Power-Tool Use in Orthopaedic Surgery

Abstract

Background:Power tools are an integral part of orthopaedic surgery but have the capacity to cause iatrogenic injury. With this systematic review, we aimed to investigate the prevalence of iatrogenic injury due to the use of power tools in orthopaedic surgery and to discuss the current methods that can be used to reduce injury.Methods:We performed a systematic review of English-language studies related to power tools and iatrogenic injuries using a keyword search in MEDLINE, Embase, PubMed, and Scopus databases. Exclusion criteria included injuries related to cast-saw use, temperature-induced damage, and complications not clearly related to power-tool use.Results:A total of 3,694 abstracts were retrieved, and 88 studies were included in the final analysis. Few studies and individual case reports looked directly at the prevalence of injury due to power tools. These included 2 studies looking at the frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%), 2 studies investigating the frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%), and 4 studies investigating vascular injury during total joint arthroplasty (1 study involving 138 vascular injuries in 124 patients, 2 studies noting 0.13% and 0.1% incidence, and 1 questionnaire sent electronically to surgeons). There are multiple methods for preventing damage during power-tool use. These include the use of robotics and simulation, specific drill settings, and real-time feedback techniques such as spectroscopy and electromyography.Conclusions:Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests that the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations, the use of advanced technologies to reduce the chance of iatrogenic injury should be considered.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Acetabular Component Removal Systems

“…In 1892, the motor-powered osteotome was introduced into clinical practice, followed by the powered circular and oscillating saw by the early 1900s 9 . The development of powered tools used as surgical instruments greatly improved overall clinical outcomes in orthopaedic surgery 10 . In rTHA specifically, extracting a well-fixed acetabular implant in a timely and safe manner is necessary to correct the underlying biomechanical or disease process.…”

Risk of noise-induced hearing loss in the spine surgeon

“…Spine surgery itself commonly involves power driven tools and impact devices to decompress neurologic structures or mobilize bony anatomy. These tools are an integral part of spine surgery but have potential to cause iatrogenic injury to the patient, OR staff, and surgeons [10] . Overall, there is limited understanding of the possible significant exposure to occupational sound pollution in the operating suite.…”

Usefulness of a drill stopper to prevent iatrogenic soft tissue injury in orthopedic surgery

“…While there are few papers examining prevalence of iatrogenic drill penetration injury, it seems to occur in approximately 0.1–0.49 % of cases [ 2 ]. However, many orthopedic studies have reported cases of iatrogenic drill penetration causing soft tissue injury.…”