Bone Surgery

A 1.6 mm trocar-tip wire, 150 mm long, driven at 400 rpm through the metaphysis of a distal radius. That is the whole of the fixation in a large share of paediatric and low-demand adult fractures, and it costs a fraction of a plate. The wire is the cheap part. What determines whether the construct […]

Before antibiotics, chronic osteomyelitis was a surgical disease treated almost entirely with steel. The dead bone had to come out, the cavity had to be laid open, and the instruments that did that work — long serrated grasping forceps and nibbling punches — were among the most-used items in any nineteenth-century orthopaedic set. Antibiotics changed

Mallet mass, striking-face material, tamp tip diameter, tip serration pattern. Four variables, and getting any one of them wrong turns a controlled impaction into a split cortex or a fractured graft bed. A bone impactor is the crudest-looking thing in an orthopaedic tray and the one most dependent on matched pairing. A 32 oz mallet on

Why does a fracture clinic still keep a rack of hand shears when there is an electric cast saw on the trolley? Because the saw only solves part of the problem. It cuts a groove; it does not open one. It is useless on a wet or freshly applied cast, hazardous over a bony prominence,

A district hospital amputation tray usually runs to somewhere between 22 and 35 pieces. The number varies less than you would expect between a trauma unit in Europe and a rural surgical centre in West Africa, because the operation itself has not changed: control the vessels, divide the muscle at the level you intend to