Introduction Orthopaedic
Instrument for Internal Fixation
and External Fixation
Pembimbing: Dr. Rendra Leonas, Sp. OT (K-Spine), MARS
Basic Surgical Instruments
Basic instrument categories used for all orthopedic surgeries are:
• Forceps
• Scissors
• Retractors
• Periosteal elevators
• Rongeurs
• Nerve hooks
• Curettes
• Dissectors and probes.
• FORCEPS
Parts
Cheatles forceps
No lock
Heavy metallic with curved blades
Used to pick sterilized instruments
& drapes to avoid touching
Transfering from one tray to another
Kept in savlon
Sponge
Forceps
Used to hold gauze sponge to
“mop
up” the surgical site
Jaws are serrated
1x2 Toothed Tissue
Forceps
• Single toothed on one side; fits
between two teeth on the other
side
• Available as 1x2 or 2x3 or 3x4
• Used to hold tough
structures like skin while
suturing.
• Used to hold scalp while scalp
suturing.
Plain Thumb
Forceps
• Used to gently move tissues out of the way
during exploratory surgery
• Used to insert packing into or remove
objects from deep cavities
• Used to hold delicate visceral organs
• Used to hold blood vessels and nerves
while dissecting.
Brown-Adson (thumb) tissue forceps
Adson-Brown Tissue Forceps are for holding and manipulating delicate tissues. These forceps
have wide, flat thumb grasp area that is commonly serrated
Artery forceps / haemostat
• Smal mosquito /
Halsted
• Medium spencer well
• Large bailey forceps
Catch hold of bleeding
ponts
Straight/curved
Curved Mosquito
Hemostat
• Used to hold delicate
tissue
• Used to compress
bleeding vessels
• Jaws are fully
serrated
Kocher (Oschner)
hemostatic forceps
With tooth & transverse
serrations
Can be straight / curved
Used to hold meniscus during
menisectomy.
Allis tissue
forceps
Used to hold skin while raising skin
flaps.
Babcocks forceps
Used to pick up appendix during appendectomy.
Used to hold delicate visceral organs.
Less traumatic
LAHEY RIGHT ANGLED FORCEPS/CLAMP
Used to pass ligatures around nerves or tendons before
division.
LISTERS SINUS FORCEPS
No lock
Prevents permanent damage to neurovascular bundle.
Used for I/D of abscess by Hiltons Method.
Pointed Reduction
Forceps
Are available in two sizes - small and large.
Ideal to grip and manipulate large bone fragments.
Speedlock bone reduction
forceps
Needle
Holder
• Used to hold and pass a suturing needle through
tissue
• Has groove to hold needle within jaws
• Criss cross striations
• Length of blade = length of box joint
Towel Clamp/ Backhaus
• Adds weight to drapes and towels to ensure they
stay in place
• Allow exposure of the operative site
Backhaus towel clamps
BP handle /Bard parker
handle
Blades 10,11,12 and 15fit in B.P handle
3.
Blades 18,19,20,21,22, 23
and 24 fit in B.P handle 4.
• SCISSORS
Sharp/Sharp Scissors
• Used to cut and dissect tissue
• Both blade tips are sharp
Blunt/Blunt Scissors
• Both blade tips are
blunt
• Can be curved or
straight
Mayo dissecting scissor (above)
Metzenbaum scisso (below)
(bottom)
MAYO
SCISSORS
LITTAUER SUTURE CUTTING
SCISSORS
HEATH SUTURE CUTTING
SCISSORS
Used to cut sutures on skin and mucous membrane.
Sharp/Blunt
Scissors
• Used to cut and dissect fascia and muscle
• One blunt tip and one sharp tip
Suture scissors (blunt
blunt)
Lister Bandage
Scissors
• Used to remove bandages and dressings
• Probe tip is blunt; inserted under bandages with
relative safety
Retractors
• Self retaining
• Handheld
SELF RETAINING RETRACTORS
• Weitlaner
• Adson
• Derrico
• Mollison
• Charnley
The type of retractor used depends on the depth of the
incision.
• Initially , Weitlaner retractors of different lengths are used
for retraction of the skin and muscle.
• As the wound deepens and lengthens, the Derrico retractor
or Adson Cerebellar retractor may be used.
Weitlaner self retaining Retractor
• 14cm/5½" length
• 3 x 4 Blunt prongs
• Prong depth 18mm
Derrico retractor is longer
to accommodate a longer
incision.
Adson Retractor
• 33cm/13" length
• 4 x 5 Blunt prongs
• Prong depth 32mm
• Jointed arms
Adson Cerebellar retractor
Mollison Self-retaining Retractor
• 1-2 levels hemi- laminectomy
• 14cm/5½" length
• 3 x 4 Blunt prongs
• Prong depth 18mm
Charnley Retractor
Also be known as the Initial Incision Retractor.
Is a self-retaining retractor, most commonly used during arthroplasty of the hip.
It is used when initial incisions are made and maintains exposure of the hip area so the surgeon has an
unobstructed view.
HAND HELD
RETRACTORS
Commonly used when obtaining bone from the iliac crest for bone
fusion in the spine.
• Army Navy retractor
• Meyerding retractor
• Taylor retractor
• Langenbeck
• Volkmann Catspaw.
• Czerny Retractor.
ARMY NAVY
RETRACTOR
• An Army-Navy retractor(manual) is used to retract shallow or
superficial incisions.
Meyerding Retractor
•22.5cm/9" length
•Meyerding Handheld Retractor is frequently
used to hold back tissue and muscle in
spinal and neurosurgical procedures such
as laminectomy.
•Blade size 50mm
x 16mm 75mm x
25mm 90mm x
50mm
19cm/7½" length
Langenbeck
Retractor
Used to retract skin, superficial
fascia
21.5cm/8½" length
Volkmann Catspaw Retractor
• CZERNY RETRACTOR
• is used to retract shallow or
superficial incisions.
Nerve Root Retractor
• Used to retract nerve roots near the disc in laminectomies.
• Nerve root retractors have a crooked design so they can be
placed deep in the wound.
• Derrico nerve root retractor
• Caspar nerve root retractor.
Caspar Bayonet Nerve Root
Retractor
24cm/9½" length
O’Connell Nerve Root Retractor
•
● 21.5cm/8½" length
COBB ELEVATOR
• Used to elevate and push the muscle away from the
bone to allow visualization of the spine.
• The Cobb elevator has various lengths of handles
and sizes of paddles.
COBB ELEVATOR
• Used to elevate and
push the muscle away
from the bone to allow
visualization of the
spine.
• The Cobb elevator has
various lengths of handles
and sizes of paddles.
Kerrison rongeur
Used to remove bone from smaller
areas of the spine.
• Variable jaw lengths including 1mm, 2
mm, 3 mm, 4 mm, and 5 mm.
• Two jaw slants (40 and 90 degree).
• Two types: Forward biting and
backward biting.
Kerrison rongeur
Pituitary rongeurs, are used to remove disc
and tissue in small spaces.
Pituitary
Rongeurs
STRAIGHT JAW
40° ANGLED forward JAW
40° ANGLED backward JAW
Caspar Toothed Disc Rongeur
Serrated/toothed jaws to help remove disc and tissue.
Serrated jaw
NERVE HOOKS
Dandy blunt nerve hook Cushing Gasserian blunt nerve hook
DISSECTORS/ Elevators:
Used to elevate tissues or raise a depressed or sunken
piece of bone or to separate soft tissues away from nerves
and vessels.
Howarth Elevator
MacDonald Elevator/Dissector
Bone curette
It is used to scrape away and
remove fibrous tissue and other
debris from bone.
It may also be used to scrape and
remove small portions of
the bone itself.
Volkmann Double Ended Curette
SPINAL CURETTES
Uses to scrap, shape and clean bone.
• Available with various sizes of cups.
• Curettes can be straight or angled.
SPINAL
CURETTES
Osteotome / Chisels / Gouges
• Used to cut, scrape, clean, scoop or sculpt the bone.
• They differ in the type of tip.
• Osteotome are beveled on both surfaces.
• A chisel has one beveled edge.
• Gouges have a cupped tip to scoop out bone material.
• They are used with a mallet.
Stille Osteotome
Lexer Osteotome
Chisel
Capener Lamina Gouge
Mallet
Lamina Spreader
• To aid in widening the space between the lamina.
• To hold the disc spaces open.
Pedicle awl –To perforate outer cortex of pedicle
Pedicle Probe- Straight with ball tipped)
• Used to sound the pedicle for any cortical breach in all four
quadrants.
• Also used to confirm wheteher there is any penetration to
vertebral body anteriorly during pedicle screw
fixation.
Periosteal elevator (Freer)
Periosteal elevators are mainly used to lift full thickness soft
tissue flaps
Farabeuf Periosteal
Elevator
AO Periosteal
Elevator
Mc Donalds Periosteal
Elevator
Bone cutter and Bone
Nibbler
Used to reshape the bone during
osteotomies, amputations.
Bone
hook
Bone is pulled up from fracture site by
hook introducing hook into the
medullary cavity
Bone holding forceps
Non self retaining ( Lion )
Self retaining( Heygroves
Reduction Clamp/ speedlock
Plate Holding For ceps
Low Man Type Plate Holding For ceps
Patellar Clamps
Used to hold patella after reducing
the fracture while putting circlage
wire in the shape of 8
Univer sal Drill
chuck
Drill bit is inserted at this
point of universal drill
T handle
Used to hold shanz pin
while introducing into bone
Pin is introduced
at this point
Drill guide
Used to mark drill point at which screw has to be
placed while fixing with DCP
Depth gauge
It is used to measure the length
of medullary cavity
Markings for measurements
2 3 4 5 6 7 8 9 10
Screw
driver
Different type of tips are available
– hexagonal, square etc.
Cutting player (wire
cutter)
Used to cut wire in
approximate size
Spanner
Used to tighten the nuts
in external fixators
Amputation
saw
Blade can be
changed
Bone file
Used to blunt the sharp edges
of bone after amputation
Spine add
exfix
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