Name: MaxForce™ Plates for MTP Fusion
Uploaded: 2020-09-24T00:00:00Z
Channel: Arthrex
Description: Brad Dresher, MD (Colorado Springs, CO), uses the MaxForce™ MTP plating system for an MTP fusion.

Foot and Ankle

<p>Brad Dresher, MD (Colorado Springs, CO), uses the MaxForce™ MTP plating system for an MTP fusion.</p>

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VID1-001471-en-US | A | MaxForce™ Plates for MTP Fusion

Brad Dresher

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

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MaxForce™ Plates for MTP Fusion

I'm Brad Drescher from Colorado Springs. Today we're going to demonstrate a first Mtrp fusion utilizing the MaxForce first Mtrp fusion set. The new MaxForce set will fit conveniently into the current CFS set, which houses your Reamers and other instruments needed. The new MaxForce plate utilizes new technology to increase compression. We have a gear mechanism that's seen here that provides first time compression and second time compression throughout this oblong, compression geared hole. Another feature of the new MaxForce plate is a laser line that indicates position of the plate. Utilizing the joint line, all the holes in the new plate, other than the oblong compression hole, can utilize the 3.0 cortical screws or the 3.0 variable angle locking screw. In addition, there will be an inner frag aiming guide available at a later date to utilize the inner frag locking screw in the inferior portion of the joint. Available in the MaxForce set are petite, standard, long, and extra long plates, in addition to a revision plating system, the plates are available in a zero degree valgus and a zero degree dorsiflexion, and also five degree valgus and five degree dorsiflexion, and in each plate are right and left sided. Available in the MaxForce set for fixation are 3.0mm cortical screws and 3.0 hybrid cortical screws, which utilize a 3.0mm head and a 3.5 threaded stem for fixation, which could be utilized in osteoporotic bone or in revisions. These screws are designed with a low profile flat head to avoid prominent hardware during fixation. In addition, for temporary fixation of the plate, a newly designed half cone tacks which are provided in threaded and smooth. So highlighted here is the difference in prominence of the old 3.0mm compression screw versus the newly designed compression screw that fits nicely into the plate, avoiding prominent hardware. Seen here is the newly designed compression mechanism demonstrating compression with clockwise rotation. It is important when engaging compression to utilize no more than two finger tightness with rotation. So we utilize standard dorsal approach for first MTP fusion center center placement of the K-wires for reaming. You will prepare the joint in standard fashion. So critical to the technique is placement of the k-bar in the inferior portion of the joint. This allows you to obtain your extension degree. This pin will remain in place until fixation is complete with the MaxForce first MTP fusion plate. To obtain proper extension through the first MTP joint, a lid is utilized to simulate the floor with extension through the IP joint. Allows a surgeon to obtain proper extension through the MTP joint for fusion. After sizing, we've selected a standard straight plate. Utilize the laser line to locate the joint for proper position of the MTP fusion plate. What's nice about the MaxForce plating system is you don't have to change your original technique. I utilized the first screw distally as a cortical screw to compress the plate to the bone. Utilizing the 3.0mm cortical screw for compression of the plate to the bony cortex following the cortical screw, the remaining holes in the proximal phalanx will be filled with the val locking screws. This utilizes a 30 degree cone for variable angles. This is the newly designed drill guide to provide the pilot hole for the geared mechanism. The solid portion fits into the oblong compression slot, allowing for a bicortical drill tunnel for positioning of the geared compression device. Prior to positioning of the geared compression device. Remove the BB-Tak proximally. Have your assistant have the BB-Tak prepared for placement on the geared compression device. Note the shoulder prevents pushing too far through the plate, and make sure that the shoulder sits against the plate prior to compression. Placement of the geared compression device is noted here. Bicortical fixation. And be sure to align the laser lines on the plate and the geared compression device. Be sure to fully seat the compression device against the plate utilizing two finger tightness turned Turn clockwise until positive stop is felt and do not tighten greater than that. Here's a nice end point with the geared compression. Once the compression is engaged, we'll fix the plate with the tack to hold the initial compression. As you can see here, the nice compression noted with clockwise rotation of the geared mechanism. At this point, we will remove the compression device and move forward with standard compression through the oblong screw hole. To maintain maximum compression, we will place the compression screw until it starts to engage the plate, then remove the tack, then tighten the screw down to allow maximum compression. With laboratory testing, on average, 24 pounds of compression force was utilized through the compression geared technique, and an additional 9 pounds of compression was achieved with the oblong compression hole in the plate. An important part of the technique is to place a locking screw in the distal hole of the metatarsal, to increase strength of strength of the construct. We'll place the final locking screw proximal in the metatarsal. You can see with the design of this plate. The screw construct allows for easy position of the inner screw and the inferior portion of the joint. To finalize compression. Seen here is placement of the 3.5mm compression screw. Notice the absence of any prominent hardware avoiding symptomatic hardware postoperatively. Post-op protocol is non-weight bearing and a post-op shoe for three weeks, followed by weight bearing in a post-op shoe for three weeks, followed by a stable shoe wear when swelling is reduced. Most patients can expect to return to full activity in nine weeks.

MaxForce™ Plates for MTP Fusion

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