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.

Background There is a growing trend across health care to perform increasingly complex procedures in less acute settings. This shift has been fueled, in part, by enhanced recovery protocols, which have shortened hospital stays after major surgeries. We set out to determine the timing of microvascular complications after deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction in a high-volume practice using continuous flap monitoring technologies. Methods The medical charts of all patients who underwent breast reconstruction with DIEP flaps over 24 consecutive months were reviewed. Postoperatively, all flaps were monitored according to a protocol that included continuous tissue oximetry with near-infrared spectroscopy. The primary end points evaluated included any unplanned return to the operating room, time to takeback, and flap loss rate. Results A total of 196 patients underwent breast reconstruction with a total of 301 DIEP flaps. Five of the flaps (1.7%) were taken back to the operating room for microvascular issues, and nine (3.0%) were taken back for nonvascular issues. Of patients who were brought back for microvascular issues, all five (100.0%) were initially identified by continuous noninvasive monitoring and taken back to the operating room within the first 14 hours (range: 1.2–13.6 hours). In the series, the flap failure rate was 0.66% (n = 2). Conclusion All of the microvascular issues were detected in the initial 23 hours after surgery, leading to prompt flap salvage. The results of this study bring into question the need for lengthy flap monitoring protocols and suggest that shorter inpatient, or even observation admissions, may be reasonable, particularly when flap monitoring protocols incorporating continuous noninvasive flap monitoring are used.

By using two simple preoperative measurements correlated with tissue resection weights in a small series of procedures, any reconstructive surgeon can create his or her own reliable formula for predicting breast tissue resection weights for reduction mammaplasty.