Evaluation of finger proximal interphalangeal joint fusion using mini-Herbert screws

Background Proximal interphalangeal (PIP) joint arthritis is a common cause of pain, stiffness, and impaired hand function. Aim This study compared the outcomes of PIP arthrodesis using tension band wiring (TBW) and intramedullary headless (Herbert) screw (HS) fixation. Patients and methods Twenty-six patients (37 digits) with posttraumatic PIP arthritis underwent arthrodesis. Eleven patients (mean age, 31 years) were treated with TBW, and 15 (mean age, 33 years) with two 2.5-mm Herbert screws. Through a dorsal approach, the PIP joint was exposed, the articular cartilage was removed, and arthrodesis was performed using either figure-of-eight TBW or double Herbert screw fixation. Results At a mean follow-up of 28 months, mean fusion time was 13 weeks (range, 9–17) in the TBW group versus 10 weeks in the HS group ( P =0.17). Mean hand grip strength was 43 lb (57% of the contralateral side) in the TBW group compared with 62 lb (83%) in the HS group ( P =0.03). The normalized Modified Michigan Hand Outcomes questionnaire score averaged 70 and 80 points, respectively ( P =0.11). Overall complications were significantly lower in the HS group ( P =0.03). Conclusion Herbert screw fixation provides stable compression across the fusion site, resulting in stronger postoperative hand grip and fewer complications than TBW. Although fusion time and functional outcome scores did not differ significantly, Herbert screw fixation represents a reliable and effective alternative for PIP joint arthrodesis. Level of Evidence Level II.