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The standard and mini-acutrak (r) bone screws are fully threaded, conically shaped screws. The conical shape and variable pitch threads cause compression of the osteotomy. The first metatarsal fixation screw can be used with the Chevron bunionectomies.
The standard and mini-acutrak (r) bone screws are fully threaded, conically shaped screws. The conical shape and variable pitch threads cause compression of the osteotomy. The first metatarsal fixation screw can be used with the Chevron bunionectomies.
The standard and mini-acutrak (r) bone screws are fully threaded, conically shaped screws. The conical shape and variable pitch threads cause compression of the osteotomy. The first metatarsal fixation screw can be used with the Chevron bunionectomies.
FIXATION SCREW William T. McPeake III, M.D. Knoxville Orthopedic Clinic, P.A. Knoxville, TN USING THE CHEVRON BUNIONECTOMY AcUTRAKr Introduction The Standard and Mini-Acutrak
bone screws are fully threaded, conically shaped screws with
variable pitch threads. The conical shape and variable pitch threads cause compression of the osteotomy when the screw is advanced. I have found little or no need to remove the hardware and very few complications associated with this fixation procedure. It represents simple, easy, reliable and appropriate fixation for the osteotomies used in Chevron bunionectomies. Step 2 The osteotomy is performed either directly at the sulcus or just medial to the sulcus. The medial exostosis is removed with an osteotome creating a flat medial surface that is in the same plane as the medial aspect of the first metatarsal shaft. 2 Step 1 With appropriate anesthesia, the foot is prepped and draped in a sterile orthopedic man- ner. A longitudinal incision is made along the medial aspect of the first metatarsopha-langeal joint approximately 1.5 inches in length through the skin and subcutaneous tissue to the capsular layer along the capsular surface. The dorsal and plantar skin flaps are developed taking care to identify and protect the dorsal and plantar medi- al digital nerve. A transverse section of capsule is removed just proximal to the joint level. The width of this capsular excision is dependent upon the degree of deformity and usually varies between 1/2 to 3/4 cm in width at its widest point. This allows exposure of the first metatar- sophalangeal joint and the medial exostosis is further visualized by carefully dissecting the por- tion of the medial capsular ligament from the exostosis. Step 3 The length of the screw is determined by measuring the width from dorsal to plantar along this flat surface. This can either be per- formed with the use of a standard ruler or an osteotome of varying sizes can be laid across the flat surface to determine the overall width of this bone. Usually, 14mm or 16mm Mini- Acutrak
screws are satisfactory. However for
a larger individual, it may go to an 18mm. Step 4 The soft tissue is freed from the dorsal and plantar neck areas of the first metatarsal just posterior to the articular cartilage and a Chevron osteotomy is per- formed as described by the late Kenneth A. Johnson. This allows lateral shift of the first metatarsal head and also a correction of the angulation deformity and abnormal alignment of the articular surface of the first metatarsal head should this exist. 3 Step 5 The osteotomy is held in place while the guide pin is placed across the osteotomy site under direct vision. The guide pin is placed where the dor- sal and plantar cortex of the metatarsal head and neck are incorporated with the cancellous bone of the shaft of the first metatarsal crossing the Chevron osteotomy on the dorsal and plantar legs of the osteotomy. A measurement can be obtained by meas- uring the guide pin, if this has not already been accom- plished. FATR-33-04 effective: 06/2003 Step 6 The guide pin is advanced thru the plantar cotex and the drill is used to drill over the guide pin to the required depth. An Acutrak
screw one size smaller than drill
depth is inserted. Alternative Method: The osteotomy is relatively stable and usually can be held without difficulty in order to insert the screw without the use of a guide pin for screw place- ment. In my experience, after the procedure has been accomplished many times with the use of a guide pin, screw fixation can easily and adequately be applied without the use of the guide pin by simply using the non-cannulated drill and drilling to the predetermined depth, and inserting a screw one size under the drill depth. Step 7 Intra-operative x-rays can be obtained or fluorescein can be used to assure the fixation and placement of the screw. The proximal medial prominence of the osteotomy is removed and smoothed with a rongeur and the capsular incision is re-approximated with figure of eight sutures of 2-0 vicryl holding the toe in an anatomical corrected position. The wounds are closed in the usual fashion and dressings applied. AcUMEDr 5885 N.W. Cornelius Pass Road Hillsboro, OR 97124 U.S.A. (503) 627-9957 (888) 627-9957 www.acumed.net 4