paul tornetta iii - orthopaedic trauma association (ota) · 2/2/2016 3 tibial ct’s 47 male 42...

2/2/2016

1

Reduction Tricks and Tips

Paul Tornetta III

Intracortical Screwsand Miniplates

Paul Tornetta III

Professor

Boston Medical Center

Disclosures!

• Publications: Rockwood and Green, Tornetta and Ricci TIFS, Tornetta

and Einhorn; Subspecialty series, Court-Brown, Tornetta; Trauma, AAOS; OKU Trauma, ICL Trauma, Tornetta; Op Techn in Ortho Surg, OTA Slide project

Journals:; JOT; Deputy editor, CORR, JAAOS, JBJS; Reviewer

• Research: OTA, FOT, AIOD, Smith Nephew

• DesignerSmith and Nephew, Kinespring

2/2/2016

2

Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

2/2/2016

3

Tibial CT’s

47 Male 42 Female

Tibial CT’s

47 Male 42 Female

12mm

Tibial CT’s

47 Male 42 Female

6mm6mm

2/2/2016

4

2.0mm – 2.7mm

2.0mm – 2.7mm

2.0mm – 2.7mm

2/2/2016

5

2.0mm – 2.7mm

Injury

• 24M

• Grade IIIC

• Arterial repair

2/2/2016

6

Postop

2/2/2016

7

Dynamization

• 161 Days

• RUST = 5

Union

• 334 Days

• RUST = 10

Injury

• 29M

• Femur

• 3B Tibia

2/2/2016

8

Clamp to Nail

Clamp to Nail

Three Loose Fragments

2/2/2016

9

Healed

Beware! Hard Bone!

2/2/2016

10

GSW: Ex Fix + Minifixation

GSW: Ex Fix + Minifixation

GSW: Ex Fix + Minifixation

2/2/2016

11

POP!

POP!

Healed

2/2/2016

12

Miniplates• Can be used temporarily

• Support reductions

• Plate over or around them

• Unicortical screws

• Accessory fixation

• Add to stability

• Hold a fragment reduced

Miniplates• Can be used temporarily

• Support reductions

• Plate over or around them

• Unicortical screws

• Accessory fixation

• Add to stability

• Hold a fragment reduced

Miniplates• Can be used temporarily

• Support reductions

• Plate over or around them

• Unicortical screws

• Accessory fixation

• Add to stability

• Hold a fragment reduced

2.0, 2.4, 2.7

2/2/2016

13

Temporary Help

AP Lateral

Temporary Help

AP Lateral

Temporary Help

AP Lateral

2/2/2016

14

Miniplate While Nailing

Miniplate While Nailing

Miniplate While Nailing

2/2/2016

15

Nailed!

Nailed!

48 YO Alcoholic

2/2/2016

16

2/2/2016

17

Leave it in!

2/2/2016

18

2/2/2016

19

Accessory Antiglide Plates

Accessory Antiglide Plates

Accessory Antiglide Plates

2/2/2016

20

Accessory Antiglide Plates

Summary• Intracortical screws

• Miniplates

• Strength

• Flexible

• Reduction tools

• Temporary fixation

• Leave it in?

Boston Medical Center