8.

2 INSTRUMENTAL

Orthopedic instruments are classified according to their function as basic, specific

and specialized.

8.2.1 Basic hemostatic. It is the instrument necessary to perform the most

frequent maneuvers in all surgical procedures. According to their usefulness, these
are classified: cutting and dissection, apprehension, support, exposure and
retraction, suture, suction and aspiration instruments.

Table 5. Basic orthopedic instruments

INSTRUMENTAL FUNCTION IMAGE

1
Instrument responsible for
Scalpel handles and- -
making incisions on the
number 3 and 4.
skin and soft tissues.

Metzembaum
They are used to dissect
scissors
tissues and can be straight •
or curved.

■
They are used to cut
material, such as sutures,
May Scissors
paper, plastic, gauze,
hydrophilic material.

KEEP GOING
 They take strong tissue to
suture skin
Standard claw
dissection

Standard
They take soft tissue to
dissection without
help release it.
claw.

Adson claw They help release

dissection adhesions.

Support delicate tissue

Clawless Adson
such as vessels and
Dissection
nerves.

They are used to grip very

Mosquito
Tweezers delicate fabrics.

KEEP GOING
 To occlude bleeding

Kelly Forceps vessels and thus perform

hemostasis

Tweezers
To occlude large structures
RochesterEdit

To effect traction on
Allis Tweezers
tissues.

Senn Miller Make exposure on delicate

Separators and small fabrics

They are the most used to

Farabeuf make separation at the
Separators beginning and end of
surgery.

KEEP GOING
 Vascular and tubular
Frazier cannula secretions are aspirated
during surgery with a small
incision

cannula Suctions liquids present in

Yankawer large surgeries

8.2.2 Specific orthopedic instruments. This instrumentation is a complement to

the basic hemostatic instrument, because thanks to it the surgeon can perform more
easily during the surgical process; It is also classified by separators, files, rasps,
cutting instruments, among others.

Table 6. Specific orthopedic instruments.

INSTRUMENTAL FUNCTION IMAGE

It is an autostatic
Cobra Separator separator used as a
separation instrument

KEEP GOING
 Separator Its primary function is
Volkman separation, and it is also
known as a fork
separator.

Hohmann separators They have a wide and

narrow tip, so you can
use it as leverage.

This, like the previous

ones, is widely used to
Bennett separator
expand the operating
field.

They are used to 1A

Hibbs separator separate muscles and YO •
adjacent structures such
as vessels and nerves.

Used in large surgeries to

Lambot hook retract flaps

KEEP
GOING
 It is used to loosen the
Cobb dissector 1
"Tmommmnn
bone

It is used in surgery to
Volkman curettes
take a bone biopsy,
ranging from 0-4mm to 0-
6.

Shears
Its greatest utility is for
cutting bone, there are Mg-e
straight and angled ones.

Comes flat and ribbed

Chisel
In diameters of 2-4-5
6mm are used to remove
wedge in bone

KEEP GOING
 —m 1m r
'

mum
There are two groups:
single and double action,
Gouges
straight and curved, used
to remove bone morsels. I-
Q. ■ -

Cuts Cold
They are basically used
to cut wire, nails.

8.2.3 Large fragment team. The large fragment team handles long bones, such
as the femur, tibia, humerus, among others; It is known as the 4.5 mm diameter, or
basic, set for any osteosynthesis procedure 74 .

It is made up of the implant box and the instrument box.

8.2.3.1 Implant box. This consists of screws, washers and plates.

74

www.insampedro.com
 Table 7. Large fragment team.

BOX OF
FUNCTION IMAGE
IMPLANTS

It is used as a traction screw

Cortex screw 4.5 in oblique fractures or for
mm diameter placing plates in the shafts
of long bones.

They are placed in the

spongy areas at the level of
Cancellous screws the epiphysis and — ... ..........*
6.5 mm diameter metaphysis accompanied by *■
washers, they come with
partial or complete thread

They are used in the

Malleolar screws epiphyses and metaphyses
1
4.5mm diameter of bones, they provide
traction on fractures.

These are used for

cancellous and malleolar
Washers screws to prevent them from
sinking into the bone.

KEEP
GOING
 Dynamic This plate has the
Compression Plates advantage of self-
(DCP) compression on fractures

LC-DCP plates Low contact dynamic

compression plate is used in
short oblique fractures

Reconstruction
They can be found straight
plates
or arched, their greatest use
is at hip level.

They are used in areas

Half-round plates where there is tension force,
they allow axial
compression.

They are used as plates to

T-plates maintain support on the
medial aspect of the tibial
plateau.
They are used to support
L-shaped support the medial aspect of the
plates tibial plateau and tibial
plateau fractures.

KEEP GOING
 Spoon plates It is used for large posterior
and multiple anterior
fractures of the tibia.

m
O.ammammmua
— WO
Its main use is hip
arthrodesis in total hip

[C C e CCDC
Cobra plates replacements.

Fr « « PI

Cloverleaf plates Its main use is for the distal h _____

part of the tibia. ______J.
They are used to perform
■"dII * H|| ))
osteosynthesis after an

Elongation plates
elongation osteotomy, that
is, it is used to replace bone
1 » IP I B ) j
fragments.

It is indicated for condylar

YO
1
fractures and in the distal
Condylar support
and lateral part of the femur.
plates

8.2.3.2 Instrument box. In this box there is all the instruments required for the
placement of osteosynthesis. (see table 5) 76

76
www.insampedro.co
m
Table 8. Instrument box of large fragments
BOX OF
INSTRUMENTAL
FUNCTION IMAGE

It is used to drill the thread

channel to place 4.5 mm
3.2mm diameter
diameter cortical screws and
drill bit
6.5 mm diameter cancellous
screws.

The smooth channel is drilled

4.5mm diameter
for the 4.5 mm cortex screw at
drill bit
the time of traction.

These protect the drill bits to

Guides direct them when drilling on an

exposed bone.

It is used to carve the channel

Males
in which the screws are fixed
to the bone when a fracture is
to be corrected.

KEEP GOING
 They adjust to the taps and
Quick release
the countersink using a quick
handle
anchor system.

They are introduced into the

bone after making the sliding
Centering sleeve
channel so that when drilling
the thread channel

This is used to create a

groove in the proximal cortex

Countersink so that the screw can attach to

the bone, preventing it from
refracturing.

They are used to measure the

Depth meter holes, after having
countersunk them and thus
choose the appropriate
screws.

KEEP GOING
 They come with a quick cuca muenw CAUG MNSUUTORL

anchor to insert or remove

Screwdrivers
screws with cross or Phillips
head, hexagonal, among
others.
This is used to remove
underlying tissue in the screw
head when it is to be
Erina
removed, and to check the
alignment of the fracture.

They are useful when outlining

Faucets
the plates.

They are useful when cutting

Machas Tweezers
plates

M 3S (, gg AN8V
1 WB
1 1 II

Plate presses They are useful when outlining

1IN

the plates.

Yo
Made of aluminum, they help KEEP GOING
shape the plates.
Malleable
templates
 It is universally used to loosen

fixed wrench
or tighten the connections of
osteosynthesis materials. and"•
8.2.4 Medium fragment equipment. The medium fragment team handles small
bones, such as the radius, ulna, and fibula; It is known as the 3.5 mm diameter, or
basic, set for any osteosynthesis procedure. It is made up of the implant box and the
instrument box.

8.2.4.1 Implant box. This consists of screws, washers and plates.

Table 9. Medium Shard Equipment

BOX OF
IMPLANTS
FUNCTION IMAGE

3.5 mm diameter It is used as a traction screw in

cortex screws oblique fractures or for placing
plates in the diaphyses of small
bones.

They are placed in the spongy

Cancellous areas at the level of the
screws 4.0 mm epiphysis and metaphysis
diameter accompanied by self-drilling
washers.

KEEP GOING
 These are used for cancellous
screws to prevent them from

“)
sinking into the bone. Their
Washers diameter is 7.0mm.

Dynamic
This plate has the advantage of
Compression
self-compression on fractures.
Plates (DCP)

It is a low-contact dynamic
compression plate whose hole
LC-DCP plates
is bidirectional and is used in
short oblique fractures.

They can be found straight or

Reconstruction
arched, their greatest use is at
plates
the level of the clavicle and
forearm.

Their greatest use is to correct

83 CONTINUED
calcaneal fractures, and their
Calcaneal plate
weakness is that they are a little
uncomfortable to place.
 They are used as plates for

T-plates fractures in the ulna, radius in

the distal portion.

Its main use is for fractures in p* ?' — 5 5 « r. 1

Cloverleaf plates e,1 - J.
the humerus (•

8.2.4.2 Instrument box. This box contains all the instruments required for the
placement of osteosynthesis.

Table 1O. Instrument box of medium fragments

BOX OF
INSTRUMENTAL
FUNCTION IMAGE

2.5mm diameter
It is used to drill the thread
drill bit
channel to place 3.5 mm
diameter cortical screws and 6.5
mm diameter cancellous screws.

3.5mm diameter
The smooth channel is drilled for
drill bit
the 3.5 mm cortex screw at the
time of traction.

KEEP GOING
 Guides These protect the drill bits to
direct them when drilling on an
exposed bone.

Carving the canal so that the

Males screws are fixed to the bone is
used when you want to correct a
fracture.

They are introduced into the

bone after making the sliding
Centering sleeve channel.

This is used to create a groove in

the proximal cortex so that the
Countersink
screw can attach to the bone, K।
preventing it from refracturing.
 They are used to measure the
holes, after having countersunk
Depth meter them and thus choose the
appropriate screws.

KEEP
GOING

CLINICA PALERMO cAuaA mu«u

They come with a quick anchor,

Screwdrivers
to insert or remove screws with
cross or Phillips head,
hexagonal, among others.

This is used to remove

F
underlying tissue in the screw

Erina head when it is to be removed,

and to check the alignment of the
fracture.

—H
They are useful when contouring
Taps .
the plates.

They are useful when contouring **

K-- - -
Male tweezers
the plates.

1
t 1
 They are useful when outlining
Plate presses
the plates.

KEEP
GOING

1
Malleable Made of aluminum, they help
templates shape the plates.

fixed wrench It is universally used to loosen or

•)
tighten the connections of
osteosynthesis materials.

8.2.5 Instrumental for DHS and DCS. Instruments for the treatment of fractures of
the neck of the femur.

Table 11. Instrumentation for DHS and DCS

INSTRUMENTAL FUNCTION IMAGE

Sliding screw Remove the sliding :

extraction rod screw. Fkál H
 Measure the depth of
the drilling to determine
Depth gauge for the length of the sliding
sliding screw screw.

KEEP GOING

Thread the slide screw.

12mm male for
sliding screw

Drill the sliding screw

bed.
8 mm cannulated
drill bit.

Impact plate, to reduce

Plate Impactor
spaces between the
(Teflon Tip)
plate and the bone.

For fracture of the

135º DHS plate
trochanter of the femur.

95º DHS plate

For fracture of the
trochanter of the femur.
s-
 Insert and remove
Hexagon screws.
screwdriver

KEEP GOING

sliding screw
Reduces
intertrochanteric III
.3
fractures.

Reduces
intertrochanteric
Security screw
fractures by fixing the
DHS plate to the bone.

•to
Protect soft tissue and
direct the path of the
Kirschner nail to the
bone.
DHS 135º angled
fixed guide

Protect soft tissue and

DCS 95º angled
direct the path of the
fixed guide
drill bit to the bone.
 Angled guide
adjustable from
120º to 180º
Manual adjustable
guide Protect soft
tissue and direct the
path of the drill bit to
sg "
Extended
the bone.

_-E »

cannulated rod Insert screws.

KEEP GOING

Cannulated T-
wrench
() ■
Insert and remove
sliding screws.
1
E ••

8.2.6 Instrumentation for cannulated screw. Special for performing

interfragmentary reduction at the level of the joints (see table 9).

Table 12. Instrumentation for cannulated screw

11
•• • n eiff 5- - 8.2- H ae6d-**ece-**4--

Measure the depth of

Depth meter
the drilling to
determine the length of
the cannulated screw.

Cut the thread of the

cannulated screw.

Cannulated Male
It is a multiple guide
through which we can
Parallel insertion insert several nails at
guide for the same time.
2.8 mm needles. instant.

um—01
Cannulated drill Drill the cannulated
bit screw bed.

Cannulated Reduces the surface

countersink of the bone so that the
screw head will bed
into the bone. KEEP GOING
Protect soft tissue and 44___—_____ gahmm
1e
direct the path of the
Drill and tap
drill bit or tap to the
guide
bone.

Used to secure the

shipping basket
Screw holder screws.
clamp

8.2.7 Instrumental for 95º and 130º angled plates. Used for the treatment of hip
fractures.

Table 13. Instrumentation for 95º and 130º angled plates

2.0 Mm Kirschner It is used to do fracture

wire trocar tip reduction.

Drill the screw bed.

2.0 Mm Drill Bit.

 Protect soft tissue and
direct the path of drills
and taps to the bone.

4.5/3.2mm double
drill guide.

Impact plate, to reduce

spaces between the
Impactor plate and the bone. -

KEEP GOING
Triangular patterns
90º / 50º / 40º 80º / They are used to know
70º / 30º 100º / 60º / the entry angle of the
20º screws.

They are used to know

Quadrangular the entry angle of the
pattern 110º / 90º screws.
90º / 70º

8.2.8 Instrumental of mini fragments. Used to treat fractures in the specialty of

the maxilla and reductions in the skull, hand and foot.

TABLE 14. Mini Fragment Instrumental

INSTRUMENTAL FUNCTION IMAGE

FROM MINI
FRAGMENTS

1.1mm drill bit

 1.5mm drill bit
Brocar
2.0mm drill bit

2.7mm drill bit

KEEP GOING
For anchoring quick-
release toothed
T-handle
instruments

Male for cortical Carve the screw channel.

screw from 1.5 to 2.7

mm.

Double Drill Guide

1.5/ 1.1 Guide the drill bit to a
2.0/ 1.5 fixed point.
2.7/ 2.0

#
Small hex
For 2.7 screws.
screwdriver
 For 1.5 screws
Depth meter
Up to 2.0mm.

For bending and holding

wire bending pliers
needles.

KEEP GOING

Reduce bone fractures.

Narrow reduction
forceps with zipper
tips.

Pull apart.
Mini Hohmann
Separator

■ K CUNICA VASCULAI NAVARRA

Periostotomes Deperioste bone.

Exert force on another

Hammer instrument to fracture

bone.
 Screws Join or fasten two
1.5 mm cortex structures.
and 2.0mm

Screws Join or fasten two

cortical 2.7 mm. structures.

KEEP
GOING

Washers for Let it not find

mini screws direct contact of the
screw head with
woven bone.

Straight They allow you to

miniplates maintain the
1.5 mm with 20 stable fracture until
holes its consolidation.

Yo
Fix the fracture and help
1.5mm and 2.7mm
mini T-plates consolidation.

Mini L-plate 2.0mm

and 2.7mm
Fix the fracture and help
bone consolidation.
li
75-------_ __ _
75
www.insampedro.com

Graph 11. Plate classification

Fountain. Prepared by the authors

77
Principles of the AO. B.Wwittner and U.Holz,
p. 170
TABLE 15. Special plates and
prostheses
BONE FRACTURE TREATMENT IMAGE

Clavicle Diaphy 3.5mm LC DCP

plate, nails
sis

Clavicle
Middle third hook plate

Total replacement

Comminuted fractures of of
the shoulder.
Clavicle glenoid and head
humeral Components of the
Implant for
total replacement
of
shoulder

Partial replacement
shoulder,
Should plate placement in
Neck fracture T
er

KEEP
GOING
 Placing philos plate.

Shoulder Neck fracture

8The
$6ee$
4.5mm DCP
Plate,Cannulated
Humerus Proximal fracture Screw «EEE==KXE

Comminuted diaphyseal intramedullary nail

fractures
Humerus

Humerus LCP 4.5 plate

Distal humerus fractures

Comminuted proximal Partial elbow

Elbow fracture replacement

r » 11
DCP 3.5 mm plate
Radio Proximal 1/3 fracture
placement .

KEEP
GOING
 Plate placement
3.5 narrow DCP
Oblique fractures
and mm.
Radio
transverse colles fracture ,
fixing with nails

Ulna
Fractures of the
epiphysis
Comminuted C intramedullary
fractures lavage
Radio

LCP lacquer plate

Radio Fractures of the 2.4 mm,
epiphysis support plates in
T

percutaneous
kirschner, steiman,
shans

colles fracture ,

Radius fixing with nails

and percutaneous
Fractures of the
ulna
epiphysis kirschner,
steiman,
shans.

KEEP
GOING
 Percutaneous fixation
with 1, 1.5 mm
Kirschner nails and
mini-fragment plates
f3
wrist and
hand
Metacarpal fractures

Placement of 3.5 mm

1 7) /pal, 4 I U
If Xs - V 9 yy
Fractures of the acetabulum, straight and curved
Pelvis sacrum reconstruction plates.

-/TO
Hip Extracapsular,

0-557
intertrochanteric, DHS Placement
subtrochanteric and 135º and 150º.
transverse fractures c

Total hip or partial hip

g
*4 Acetabular Shel

Intracapsular fractures:
replacement
Q Polyethyfera Lirter 49
Subcapital of the neck Femoral Head 20"9

. Ho tmplant YO '
Hip I1
95º DCS plate AND
Subtrochanteric wedge
Femur
fracture: 4.5 mm LCP plate.
KEEP
GOING
 Femoral head neck fracture

Femur DHS, DCS

z/
Diaphyseal fractures DCP 4.5 : —— -
Femur

intramedullary nail for

Femur Diaphyseal fractures
femur

Knee
Osteoarthritis and
Total replacement
degenerative pathologies

l Yo Y
o
Yo í y11I
Tibia Diaphyseal fractures intramedullary nail

Retrograde nail in
Warm Diaphyseal fractures
tibia

KEEP
GOING
 Diaphyseal fractures External tutor -

Foot
-
•1
Spongy screw

Scaphoid fracture