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Bone Packs. Rongeurs. Bone-Cutting Forceps. Bone-Holding Forceps. Curettes. Curettes. Periosteal Elevators. Elevators and Osteotomes. Mallet, Chisel, and Osteome. Cutting Edges. Gigli Wire. Used to cut bone T-shaped handle hook onto wire Wire wrapped around bone - PowerPoint PPT Presentation

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Bone Packs

Bone Packs2Rongeurs

(left to right) Single-action rongeur, double-action rongeur, Kerrison rongeurSingle-action used in very confined areas.Double-action is smooth-cutting and mechanically stronger; preferred for removing large amounts of dense tissue.Kerrison used in spinal surgery.2

4Bone-Cutting Forceps

Bone-cutting forceps are similar to rongeurs, but have paired chisel-like tips; they cut bone and should not be mistaken for wire cutters.(left to right) Wire cutters, bone cutters 4

6Bone-Holding Forceps

Bone-holding forceps hold bone and fragments in alignment.(left to right) small Kern forceps, large speed-lock forceps, large point-to-point forceps, small clamshell forcepsKern: has ratchet to hold in place.Self-retaining bone-holding forceps: known also as speed locks; use nut to tighten.6

8Curettes

Used to scrape hard tissue such as bone or cartilage. 8

10Curettes

Curettes are inserted into the joint to debride a defect left in cartilage or bone.1011Periosteal Elevators

They pry the periosteum or muscle from bone surfaces.Figure shows the Freer elevator and 1/4-inch Key elevator.11

13Elevators and Osteotomes

These instruments cut or breakdown, and elevate chip fragments.1314Mallet, Chisel, and Osteome

Osteotomes and chisels cut bone by pounding on the flared end of the handle with a mallet. 14

17Cutting Edges

Osteotome (left) and chisel (right)The cutting edge of the osteotome is tapered on both sides, whereas the chisel is tapered only on one side. 1718Gigli WireUsed to cut boneT-shaped handle hook onto wireWire wrapped around boneBone is cut in sawing fashion

Wire is used to cut bone by placing the wire around the bone and drawing it back and forth in a sawing fashion.T-shaped handles hook onto the wire to give the surgeon a rm grasp of the wire.18

20Trephine

Used to remove a core of bone for biopsy. 20

22Power Equipment

Some drills are electric or battery powered.Many orthopedic drills and saws are powered by nitrogen gas supplied via a sterile hose.Hall air drill (lower right) is a specialized high-speed burr, used for spinal surgery.2223Orthopedic ImplantsInside bone vs. around bonePermanent vs. extended period of timeMetal implantsStainless-steel alloyCobalt-chromium alloyTitanium2324Bone Pins

Figure showsJacobs hand chuck, key, pin cutter, and various sizes of Steinmann pins and K-wires.Steinmann pins are smooth stainless-steel pins; also known as intramedullary pins.Interlocking nails (not pictured) are similar to the intramedullary pins but have pre-placed holes that allow screw placement; are more rigid than pins.K-wire (Kirschner wire) is used for small bone fragments. 24

27Orthopedic Wire

Figure shows wire, wire twisters, wire cutters; wire twisters look similar to needle holders but are designed to withstand higher force. 27

29Orthopedic Wire Sizes

Table shows commonly used orthopedic wire sizes.Wire is supplied on spools.Wire used in combo with pins or plates.2930External Fixators

Pins are placed through the skin and bone, and are held rigid by a connecting bar using special clamps.Ring fixators use wire instead of pins.Figure shows an external xator on the radius of a dog.3031Bone Screws

(left to right) Partially threaded cancellous screw, fully threaded cancellous screw, and fully threaded cortical screwCortical screws are fully threaded, designed for dense bone.Cancellous screws are designed with wider threads in order to have better grip in the softer cancellous bone; may be partially or fully threaded.3132Placement of a ScrewDrill hole in boneMeasure hole with depth gaugeUse bone tap to cut screw pathInsert screw with special screwdriverMay be used aloneOr in conjunction with bone plateOr in conjunction with interlocking nail3233Bone Plates

Plates are more complex to place but more stable in most cases.Are named by number of screw holes and screw diameter size.Must be bent to match the curve of the bone.3334Bone Plating Equipment

Figure showsspecialized equipment necessary: (left to right) drill guide, drill bit, depth gauge, tap sleeve (to prevent soft tissues from being caught on the bone tap), bone tap, and screwdriver.3435Total Hip ProsthesisProcedure for dogs with severe arthritisLong stemFits inside proximal femurBallReplaces femoral headSpecial cupReplaces acetabulum

35

50ArthroscopeUsed for diagnosisUsed as a surgical toolArthroscope used to examine joints in horses and dogs.Various arthroscopes have different diameters and viewing angles.Image can be viewed on TV monitor: larger image, plus better aseptic technique.5051Ancillary Arthroscopic Equipment

The sharp trocar (b) ts inside the arthroscope sleeve (a).Unit is used to penetrate the brous joint capsule through a stab incision in the skin.The conical (blunt) obturator (c) replaces the sharp trocar in the sleeve once the brous joint capsule is penetrated.5152

Once the sleeve is in position in the joint, the obturator is removed and the arthroscope is placed into the sleeve.5253Light Cable

A light projector is designed to project light through a beroptic light cable.Light cable attaches to the light port of the arthroscope.Optical light that illuminates the joint space and the image is fed back to a TV.Light cable should be handled carefully to avoid damaging the optic bers.5354Fluid Delivery Systems

Figure shows arthroscopic sleeve (a), fluid line (b), light cable (c), arthroscope (d), and camera (e).Usually balanced electrolyte solution is infused under pressure into the joint to maintain distention of the joint capsule. Gas insufflation (carbon dioxide or nitrous oxide) can be used as well, but needs more specialized equipment. 5455Pressurized Bag System

Pressurized bag of fluids can be used to distend a joint during arthroscopy.Pneumatic pressure cuff can be slipped around a bag containing sterile fluids. Cuff is inflated with air, which squeezes the fluid bag, thus pressurizing the fluids.Amount of pressure is regulated by the amount of cuff inflation.5556Automated Pump System

Automated fluid pressure pump can be used to infuse sterile fluids into a joint during arthroscopy. Pressure within the joint is automatically regulated by the pump.5657Hand Instrumentsfor Arthroscopic SurgeryInstruments designed to:Remove or retrieve fragmentsDebrideProbe cartilage or lesionsInserted in joint through separate probeTriangulation technique5758Blunt Probe

Instrument probes the site to determine integrity or extent of lesion. 5859Rongeurs and Grasping Forceps

Rongeurs have cupped jaws to cut attachments as a fragment is being removed. Grasping forceps retrieve loose or loosely attached fragments. Figure shows rongeurs used in arthroscopy: Love and Gruenwald (a), grasping forceps (b), and Ferris Smith (c).5960Motorized Burrs

Also known as motorized arthroplasty system. System debrides defect in cartilage or bone. Figure shows motorized arthroplasty system with burr attachment (arrow).60