Orthopedic instruments: the basic hand tools and what they do

Cutting and shaping bone: osteotomes, chisels and gouges

Osteotomes and chisels have a flat, sharpened blade that is driven with a mallet to divide or shave bone. Gouges have a curved, channelled blade for removing bone in a scoop. Lambotte, Smith-Petersen and Hibbs patterns appear in the REDA orthopaedic range, in different widths and lengths.

They are struck, so they need hardened but tough steel and a handle that is not bent under impact. For more detail see our article on osteotomes, chisels and gouges.

Always pair them with a suitable mallet, listed in the same section, and check the striking end for mushrooming over time.

Biting and scooping: rongeurs and curettes

Rongeurs are strong bone-biting forceps with cupped jaws for removing small pieces of bone. Luer and Stille patterns are common, in straight and angled versions. See bone rongeurs.

Curettes have a sharpened ring or spoon to scrape cancellous bone, cysts and tissue. Bruns and Volkmann bone curettes are typical. Our guide to bone curettes shows how sizes are used.

For spinal work, specialised rongeurs such as the Kerrison punch are covered in a separate Kerrison rongeur article.

• Rongeurs: bite and remove fragments
• Curettes: scrape and scoop soft or cancellous bone
• Gouges: shape and remove bone in a channel

Holding and exposing bone: forceps, levers and elevators

Bone-holding forceps grip bone fragments with pointed or serrated jaws and a ratchet to keep the grip while the surgeon works or applies fixation. See bone-holding forceps.

Hohmann bone levers hook around bone to retract soft tissue, and periosteal elevators such as Cobb separate the periosteum from bone to expose the surface. Details are in our periosteal elevator guide.

Drilling, wires and other accessories

The orthopaedic section also includes drill bits, medullary reamers, mallets, Kirschner wire instruments, wire twisters, tendon instruments and meniscotomes, together with plaster saws, shears and spreaders for cast work. Which of these belong in a set depends on whether the department handles trauma, elective joint work or paediatric orthopaedics.

Ask whether drill bits and reamers are supplied as separate items or in cases, and make sure the connection to the power system you use is compatible.

Care, sharpening and common mistakes

Orthopaedic instruments work hard. Cutting edges on osteotomes and gouges dull with use, and rongeur jaws lose their bite, so schedule inspection and sharpening rather than waiting for failure in theatre.

Avoid striking instruments that are not designed for a mallet, avoid using chisels as levers, and clean cannulations and hinges thoroughly because bone debris is difficult to remove once dried. Rinse promptly after use and follow the manufacturer's reprocessing instructions.

Check periodically that bone holders keep their grip on the ratchet and that handles of impact instruments are not loose.

Building an orthopaedic set

Start from the procedures: a trauma tray needs holders, levers, elevators, curettes and mallets, while a hand or foot set needs smaller patterns. Keep spare instruments for the busiest trays, and plan for sharpening of cutting edges.

Beckfinity can assemble a quotation for REDA orthopaedic instruments matched to your procedures. Send us your set list and our specialists will respond.