Orthopedic instruments are the tools and devices used during operations and a number of non-operative interventions in orthopedic and trauma surgery. Part of the orthopedic instrumentation is a purely traumatologic instrumentation used in operations mainly in trauma patients. Depending on the purpose, orthopedic instruments are divided into: 1) orthopedic instruments intended for carrying out operations, and 2) orthopedic instruments for non-operative interventions (imposition of skeletal traction, application and removal of plaster casts, etc.). When performing orthopedic and trauma surgeries, in addition to special ones, general surgical instruments are also needed (see Surgical instruments). Sterilization of metal orthopedic instruments is carried out by boiling or autoclaving (see Sterilization in Surgery ). Keep tools clean and dry in special cabinets. The hinges of the locks of the moving parts of the orthopedic instrumentation should be lubricated with vaseline oil. Tools with a sharp cutting surface can be stored in alcohol or disinfectant solution, they must be sharpened periodically.
Orthopedic instruments designed for surgical interventions include instruments and toolkits for operations on bones, tendons, muscles and other soft tissues, as well as special kits for certain types of orthopedic and trauma surgery (for example, a set for intraosseous hip osteosynthesis, etc.). Depending on the purpose and principle of operation, orthopedic instruments can be divided into several groups.Go
Retention tools - tongs and bone holders. Bone forceps are used to hold bone fragments (Fig. 1), sequestral (Fig. 2) are used to grab bone fragments and sequesters . Various bone holders are designed to fix bone fragments in the wound and to hold them during osteosynthesis (see): Lambott (Fig. 3), screw-toothed (Fig. 4) and others. tool in the wound. Depending on the diameter of the bone, the type of the fracture, the characteristics of the surgical wound and the operation itself, bone holders of various sizes, straight or curved at an angle, are used. To remove a bone fragment into the wound, a blunt, single-toothed bone hook serves (fig. 5).
For operations on the bone — cutting and chipping, biting, sawing, drilling, etc. — tools with sharp sharpening are intended. Flat bits (fig. 6) and grooved (fig. 7) are used for chipping and dissection of the bone. Flat bits can be single-sided or double-sided. For nibble bone protrusions, refreshing the edges of the bones, use nippers: Lyuer - with grooved sponges (Fig. 8) and Liston - with straight sponges (Fig. 9). These nippers can be straight, curved along the plane, curved along the edge, and also hinged with double gear. For sawing bones are saws frame, or arc, and wire saw Gigli. Usually 4 cutting blades are applied to the arc saw (fig. 10) - wide, 2 medium and narrow. Saw Gigli (Fig. 11) consists of a twisted wire saw and two handles. This saw is used for sawing the bone in hard to reach places. A saw is brought under a special conductor under the bone, then handles are inserted into the loops at its ends. Circular saws - double with a fixed distance between them and single (fig. 12) are intended for cutting out a bone graft. They are driven by an electric drive (Fig. 13).
To separate the periosteum from the bone, the raspers are straight and curved (Fig. 14). Scraping of the cavities in the bones is carried out with sharp bone spoons (Fig. 15) of various sizes. For drilling holes, holes, channels in the bones, the formation of articular surfaces in arthroplasty used cutters (Fig. 16) and drills of various sizes. There are special sets of cutters and drills (Fig. 17). For processing the sharp ends of the bones, use rasps with a large incision.
Tools for operations on tendons, muscles and other soft tissues include: tenotomy (Fig. 18), tendon hooks (Fig. 19), amputation knives (Fig. 20). For plastic operations on the tendons of the hand and fingers, a set of Rosov's instruments is used (Fig. 22), which includes tendon disintegrators, a tenote, a transfalangal awl, a guide, a “goat leg” for separating tendons , bougies. When working with tools with sharp sharpening, elevators (Fig. 21) and retractors (Fig. 23) are used to protect the soft tissues from damage.
The structure of orthopedic instruments necessarily includes various hammers (Fig. 24), which are necessary for working with bits, for hammering nails during osteosynthesis. For fastening of bone fragments are designed various kinds of clamps. Intraosseous fixation for fractures of long tubular bones is performed using metal rods of the Dubrovo design (Fig. 25), Küncher (Fig. 26), CITO, etc. , retainers, rod extraction hook, trihedral drill bit, hand vise, small chisels, single tooth hooks, pliers, nozzle, awl, impactor and extractor. For osteosynthesis, bolts with nuts (fig. 28), cervier ribbons (fig. 29), plate plates (fig. 30), screws (fig. 31) are used. The slots of the screws and bolts must be sufficiently deep and correspond to the screwdrivers (Fig. 32). For osteosynthesis of hip fractures, three-blade nails of different designs are used (Fig. 33), for the introduction of which special devices are used (Petrova-Yasnova, Kaplan, etc.).
A set of orthopedic instruments for skeletal traction with the help of knitting needles (Fig. 34) consists of a staple, knitting needles, a wrench, a spokes tensioner, a spoke knob, pliers, a drill, and a clamp. Terminals are also used for skeletal stretching (fig. 35).
A set of orthopedic instrumentation for applying and removing plaster casts - see Gypsum technique .
A significant part of the orthopedic instruments consists of the instruments proposed for operations on the joints and bones during their fresh injury. This is the so-called trauma toolkit. Modern orthopedic instruments can be divided into: 1) general instruments for orthopedic operations; 2) special tools for osteosynthesis, alloplasty, for spinal surgery, etc .; 3) tools for bloodless interventions.
Common tools include chisels, wire cutters, raspers, hooks, lifts, saws, cutters, and apparatus for machining bones. In the Bergmann bits, the blades go directly into the handle (Fig. 1). The Makuin chisels have an octahedral handle and an extended strike platform (Fig. 2). The CITO set consists of bits of various sizes (fig. 55): 6 bits with double-sided sharpening, 6 bits of chisels with single-sided sharpening, 9 grooves and 2 trapezoidal shapes. There are various types of pliers: with straight jaws (Fig. 3), with round (Fig. 4) and with rectangular (Fig. 5). For the detachment of soft tissue from the bone, disintegrators are used: straight (Fig. 6), curved (Fig. 7) and oval (Fig. 8). To hold the bones during operations, bone holders are used: two-horned (Fig. 9), three-horned (Fig. 10) and Lambott type (Fig. 11). It is often convenient to hold fragments of bones with a single-toothed hook (Fig. 12). Saws for bones are used the following types: frame (Fig. 14) and knife (Fig. 13), and for the figured cut of bones - Gigli's wire saw (Fig. 15) and Sivash continuous-chain power saw (Fig. 16). For drilling bones are cutters with a crank (Fig. 17) and mushroom (Fig. 18), driven by an electric motor.
Special tools are designed for osteosynthesis surgery (see). The plate clamps include Lane plates (Fig. 21), Hic's plates, figured plates, face-screw plates (Fig. 20), plates with a slit for converging and fixing bone fragments, plate-hooks and an apparatus for stitching fragments of tubular bones with titanium clips. , as well as the close-fitting bracket design Herzmaia (Fig. 19). Intra bone fixers are used in the form of nails of various designs: Küncher (Fig. 24), Dubrova (Fig. 22), CITO (Fig. 23). The transosseous clamps include various screws, bolts with nuts and sets of so-called compression apparatus: the Sivash apparatus (Fig. 25), based on the rapid approach of bone fragments with the help of two “worms” with special nuts with a rotating finger and two cobalt nails; the Gudushaurn apparatus (Fig. 26), consisting of two pairs of half arcs and two pairs of V-shaped spokes; Ilizarov apparatus with X-shaped needles; Grishin apparatus (Fig. 58), consisting of two pairs of clamping devices and three nails.
The Ashkazi apparatus for the bones of the wrist joint is built on the same principle (Fig. 27). A well-known method of Greifenshteyner, which allows to bring together fragments of bones with the help of two Kirschner spokes, tightened by one arc.
For alloplasty, many designs of endoprostheses of the femoral head of the Moore type (Fig. 28) and the Jude type (Fig. 29) have been proposed, but they gradually fade due to frequent poor long-term results. At present, the Sivash metal hip joint (Fig. 30) and a number of tools for its use are used: sweep of the femoral bone canal channel (Fig. 32) cranks for immersion of the prostheses (Fig. 33), guides (Fig. 34).
A special group of orthopedic instruments consists of instruments for spinal surgery.
A vertebral spreader (Fig. 31) is distinguished by a width determined by the radius of the rounding and the tool sharpening angle. Nippers fenestrated (Fig. 35) make it easy to bite on one side of the arms of the spinous processes, if you need to limit hemilaminectomy. Nippers with a double bend along the edge and along the plane (Fig. 36) make it possible to work on the vertebral bodies through a small hole made by a cosotransversectomy. The beak-shaped nippers (Fig. 37) allow manipulation on the intervertebral discs and deep in the medullary canal.
A set of spoons (Fig. 57) provides for the treatment of bone cavities in the depth of the wound during anterior and posterior approaches. The Kazmina distractor (Fig. 38) allows one to eliminate spinal curvatures during scoliosis operations. The Williams metal plates are designed for posterior spinal fixation, but the Sivash thermoplastic fixator (Fig. 40) is more convenient for this purpose, especially in patients with pronounced kyphosis and lordosis. This fixative can be given any shape, if you place it for 1-2 minutes. in hot water.
Tools for operations on the hands and fingers are available in sets: the Degtyarev set (Fig. 60), the Kuster set (Fig. 56), the Hamarai set (Fig. 59). The tools in these sets differ not only in size and shape, but, most importantly, the features of the working part.
Instruments for bloodless treatment of orthopedic patients are divided into three groups: for applying and removing plaster casts, for treating with skeletal traction, and various tires for immobilizing and functional treatment of bone fractures. The application of gypsum dressings is carried out on orthopedic tables (see Operating Tables), on Krasnobayev’s pelvic support (Fig. 39) and on a device for applying gypsum corsets (Fig. 46). A special knife (Fig. 41), scissors (Fig. 42), a saw (Fig. 43), forceps for breeding edges (Fig. 44), tongs for bending the edges (Fig. 45) and electrogypsum cutting (Fig. . 47). Skeletal traction (see) is carried out using knitting needles and a Kirchner arc (Fig. 52), and a drill is attached to them to hold the spokes (Fig. 50). The most commonly used tires are: the Kuzminsky splint for treating clavicle fractures (Fig. 48), Ivanov splint for treating forearm fractures (fig. 49), Aleinikov splint for treating shoulder and forearm fractures (fig. 53), Beler splint for treating bone fractures hips and tibiae (Fig. 51), Sivash-Zdvizhkov splint (Fig. 54) to restore function in the hip and knee joints in the treatment of fractures of the hip and tibia.