00:00 this is Aaron Fralick and the following 00:03 video shows a di P joint or distal 00:07 interphalangeal joint fusion of the 00:08 small finger once again we begin with an 00:12 H type incision over the di P joint 00:17 allowing adequate access to the joint 00:20 surfaces for later preparation the skin 00:28 is incised and five polar cautery can 00:33 use be used for hemostasis once again 00:36 care should be taken to protect the 00:40 extensor mechanism as well as the 00:42 germinal matrix from inadvertent injury 00:45 the flaps are elevated allowing us 00:48 access to the extensor mechanism 01:01 these can be tacked back to allow access 01:05 to joint and the extensor mechanism is 01:08 then incised creating a flat for later 01:12 closure and allowing us excellent access 01:15 to the joint for preparation the 01:17 services 01:23 dissection has continued releasing the 01:26 collateral ligaments and the bowler 01:28 plate as necessary the joint is then 01:33 opened to prepare the services and all 01:38 the cartilage is removed with Roger 01:43 curettes or saw to provide surfaces for 01:47 adequate effusion at this point given 01:50 that it's a small joint k-wire fixation 01:53 was chosen as opposed to a screw 01:56 fixation technique and the wire is 01:59 passed in antegrade and then 02:02 subsequently in retrograde fashion once 02:05 the joint is held reduced position of 02:13 the k-wire is then confirmed under 02:16 fluoroscopy and for stability a second 02:25 ke wire is placed either longitudinally 02:28 or in this case in an oblique flat 02:30 fashion to control rotation of the joint 02:41 you 02:44 these wires can either be left outside 02:47 or given the fact that they are going to 02:50 be in place for an extended period of 02:53 time I cut them and allow them to 02:56 protect under the skin with the plan to 02:58 remove these at approximately 12 weeks 03:02 after adequate fusion is seen the wound 03:06 is then closed with the absorbable 03:08 sutures after closing the extensor 03:09 mechanism with absorbable sutures and 03:12 the fingers then splendid after a 03:14 sterile dressing is applied 03:19 final fluoroscopic images are taken