RCT Ortho technique is live

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[00:00:23]partner learning of TVRI very very cost effective way of doing supra learning of TV so multinational companies Smith and Nephew and Johnson and Johnson instruments.

[00:00:55]Uh implants nail Innovative technique of supra learning of TBS or nail implants screw Dr. Innovative technique of supraal learning advantage throughout the sea.

[00:02:27]or distinguative technique of supraing of TV uh Nepal, Bhutan, Pakistan, Bangladesh location of Back up instrument techniques Dr. innovative technique of introperting instrumenting as a backup plan. So yeah, RCT introducer composition.

[00:04:20]or complication be comparable.

[00:04:23]So my live push brush.

[00:05:25]So hi friends today I'm going to give a demo of permutation fix of the medial bolus fracture in a 60 years old patient who had osteoprotic bone. So along with the fracture of the medial myolus he had also a fracture carcanium. So we decided to fix it with the help of the 2.5 mm K wire after cut to 10 years reduction of the fracture by sticking and you can see that how I am fixing this fracture with the help of the uh ky by joing the same k is introduced inside the medary canal for fixation of the medial medular fracture. I am confirming the fracture in that whether it has gone in proper position or not by rotating the foot. So this is the empty view and you can see that will reduce fracture and the k is going well inside the intra metabolic canal. So this is the oblique view you can see and this is also oblique view the ki is going well after fixation of the median burus spontaneously.

[00:06:55]So friends this why I choose this KY 2.5 mm KY because the patient was old and also protein and fragment was small so there were chances of scattering of the distal fragment that in the medial my fragment this is the lateral view you can see the well reduced fracture and well placed k inside the canal And this is the clinical picture. You can see that how beautifully there is no incision given for the introduction of the KY and peraneous reduction of the fracture. And this is the oblique view as you can see in this picture. And uh this is the uh so far as the side effect of this percutaneous fixation is concerned is dated union due to interposition of the podium inside the fracture fragment and slightly more fluoroscopic time because all the steps are done with the help of the CR. So the ex radiation exposure is more than the open reduction internal fixation of this. So these are the two computation and the the advantage of one fixation is that the less chance less chance of infection and the indications are the skin condition is bad and osteoporotic patient and diabetic patient where there are chances of infection is more a fixation can be done. This is a well bull ky 2.5 mm k and I am doing uh this I hammering this last end of the ky to b this ky last end of the k is within the soft tissue and this is the final stage of the uh surgery that I am putting this in species finally after thorough wash of the bone.

[00:09:18]This is a skin incision given in the last step because to because the buring of the last end of the k was not possible without putting this incision.

[00:09:36]So this was this incision was given at last and finally that skin incision is given and and the last was buried within the soft tissue and this is my over and surgery is over. So this is the well done surgery for this patient. So thank you very much for patient hearing and these are the take. Thank you for watching this video.

[00:10:26]Stainless steel, titanium, modus of elasticity, vertical or modus of elasticity, modified titanium which made porous and uh modified to to simulate the modulus of elasticity of the cortical bone.

[00:11:15]bearing implant or steering implanting.

[00:11:27]Fracture nailing shape or nail fracture.

[00:12:03]The force which is applied on the weighting bone is central in case of nail. So the nail is a better implant than plate. So uh these are the differences in plate plating and nailing of the fracture of long bone of weight bearing bone of the human body. So the plate is weight steering whereas the nail is weight steering. In plate in the cases of plating the force is eccentric whereas in nails the force is central in center while we are on we. So the kind of form is primary kind in case of plating whereas in case of ning the callus is secondary kind which is supposed to be very very strong and after removal of the implant the there is no chance of refracture whereas the after removal of the plane there is chance of fracture at the fracture site.

[00:13:25]Moreover, there is a stress shing in cases of plating whereas in cases of nailing uh there is no stress shing. So under surface of the plate removal from second day of the surgery. So these are the differences and the most important is in case of plating there is soft tissue threading. So the soft in the form of infection. So the infection rate in plating is more than about 2 to 8% so far as the my is concerned and in the best condition of the whereas in nailing it is about 1%.

[00:14:55]Because the nailing is done no softing no disturbance in the posterior blood supply no disturbance in the industrial blood supply. So these are the distances in platin and Delhi. So we have also discussed about the uh about the uh uh material used in arthopedic implants like stainless steel titanium and titanium elastic nails and carbon fibers. uh about the material used in the car fibers is supposed to be just to reproductate the best implant because the modulus of elasticity of this carbon fiber is about same as the modus of elasticity of particle bone of the human body. So it is and there are four C uh we can just to remember the uh advantage of the carbon fibers. So far as the orthopedic implants of carbon fibers are concerned it is it is costly. It is not cost effective and it is lightweighted because he seems so lightweight or 45° 48° 50° Extreme temperature.

[00:17:01]So it is lightweighted and not cost effective. It is very very costly affairs in comparison to titanium and stainless steel. So number three is no cold wing.

[00:17:31]pressure.

[00:17:42]So fun the third C it is not cost effective there no cold welding in cases of carbon fiber implants and third C is the steel titanium the fourth C 1 C is the cost the is very very costly.

[00:18:15]The second C is the uh old welding and third C is the concluding. The concluding is not possible at the time of surgery in carbon fiber.

[00:18:50]Custom made or se corrosion resistant to corrosion. Corrosion like leaching or feeding of implants after prolong period of time still stainless steel or titanium cancer patient the C14 it is very useful in cancer patient because it is radio and not radio.

[00:19:50]time to time because CTS scan or MRIS discuss human correlation are given. So it is cost it is not cost effective. Number two, it cannot be controlled manually in the OP. And third C is the corrosion resistant and forced it is very useful in cancer patient and uh other advantages are there is no stress setting in case of steel implants as well as titanium plate. There is a stress shing and in case of carbon fibers plate it is there is no stress shing the weakening weakening of the bone under the plate is not there in cases of carbon fibers plate. So these are the advantages of and disadvantages of carbon fiber plates.

[00:21:26]theoretically possible magnesium degradable synthetic polymer like poly like poly acid PCA and PA poly acetic acid Biodegradable electricity fracture.

[00:22:23]of elasticity of elasticity. So, so the use of this synthetic polymer or arthopetic so far as arthopetic implants are concerned is limited to the nonbearing bone like facial bones and pediatric fractures. Yes.

[00:22:59]Fracture fracture.

[00:23:25]synthetic polymeration.

[00:23:38]Hi friends, today I will discuss more about the orthopedic implants to redulate the whole thing that in 1939 brothers from Australia Both 4 hours pressure 197 compression state.

[00:24:40]Low contactial fracture.

[00:25:05]advanced to let's say lower end of the femur and upper upper end of the upper third of the femur. So protective fracture protective fracture and supra fracture fracture or some protective fracture PSN A2. Fore about 10 times steeper than the vertical bone of the human body. So bearing human body.

[00:26:28]of elasticity almost.

[00:26:47]So it is more bioric and biofable.

[00:26:55]So carbon fiber carbon fiber because it is translucent it is not radio effect. So it is very useful in cancer patient pathological fracture due to bone tumor.

[00:27:30]Radio Fialing.

[00:27:58]Carbon cancer patient useful disadvantage.

[00:28:40]So thank you of long bone of human food.

[00:29:21]I can't b friendly or bio 1939 to 40 1940 kale. injuries.

[00:30:23]Upper end of the femur 1939 to 40 second world.

[00:30:43]First world pneumonia world.

[00:31:07]Second one this second environment.

[00:31:30]Children IDE.

[00:32:14]Uh 1950 area concept.

[00:32:43]1950 or 1970.

[00:32:46]Uh, Gross and K.

[00:32:54]Gross and K. Uh solid interlocking inception 197 G upper upper fragment or lower fragmentes or locking aesthetic or dynamic locking concept in 199.

[00:33:46]90 fracture.

[00:33:55]So fracture through free.

[00:34:33]root.

[00:34:36]So upper fold of the tibia fracture intra 90° fction of the knee 90° antior angular deformity through pull of the patella.

[00:35:10]This 19 96 tornado and police concept extended position of the knee.

[00:35:32]root 90°.

[00:35:54]So first time to prove and police concept.

[00:36:17]Supraed instrumenticated instrument.

[00:36:43]Mr. Johnson.

[00:37:09]So nursing home hospital Drop instrumental protective or politial nail extractor.

[00:38:26]TBL extractor.

[00:38:34]Okay.

[00:38:37]A B C D E C Ector of the throughout the nailing process. A conc surface of the nail or C or B concide and radial surface or D to post.

[00:39:39]So, so instrument or adapter screw.

[00:40:09]cost effective.

[00:40:16]So RCT compositional Upper level. Upper level of the color instrument.

[00:41:10]rotate either anticlockwise or clockwise. So goate proper position till last end of the nail seated in proper position. This can be rotated in proper position. So So thank you very much for patient hearing of history of learning the supine position of the patient with a bone in the intercapular space in which position I do interlocking of humorous with the traction only with assistant both side attraction is given and externally rotation external rotation of the proximal fment is done with the body you can see in this picture in theoscopic picture you can see and I am externally rotating the proximal fragment and to see the lateral view of the fracture. So after reduction of the fracture in both empty and lateral view and confirm on the uh chloroscopic picture we make an uh we introduce a 2.5 mm or 3 mm thy or stream peraneously and and selected in the point both in MP Here later the entry point is usually in MP view it is at the point at the junction of the articular and nonarticular fracture and at nal view it is in the line with the intram.

[00:43:30]So if the fracture is in the upper part above hole of the funeral the entry point is in a epic view it is in articular surface of the unit head because it is it should be central c center in both and lateral view so I am introducing two 2.5 mm the statement simultaneously at the selected input point. You can see this this is the empty view. I'm selecting the inter coine uh it is uh it is in particular portion of the you can see in this picture because the pressure is uh for of himself and this is the latter I am seeing it in the lateral group. It is inside the in the line of the intrameary canal and it is inside the intraary can in both and blue are formed in the fluoscopy picture and I exchanging this beam with a kind wire a 2 mm kind wire is exchanged for this uh statement be a 2.5 mm statement be pin and after making a a stand after making a small range in the rotator cm in the proper position canal And in the same time while producing the practice time of practice size while in the distment it should be reduced the practice should be reduced in both and lateral and now I am inside the distment don't put the k wire inside the soft tissue and group. Then this is the reading of the of interal serial reading is done. First of all with the 6 mm rever and it is being removed and then the 7 mm remer is used up to the lower end of the uh humorus.

[00:46:34]It is about up to the 2 to 2.5 cm approximal to the 8 mm is being used in this picture as you can see in a view and it is it has cross it is crossing the fracture side to take the proper time and the fracture should be reduced while doing and it should not be in vus and vital position and it is inside the distal fragment. Uh as you can see in this picture the 8 mm rema is inside the distal fragment is introduced. So after reming we introduce a 7 mm nail of our size uh with hand movement only. Don't use uh electric limo or hammer. Uh only the last few cm of the nail is introduced by hammering. So it is a well blessed nail up to about 2 to 2.5 cm above the pa. And now I am I am deciding where I should put my incision for this locking. And this is the ky position uh on the skin put on the skin horizontally. Another ky vertically over the over the overlapping the nail and crossing the uh hole. So where where the both ky cross each other the b shifting point uh in the middle of the proximal dynamic hole will be the my point of incision in the skin. So after putting about 1 to uh 1.5 cm length skin incision we do dissection soft tissue dissection with the fus or the artifes and then 1.5 mm k is used to make a hole. uh after making both holes circular the lower hole circular and relaxing the upper hole dynamic hole in the bridge as much as possible and this is the 1.5 mm ky is being pulled you see this is put in angle because the because the shape of the anterior surface of the distal humus is triangle so It should be put in hand.

[00:49:34]So in producing in near cortex we do drilling of the digital prox through this hole. And after after drilling I put both the screw you can see in AP and lateral view size and uh well placed a screw inside the hole in both a lateral view. So I am putting the proximal screw. Now you can see that the nail has been married about 5 mm from the articular surface inside the intramary canal. First the screw I will put with the help of the G and drill sleeve and the and the sleeve both the screw I will put the side screw you can see and I'm confirming an object view I do even along with the uh jig you can see that the jig is in place and still I confirming it whether it has gone inside the hole properly or not and uh two bold a screw uh inside the both hole inside the screw in active view and well placed a screw in the lateral view also. So this is the last step and uh first of all I will I do disting because the back hing of the of the nail is done when required to to reduce the distraction at the fracture side to eliminate the distraction at the fracture side and the fracture is compressed.

[00:51:26]But in this case there is no distraction at the side and nail has been buried inside the intra canal about 5 mm from the articular surface of the head. So this is the lateral view and view of chloroscopic picture. You can see this is the lighter wing uh well placed dist and this is attribute and can see the final position there are two escalating incision one for the injury of the neck and other for the proximal to the screw. So these are the uh last confirming fluoroscopy picture you can see the very fresh motion through and there are 5 mm from the articular surface this is the fracture you can see there is a fracture there is no okay thank You surgery innovation award.

[00:53:03]Innovation Award, Indian Orthopedic Association, 25 Opetopedic surgeon.

[00:53:52]Yeah, okay.

[00:54:12]Yeah.

[00:54:22]Okay.

[00:54:33]I picture autourgical center.

[00:54:59]for this Operation Even.

[00:55:42]Low chairs. Baby comfortable movement.

[00:56:02]you know, we Okay.

[00:56:35]The number one myth is interlocking of penis will severely impair the shoulder function due to rotator cuff damage. The reality is with proper technique and injury point the rotator cuff damage kindly minimized and shoulder function kindly preserved. So the myth number two is the there is she always chance of radial nerve injury as it is a complication for the interlocking reading of humorus and it is not a complication for the open reduction internal fixation perforating. So it is yes it is uh there is risk of radial nerve injury where the fracture is at the spinal root there is chance of the interior nerve injury but in the rest of the part if the fracture is in the rest of the part of the humorus there is minimum chance of the radial nerve injury when the instrument like the grind wire removes produced after proper reduction of the fracture in the distal fragment both empty and lateral view the fracture is induced properly only then the instrument are introduced inside the dist fragment and don't allow your instrument to wander inside the soft tissue. So these are the two myths which is uh associated with interlocking of humorus and uh other two controversies whether the which position of the patient should be used for the rocking nailing of the humorus. The number there are three position number one supine position when it is used it is comfortable for the anesthesia point of view as well as the surgeons but the digital locking which is done by free hand technique is slightly difficult and tricky because the anterior surface of the distal part of the humorus is triangular. So finding the the entry point for the distal locking is is slightly difficult because slipping of the drill bit or TY. So it should be at angle it should be introduced at angle and then it should be it should be kept in a straight line.

[00:59:20]So they see the disadvantage of supine position and in latic position as well as the prone position the distal locking is done from the posterior surface which is flat. So the entry entry hole finding the entry point for the distal locking is easy because the surface is the flat but it is uncomfortable position for anesthesia point of view and the surgeons uh depends on the surgeon's choice. So I do use supine position for all my rocking. Number three uh controversy is because it is not going to be nearing bone. So one screw distal and one screw proximal is sufficient.

[01:00:20]But I use two screw distal and two screw proximal because the two is always better than one always stronger than one. If it is just like the two kidney present in human body if one fails other start working. So and and two engines in the aeroplane one engine fails the other start working automatically. So if one screw is not working then the other screw will do its work. So the fixation is better by two screw proximal and two screw distal. So friends these are the advantages of the locking nailing over the plating of the humorus and the these are the myth and these are the controversies whether two screw should be put and the distal what position should be used in this in this uh talk and let us get tuned for the next video and subscribe my channel for more update on arthopedic surgery and insight.

[01:01:42]Hello friends, I am Dr. Ashi Kapur orthopedic surgeon Chabra Vya. Today I am going to present my innovative work name Dr. Kur innovative technique of supraular nailing of tvia. TV fractures are most common among the long hole fractures in human body.

[01:02:10]These are usually caused by high energy trauma like fall from height. Study shows Dr. innovative technique of supra patellular nailing of tibia is safe cost effective method of treatment for metaphysicial tial fractures. Intraator technique is the treatment of choice for diaphysicial fracture of tibia in adults.

[01:02:46]In treatment of metaphor fractures, concerns regarding difficulties with reduction due to anterior deformity becomes a challenge.

[01:03:00]Supraing becoming popular choice for treating metaphures.

[01:03:10]highly specialized surgery and requires very highly specialized instruments sets and implants that tends to be very costly. Dr. Tur innovative technique of supraular milling of tibia delivers 100% satisfactory union of fracture in safe and cost effective way. No special instrument or jig are required. A protective slip and a dropper can be used from PSN A2 and colorcoded infrastructure can be used to introduce the nail in proper position.

[01:04:02]uh between March 2020 to March 2021 Dr. Tangur innovative technique of supracular training of TV conducted on 25 patients to fix the interior lectures. The patients having lectures with no involvement of articular surface we are included in this study. Age of the patient range between 18 to 60 years and they had no coalities.

[01:04:37]All surgery we have performed after an average of 5.5 days. The range being 3 to 12 days after accident.

[01:04:50]2.5 mm k used as a blocking wire to improve netting of possible tial fractures. The tial fractures of all the patient was fixed by Dr. T inative technique of shra nailing of area. This is the floor diagram how Dr. Kaku innovative technique of supra and neotia done. It is done in semi-extended position about 20° of X flexion at the knee joint either transverse or longitudinal skin incision we are given but longitudinal aspect of body of knee joint injured from above proper and protective sleeve from PFNA bushet inserted in wire is just medial to the lateral tibial spine. The guide wire first malleable guide wire we are introduced after serial living fracture reduction and confirmed by fluoroscopy mounting of the nail with appropriate size over the colorcoded tial nail extractor done. Introduction of appropriate near side over the line wire done in proper position with the help of colorcoded uh tial and extractor.

[01:06:40]Locking both proximal and dist by free hand technique. No jar used wash and repair of body shape candle done and closure done.

[01:06:55]These are the pictures how we do we did uh our cases by Dr. T inative technique. These are the instruments. The colorcoded tibial nail extractor protective slim from PF and A2 set rocker and malleable guide and stout and hard guide.

[01:07:28]Remark.

[01:07:30]These are the prices of flame dropper and hard wire in the retroactive space in AP and natural view.

[01:07:41]Pric over the line wire after peraneous reduction with the reduction forces in AP view and this is in later viewing three over the wire and nailing three in distment in AP view. Nearly distrament in lateral view and then both locking screw introduced in proximal fragment.

[01:08:11]In AP and lateral view all the three screws introduced in distal fragment by free hand technique.

[01:08:24]This is the clinical picture.

[01:08:27]Proximal locking done by freeand technique.

[01:08:31]Post-operative followup steps. First post-operative day bing flexion and extension of the knee and ankles right.

[01:08:42]Third postoperative day active flexion and extension at the knees right and ankles right. done 10 postoperative day patient started with I started working with the help of worker nonweightbe 6 to 8 weeks posture we started partial weightbearing 12 weeks after operation we started full weightbearing now the final observation operative Time was in this study 80 + - 10 minutes.

[01:09:26]Range was 65 to 110 minutes. Average chloroscopy during surgery was 38.5 + - 6.5 seconds tering 10 to 50 seconds.

[01:09:43]The average time of union fracture was 8 weeks after surgery with fracture any time was 12 weeks.

[01:09:56]Average hospital stay was 10 to 12 days.

[01:10:01]All pat followed up after 2 3 6 and 12 weeks. Those who could not return for followup telephonic followups we are done and call for follow up in hospital. No complication.

[01:10:22]We are observed no patient experience any loosening or breakage of his stroke or head. No one complaint of knee pain.

[01:10:35]No reduction of loss reduction loss or significant displacement of fracture occurred after surgery. I final followup 21 cases found excellent and four good results in none of the patient removal of nail for any cause. These are the results.

[01:11:04]Fracture lower third tibia lateral view post X-ray of lower thirdia lateral view.

[01:11:14]Frances lower third tibia. Again second case a lateral view portray picture and lateral view.

[01:11:26]This is third case of fracture of upper third and later view poster and this is the clinical pictures 3 weeks follow.

[01:11:44]Okay. Fourth case is pre-ray upper metaphysicial fracture of and this is the poster Xray of upper third fracture of metapacia TV.

[01:12:04]This is case the lower third very very low fracture of tibia and this is the posttop view. This is the clinical picture 3 weeks after the surgery of this surgery. The number of cases included in this study was small. The study was not cooperative with the standard technique. The status of cut over the patella and tropa posterly highlight being evaluated. Thus further more study with larger population and long follow time is required to compare this innovative technique with a standard technique of suprain.

[01:12:54]In this technique time was slightly more than the standard technique because both distal and proximal docking were done by free hand technique.

[01:13:10]Finally friends this innovative temping is very very positive. In fact no cost is incured for this supra alert technique whereas the standard instruments are very very costly. This technique can be adopted in a smaller and medium class arthopetic hospital.

[01:13:49]But the only disadvantage of this technique is the slightly more radiation occurs because the locking both proximal and dist are done with free hand tactic. But this can be lessened by gaining more and more experience in freehand technique for locking proximal indister TV. Thank you.

[01:14:29]Hello friends, I am Dr. Ri Kapuretic surgeon sabra. Today I will give a demo of fear surgery for a osteoporotic patient for interroactive fracture of the feur. The design of the spiral plate provides a stable fixation of this fracture and can make mobile our patient. So today let us conclude the surgery. This is the X-ray of 72 years man having osteoporosis with a fracture of the interropetic onestable time and this is a post-operative X-ray of the same patient and now I going to start my surgery the screen incision before the screen incision I will draw a line from anterior superior iac spine uh down to the table and another line from the tip of the greater to towards this first line and the point of missions bisection of these two lines is the uh point of incision for this surgery. So I am making an incision at the by these bicting points where there are the two lines biceps. So I am giving incision about 2 cm as you can see in the picture. So I am feeling the correct point of entry uh it should be uh at the junction of the anterior 23 and posterior one/ird in lateral view and in epic view it is just medial to the greater procure uh in the bio form. fossa. So I am feeling with my fingers the correct entry point. So after filling this I am confirming uh I am introducing a moon out at the correct point selected and then I am confirming this method this bone is at correct selected point or not in CR picture.

[01:17:30]So I am introducing the how in correct position after confirming the entry point AC of teacher both in a lateral view.

[01:18:07]So this is altitude. It is entering in proper selected position and this is inside the inside the intra canal in correct position going medally in AP view and this is h if it is in place inside the intram canal in proper position confirming in for lateral view. And then I will push pull the this bone out for 2 cm to reproduce the thigh wire.

[01:18:58]The depression or glue present in the lateral side uh will hide this guide wire inside the hole and the guide wire is entering inside the intramuri canal along the depression or roof present laterally. to the owl. So it is inside the intermediary canal well placed in happy view. And now I will remove the owl.

[01:19:49]So I have removed the out and uh I'm doing reading of the meduli canal in the politic patient. The reading is not required. This is for the measuring the size of the intrarami diameter of the intramuric canal to select the correct size of the PFA to nail. So but this is for measuring the interal and I am reming by number 10 and then number 11 remo and the size is 11 mm diameter. the PFNL selected and then I am reming with a 15 mm rear because the upper part of the nail is about 15 mm diameter. So I am reming this and my assistant is pushing the reverse sleeve medally so that it goes in correct position. So it has been with 15 mm remo and now I am introducing the nail of selected size and I will hammer the rebar With the help of supine drive I'm hammering the nail inside the exam canal so that the hole present in the nail comes in the center position.

[01:22:24]of the neck of the feur in every view and the spinal blade can be introduced in central position in every view.

[01:22:46]And now I have I am giving an incision for introduction of the spiral blade.

[01:22:59]And this is the butress nut. My assistant is tightening it and so that it touches the lateral wall of the feur.

[01:23:14]And then I will introduce a guide wire sleeve. And the hard and stout guide wire is being hammered in the central position of the neck of the feur and I'm confirming it whether it has gone in center position in both a and lateral view. You can see in the picture it is in very good place. It is central in empty view and central in lateral view also.

[01:23:55]So I am doing ribbing.

[01:23:58]Some surgeons do readings up to the lateral cortex only but I do reing up to the side of the nail selected.

[01:24:15]So I have re up to the proper distance.

[01:24:24]And now I am hammering the spiral blade.

[01:24:34]After confirming it center c center position in both view and I am compressing this I spiral blade by clockwise movement and so I am compressing the spiral blade by clockwise movement and removing the screwdriver by anticlockwise. profile movement. So the spiral brake is introduced in proper position both an lateral view and then my assistant is attaching the arm for disting from the cheek.

[01:25:26]And after measuring the screw size, I am introducing the drill sleeve for drilling the cortex for digital locking.

[01:25:57]And this is the 2.5 mm guide I am introducing just perforating the making a dimple uh on the lateral cortex.

[01:26:27]I am hammering this hard and stout guide wire in the lateral cortex.

[01:26:35]And after confirming it in see picture I am drilling with the power drill both lateral and the first port is drilled and now second vortex is also and Now I will put a selected size of a screw for digital locking. I am measuring this on the CR.

[01:27:18]I'm measuring this size of the and now I am tightening the screw. This screw the final tightening is done.

[01:27:38]confirming it.

[01:27:40]See our picture.

[01:27:49]The final tighting is being done now.

[01:27:56]It has been tightened.

[01:28:14]And now my surgery is over and I will this is the healthy view. You can see that it is a good position and this is the lateral view of distro.

[01:28:28]Okay, has been introduced in proper position in the hole and this is the lateral view. The spiral blade has gone in the central position in lateral view also. So I will give a forceful wash of the wound and finally I will stitch the skin and close the wound in layers.

[01:29:00]And I'm closing the moon has been closed.

[01:29:27]without any >> and I'll mobilize this patient on second post-operative