Orthopaedic Instruments - Uses

1. Periosteal Elevator

• Subperiosteal dissection during exposure of bones for osteotomy, fracture fixation, or bone grafting
• Elevating periosteum off the iliac crest before harvesting bone graft
• Lifting periosteum off the tibia or femur before inserting implants
• Creating a subperiosteal tunnel along the medial/lateral surfaces of bones during limb lengthening procedures
• Dissecting around the sciatic notch during pelvic surgery
• Used as the Freer elevator in ENT/nasal surgery to raise mucoperiosteal flaps

2. Curette

• Scooping out cancellous bone, cartilage, or fibrous tissue from a cavity (e.g., bone cysts, joint spaces)
• Curettage of bone tumors or infected bone in osteomyelitis
• Removing remaining articular cartilage from joints before arthrodesis (e.g., wrist fusion)
• Removing sclerotic bone to reach bleeding cancellous bone at fracture nonunion sites
• Clearing out cancellous bone from the cuboid or other tarsal bones during foot surgery
• Curetting facial bone in ear/temporal bone surgery (mastoidectomy)

3. Bone Gouge

• Cutting and shaping bone, especially curved surfaces
• Removing blocks of cartilage or bone (e.g., inferior facet in subtalar fusion)
• Creating slots or notches in bone for graft placement
• Harvesting cortical or cancellous bone grafts
• Often used alongside the curette - the gouge cuts and the curette scoops out the fragments

4. Osteotome

• Cutting through cortical bone (corticotomy) for limb lengthening (Ilizarov technique)
• Harvesting cortical bone grafts from the outer table of the iliac crest
• Performing osteotomies (cutting bone to correct deformity), e.g., femoral, tibial, pelvic, iliac osteotomies
• Making medial and lateral osteotomies of nasal bones in rhinoplasty
• Opening or closing wedge osteotomies for deformity correction
• Cutting windows in tarsal bones for bone grafting (e.g., cuboid)

5. Kirschner Wire (K-Wire)

• Provisional fixation - temporarily holding reduced fracture fragments while definitive fixation is applied
• Definitive fixation of small bone fractures (hand, wrist, foot, ankle, pediatric fractures)
• Pinning of phalanges, metacarpals, metatarsals, and carpal bones
• Guide wires for cannulated screw placement
• Holding osteotomies in corrected position (e.g., foot osteotomies in clubfoot)
• Percutaneous fixation of pediatric supracondylar humerus fractures
• Maintaining position after joint reduction

6. Steinmann Pin

• Skeletal traction - inserted through the calcaneus, proximal tibia, distal femur, or olecranon to apply longitudinal traction to a fractured limb
• Fracture reduction - used as a joystick to manipulate and reduce fracture fragments percutaneously (e.g., Tillaux fracture of the ankle)
• Temporary fixation of larger bones after reduction (e.g., wrist arthrodesis: drilled through carpus into the radius)
• Distracting the tibiotalar joint during posterior tibial lip fracture fixation
• Holding corrected position after osteotomy (e.g., congenital vertical talus reduction)
• Serving as an intramedullary strut in certain reconstructive procedures

7. Ilizarov Ring Fixator

• Distraction osteogenesis - gradual bone lengthening after corticotomy (treating limb length discrepancy, dwarfism)
• Bone transport - moving a segment of bone across a defect to fill large bone gaps (after tumor resection, osteomyelitis debridement)
• Nonunion treatment - compression or distraction across hypertrophic/atrophic nonunions to stimulate healing
• Deformity correction - gradual correction of angular, rotational, or multiplanar deformities
• Open fracture stabilization (Type IIIA/IIIB) - allows wound access while stabilizing bone
• Treatment of neglected dislocations (e.g., elbow) with gradual reduction
• Osteomyelitis management - stabilizes infected bone while allowing wound care

8. Interlocking Nail (Interlocking Intramedullary Nail)

• Definitive fixation of long bone shaft fractures - femur, tibia, humerus (the gold standard for most diaphyseal fractures)
• Subtrochanteric fractures of the femur (reconstruction nail with proximal hip screws)
• Pathological fractures through bone metastases (prophylactic or therapeutic)
• Nonunions of femoral and tibial shaft fractures
• Infected pseudarthrosis - antibiotic cement-coated IM nail
• Ipsilateral femoral neck + shaft fractures (reconstruction/cephalomedullary nail)
• The proximal and distal interlocking screws prevent rotation and shortening of the fracture

9. Bone Nibbler (Rongeur/Bone Nibbler)

• Trimming and contouring bone edges - removing sharp bony spurs, osteophytes, or irregular bone fragments
• Removing small bony prominences (e.g., in spinal surgery to remove laminar bone during laminectomy)
• Nibbling away bone to enlarge a foramen or joint space
• Debridement of bone in infected wounds
• Removing small bony tabs in nasal/sinus surgery
• Trimming the edges of bone after osteotomy
• Removing exostoses

10. Bone Plate Holder (Plate-Holding Forceps / Bone-Holding Forceps)

• Holding bone plate against the bone surface while the first screws are drilled and inserted, ensuring accurate plate positioning
• Holding bone fragments in reduced position during internal fixation (bone-holding forceps / reduction clamps)
• Maintaining anatomic reduction while definitive fixation is achieved
• Used in open reduction and internal fixation (ORIF) of fractures of the femur, tibia, humerus, radius/ulna, and other long bones
• Pointed reduction tenaculums grip fracture fragments; plate-holding forceps hold the plate against bone

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