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Instrument breakage during orthopedic surgeries infrequent, poses low risk to patient

Thursday, December 11 2008 | Comments
Evidence Grade 3 What's This?
A recent study indicates that the overall rate of instrument breakage during orthopedic procedures is low and that the risk of patient harm is small as long as certain guidelines for removal are followed.

To determine the rates of instrument breakage during orthopedic procedures at 2 hospitals and to evaluate the potential adverse effect on patients after the breakage, researchers prospectively documented every case of instrument breakage from January 2005 to December 2006. All orthopedic surgeries of the upper and lower limbs, the spine, and the pelvis were included in the trial.

Postoperative follow-up ranged from 12 to 36 months. At every follow-up interval, radiographs were obtained to evaluate any changes to the broken object and to see if migration had occurred. The investigators also sought to identify potential correlations between surgeon experience and instrument breakage rates.

According to the results, 11,856 orthopedic surgeries were performed at both hospitals and the overall rate of instrument breakage at the 2 hospitals was 0.35% (42 of 11,856). In 2005, the breakage rate was 0.27% (16 of 5,886), and in 2006 it was 0.44% (26 of 5,970). Instrument breakage included 23 drill bits, 14 Kirschner wires, 3 taps, 1 probe, and 1 screwdriver tip.

The authors noted that the broken instrument was not removed in 37 cases as was recommenced by the guidelines established for the study. Of these, 36 of the pieces were safely buried in bone and 1 broken screwdriver tip was stuck firmly in the screw head. None of the 37 patients demonstrated any symptoms during the follow-up period.

No significant correlation between surgeon experience and the rate of instrument breakage was detected.

"[P]reoperative education of the patient regarding instrument breakage is not mandatory in our opinion," the investigators wrote. "Nevertheless, if an instrument breaks during an orthopedic procedure, accurate documentation of the event in the surgical record is recommended." (Pichler W, et al. J Bone Joint Surg Am 2008;90:2652-2654.)

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