Orthopedics Instruments , Viva voce mbbs

Instruments in Orthopedics

1. M.S.,FICRS.,FAIS.,FMAS.,FALS., SENIOR ASST PROFESSOR OF SURGERY GOVT. STANLEY MEDICAL COLLEGE ASSOCIATION OF SURGEONS OF INDIA –CHENNAI SURGICAL INSTRUMENTS DR.G.CHANDRASEKAR

2. CLASSIFICATION CUTTING AND DISSECTING GRASPING AND HOLDING CLAMPING AND OCCLUDING RETRACTING AND EXPOSING SUTURING AND STAPLING DILATING AND PROBING SUCTIONING AND ASPIRATING VIEWING – MEASURING OTHERS ( MICROINSTRUMENTS )

3. BASIC TERMS TRAUMATIC- Cause injury by penetrating or crushing ATRAUMATIC- Without trauma DISSECTION – process of separating tissues through anatomic planes by sharp or blunt instrumentation DILATION –Enlarging an opening in a progressive manner GRASPING –Holding in a traumatic or atraumatic manner

4. BASIC TERMS RETRACTION – exposure of a part for proper stabilization of tissue in a safe position . SHARP – Instruments with a cutting edge or pointed tips TROCAR – A device used for penetration of tissue layers . Commonly in laparoscopy for temporary pathway fir gases , other instrumentations or the removal of organ –substance

5. STERILISATION Autoclaving - using steam under high pressure Boiling Chemical sterilisation – Cidex , Lysol ,70% alcohol , Peracetic acid Gas sterilisation – Ethylene oxide / formaldehyde gas Others – Gamma irradiation , direct flaming , Hot air oven

6. PARTS OF AN INSTRUMENT Two finger bows for holding the instrument A pair of shaft or body of instrument A catch or ratchet . Once the rachets are pressed the blades are kept in a closed postion Blades – A pair of blades constitutes the terminal part of the instruments Joints – The two parts of the shaft and blades are kept attached by a joint . Either BOX joint or PIVOT joint .

7. CUTTING AND DISSECTING Blade with BP handle BARD PARKER ‘ HANDLE SIZE NUMBERS – 3, 4, 5 & 7 SURGICAL BLADES – number 10 ,11,12,and 15 fit in 3, 5, & 7 . Blades number- 18,19,20,21,22,23,and 24 fit in BP handle 4 . Blades number -20,21,22,23,&24 for larger incisions and dissection Blade number – 15 -smaller incisions Blade number -11 - stab knife and used to incise for drainage of an abscess.

8. SCISSORS MAYO’ SCISSORS ( straight and curved ) Long and stout scissors Used for cutting sutures Used to cut tough structures like linea alba , aponeurosis , rectus sheath Used to cut dressing Mayo’s straight

9. METZENBAUM SCISSORS STRAIGHT AND CURVED -Long fine scissors -Used for dissection at depth -during vagotomy and during cholecystectomy

10. CUTTING AND DISSECTING HEATH’S SUTURE CUTTING Fine scissor curved on angle type Blades are small and sharp with serrations at the tip Serration at the tip helps in holding the suture during removal SCISSOR

11. LISTER -SINUS FORCEPS Long slender instrument with a pair of small blades with transverse serration . No rachet in the handle For incision and drainage ( HILTON’S method )

12. ARTERY FORCEPS Mosquito haemostatic forceps -ADSON FORCEPS Very light ,small and delegate . Fine curved or straight clamp with horizontal serration Used to hold fine bleeding

13. HAEMOSTATIC FORCEPS SPENCER WELL’S KELLY’S The blades are usually half the length of the shaft Tips are conical and non toothed Used in all operations (hold the bleeding vessels ,hold the cut margins , to suture and knot , dressings ..etc )

14. Lahey’s right angled forceps Terminal part of blades are bent at right angles to the shaft of the Instrument . Used to dissect the pedicle of important organs and ligature may be passed around the vessels . During vagotomy , thyroidectomy , cholecystectomy , splenectomy …etc

15. Desjardins’ forceps The blades are small and fenestrated centrally . No serrations in the blade Used in choledocholithotomy Stones are removed by holding them in the fenestrated blade

16. TOOTHED FORCEPS There is a tooth at the tip of one blade and a groove at the tip of other blade Used in almost all surgeries to hold the skin margins , to hold the tough tissues for approximation ..etc Fine toothed - ADSONS’S Heavy toothed – VICTOR BONNEY’S

17. NON-TOOTHED FORCEPS

18. Rampley’s swab HOLDING FORCEPS -Long instrument ( 91/2” in length ) Blades are oval , fenestrated and provided with serration on the inner aspect Used for cleaning skin with swap Used to hold the fundus of gall bladder Used for removing the laminated membrane and daughters cyst during hyadatis cyst operation . .. etc

19. Rampley’s swab holding forceps

20. BABCOCK’S FORCEPS Terminal part of the blades are curved and fenestrated As there is no teeth , this is a non traumatic forceps Fenestration in the blade allow some soft tissue ( bowel holding forceps ) Used in all bowel holding procedures . Used to hold the tubular structures like appendix, fallopian tube , ureter , bladder , duodenum ..etc .

21. BABCOCKS FORCEPS

22. ALLIS’ FORCEPS Blades are longer and some gap between the blades . Tip of the blades are provied with sharp teeth with grooves in between . Used to hold the tough tissues , skin, linea alba , aponeurosis ..etc

23. Cheatles forceps Used to select and pick autoclave article like drape and instruments. Avoid touching the sterilised article.

24. LANE’S TISSUE FORCEPS Thick and heavy instrument Terminal part have heavy tooth in one blade with groove in the other blade Traumatic forceps To hold the gland , lump in breast . Some times an alternative to towel clip

25. DUVAL LUNG HOLDING FORCEP Atraumatic grasping forcep Used for grasping large tissues and organs . Mostly in lung and stomach surgery .

26. DOYENS TOWEL CLIPS

27. CORD CLAMP In addition to finger bows and shaft there are two semi circular blades and when the rachet is closed the blades are apposed and makes a circular opening the blade Used in hernia operation to hold the spermatic cord for retraction

28. CORD CLAMP

29. NEEDLE HOLDER

30. Needle holder SMALL , MEDIUM , LARGE CURVED AND STRAIGHT Blades of the needle holder are smaller than the shaft Criss cross serrations with longitutional groove in the centre of serration which allows firm gripping . Used to hold the needle for suturing .

31. JOLLS’S THYROID RETRACTOR -Two towel clip like forceps at either end -Two flanges can be adjusted by means of a screw mechanism -Self retaining retractor for thyroid operation Once the upper and lower flaps are raised , flaps are held by the towel clip like forceps attached to retractor .

32. LANGENBECK RETRACTOR Single bladed Langenbach’s retractor has a handle ,long shaft and a flat solid blade . Blade is curved and right angle to the shaft . Double bladed is another flat solid blade at other end of the shaft .

33. LANGENBECK RETRACTOR

34. CZERNY RETRACTOR BIFLANGED HOOK IN ONE END AND RIGHT ANGLED BLADE IN ANOTHER END

35. DEAVER RETRACTOR A LARGE CURVED RETRACTOR Shaped like S Used in all major abdominal surgeries to retract the abdominal wall , liver , Stomach , bladder , uterus ..etc.

36. MORRIS RETRACTOR Handle is wider and blade is also wider Shaped li ke ’ L’ Used to retract the tissues and layers in different operations Pelvic surgeries , bladder retraction , in mastectomy , thyroidectomy ..etc.

37. KELLY RETRACTOR Long flat blade right angled with handle . Used in abdominal surgeries for retraction of major organ like Liver . Used to retract the recto vesical area in rectopexy .

38. finochietto rib retractor For open thoracic surgery Stainless steel rib retractor with fenestrated blades and hand –cranked lever to both separate and lock them in place .

39. Finochietto retractor

40. Balfour abdominal retractor Self retaining abdominal retractor used in laparotomy Adjustable side wall Scoop style bladder blade Ideal for bowel resection ,cesarean section and major abdominal surgeries.

41. Doyens occlusion clamp Usually labeled as Intestinal occlusion clamp The flexible jaws and the concavity are really very helpful in preventing tissue damage and necrosis .

42. Doyens occlusion clamp

43. RYLES TUBE

44. FOLEYS CATHETER

45. MALECOTS CATHETER

46. T-tube

47. Flatus tube Used to relieve gaseous distention of large gut due to paralytic ileus . Used to decompress the sigmoid volvulus non operatively

48. Skin stapler Used to close the skin wounds Sterile single patient use instrument designed to deliver rectangular , stainless steel staples for routine wound closure .

49. proctoscope Used to examine anal cavity approximately 15 cm long Parts: outer- proctoscope sheath Inner – obturator

50. THANK YOU LONG LIVE ASI