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Three Essential Instruments For Operating Room Efficiency

There are many tools available to podiatric surgeons, including tools for retraction, tools for dissection and tools for removing and remodeling bone and tissue. Many of these tools bear the names of their inventors as a tribute to their hard work and innovation; McGlamry, Weitlaner, DeBakey and others as a tribute to their hard work and innovation. These tools are all essential elements of our day-to-day procedures as surgeons. 

Then there are those instruments that can help make a case much more efficient or allow us to make a difficult procedure much easier to execute. Throughout my training, I was fortunate to work with attending surgeons who had years of experience and many pearls to share for how to take a difficult part of a case and, with the appropriate instrumentation, make it easier to perform, more efficient and require less help (and hands) in the process. 

Here are a few instuments that I consider absolutely essential. 

First is the Hintermann retractor, which one can utilize to facilitate small- and medium-sized joint exposure. I will often use this instrument for my Lapidus procedures or Lisfranc fractures to gain access to those tight joints tHere one can see a Hintermann Distractor as well as a reciprocating power rasp used for joint preparation in a midfoot arthrodesis. hat enable me to use other tools to prep those joints for fusion. I find that bending the wires that go into either side of the exposed joint is key for the retractor to not slip proximally and compromise our exposure. 

The next tool that I find absolutely essential in any arthrodesis case is the reciprocating power rasp. This is a tool that attaches to the standard Stryker RemB that most hospitals and surgery centers have. In my experience this tool allows for rapid, uniform and safe cartilage resection down to the subchondral plate prior to further prep via a small drill bit or osteotome and subsequent fixation placement. I won’t do a fusion case any other way (see first photo to right). 

The third tool that I find absolutely essential for access to any hindfoot joint (i.e. ankle, subtalar, talonavicular, etc.) is the ratcheted Synthes large bone spreader. I find this instrument far superior to standard lamina spreaders in that the retractor will lock into place via a “speed lock” mechanism that screws the distraction in place and locks it tight. Thus, the ratcheted spreader does not allow the force of distraction to pop off the mechanism and land the instrument on the floor, which often happens with the standard lamina spreader (See second photo to right). The photo on the left shows use of the ratcheted Synthes large bone spreader for access to an arthritic ankle joint. The photo on the right shows a closer view of that instrument.

While there are a countless number of tools at the surgeon’s disposal, I consider these three to be some of the more useful and commonly used in my day-to-day cases. Other incredibly helpful instruments outside of my top three include the Cobb elevator as well as a flexible osteotome set that one can use for blunt dissection and osteotomy management/removal of joint cartilage, respectively. 

While this list is in no way comprehensive, I would struggle in even the most basic of cases without them. 

Dr. Ali Rahnama is a fellowship-trained foot and ankle surgeon and an Assistant Professor at the Georgetown University School of Medicine in Washington, D.C. You can follow him on Instagram @DrAliRahnama for interesting cases and educational material. 

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