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MICRO POWER TOOLS Speed and torque strongly influence what small bone power tools can do, how easy they are to use and the precision they offer.
Just as in golf you don’t tee off with your putter, in surgery you pick the right power tool for the job. Some are designed for larger operations — like knee and hip replacements — where surgeons need more speed and power, while others are intended for small bone procedures that require more precision and finesse when sawing, shaping, dissecting and drilling bone, or fragmenting, emulsifying and aspirating soft tissue.
“The importance of having specific power tools for what I do is that they’re more precise,” says D. Scott Biggerstaff, MD, a foot and ankle specialist at OrthoCarolina in North Carolina.
Precision is only one of the features to look for when buying small bone power tools. Here are some others to consider:
- Pencil grip. It doesn’t get any more precise than the pencil grip. The name is exactly what it implies, you hold it like a pencil. The pencil grip is for more intricate, fine-detailed procedures, like nerve repair, wrist arthroscopy, wrist fractures, minimally invasive surgery of the hand and carpal tunnel syndrome. It’s not meant to be used to penetrate the bone but used, for example, to open a small hole in the bone. Speed is important for pencil grips because it prevents the burr from wobbling. But too much power can actually be bad. It could split the bone and make it difficult to control the pencil.
- Pistol grip. You hold it as you would a power drill that’s stored in your garage. It has a little more power and is used for drilling holes in which to place screws and for some bigger procedures.
“There are some occasional larger osteotomies that I’ll use the pistol grip for because it has more power and the saw blades are a little bigger,” says Dr. Biggerstaff. “You can get the procedure done efficiently and maybe not need as much of the preciseness or accuracy.” • Blade width. When a surgeon wants to shorten a bone, the width of the saw blade is critical. The narrower the blade, the more precise it is. The wider the blade, the more bone it takes and the wider kerf (the narrow channel or slit from cutting) it leaves.
- Blade width. When a surgeon wants to shorten a bone, the width of the saw blade is critical. The narrower the blade, the more precise it is. The wider the blade, the more bone it takes and the wider kerf (the narrow channel or slit from cutting) it leaves.
“Having a blade with a narrow kerf is very helpful,” says Christopher Lincoski, MD, a hand surgeon at University Orthopedics Center in State College, Pa. “If it has a wide kerf, then I need to figure that into my measurements.” He adds that several factors impact the kerf, including the width of the blade, the set of the blade’s teeth, the amount of wobble created during cutting and the amount of material pulled out of the sides of the cut.
- Bits and compatibility. The quality of the machinery — in particular the bit and how it fits into the drill — is also a key consideration.
“You want a very high-quality machine bit,” says Dr. Lincoski. “If I want to drill a 2-millimeter hole, there is no real margin for error. The key thing is that it drills true and straight. There is no tolerance in surgery for the drill bit to wobble.”
To prevent that wobble, make sure the chuck — a specialized type of clamp in the drill — tightly secures the bit. There is also something called a “quick chuck,” a universal adapter that addresses another important factor: compatibility.
You need to have good interchanging parts, so keep compatibility — of the chuck and the bit, and of the chuck and the saw blade — in mind. “Let’s say I’m fixing an ankle fracture or doing a fusion,” says Dr. Biggerstaff. “I might use 2 or 3 different drill bits depending on the size of the screw. I know 30 to 45 seconds doesn’t sound like a lot of time to chuck up a drill bit every time you want to change it. But if you’re putting a bunch of screws in, the time adds up. And when you expand that to an entire day of operating, there is a lot of wasted time if you don’t have that compatibility.”
- Ergonomics. Most of the tools are ergonomically balanced now, and it’s important that the drill have a comfortable feel. Even the pencil and pistol grips provide varying tactile sensations in your hands. You want as little vibration as possible and very little kickback from the instruments.
“The less vibration, the better, so that it’s just the saw blade that’s moving and I’m not having to counteract the inertia of the tool,” says Daniel Farber, MD, foot and ankle specialist and assistant professor of clinical orthopedic surgery at University of Pennsylvania Medicine in Philadelphia. “If it’s smooth, you’re just working the saw and you’re not fighting it with your hands.”
Consider the ease of toggling between forward and reverse. The oscillate (back and forth) feature, for example, can be useful when putting wires into a fracture to hold it in place.
“If there’s a nerve nearby and you put the drill on forward, you can wrap up the nerve,” says Dr. Lincoski. “So sometimes we put it on oscillate, which prevents the nerve from winding around the wire.”
One critical design feature of the drill is the safety lock that will stay secure, even if it’s bumped. You don’t want the drill turning on unexpectedly. And you also want it to shut off when it’s supposed to. “When I’m sawing or using a burr, I want to know that as soon as I take my finger off the trigger, the device is going to stop,” says Dr. Biggerstaff.
And in case it doesn’t stop, it’s important to look at a company’s repair history and its reputation for servicing the equipment. A tool may be durable and easy to use, but it’s also important to assess the reliability of the customer service behind it. “If the company that’s selling a device doesn’t have good representation and doesn’t service their product well, to me that’s a big downfall,” says Dr. Biggerstaff.
- Cords and batteries. Handheld power tools come power-corded or battery operated. With those that plug into the wall, the cord is just one more thing draping off the surgical field that possibly could get contaminated. Or a team member could be leaning on the cord without realizing it, creating a pull on the surgeon.
“With a battery-powered tool, you’re less encumbered in terms of what position you’re in,” says Dr. Farber. “If you’re near the end of the length of the cord, it can pull the instrument while you’re using it and it can change the direction of your hand.”
On the other hand, batteries don’t hold their charge very long and they’re not immune to problems. What if there’s no indicator on the battery to know if it’s good and still holding its charge? What if a battery you left on the charger last night is still dead in the morning? “Sometimes you end up opening a lot of batteries to find one that’s good,” says Dr. Farber, adding that a battery should hold its charge for a whole case, long enough to saw and place 8 to 10 screws. There is also a pneumatic power option, which requires hose connections to a tank of compressed nitrogen or is integrated into the OR gas system. The downside of pneumatic power is your surgeon is reliant on the proper gas settings and pressurization. “It offers a little more power than electric,” says Dr. Farber. “It’s better than battery, but maybe not quite as smooth as electric.”
- Cost. Cost is a major factor in purchasing power tools, and the smaller sets can be around $25,000, not including disposable bits and blades (which can run $150 to $200 each), backup batteries and other accessories. But cost isn’t the only factor. When weighing choices and presenting options to surgeons, be sure to consider the details beyond the expense. OSM
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