphalangeal (IP) joint is a commonly per-

formed procedure for the treatment of severe arthritis

accompanying pain, instability and deformity. In addition,

it can be performed for chronic mallet deformity, chronic

flexor digitorum profundus avulsions, or for nonunion in

J.-H. Song � J.-Y. Lee

Department of Orthopedic Surgery, St. Vincent’ Hospital,

The Catholic University of Korea, 93 Ji-dong,

Paldal-gu, Suwon 442-723, Korea

Y.-G. Chung

Department of Orthopedic Surgery, Seoul St. Mary’s Hospital,

The Catholic University of Korea, 505 Banpo-dong,

Seocho-gu, Seoul, Korea

I.-J. Park (&)

Department of Orthopedic Surgery, Bucheon St. Mary’s

Hospital, The Catholic University of Korea,

2 Sosa-dong, Wonmi-gu, Bucheon 420-717, Korea

e-mail: [email protected]

123

Arch Orthop Trauma Surg (2012) 132:663–669

DOI 10.1007/s00402-011-1413-3

Page 2: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

fractures in the distal part of the middle phalanx [1]. For

successful arthrodesis, not only firm bone union should be

obtained, but also irritation caused by the hardware should

be absent, and early joint movement can be allowed to

prevent the stiffness of adjacent joints.

Early techniques such as K-wire and intraosseous wiring

provided stabilization of the joint but produced poor

compression of the fusion surfaces [2]. Complication rates

of these early techniques were relatively high involving

hardware protrusion or migration, loosening, nonunion,

pin-track infections, dorsal skin necrosis, osteomyelitis or

permanent stiffness of an adjacent joint [3]. Therefore,

several authors have recommended alternative techniques

in an attempt to avoid these complications. Based on the

expectations that compression across the joint might

accelerate the fusion rate and that buried hardware might

decrease the infection rate, various surgical techniques

using headless compression screws have been developed.

The Herbert screw, acutrak standard screw and acutrak

mini screw have been used for DIP joint fusions with rel-

atively good results [1, 2, 4–7]. However, complications

related to the medullary reaming or incompatibility of

screw size to the distal phalanx have been reported [2, 3, 5,

7]. Because Koreans are generally smaller than Caucasians,

the selection of an appropriate headless compression screw

suitable for Koreans might be important for the success of

DIP arthrodesis in our population.

There are the two viewpoints about the purpose of this

study. First, morphometric measurements of the distal and

middle phalanx of the normal population were performed

on radiographs to determine the size of headless com-

pression screws suitable for Korean hands. Second, we

evaluated the clinical and radiological outcomes of

arthrodesis of the DIP joint and thumb IP joint using

acutrak fusion screws (Acumed�, Beaverton, OR, USA).

Materials and methods

Theoretical study

To determine the optimal size of a headless compression

screw, radiologic measurements on the distal and middle

phalanx were performed. Five hundred fingers from 50

adult Koreans without any abnormality on plain radiographs

were selected and anteroposterior (AP) and lateral radio-

graphs were obtained for measurements. To reduce the

errors in magnification and estimate the real dimensions, we

used radiopaque scale markers of known size. For the distal

phalanx, the narrowest diameter of the cortical bone was

measured on AP and lateral radiographs to determine the

minimal diameter of a screw that would not penetrate the

cortex (Fig. 1). For the middle phalanx, the narrowest

diameter of the medullary canal was measured on AP and

lateral radiographs to determine the appropriate size of the

screw used for fixation (Fig. 2). Measurements were per-

formed with PACS software (Maroview�, Infinitt Health-

care Co., Seoul, Korea). Eighteen men and 32 women were

included and their average age was 46 years (range 20–72).

Differences between fingers and genders were analyzed

statistically using SPSS software (version 12.0, Chicago,

IL, USA) and P \ 0.05 was assumed significant.

Clinical study

From May 2004 to December 2007, finger DIP joint or

thumb IP joint arthrodeses were performed on 23 fingers in

22 patients using acutrak fusion screws (diameter leading

Fig. 1 The narrowest area of the cortical bone of the distal phalanx

was measured on anteroposterior (AP) and lateral radiographs for

estimating the minimal diameter that would prevent the screw thread

from penetrating the cortex

Fig. 2 The narrowest area of medullary canal of the middle phalanx

was measured on AP and lateral radiographs in assessing the

appropriate size of screw for fixation

664 Arch Orthop Trauma Surg (2012) 132:663–669

123

Page 3: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

2.0 mm, trailing 2.5 mm, available in 14–24 mm length).

There were six male and 16 female patients and the aver-

age age was 54 years (range 22–77). The mean follow-up

time was 18 months (range 10–35). The affected digits

were two thumbs, six index fingers, six middle fingers, six

ring fingers and three little fingers. The preoperative

diagnoses included primary osteoarthritis in 12 cases,

rheumatoid arthritis in five, posttraumatic arthritis in three,

septic arthritis in two, and severe injury with soft tissue and

a terminal tendon defect in one. In all cases, arthrodesis

using the acutrak fusion screw was performed by a single

surgeon. This screw has the smallest diameter among

headless screws available on the market. Its maximum

length available is 24 mm, so it was considered suitable for

arthrodesis of the DIP joint of the fingers or the IP joint of

the thumbs. At the final follow-up observation, time to

union, complications, clinical fusion angle, pinch power,

visual analog scale (VAS) for pain, and the Korean version

of the disabilities of the arm, should and hand (DASH)

questionnaire were assessed. Bony union was defined as

radiographic trabecular bridging and clinical stability and

determined by three independent observers (one hand

surgeon and two orthopedic senior residents). Nonunion

was defined as the radiographic loosening of the screw or

radiolucency in the fusion site or clinical instability.

Operative technique

Under general or axillary anesthesia, patients were posi-

tioned supine and a tourniquet was applied to the upper arm

area. An H-shaped incision was made over the dorsal aspect

of the DIP joint, and the extensor tendon was exposed. At

that time, care was taken to avoid damage to the germinal

matrix, close to the surgical field. The tendon was divided

transversely, the joint was flexed, and the collateral liga-

ments were released. The articular cartilages and osteo-

phytes were removed with a curette and small rongeur while

minimizing injury to the subchondral bone in improving the

contact of the distal phalanx and the middle phalanx.

A 1.6 mm size K-wire was drilled antegradely through

the base of the distal phalanx out through the finger tip.

When it pressed up the skin pulp distally, a small incision

was made sufficient for exit of the wire. The K-wire was

then withdrawn and reinserted retrogradely across the joint

and into the medullary canal, while maintaining 0–10�flexion of the DIP joint. The position of the K-wire was

checked under an image intensifier. A cannulated drill bit

was used to drill the bone over the K-wire into the distal

and middle phalanx and then the screw was inserted toward

the middle phalanx. At that time, it was advanced until the

distal end of the screw was fully buried in the tuft of the

distal phalanx and its tip was located within the medullary

canal of the middle phalanx. After assessing the fixation,

the extensor tendon was repaired with nonabsorbable

sutures and the skin was closed. Immediately after surgery,

a full range of motion of the adjacent joints was started by

the patients without protective immobilization. From

6 weeks, gradual pinch movement was allowed, and rou-

tine activities were allowed from 3 months after surgery.

Results

On AP radiographs of the distal phalanx, the average nar-

rowest diameter of the thumb was 6.39 ± 0.76 mm, for the

index finger it was 4.40 ± 0.52 mm, for the middle finger

it was 4.74 ± 0.63 mm, for the ring finger it was 4.61 ±

0.56 mm and for the little finger it was 3.54 ± 0.55 mm.

On lateral radiographs, the average narrowest diameter of

the thumb was 5.04 ± 0.73 mm, for the index finger it was

3.13 ± 0.52 mm, for the middle finger it was 3.17 ±

0.55 mm, for the ring finger it was 3.05 ± 0.49 mm and

for the little finger it was 2.64 ± 0.51 mm. On AP radio-

graphs of the middle phalanx of the fingers or proximal

phalanx of the thumb, the average narrowest diameter of

the medullary canal of the thumb was 5.04 ± 0.64 mm, for

the index finger it was 3.68 ± 0.57 mm, for the middle

finger it was 3.82 ± 0.61 mm, for the ring finger it was

3.71 ± 0.50 mm and for the little finger it was 2.75 ±

0.55 mm. On lateral radiographs, the average narrowest

diameter of the medullary canal of the thumb was 4.17 ±

0.68 mm, for the index finger it was 2.09 ± 0.56 mm, for

the middle finger it was 2.10 ± 0.55 mm, for the ring

finger it was 1.95 ± 0.53 mm and for the little finger it was

1.83 ± 0.50 mm (Table 1). In all cases, the results on

Table 1 The average diameters

of the distal and middle phalanx

in healthy Koreans

Distal phalanx Middle phalanx (Proximal for thumb)

AP (mm) Lateral (mm) AP (mm) Lateral (mm)

Thumb 6.39 ± 0.76 5.04 ± 0.73 5.04 ± 0.64 4.17 ± 0.68

Index 4.40 ± 0.52 3.13 ± 0.52 3.68 ± 0.57 2.09 ± 0.56

Middle 4.74 ± 0.63 3.17 ± 0.55 3.82 ± 0.61 2.10 ± 0.55

Ring 4.61 ± 0.56 3.05 ± 0.49 3.71 ± 0.50 1.95 ± 0.53

Little 3.54 ± 0.55 2.64 ± 0.51 2.75 ± 0.55 1.83 ± 0.50

Arch Orthop Trauma Surg (2012) 132:663–669 665

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lateral radiographs (dorsal–palmar dimension) were smal-

ler than the results on AP radiographs (medial–lateral

dimension) and no statistically significant differences

between male and female hands were detected.

During the operation, all fingers except one achieved

rigid fixation with a single screw. One thumb IP joint

required additional K-wire fixation after screw fixation for

controlling rotational instability. On plain radiographs,

bony union was observed in all cases, and the loosening or

destruction of screw was not detected. The time required

for union was an average of 10 weeks (range 8–12). The

average clinical fusion angle was 11.9� (range 0–20;

Figs. 3, 4), and no finger nail deformity was observed.

Removal of a screw because of local irritation or infection

was not required in any case. No other complications such

as dorsal skin necrosis, injury of digital nerves, or stiffness

of the proximal interphalangeal joint observed. Pinch

power was measured to be 75% of the normal side. The

VAS pain score decreased from 6.7 points to 0.4 points

after surgery (range 0–3; p \ 0.001). No patients reported

pain during resting and four reported mild pain during

routine activities. The average Korean DASH score mea-

sured after surgery was 5 points (range 0–8).

Discussion

Arata et al. [8] stated that arthrodesis is a generally

accepted operative treatment for arthritis of the DIP joint to

relieve pain, and to correct deformity and instability when

conservative measures have not improved the problem.

Arthroplasty of the DIP joint is a much less commonly

reported procedure. Silicone implants have been recog-

nized as the mainstay for small joint arthroplasty of the

hand. However, because of high rates of complications,

such as decreased range of motion, bony erosions, implant

fracture and poor patient satisfaction, it is difficult to make

strong recommendations in this regard [9–11]. Further-

more, because the successful fusion of these joints

improves the function and appearance with acceptable

morbidity, arthroplasty is not often recommended except in

special cases where greatest mobility is needed [9, 12]. For

arthrodesis of the DIP joint, a wide variety of techniques

has been used. Because each technique has its own

advantages and problems, no single technique has gained

universal popularity. Early techniques such as a single

K-wire, crossed K-wires and intraosseous wiring provided

stabilization of the joint but produced poor compression of

the fusion surfaces [13–15]. The complication rate of these

early techniques was high, with hardware protrusion or

migration, loosening, nonunion, pin-track infections, dorsal

skin necrosis, osteomyelitis, or stiffness of the adjacent

joint [3].

The principles of obtaining stable union are good bone-

to-bone contact and appropriate compression of the sur-

face. Seitz [16] suggested that compression improved

union rates, time to union, and time to return to work.

Sabbagh et al. [17] revealed that the compression across

the joint is an important factor by reporting 15% nonunion

Fig. 3 Arthrodesis in a nonflexed position. a Preoperative radio-

graphs. b Postoperative radiographs. c Last follow-up clinical

photographs

666 Arch Orthop Trauma Surg (2012) 132:663–669

123

Page 5: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

following fixation using biodegradable smooth pegs. Based

on expectations that compression across the joint might

accelerate the fusion rate and that buried hardware might

decrease the infection rate, the use of headless compression

screws is on the rise. Despite the hope that these screws

would solve the problem, high nonunion rates have been

still reported [2–4, 7]. The exact reason is not clear, but we

suppose that the large diameter of the trailing threads break

through the cortex of the distal phalanx, resulting in loss of

purchase by the screw. In our series, successful union was

observed in all cases and the time required for union was an

average of 10 weeks. The acutrak fusion screw has the

smallest diameter among headless compression screws.

Therefore, the chance of penetration of the distal phalanx

by the screw thread was lower than for other types, which

resulted in good purchase and compression.

There are some reports on DIP joint arthrodesis with the

Herbert screw [3–7]. However, the acutrak screw has been

shown to provide greater compression [18, 19]. Because

the acutrak screw is threaded along its entire length, a

Fig. 4 Arthrodesis in a flexed

(11�) position. a Preoperative

radiographs and clinical

photograph. b Postoperative

radiographs. c Last follow-up

clinical photographs

Arch Orthop Trauma Surg (2012) 132:663–669 667

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Page 6: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

greater surface area is available for fixation between the

bone and the screw. The conical shape of the screw also

may provide an advantage by increasing resistance to pis-

toning within the bone [19]. Furthermore, in contrast to the

acutrak screw, the Herbert screw has a rather thin shaft that

could result in instability. We believe that these factors

might also influence the outcome.

Nail deformity as a result of dorsal cortex penetration of

the distal phalanx by the screw threads is observed fre-

quently. Brutus et al. [2] noted a 7% incidence of nail

deformity out of 27 fingers with the acutrak mini screw. In

a cadaveric study, Wyrsch et al. [20] found distal phalanx

fracture and penetration of the dorsal cortex by screw

threads in 25 of 30 specimens during joint instrumentation

with a Herbert screw. This can lead to stretching or dis-

ruption of the nail bed with deformity of the nail. When

compared with the results using other headless compres-

sion screws, our results were promising.

Distal-to-proximal placement of the screw in fusion of

the DIP joint is only possible in nearly full extension.

Brutus et al. [2] stated that arthrodesis with an acutrak mini

screw was considered very useful if it is acceptable to

positioning the DIP joint with extension and that another

technique should be performed if more than 10� of flexion

is desired. However, in our series, the mean clinical angle

of the fusion was 11.9� (range 0–20). A slight flexion

position was possible because of the small diameter of the

acutrak fusion screw, especially in the thumb. In this study,

almost all patients seemed to adapt well and they did not

complain about the fusion position.

The selection of proper headless compression screws

with the size appropriate to the distal phalanx may be one of

the most important factors for success of fusion. Koreans

tend to be smaller than Caucasians and thus the distal

phalanx is also smaller. Hence, the possibility of penetration

of the screws in the distal phalanx is higher. Wyrsch et al.

[20] dissected 30 distal phalanges from cadavers and mea-

sured the size. The average height (dorsal-palmar dimen-

sion) of the distal phalanx was 3.55 mm, smaller than the

trailing thread diameter of the Herbert screw (3.9 mm). In

their study, they found fracture and penetration of the dorsal

cortex by screw threads in 10 among 15 male cases and in

all 15 female cases during joint instrumentation with a

Herbert screw. In the study, the smallest diameter of the

distal phalanx was 2.54 mm (the little finger on lateral

radiographs). Regarding the headless compression screws

currently available on the market, the trailing thread

diameter of the acutrak standard screw is 4.2 mm; it is

3.9 mm for Herbert screws, 3.5 mm for acutrak mini

screws, 3.2 mm for Herbert mini screws and 2.5 mm for

acutrak fusion screws (Table 2). We determined that only

the acutrak fusion screw would not penetrate the distal

phalanx during the arthrodesis of the DIP joint.

The diameter of the medullary canal of the middle

phalanx might be an important factor for fixation with

headless compression screws. To the best of our knowl-

edge, this issue has not been studied in the literature. In our

study, the minimal diameter of the medullary canal was

1.83 mm (the little finger on lateral radiographs) and the

maximal diameter was 4.17 mm (the thumb on lateral

radiographs). During thumb IP joint arthrodesis, inadequate

purchase in the proximal phalanx can occur if it has a wide

medullary canal. In our series, we experienced one intra-

operative fixation loss with the acutrak fusion screw, so we

added a longitudinal K-wire for stability. Care should be

taken and alternative fixation methods should be consid-

ered for thumb IP joint arthrodesis in cases with a large

medullary canal in the proximal phalanx.

In conclusion, the acutrak fusion screw is feasible and

adequate for arthrodesis of the DIP joint and thumb IP

joint, particularly in Koreans. However, meticulous atten-

tion to the size of the distal phalanx is important to avoid

complications in some little fingers. If preoperative radio-

graphs suggest that the thumb has a wide medullary canal

in the proximal phalanx, alternate methods of fixation

should be considered.

References

1. Tomaino MM (2006) Distal interphalangeal joint arthrodesis with

screw fixation: why and how. Hand Clin 22(2):207–210

2. Brutus JP, Palmer AK, Mosher JF, Harley BJ, Loftus JB (2006)

Use of a headless compressive screw for distal interphalangeal

joint arthrodesis in digits: clinical outcome and review of com-

plications. J Hand Surg Am 31(1):85–89

3. Stern PJ, Fulton DB (1992) Distal interphalangeal joint arthrod-

esis: an analysis of complications. J Hand Surg Am

17(6):1139–1145

Table 2 Size of the commercially available headless compression

screws

Screw name Diameter (mm)

Leading Trailing

Acutrak fusion (smallest) 2.0 2.5

AutoFix 2.0 2.0 3.0

Herbert mini 2.5 3.2

AutoFix 2.5 2.5 3.3

Acutrak mini 2.8 3.2–3.5

Kompressor mini 2.8 3.6

Synthes 3.0 HCS 3.0 3.5

Herbert 3.0 3.9

Acutrak 3.3 3.8–4.6

Twinfix 3.2 4.1

Kompressor 4.0 5.0

668 Arch Orthop Trauma Surg (2012) 132:663–669

123

Page 7: Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

4. El-Hadidi S, Al-Kdah H (2003) Distal interphalangeal joint

arthrodesis with Herbert screw. Hand Surg 8(1):21–24

5. Faithfull DK, Herbert TJ (1984) Small joint fusions of the hand

using the Herbert bone screw. J Hand Surg Br 9(2):167–168

6. Ishizuki M, Ozawa H (2002) Distal interphalangeal joint

arthrodesis using a minimally invasive technique with the Herbert

screw. Tech Hand Up Extrem Surg 6(4):200–204

7. Gomez CL, Proubasta I, Escriba I, Itarte J, Caceres E (2003)

Distal interphalangeal joint arthrodesis: treatment with Herbert

screw. J South Orthop Assoc 12(3):154–159

8. Arata J, Ishikawa K, Soeda H, Kitayama T (2003) Arthrodesis of

the distal interphalangeal joint using a bioabsorbable rod as an

intramedullary nail. Scand J Plast Reconstr Surg Hand Surg

37(4):228–231

9. Drake ML, Segalman KA (2010) Complications of small joint

arthroplasty. Hand Clin 26(2):205–212

10. Mikolyzk DK, Stern PJ (2011) Steinmann pin arthrodesis for

salvage of failed small joint arthroplasty. J Hand Surg Am

36(8):1383–1387

11. Namdari S, Weiss AP (2009) Anatomically neutral silicone small

joint arthroplasty for osteoarthritis. J Hand Surg Am

34(2):292–300

12. Wilgis EF (1997) Distal interphalangeal joint silicone interposi-

tional arthroplasty of the hand. Clin Orthop Relat Res 342:38–41

13. Olivier LC, Gensigk F, Board TN, Kendoff D, Krehmeier U,

Wolfhard U (2008) Arthrodesis of the distal interphalangeal joint:

description of a new technique and clinical follow-up at 2 years.

Arch Orthop Trauma Surg 128(3):307–311

14. Leibovic SJ (2007) Instructional course lecture: arthrodesis of the

interphalangeal joints with headless compression screws. J Hand

Surg Am 32(7):1113–1119

15. Mantovani G, Fukushima WY, Cho AB, Aita MA, Lino W Jr,

Faria FN (2008) Alternative to the distal interphalangeal joint

arthrodesis: lateral approach and plate fixation. J Hand Surg Am

33(1):31–34

16. Seitz WH Jr, Sellman DC, Scarcella JB, Froimson AI (1994)

Compression arthrodesis of the small joints of the hand. Clin

Orthop Relat Res 304:116–121

17. Sabbagh W, Grobbelaar AO, Clarke C, Smith PJ, Harrison DH

(2001) Long-term results of digital arthrodesis with the Harrison–

Nicolle peg. J Hand Surg Br 26(6):568–571

18. Faran KJ, Ichioka N, Trzeciak MA, Han S, Medige J, Moy OJ

(1999) Effect of bone quality on the forces generated by com-

pression screws. J Biomech 32(8):861–864

19. Toby EB, Butler TE, McCormack TJ, Jayaraman G (1997) A

comparison of fixation screws for the scaphoid during application

of cyclical bending loads. J Bone Joint Surg Am

79(8):1190–1197

20. Wyrsch B, Dawson J, Aufranc S, Weikert D, Milek M (1996)

Distal interphalangeal joint arthrodesis comparing tension-band

wire and Herbert screw: a biomechanical and dimensional anal-

ysis. J Hand Surg Am 21(3):438–443

Arch Orthop Trauma Surg (2012) 132:663–669 669

123