Instruments for working with bone tissue
Operations on the musculoskeletal system require massive and durable instruments. They can be divided into several functional groups:
- Periosteal handling: exposing the bone requires reflecting the periosteum. For this, elevators (straight and curved instruments of Farabeuf, Volkmann, Langenbeck/Liston, as well as the Doyen rib elevator) are used. Elevators are used to lift bone fragments.
- Chiseling and scraping: surgical mallets are used in combination with chisels. Chisels can be gouge-shaped or flat. A special type is the osteotome, sharpened on both sides and intended for bone transection. Sharp bone curettes are used to clean bone cavities.
- Grasping and biting: holding bone fragments is performed with bone-holding forceps and sequestrum forceps (for removing sequestra). Bone rongeurs are used for cutting: Liston forceps transect small bones, while Lüer forceps (with oval jaws) smooth sharp edges. Rib transection is performed with Doyen guillotine-type rib shears, and cranial bones with Dahlgren forceps.
- Sawing: arch saws (with an adjustable blade angle in the frame), plate (leaf-type, hacksaw-style) saws, as well as flexible saws — the Gigli-olivecrona wire saw and chain saw — are used.
- Drilling and osteosynthesis: holes are created using hand trephines, perforators, gimlets, drills, and burs (spherical and spear-shaped). Bones are fixed using metal plates with screws, intramedullary pins, and wire sutures (special guide probes are needed to pass the wire).
Neurosurgical instruments
Access to the brain requires jeweler-like precision and specialized equipment. The main stage is craniotomy. First, spear-shaped and spherical burs are rotated using a manual or electric drive to form burr holes.
Then, a Gigli wire saw is passed between the holes using a Polenov guide. After opening the cranial cavity, neurosurgeons use brain spatulas — special flat retractors that allow gentle holding and retraction of delicate brain tissue without traumatizing it.
Urological instruments
The urological set features a wide variety of endoscopic and probing devices.
Kidney and bladder surgery Special renal and bladder retractors are used to create surgical access. Bleeding from the renal pedicle is stopped using curved Fedorov clamps. Removal of calculi from the renal pelves and urinary bladder is performed using scoop forceps and curved Levkovich forceps.
Urethral manipulations and catheterization Examination of the bladder mucosa and urethra is performed using diagnostic and catheterizing cystoscopes and urethroscopes. Urethral sounds are used to dilate a narrowed urethra, and urethrotomes to incise it. Urine drainage is performed using catheters of varying rigidity: solid metal, semi-rigid synthetic, or soft rubber. Special guides are used for retrograde catheter placement.
Proctological instruments
Interventions on the terminal parts of the gastrointestinal tract require a compact yet specific set of instruments.
Exposure of the surgical wound and visualization of the anal canal are provided by rectal specula. A rectosigmoidoscopy is used for deeper examination (of the rectum and sigmoid colon). In hemorrhoid surgery, fenestrated Lüer clamps are used for secure yet atraumatic grasping of hemorrhoidal nodes.
Briefly: answers to topical questions
What instruments are required to perform a bone-plastic craniotomy?
Performing a bone-plastic craniotomy requires instruments for drilling, bone sawing, and working within the cranial cavity.
- Burs — spear-shaped and spherical instruments for forming holes through rotation.
- Gigli saw — a wire saw for connecting trephination holes.
- Polenov guide — used to pass the Gigli saw and for blunt detachment of the dura mater.
- Dahlgren bone forceps — rongeurs for transecting cranial bones, sawing, or biting the base of the bone flap.
- Elevators — used to fracture the base of the bone flap.
- Spatula retractors — brain spatulas for holding the brain during work in the cranial cavity.
What designs and devices are used for fragment fixation in osteosynthesis?
Implantable metal fixators and external fixation devices are used for fragment fixation in osteosynthesis.
- On-bone plates — rigid structures (pre-contoured buttress/condylar, reconstructive) with cortical and cancellous screws.
- Intramedullary pins and nails — intraosseous fixators (Küntscher, NIIXAI, Bogdanov nails, universal interlocking nails, proximal femoral nail PFN).
- Dynamic screws — DHS and DCS devices.
- Wire sutures and K-wires — bone orthopedic wire, thick Kirschner wires.
- External fixation devices — pin-based (circular Ilizarov, Gudushauri, Volkov-Oganesyan apparatuses) and rod-based (single- and multi-plane) devices.
To avoid confusing bone rongeurs: Liston breaks (beaks/cuts bone), Lüer liquidates margins (clears sharp ends thanks to oval jaws).
Class and exam questions
What is the difference between an osteotome and a conventional chisel?
An osteotome has double-sided blade sharpening and is used directly for bone transection (osteotomy). Conventional chisels usually have single-sided sharpening or a gouge shape and are used for shaving or chiseling grooves.
What are the features of working with the Gigli saw?
The Gigli wire saw cuts through reciprocating pulling of the handles in opposite directions. The main rule is to always have a spare blade, as the instrument is very fragile and frequently breaks during surgery.
What is the Fedorov clamp intended for?
This is a specialized hemostatic clamp that has a characteristic curve and is used in urology for securely grasping the massive renal pedicle.
What else to study on this topic
- Design features and types of osteosynthesis devices (pins, plates).
- Technique of working with manual and electrical trephines.
- Types of urological sounds and rules for their passage.
- Design of cystoscopes and rectidoscopes/sigmoidoscopes.
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