Name: Phalangeal Fracture Fixation With the Mini Comprehensive Fixation System 1.6 mm Triangle Plate
Uploaded: 2020-06-03T00:00:00Z
Channel: Arthrex
Description: Steven J. Lee, MD (New York, NY), demonstrates a phalangeal fracture fixation using a 1.6 mm triangle plate from the Mini Comprehensive Fixation System.

<p>Steven J. Lee, MD (New York, NY), demonstrates a phalangeal fracture fixation using a 1.6 mm triangle plate from the Mini Comprehensive Fixation System.</p>

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VID1-000716-en-US | A | Phalangeal Fracture Fixation With the Mini Comprehensive Fixation System 1.6 mm Triangle Plate

Steven J. Lee

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Phalangeal Fracture Fixation With the Mini Comprehensive Fixation System 1.6 mm Triangle Plate

So today we have a proximal phalanx fracture in a right hand of a male patient. So we've simulated a fracture in the metacarpal neck. And today we're going to demonstrate the triangular plate. Its usage is interesting because this plate can be used in many different places, especially for a periarticular fractures. The benefit of it is that it conforms nicely to a lot of different surfaces in and around the joint, and gives you multiple different hole locations to put screws in, especially for more comminuted fractures. I just want to show the plate cutter. It is a nice plate cutter that makes a very smooth cut. There are different places to put the plate. So for example the first peg here is for the one four plate. The second peg here is for the one six and the 2.0 plates. And the third peg here is for the 2.0. So here maybe we'll cut off about three holes just for demonstration purposes. And you'll notice that this makes a very easy cut. So if you if you notice that the plate cutter makes a beautiful cut or round cut, and the edges that it makes are relatively smooth. If you feel feel it with your fingers and it's still a little bit rough, you can use the the file that's on the side of your plate cutter. And you can go ahead and make the any edges that you might feel even smoother. Like most of our fractures. We're going to go ahead and put this on where we like it. And you can notice right from the get go without any contouring or of any kind, that the shape of this triangular plate already fits very nicely onto the distal aspect of the proximal phalanx. I'm going to take this tack and make some and hold this provisionally with the tack. So I'm going to put another tack in distally here. Of note the tack is a 1.1mm thickness, which is actually also the same size as the drill you can use. So obviously you can go ahead and use the same hole to put in your screw at the same time. This is a 1.1mm drill. You see there's a nice black laser line on it that corresponds and allows you to measure directly off of your drill guide and saves you a step. If you'd like to go ahead and measure directly here, as opposed to using a separate step with the depth gauge. And of course, if you're not sure if you're more comfortable using a depth gauge, there's a beautiful depth gauge on the set as well. So at this point, I've gone through the first Vortex I'm up against the second Vortex I can clearly see that my laser line is at about eight millimeters or so. So at this point I'll go ahead and come through the second Vortex. And if I measured eight with that Vortex, I'm okay putting on a ten millimeter screw. However, there's a very nice and smooth depth gauge that's in the set as well. It's very intuitive to use. And you can notice that my measurement here is somewhere around 9 or 10mm. So that does correspond with what we measured directly off the drill guide. The other thing I want to show is the screws the actual set. If you put your fingers over this, the tops of the screws and you feel that they're all level, then this is what we call stadium seating. So only the screw that fits that hole will actually be able to will be able to fit nicely in that slot. The second thing I want to show is how nice the screwdriver and the locking the mechanism is to hold the screw in. So I'm going to put this in for a ten and go ahead and put the locking mechanism down on it. You're going to feel a beautiful nice positive click to it so you can see how stable this is right from the get go. And I didn't have to do anything. Additionally just then to just put the sleeve right over it. The sleeve has a spring loaded mechanism, and it's a very positive and direct click that you feel once you do it. You do not need to do any additional pushing in or tightening with your fingers, which may obviously allow the screw to come off. There are different screw drivers in the set that will hopefully appeal to just about any hand surgeon. You also notice how easily the retaining screw comes off, and it allows this to do this all in one step. So I'm going to put one distally. I just want to show the variable angle part of this. So I'm going to aim a little bit more proximally just to make sure I'm away from the joint. Same thing here. I kind of feel the other cortex and I'm about at a ten, so I'll probably be okay with either 11 or 12 screw. These are this is going to be a locking screw that I'm going to put in. So obviously I don't need to necessarily go that much past the Vortex or even just up to it. So then obviously we'll repeat this process to drill a measure and put the appropriate size. Screw in until you feel like you've had enough fixation for your fracture pattern. So my ProStop protocol depends on how comminuted the fracture is and how stable the fixation they get. So in general, as we all know, that the earlier we can get range of motion going on, especially with proximal phalanx fractures the better. So after about a 1 to 2 week period of time as the skin is healed, if the fracture is stable enough, I'll start them early. Range of motion. If not, I will wait even up to three, four, six weeks or so, depending on how stable that fracture actually is.

Phalangeal Fracture Fixation With the Mini Comprehensive Fixation System 1.6 mm Triangle Plate

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