The Trim-It™ pin simplifies PIP joint fixation, as the 1.5 or 2.0 mm pin seats into any standard wire driver. The PLLA material provides superior shear strength over competitive absorbable pins and enables the surgeon to anatomically position the toe after implantation, leaving the patient with an aesthetically pleasing flexed toe fusion.1,2 
 
Trim-It Pins can also be used for 1st metatarsal bunionectomy, proximal interphalangeal resection, ankle fractures, and fixation of chondral fragments.
References
1. Arthrex, Inc. Data on file (APT-00369). Naples, FL; 2005.
2. Arthrex, Inc. Data on file (APT-01305). Naples, FL; 2009.

Foot and Ankle

Trauma Lower Extremities

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A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

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Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

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Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

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Trim-It Drill Pin® All-Inside Technique

Trim-It Drill Pin® Kit

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

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Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

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Surgical Technique Guides

Hammertoe PIP Joint Arthrodesis using Trim-It Spin Pin™ Fixation

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Trim-It Drill Pin® - Técnica All-Inside

John M. Crates, MD, (Plano, TX) demonstrates his surgical treatment technique for hallux valgus deformity. Dr. Crates performs a double osteotomy using the Arthrex® Low Profile Proximal Opening Wedge Plate and Arthrex TRIM‐IT™ pins for a distal Chevron osteotomy. The surgical technique video includes an extensive overview of the procedure from dissection to closure, complete with pre‐op and post‐op films to highlight the correction achieved intraoperatively.

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Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

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Double Osteotomy for Moderate Hallux Valgus Correction Utilizing the POW Plates and Trim-It™ Pin

My name is Doctor John Crates. We're going to do a proximal metatarsal osteotomy with a chevron osteotomy added to it. This is our pre-operative films. Conceptually, what we're trying to do is take a moderate to severe deformity to a mild to moderate deformity, and then finish it off with a second osteotomy so that we're not asking either osteotomy to do much work, starting off with a soft tissue release through the first webspace and then a lateral sesamoid release test to release again. I like doing a one layer closure here. We've cauterized the superficial veins. There shouldn't be a whole lot of bleeding after that. So conceptually, when I'm looking at bunions and trying to decide if I should do a double or just a single osteotomy, it's really based on the angles. So we can see right here the transverse fibers of the capsule right there. And that's the layer we want to want to be in. So here's the nerve here coming down. We'll just make sure we've got it out of the way for our proximal osteotomy. Dissect plan early so I can free up the tissue a little bit of motion so I can get my sesamoid pulled over and reduced. Now we're going to do a L shaped Capsulotomy. And so up here I expose this medial eminence. Get right up to where the extensor accessory extensor is. You can catch it right there. And I try to follow that line down to the joint. Slide into this pocket that's always there to start exposing this medial eminence and being careful not to release too much of the planter capsule, because those collateral ligaments are important for blood flow to the metatarsal head. Then we'll release dorsally. So before I make the cut, I'll look for that little sulcus there, and then look at my x rays to make sure I know the The anatomy. So first we'll decorticate. And you can see we have a really nice surface of bone there, which will be great for our bone graft. I'm going to go ahead and make a pilot hole for my chevron, because I know on this patient I'm going to do a chevron. So I go about a 1.1cm approximately articular surface. She does not have an elevated dmaa. So I don't have to worry about doing a biplanar chevron. So if you've not done a lot of these, it's it's good to take the the flat plate and just kind of template where you want your cut to be. And we're just going to expose enough to put the plate on. So we're going to be cutting about right there. So I'm going to give this back again. When I do my cut I do it perpendicular to the bone perpendicular to the joint surface. And we'll be sure I don't penetrate the lateral cortex. You'll hear that chatter when I hit the opposite cortex that lets us know we're in the right spot. So gently tap and we have it. Now, when I open up this osteotomy, I essentially what I'm trying to make sure I don't do is break that lateral cortex. So I will gently tap the osteotomy so I'll have control of how much I open it in the force. Then I'll take the the smaller of the two osteotomies that come with the set, and I'll measure with the tree. What I really like about this plate is the square spacer is very stable. It's not spitting off out of the osteotomy like a angled one would. It's very stable. I don't even need a tax which would get in my way. And the fact that it's square also helps me maintain the plantar flexion dorsiflexion of the osteotomy so that I don't get a malpositioned osteotomy. The order that I like to put these screws in, or I put the planter proximal, went in first. I work my way distal and the last one is the dorsal proximal. You can see right here that it's off the bone. So I've got to bend that back down to the bone. You can see I've got that space there. We'll drill this. It says 18 here. So we're going to put in a 16 because we're going to suck that plate down. So when we get down to the end you will see this screw which really has a great bite through this cortex. And it's tapping itself right through. I think they've matched the diameter of the screw and the diameter of their drill bit perfectly. We get to this point and it'll suck right down. See it go. Now we're getting FlushCut. Good bite. Now we're going to check our range of motion. We've got good range of motion. So we don't have to do anything to shorten this. And now we'll give her just a little bit of a chevron. Okay. That's our dorsal limb. Now with our planar limb, we want to make sure that we get to the other side of the collateral ligaments because we do not want to disrupt the blood supply. We're through there. Sometimes I'm able to shift these right over every now and then. I'll have to tease them a little bit with the osteotomy. It picks up a little bit of the soft tissue over there. And then we'll shift this over 3 to 4mm, typically four millimeters in a male and three in a female. Then I will put two TRIM-IT pins in here I've used bio compression the absorbable bio compression screws here as well. And these are nice because you can reuse them. So you just make your angle and try to make sure that you've done it to where there's not a lip here Kind of make the drill hole and then I'll angle it. I try to get these parallel bouncing off the cortex there. Don't penetrate it. So you're not in the joint. Then I will remove this overlying ledge. And now we're going to go pack in our bone grafts and prepare the graft by just taking the cartilaginous portion off of this medial eminence resection. Place it into the opening wedge. Get a real tight fit, which helps me early weight. Bear these right after surgery. And then we'll put some on the plantar side okay. So you can see here I've got a very nice packing of this osteotomy. It's good and stable. And I will actually weight bear these in a walking boot. Day one I. So the capsule with the foot held in dorsiflexing because it helps me make sure the sesamoids find their grooves, which is the goal of the operation to begin with. Pants over vest. Corner stitch. All right, now that I've got my capsule closed, I'm going to check my position and then check my functional range of motion. Got a nice functional range of motion. So right there you can see that we've got that I may shut down. Valgus angle is nice and straight. Sesamoids are where they're supposed to be. And you can see this is where we started and that's our reduction.

Portuguese (Português) - pt

Luke Cicchinelli, DPM, (Mesa, AZ) demonstrates the All-Inside PIP Arthrodesis using a 2.0 mm Trim-It Pin. The cadaveric surgical technique demonstration is followed by Dr. Cicchinelli’s responses to commonly asked questions in regards to bio-materials, revisions and technique pearls. The All-Inside technique is a method that eliminates pin migration, hardware removal and overly straight toes.

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

All-Inside PIP Arthrodesis Technique with the Trim-It Drill Pin®

Okay, so we've gone ahead and opened up the pip joint of a second toe for a pip joint. Arthrodesis. We've gone ahead and resected the tendon back or reflected it back so we could later put a stitch in that if we'd like. Collateral ligaments are released immediately and laterally. We've gone ahead and released the extensor tendon from just the dorsum of the base of the middle phalanx. And then we've used a saw to resect the condyles and the head of the proximal phalanx, as well as the base. Here you can certainly use and I often do use a round jaw to get rid of the cartilage there at the base of the proximal, I'm sorry, the middle phalanx. And now we're going to go ahead and demonstrate the all-inside technique. And this is with a 2.0 TRIM-IT drill pin. This is the. The undersized, slightly undersized metallic pre-drill pin and then the PLA. Polylactic acid 2.0 pin with the metal tip. Now we can just load this and drill because we have the metal tip on the end of the bio pin right into the canal. Intramedullary like that until I can feel the base of the proximal phalanx, the base, which is essentially the subchondral bone plate. So I know I have not crossed the metatarsophalangeal joint. Sometimes the proximal phalanges intramedullary canal is more dense, particularly the fourth toe. I often see that. And so we'll just go ahead and demonstrate here. And we drill in until we feel the base of that proximal phalanx. That's the subchondral bone plate. We know we haven't penetrated it. You could certainly check with Flora, but it's really not essential that you do that. And then the middle phalanx let us sponge there. And so palpating again, laterally, medially, plant early and dorsally, getting intramedullary in the center. This bone's a bit soft and we'll just drill. And essentially depth gauge. And usually it's a between 10 to 15mm. As you can see with the laser mark here's ten millimeters. Here's 20mm. And essentially it's 15 usually. And of course you can also determine that when the pin is in by dorsiflexing and plantar flexing the dip joint okay. And then we take the pin and we load it up with the metal tip into the K-wires driver. And this is also tapered at the other end. And we could just push it here. But in denser bone you're going to drill it in until you feel that resistance as well. I like to have maximal amount of pin in the proximal phalanx, because that discourages pistoning of the pin later, which can cause soft tissue swelling. And when we have docs ask us if the pin is causing swelling of the toe, it's not. But sometimes they don't have maximum amount of pin in the proximal phalanx, and there could be some pistoning and then that causes soft tissue swelling around it. I frequently cut this end off myself with a pair of scissors. And we'll just put a little mark there. And that may be generous, but I'd rather have it a hair long and cut it a second time if necessary. And then I always cut these obliquely with a double sharp, basically straight edge bone Nipper. Okay, so it's a actually let's cut it this way and it's just a little quick snip so that this stays oblique and slightly pointed. If we do that too slowly, you can mushroom the pin. Okay, look how I'm doing it. More slowly. And you can mushroom the tip of the pin, so it's a quick snip, a sharp snip. We then take a slightly heavier stat versus a mosquito, and the idea will be that we just bend this pin like this and just get a little bend and pop the toe over it. Okay, once it's there, I then simply pull. And you guys can come out. Now as I start to manipulate the toe into the position I'd like. Okay. And then basically we impact it. Okay. And I be sure that I have right there the base of the middle phalanx and the distal aspect of the proximal phalanx opposed. I believe that is very, very important. And you can see how I preserve the tendon when I open this up. Now I can put a little stitch in this, which gives a little additional stability to stop pistoning of the toe. I'm convinced that when we get the occasional question about swelling of the toe, it's because there's pistoning of the toe and they do not have a completely flush union, as you can see right there at the Pip joint. And so you can put a small absorbable stitch in there if you wish. And it gives a little extra stability. Okay. And then you close the surgeon's preference. And then again the advantage of these absorbable pins for myself is simulating weight bearing in the operating room prior to putting the dressing on and simply manipulating the toe by utilizing the mechanical characteristics of the absorbable pin, which I can demonstrate here. This will hold its position if we bend it a few times and then hold it. We've created a malleability in the PLA material where it simply holds its position. Okay. And so we utilize that when we do the hammer toes to get what I call a slightly flexed fusion. This is the resting tension of a finger. Your finger doesn't rest like that. Your finger rests like that and so do toes. And so that's what I seek to gain with the final position of the toe. The reason I prefer the TRIM-IT drill pin over alternative devices available in the market is that it really just captures intramedullary fixation in an absorbable product, just like we've always used K-wires in the same fashion. And it doesn't require any two component or connection of any sort or device at the interphalangeal joint. And so ease of insertion, it's reproducible and it's really intramedullary fixation, which is the most stable but absorbable and nothing coming out. The tips of the toes. The reason I now use the all-inside technique is that it's basically a way to avoid the occasional complication of a of a pin coming out the tip of the toe. And so the original technique that I used was putting the pin in just like a metal wire, and then cutting it off and tamping it back in. Now, I still do use that for procedures such as pan metatarsal head resections where I no longer use metal pins, and I do use the full length TRIM-IT drill pin, tamping it in. However, for all hammer toe surgery, it's very simple and reproducible to just do an all inside technique where you put the pin into the proximal phalanx, cut it, and then bend the toe down and essentially pop the middle phalanx over the toe so you have no material crossing the dip joint nor coming out the tip of the toe. And the memory of the pin. The PLA pin poly lactic acid pin is just right, so that it does not have a bounce back effect or to elastic memory. And so it keeps its position and allows you reliable fixation. Basically every single time. Probably the biggest preference I have for the absorbable TRIM-IT drill pin and hammer toe surgery is the adjustability to the final position for every single toe on every single patient, exactly as I would like for that case. So although there's alternative products on the market that might capture ten degrees of flexion or 15 degrees of flexion at the Pip joint, the PLA pin allows me, prior to putting on the dressing, to simply reposition the toe in any plane. I frequently will even get a little bit of transverse plane correction if I want the toe, for example, second toe, to lay more parallel in the transverse plane to the third toe. I like an anatomically flexed fusion at the pip joint, and I simply just load the foot on the Or table prior to putting the dressing on, and bend that toe to the direct to the desired position, and the PLA material captures that position and holds it there. And so I'm not worried about whether I've got a metallic type device or something else that might fatigue or might break, or may not give me the exact positioning that I want. So really, it's the best of all worlds. It's intramedullary fixation as if it was a metal wire, but it's a more pliable, malleable biomaterial that I can position exactly as I want every single time, for every single toe. Okay, speaking directly to the biomaterial, the history of absorbable products in foot surgery in particular did speak to an incidence of foreign body reactions. It just does not exist with polylactic acid. I've been using this Pin specifically since 2005. The material polylactic acid has been used worldwide over 20 years. There's there's volumes of literature on the material. And so we do still get questions about whether there are foreign body reactions or swelling. That is due to the pin and the the clear answer really is that they are not due to the pin. Now, you can certainly have some soft tissue swelling with hammer toe surgery. It's always technique related and it's because the soft tissues swell. Perhaps there's the pin was not put in snugly enough, or there's some migration because the toe the joint was not opposed completely. So the question about whether the, the the biomaterial itself is causing a foreign body reaction is the answer is no, because the polylactic acid just absorbs so slowly that it just doesn't even cause a foreign body reaction. It doesn't even start to absorb for six months after implantation. And then we have a very nice article in the literature now by Doctor Kunkel, came out in Foot and Ankle International in the fall of 2011. Excellent results. Over 95% Of good results, with no foreign body reactions noted clinically, nor. And this is really nice, with three year MRI follow ups showing no real bone marrow or edema or soft tissue reactions, which quite frankly parallels the literature in other bone and joint surgery around the entire body and around the world over the last 20 years with polylactic acid, particularly in terms of having to revise a case I believe in intramedullary absorbable product really doesn't burn any bridges. If we had a complication that the Pin need to either be removed or cut through or redrilled through, that's easy to do with a competitor, which is not common at all. However, with the competitive products where there are metallic type devices, some are single or one piece, others are kind of dual construct two component to revise these cases, and I've seen these cases, it's a very difficult And what you have to do is you have to remove the implant. And by removing the implant, you're now removing bone. You're left with less bone to work with. And you may have to do a little bone grafting type procedure, or your revision becomes a much more complicated scenario than an intramedullary absorbable type pin, if you were to have a complication with that. In regards to patient satisfaction, or quite frankly, customer satisfaction nowadays, I have honestly never had a single patient ever, when I proposed to them that I could do their hammer toe surgery with an absorbable pin all inside, with no foreign material coming out of the toe, such as a metal K-wires have never had a patient choose the metal wire protruding from their foot versus the all-inside type technique. And the reason is logical. And patients get it completely and that is they can get into shoes faster. They can bathe faster by getting hammertoe surgery into shoes faster. They get less swelling because they're now in a closed tennis type shoe versus a surgical shoe or a surgical boot, which protects the foot but doesn't compress the foot. And so patients embrace this very, very readily. They're thrilled to know that they can have this surgery done without any extruding metal K-wires. And quite frankly, it's a practice builder. And if you have other docs in the community who are still doing hammertoe surgery with external K-wires and you're doing it with internal, you'll have some patients coming over wanting their toes done in that fashion. It just makes so much sense to the patient.

The need to remove hardware is eliminated with the Bioabsorbable Trim-It Drill Pin All-Inside Technique.
<ul>
 <li>Eliminates pin protrusion and removal for patient comfort</li>
 <li>Enables anatomic positioning of the toe after implantation for a "flexed toe fusion"</li>
 <li>Inserts quickly with a standard pin driver</li>
</ul>

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

Artrodesis de la articulación PIP del dedo en martillo utilizando fijación Trim-It Spin Pin™

Hand and Wrist

French (Français) - fr

Le Système de Vis Trim-It™

Soluciones Arthrex para el Hallux Valgus

Surgical Techniques for Use with the Arthrex 2.0 mm Trim-It Drill Pin®

Manual Insertion Instruments for TRIM-IT Drill Pin with 2 mm Tamp, Sleeve

TRIM-IT Drill Pin, manuelles Setzinstrumentarium, mit 2 mm Punch, Hülse2 mm

Manual Insertion Instruments for TRIM-IT Drill Pin, 2.0 mm

Instrumental de inserción manual para TRIM-IT Drill Pin, Ø2 mm

INSTRUMENTO DE INSERCAO MANUAL PARA PINO DE BROCA TRIM-IT 2MM

Bi-Cortical Bio-Post Implantatkürzungszange

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All-Inside PIP Arthrodesis Technique with the Trim-It Drill Pin®

Surgical Techniques for Use with the Arthrex 2.0 mm Trim-It Drill Pin®

Surgical Technique Animations (1)

Trim-It Drill Pin® All-Inside Technique

Surgical Technique Guides (2)

Hammertoe PIP Joint Arthrodesis using Trim-It Spin Pin™ Fixation

Artrodesis de la articulación PIP del dedo en martillo utilizando fijación Trim-It Spin Pin™

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Trim-It Drill Pin® All-Inside Technique

Trim-It Drill Pin® Kit

Trim-It Drill Pin® - Técnica All-Inside

Trim-It Drill Pin® - Técnica All-Inside

Le Système de Vis Trim-It™

Soluciones Arthrex para el Hallux Valgus

Catalogs (1)

Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

Presentation Videos (1)

Double Osteotomy for Moderate Hallux Valgus Correction Utilizing the POW Plates and Trim-It™ Pin

Related Products (3)

AR-4152DS

AR-4151DS

AR-4156DS

Accessories (2)

AR-4152MS

AR-1367F