Letter to the Editor

Sir,

We read with interest the article in the April, 2004 issue by Caterini et al. entitled: “Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity”. ¹

First, the authors report a high reoperation rate of 13%, with the most common cause for this being persistent pain at the tip of the toe due to a prominent screw head. We would like to suggest that headless cannulated screws are commercially available and can avoid this problem.

Second, this technique is for arthrodesis of the proximal interphalangeal joint but in effect the distal interphalangeal joint also is stiffened as a result of the screw. This would not be acceptable to our patients.

Last, the authors state that this technique of internal fixation in arthrodesis of the smaller toe joint has never been previously described. We would like to make the authors aware that it has been described in horses, ² and we have reported the use of the Barouk screw for distal interphalangeal joint fusion. ³

S Jones Consultant, Orthopaedic Surgeon, Northern General Hospital, Sheffield, UK

H Al Hussainy Orthopaedic, Specialist Registrar, Northern General Hospital, Sheffield, UK

MJ Flowers, Consultant, Orthopaedic Surgeon, Northern G. Hospital, Sheffield, UK