Though DIP joint fusion can be successfully achieved with K-wires in both the osteoarthritic and rheumatoid patient, their use is often somewhat of an inconvenience to the patient. They prohibit showering, may become infected, may back out and catch on clothing, and surely slow down mobilization of the rest of the finger [1]. For optimal prehension, a modest amount of DIP joint flexion is required, however. Thus, one advantage of K-wires is that they allow fusion in 5° to 10° of flexion (Fig. 1). In the rheumatoid patient in particular, bone stock may be so compromised that getting enough purchase with wires alone can be challenging.

Since making the transition to the Herbert screw, hardware-related complications and patient dissatisfaction with obligatory postoperative functional limitations until union is achieved have been eliminated. Despite the fact that the fusion must occur without flexion—a necessity to ensure intramedullary placement of the screw—patients seem to adapt well (Fig. 2). One further potential disadvantage of screw fixation is the issue of size mismatch between phalanx and screw—especially in the small finger. Though cautious insertion is justified, precise technique allows use even in the small finger—a benefit when early motion is indicated; for example, when concomitant proximal interphalangeal (PIP) implant arthroplasty is performed in an adjacent digit. This device is con-traindicated, obviously, if future PIP joint arthro-plasty is anticipated in the same finger (Fig. 3).

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