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4Fixation

Two 5.5 mm cortex screws are now placed transarticularly in lag fashion

Insertion of transarticular lag screws

Two 5.5 mm cortex screws are now placed transarticularly in lag fashion extending from the dorsal distal proximal phalanx into the proximal palmar/plantar middle phalanx. They cross the joint at the junction of the palmar/plantar ¼ and the dorsal ¾.
It is important that first one screw hole is finished and the screw inserted before the thread hole for the second screw is prepared.
The screws are placed medial and lateral to the plate and parallel to the sagittal plane.
Real time imaging is useful to direct screw positioning and intraoperative imaging of some nature is necessary to confirm proper implant position.