Name: MIS Hammertoe Correction Using 2.5 mm Compression FT Screws
Uploaded: 2019-10-08T00:00:00Z
Channel: Arthrex
Description: James McWilliam, MD, (New York, NY) demonstrates a minimally invasive hammertoe correction with a 2.5 mm Compression FT screw. Dr. McWilliam uses the MIS power unit to prep the PIP joint before placing a percutaneous 2.5 mm Compression FT screw.

<p>James McWilliam, MD, (New York, NY) demonstrates a minimally invasive hammertoe correction with a 2.5 mm Compression FT screw. Dr. McWilliam uses the MIS power unit to prep the PIP joint before placing a percutaneous 2.5 mm Compression FT screw.</p>

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VID1-000633-en-US | A | MIS Hammertoe Correction Using 2.5 mm Compression FT Screws

James McWilliam

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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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MIS Hammertoe Correction Using 2.5 mm Compression FT Screws

We're going to be doing a hammertoe repair by Pip arthroplasty using the Arthrex minimally invasive instrumentation. And the 2.5mm compression foot screws. We have a right foot. There's a flexion contracture of the Pip joint. And we're going to address the hammertoe by addressing that flexion contracture using the beaver blade. That's part of the Arthrex mis instrumentation set. We're going to make an incision through the extensor mechanism over the dorsum of the pip joint. Entering the joint as best we can. I'm taking care not to affect the medial and lateral nerve vascular bundles. First we use the two by eight millimeter Shannon Burr. This is going to create a pocket in our joint to accept the larger 2.9mm wedge burr. So I can feel the bird going into the joint. You can do this under Fluoroscopic guidance if you're not familiar with the field. Next, we're taking the 2.9mm wedge burr. The wedge burr is different than the Shannon burr in that instead of cutting bone it's actually designed to remove bone. And we're going to remove bone from both the proximal phalanx by some gentle pressure on the proximal phalanx and a sweeping motion with a little bit of rotation. And we're going to remove burr from the middle phalanx with a little distal pressure, a sweeping motion, and a little bit of rotation. Next we're going to use the 0.86mm guidewire. This is the guidewire that accepts the drill for the 2.5mm compression screw. I'm going to put this guidewire down into the intramedullary canal of the proximal phalanx, because the overall alignment of the toe is going to be contingent upon our drilling and the position of our screw. I'm going to check this under fluoroscopy. So on the AP image we can see good placement of the guidewire down the Intramedullary canal. It's also important to check on the lateral image. And you can see it's right down the shaft. The other thing we see on the AP image is that our joint is unevenly prepared. So we're going to have to remove a little bit more bone from the lateral part of the joint. And that can be done in subsequent steps. So next we're going to use the 2.0mm Cannulated drill that prepares the Intramedullary canal for the 2.5mm compression ft screw. And I'll do this as the positive stop will be my. Proximal cortex or the proximal phalanx. You could drill through. So you do need to use some care in doing this. Next we're going to place in a retrograde fashion the 0.8mm guidewire for the two millimeter drill so that we can prepare the middle phalanx. We're going to send this out, ideally through the tip of the distal phalanx, because once again, our overall alignment is going to be contingent upon our guidewire placement and our drilling. I'm looking at my position here and it looks good, but it's really important to check this under fluoroscopy. So in the AP plane the position is great, particularly with regards to the middle phalanx. On the lateral plane, we can see we're completely lined up appropriately within the middle phalanx. Using the beaver blade, I'm going to cut an incision for exit of the drill bit and insertion of the screw at the tip of the distal phalanx around the exit point for the guidewire. Now we're going to drill antegrade through the middle phalanx and out the distal phalanx using the two millimeter cannulated drill. If you recall, we had a little bit of excessive bone on the lateral side of the proximal phalanx. So we're going to preferentially remove a little bone there. And I can literally I can hear. And I'll be able to feel when the appropriate amount of bone is removed. We can see now that the joint is appropriately prepared. So then by hand, we're going to replace the K-wires antegrade through the middle and distal parts of the toe and then retrograde through the proximal phalanx. But once again I think it's really important to check this fluoroscopic. So here this is going to be the final position of our Toe, which is satisfactory in the AP plane and then in the lateral plane. And you can see it's in the middle and proximal phalanges on the lateral plane as well. I don't typically measure this screw. I almost always use a 26 millimeter 2.5mm compression screw. If it's a really short toe I might go down to a 22. You can see when I insert the screw, there's a tendency for the distal phalanx to rotate. It's important to correct that rotation during insertion of the screw, and I do that manually. I'll check the position on fluoroscopy and then finish this by hand. When you start getting compression across the joint, it's particularly important to hold rotation of the toe because even though clinically it probably doesn't cause much problems, patients are very dissatisfied if their toe is mount rotated. There's your final fluoroscopic image in the AP plane, and here's your image in the lateral plane. Frequently, with the hammer toe deformity, I'll perform a metatarsophalangeal joint release. I'll either palpate the joint or if I can't palpate the joint, then I'll mark the joint using fluoroscopy. I'll take the beaver blade and I'll go almost directly into the joint. Make sure that I cut the long extensor. And then I'll come in. And I'll also cut the short extensor. Putting some gentle plantar flexion pressure on the toe. And you feel a satisfying release once you've been through the tendons. In addition to the tendon release, sometimes you have to release the collateral ligaments off the base of the proximal phalanx, and that can be done through the same incision by gently turning your blade, directing the distal with care taken to prevent injury to the adjacent neurovascular bundle, and continue sequential releases until you have adequate release of the dorsiflexion contracture at the MP joint. For the purposes of this demonstration, we didn't use the irrigator, but every time I'll do the surgery in a live fashion, I will use the irrigator, and you can see the irrigator delivers a constant flow of saline to the field to decrease temperature and decrease the risk of thermal necrosis.

MIS Hammertoe Correction Using 2.5 mm Compression FT Screws

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