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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

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Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

Intracortical Screws

• Lag screws

• Tibia

• Humerus

• Femur

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Tibial CT’s

47 Male 42 Female

Tibial CT’s

47 Male 42 Female

12mm

Tibial CT’s

47 Male 42 Female

6mm6mm

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2.0mm – 2.7mm

2.0mm – 2.7mm

2.0mm – 2.7mm

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2.0mm – 2.7mm

Injury

• 24M

• Grade IIIC

• Arterial repair

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Postop

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Dynamization

• 161 Days

• RUST = 5

Union

• 334 Days

• RUST = 10

Injury

• 29M

• Femur

• 3B Tibia

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Clamp to Nail

Clamp to Nail

Three Loose Fragments

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Healed

Beware! Hard Bone!

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GSW: Ex Fix + Minifixation

GSW: Ex Fix + Minifixation

GSW: Ex Fix + Minifixation

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POP!

POP!

Healed

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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

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Temporary Help

AP Lateral

Temporary Help

AP Lateral

Temporary Help

AP Lateral

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Miniplate While Nailing

Miniplate While Nailing

Miniplate While Nailing

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Nailed!

Nailed!

48 YO Alcoholic

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Leave it in!

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Accessory Antiglide Plates

Accessory Antiglide Plates

Accessory Antiglide Plates

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Accessory Antiglide Plates

Summary• Intracortical screws

• Miniplates

• Strength

• Flexible

• Reduction tools

• Temporary fixation

• Leave it in?

Boston Medical Center