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Surgical instruments and implants

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Abstract

Combining correct technique with selection of appropriate instrumentation helps optimize access to, and observation of, the anatomical structures within the surgical site. This chapter covers the instrumentation most commonly used in small animal orthopaedics as well as a selection of widely used basic implants.

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Figures

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14.1 Basic joint surgery instruments. 1 = Backhaus towel clamps; 2 = Allis tissue forceps; 3 = Mayo–Hegar needle holders; 4 = straight Mayo scissors; 5 = straight Metzenbaum scissors; 6 = No. 3 scalpel handle; 7 = DeBakey dissecting forceps; 8 = rat-toothed dissecting forceps; 9 = Halsted artery forceps; 10 = curved Spencer Wells artery forceps; 11 = straight Spencer Wells artery forceps.
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14.2 Scalpels. 1 = No. 3 handle; 2 = No. 10 blade; 3 = No. 15 blade; 4 = No. 11 blade; 5 = Beaver-type handle; 6 = No. 64 blade; 7 = No. 65 blade.
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14.3 Tissue forceps showing different tips. 1 = Adson–Brown forceps; 2 = DeBakey; 3 = rat-toothed.
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14.4 Ratchets on a pair of needle holders.
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14.5 Needle holders. 1 = Mayo–Hegar; 2 = DeBakey; 3 = Olsen–Hegar.
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14.6 Multipronged self-retaining retractors. 1 = Travers 20cm; 2 = Travers 9.5cm; 3 = Weitlander; 4 = West.
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14.7 Gelpi-type retractors. 1 = long reach; 2 = standard with blunt tips; 3 = small; 4 = mini 9.5 cm.
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14.8 Odd leg Gelpis (i.e. Gelpis with one long and one short leg) are useful for eccentric distraction.
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14.9 Hand-held retractors. 1 = Langenbeck; 2 = Meyerding; 3 = Senn ‘cat’s paw’.
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14.10 Cat’s paw finger retractor.
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14.11 A selection of Hohmann retractors; the ‘standard’ 18 mm version with short tip is indicated by the arrow.
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14.12 Disarticulators (1–2) and Hatt spoons (3–5) in various sizes.
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14.13 Stifle distractors. Note the crossing tips for insertion into the joint (insert).
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14.14 Extra-articular stifle distractor applied to bone model.
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14.15 Saws. 1 = X-ACTO saw; 2 = hard-backed orthopaedic saw; 3 = adjustable bone saw.
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14.16 Gigli wire saw with handles.
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14.17 1 = edge profile osteotom; 2 = chisel.
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14.18 Modular osteotomes are particularly useful for block sulcoplasties of the femoral trochlea in patellar luxation surgeries.
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14.19 Rongeurs and bone cutters. 1 = small-angled rongeurs; 2 = straight Lempert rongeurs; 3 = small-angled cutters 15 mm jaw.
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14.20 The use of notched small-angled cutters during tibial tuberosity transposition in a cat.
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14.21 Rasps. 1 = a curved rasp used for excisional arthroplasty; 2 = a flat rasp used in block sulcoplasty; 3 = a tapered rasp used in wedge sulcoplasty.
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14.22 Bone scoops and curettes. 1 = OCD curette; 2 = Volkmann bone scoop.
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14.23 Periosteal elevators. 1 = AO-type with curved tip; 2 = Freer; 3 = modified Howarth.
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14.24 Exposed and shrouded orthopaedic power tools. (a) Industrial-type battery drill – Makita shown. (b) Industrial-type battery saw – Fein Multimaster shown.
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14.25 Autoclavable orthopaedic power tools. (a) Autoclavable stand-alone surgical battery drill and battery saw – VI Black Series shown. (b) Modular autoclavable surgical battery system – Arthrex V300 system shown. (b, © Arthrex GmbH)
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14.26 Air-powered tools. (a) Modular autoclavable air system – Mini Driver shown. (b) Air-driven TPLO saw – Whittemore shown. (c) Pencil grip high speed burr – Minos shown.
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14.27 (a) Screw with spiked washer. (b) Tissue staple.
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14.28 Suture anchors.(a) Suture screw. (b) Suture anchor pin. (c–d) Arthrex FASTakanchor in insertion tool and deployed. (c–d © Arthrex GmbH)
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14.29 Arthrex SwiveLock, a modified headless interference screw. (© Arthrex GmbH)
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14.30 Buttons and a toggle:. (a) An ‘Ormrod’ button made of ultra-high molecular weight polyethylene (UHMWPE) (top right) alongside two titanium buttons. (b) A titanium button used to anchor a braided UHMWPE suture in a modification of the lateral suture technique for cranial cruciate ligament insufficiency. (c) The medial wall of an acetabulum showing a hip toggle as used in the management of hip luxation.
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14.31 1 = arthrodesis wire; 2 = Kirschner wire.
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14.32 (a) Kirschner wire bender. (b) The single bend technique. (c–d) The two bend technique. The arrows suggest the direction in which the instrument should be moved.
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14.34 Coiled orthopaedic wire (left) and eyed wire (right).
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14.35 (a) Good twist – both wire strands wrap around each other. (b) Bad twist – one wire wraps around the other, which may allow the central wire to slip through.
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14.36 (a–b) Once the wire is tight, continuing to twist while pushing down and sideways will flatten the twist against the bone with minimal loss in tension. The tail can then be trimmed to the appropriate length. (c) Flattened twist (left) and proud twist (right).
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14.37 Twisting both sides of the tension-band wire will provide symmetrical tension.
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14.38 Eyed wire-tightener – single loop technique. (a) The wire is fed around the bone, through the eyelet, through the tip of the device and through a hole in the shaft of the crank. The crank is turned until the desired tension is achieved and then folded back on itself away from the eyelet. (b) The crank is loosened, exposing more wire before bending upwards. (c) The wire is cut leaving a 0.5–1.0 cm return. (d) The double loop technique using the double crank. The wire is folded to create a loop. This is passed around the bone and both free ends are passed through the loop, through the tip of the double wire-tightener and through the holes in the shafts of the cranks. The cranks are turned separately to take up the slack and then turned simultaneously to create equal tension in both free ends of the wire. The wires are folded back on themselves. (e–f) The cranks are loosened and the free ends bent upwards at a suitable length as per the single loop technique.
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14.39 (a) An obliquely placed wire feels tight with twisting in one direction only. (b) A small rotation in the other direction as may occur under normal load-bearing leaves the wire loose.
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14.40 Electrosurgical machines. (a) Monopolar; (b) Bipolar.
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14.41 Adson suction tip.
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14.42 (a) Components of an artroscope. 1 = arthroscope; 1a = shaft; 1b = eyepiece; 1c = light-post; 1d = adaptors for light-post; 2 = arthroscopic sheath; 2a = flushing port and stopcock; 3 = sharp and blunt obturators. (b) Objective end of an arthroscope.
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14.43 Viewing angle.
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14.44 A sterile plastic sheath used to enclose the camera in a sterile manner.
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14.45 A blunt (right) and sharp (left) trocar point used to insert cannulae into the joint.
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14.46 Arthroscopic probe with an etched tip.
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14.47 Example of knives used in arthroscopy. (a) Hook. (b) Smiley push knife. (c) VI pull knife. (d) Banana knife. (a, c, Courtesy of Rita Leibinger Medical)
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14.48 Gordon coronoid osteotome – available in 2 mm and 4 mm widths.
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14.49 Articulating arthroscopic instrumentation. (a) Arthroscopic punch. (b) Arthroscopic scissors. (c) Arthroscopic biopsy forceps. (d) Arthroscopic grasping forceps. (© Arthrex GmbH)
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14.50 (a) OCD curette and pick (large). (b) OCD curette and pick (small). (c) Hand mill.
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14.51 Arthroscopic shaver. (a) Console. (b) Example shaver tip. (© Arthrex GmbH)
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14.52 Fritz triangulator, commonly used in shoulder arthroscopy. (Courtesy of Dr Fritz)
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14.53 Tower system incorporating monitor, light source, image/video capture, irrigation pump and shaver unit. (© Arthrex GmbH)

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