Why power tools form an integral part of modern orthopaedic surgery
Introduction
The use of power tools is intricately associated with modern operative orthopaedics. The introduction of power tools has revolutionised orthopaedic surgery. These instruments have allowed the surgeons to work efficiently and accurately. Power tools are now used in all aspects of orthopaedic surgery, ranging from use in wound management through pulse lavage, to the use of drilling and reaming in long bone fractures using screws and intramedullary nails. These instruments have been further modified to make them lighter for the ease of use. Metal alloys that are lighter in weight and that generate less heat on repetitive use are being used more often. Air operated cabled devices have given way to battery operated, more ergonomic, devices. Modern power-assisted tools are more consistent with their performance and easier to assemble, making it suitable for surgeons and staff alike. Moreover, these tools are increasingly designed to be modular to render it cost effective for maintenance and repair.
The efficacy of power-assisted saw devices has been attributed to their precision which leads to improvement of the technique and surface geometry of the osteotomy.1 The use of power-assisted drills have also been shown to produce a consistent thread pattern in the cortical bone with the advantage of such power drills being faster than manual devices.2 On the other hand, power-driven instruments have been commonly associated with bone necrosis due to local rise in temperatures, plus, there is risk of infection from the exhaust air.3,4 Modern power-assisted tools have addressed such concerns with highly efficient and engineered machines supplemented with coolants to minimise the surface temperature.
In this review we have appraised relevant specifications of power tools supplied by major commercial providers to identify the relevant factors that can potentially influence technique and outcome of orthopaedic operations. This will provide orthopaedic surgeons and the theatre team over-arching information about the available resources from manufacturers to aid choice of the appropriate power-assisted device for different types of orthopaedic surgeries.
Types of power tools
A review of the power–tool options leads to several devices specifically tailored for large or small bone with precise technical specifications for each. We have tabulated specific features of power tools from major suppliers that are illustrated in Table 1 in addition to their portfolio of attachments.
Discussion
The power tools supplied by the different companies can be broadly classified according to their functional use – the heavy duty being used for larger bones and lightweight devices being advantageous for smaller bones, specifically for upper limb, foot and ankle surgery. The tools for larger bones have more torque with higher CPM in comparison to smaller tools, although the power source can be variable according to the type of the device. The smaller tools are typically lightweight in comparison to the heavy-duty tools.
These devices can also be categorised according to their power source, which can be battery, electric and pneumatic. Battery-assisted devices are convenient to the user as they have no lead attached with the tool and usually have lithium (Li) or nickel (Ni) batteries as power source. These batteries need to be recharged after use and lithium batteries have longer life than nickel batteries. Pneumatic power source, on the other hand, is light and is not limited by duration of use and/or recharging, but such sources need to be installed in operating theatres. Electric power source is infrequently used but these devices have enhanced safety precautions including internal fuses to prevent accidental injuries and can be equally effective.
Most of the devices have a flexible portfolio of attachments, rendering them versatile for use with drills, reams, burrs and K-wires. The power-assisted heavy-duty saws in contrast are unique although most of the devices will allow up to eight positions for setting of the blade to add to the precision of the bony cut. Coupling and quick but safe switching over of the attachments or positions of the blade are the other major dimensions of modern tools adding to the ease of the surgical user and the provider, such as a scrub nurse during operations.
The newer generation of the power tools uses advanced ergonomics in designing tools making them lightweight with well-designed curved handles, having appropriate dimensions and texture to improve the grip and hence dexterity of the surgeons during its use. All the devices essentially should also comply and conform to the Medical Devices Directive, published by The European Economic Council, which sets standards to ensure patient safety.5
Conclusion
Power tools form an integral part of modern orthopaedic surgery. It is a key instrument in the armamentarium of the operating department for many surgical techniques practiced by the current generation of orthopaedic surgeons. These tools, despite their inherent advantage, can potentially expose surgeons to the risks pertaining to prolonged use of vibrating tools on the upper arm, protracted period of exposure to noise pollution and hazards associated with droplet/aerosol infections from the patients (AS). The industry has actively engaged in these aspects of power tool ergonomics and safety over the last decade to develop a spectrum of power-assisted devices tailored to precision of the nature of the procedure, at the same time addressing safety and efficacy of surgeons. The National Institute for Occupational Safety and Health have developed guidelines to minimise occupational hazards while operating hand held tools by the surgeons.6
This review comprehensively demonstrates the range of power tools available to the surgeons, along with its specific feature, aiding choice of the right device. An ideal power tool should be an educated choice of the surgeon depending on their requirement, ergonomics, safety and availability of the device. Importantly, surgeons’ meticulous selection of the accurate device should drive the development for exactitude for power-assisted devices by the industry in future years to come.
References
1. J-Y Giraudt SV, R Darmanat, J-Ph Cahuzac, A Autefages and, Moruccit J-P: Bone Cutting. Clin Phys Physiol Meas 1991, 12(1):1-19.
2. Elliott D: The use of power tools in the insertion of cortical bone screws. Injury 1992, 23(7):451-452.
3. Augustin G, Davila S, Udilljak T, Staroveski T, Brezak D, Babic S: Temperature changes during cortical bone drilling with a newly designed step drill and an internally cooled drill. International orthopaedics 2012, 36(7):1449-1456.
4. Sagi HC, DiPasquale T, Sanders R, Herscovici D: Compressed-air power tools in orthopaedic surgery: exhaust air is a potential source of contamination. Journal of orthopaedic trauma 2002, 16(10):696-700.
5. Public Health-Medical devices. European Comission Website acessed on 4th October 2013.
6. Portable Hand and Power Tools : Self-Inspection Checklist. National Institute for Occupational Safety and Health (NIOSH) Website acesed on 4th October 2013.
