Accidentally falling instruments during orthopaedic surgery: time to wake up!

BACKGROUND: The aim of the study was to evaluate statistically the occurrence and causes of accidental fall of instruments and implants during orthopaedic procedures. METHODS: A prospective study was carried out over a period of 18 months. Total of 120 randomly chosen major orthopaedic surgeries were observed. The observer counted the number of times an instrument fell during surgery. The offending operating room personnel were identified. A note of the nature of instrument falling was made. RESULTS: A total of 120 surgeries were observed. There were 15 falls (38.5%) during elective surgeries and 24 (61.5%) during emergency (trauma) surgeries. Falls were classified as major and minor. There were a total of 39 falls with 11 major and 28 minor falls. Seven surgeries had two or more falls. In 26 instances (66.7%) the operating surgeon was responsible for the fall. In seven (17.9%) assisting surgeon and in three (7.7%) of the instances the scrub nurse was responsible for the fall of the instruments. Three falls (7.7%) were unaccountable. An average delay of 7.6 min was noted after the fall of the instrument or implant. CONCLUSIONS: Fall of instruments in the theatre is a common problem all over the world. It leads to increased operating time and extra resources and can hamper the end result of surgery. Our study is the first of its kind to evaluate the problem. Most falls occurred because of the operating surgeon. A course in instrument handling similar to one conducted by the theatre nurses may be helpful in preventing such falls.

Limb length discrepancy following titanium elastic nailing in paediatric femoral shaft fractures.

The authors performed a prospective study to evaluate limb length discrepancy in children following titanium elastic nailing for femoral shaft fractures. Thirty-seven children (28 boys and 9 girls) were included in the study. The average time to radiological union in our study was 7.8 weeks (range: 5 to 14). Results after 3 years were evaluated for 29 children. Limb lengthening was noted in the first year in 15 children: at the time of nail removal, an average of 10.6 mm and at the end of one year 8.7 mm. After three years only nine were lengthened an average of 2.7 mm. An average of 12.6 mm shortening was seen in four patients at the time of nail removal, reduced to 12.1 mm at the end of one year. After three years three remained short, an average of 11.7 mm. No limb length discrepancy was seen in 10 patients. We conclude that limb length discrepancy is common following elastic nailing in paediatric femoral fractures, with lengthening being more frequent than shortening. Lengthening tends to decline with time at an average rate of around 1.5 mm per year.