(About Bone Instruments)
Instrument usage: Bone instruments are sharp instruments used for cutting into or through bone and cartilage.1 Bone instruments include osteotomes, files, elevators, rongeurs, manual saws, mallets, bone holders, and screwdrivers. These cutting instruments can be blunt for bluntly dissecting or sharp for cutting.2 Bone instruments are most commonly used in orthopedic surgery, but can also be used in thoracic, cardiac, and plastic surgery.
Key differences:
Osteotomes are sharp and are used to decrease the bulk of firm tissue/bone and not usually used to cut along defined tissue planes.1 Osteotomes come guarded or unguarded and can be straight or curved.
Files are also sharp and used to decrease the bulk of firm tissue/bone, so are used by filing down the unwanted tissue.1
Elevators, such as periosteal elevators, are used to bluntly separate tissue planes such as the periosteum from bone or dura from the inner aspect of the skull.1 Elevators come in many sizes with different tips that can be straight or curved.
Rongeurs can be single action or double action with a scooped tip used to extract heavy tissue or bone.
Manual saws are used to cut into or through bone and cartilage.1 The blade of the saw should not be touched by scrub personnel because it is sharp.
Mallets are hammers that are used to drive a cutting instrument into bone.1 Mallets can have a soft silicon end or stainless steel end, and they come in different sizes.
Bone holders, such as pliers and bone clamps, are used to stabilize bone.1 Some styles of bone holders have ring handles and locking ratchets, while others have compression grips and do not lock.1
Screwdrivers are used to affix screws into bone.1 It is vital to use the correct screwdriver for the screw that is being used. This will assure that the screw is placed securely and that the integrity of the screw is maintained.
Safety on the sterile field:
Bone instruments that come in multiple sizes should be arranged on the sterile field from smallest to largest.
Osteotomes may be packaged in a sterilization rack so that the blades and tips are suspended.1 These instruments should remain in the rack on the sterile field until they are needed during the surgical procedure.1
When passing an osteotome, the scrub personnel should pass a mallet. These instruments are used together.
When passing a rongeur, the scrub personnel should have a wet radiopaque sponge or lap pad to clean out the jaws of the rongeur from bone. The bone should be saved on the sterile field for specimen.
When passing a manual saw, it should be passed by the handle, since the blade is sharp.
The scrub personnel must use proper precautions during the handling or disposing of bone instruments to prevent injury and/or damage to the instrument.1
When passing a sharp bone instrument, a neutral zone or hands-free technique can be used so that the scrub personnel uses a no-touch technique.3
Instrument names:
These instruments are most often called by their use, such as osteotome, file, elevator, rongeur, saw, mallet, bone holder, or screwdriver. If there are multiple sizes or angles, then the size and the angle would be specified, such as “small curved rongeur.”
References:
1. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.
2. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
3. Guidelines for Perioperative Practice. Sharps Safety. AORN, Inc, Denver, CO; 2021