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