Rew lkbtments

AN INEXPENSIVE ELECTRIC DRILL, SAW AND KIRSCHNER

WIRE DRILL GUIDE

W. COMPERE BASOM, M.D. AND LOUIS W. BRECK, M.D.

On Orthopedic Staff, El Paso City County HospitaI DipIomate of the American Board of Orthopedic Surgery

EL PASO, TEXAS

H OLES can be driIIed much more easiiy with an eIectric driI1 than with a hand driI1. Bone grafts can

be easiIy and quickIy removed with an electrically driven saw. In some operative procedures, a bone saw is superior to any other instrument. The eIectricaIIy driven driI1 and saw have a definite pIace in the surgeon’s armamentarium. There are many motor driI1 and saw sets on the market. Since a11 of them are expensive, we have devised the foIIowing :

ELECTRIC MOTOR HAND DRILL

There are numerous electric hand driIIs avaiIabIe for work other than surgica1. These machines give good service and withstand considerabIe abuse. About five years ago we first attempted to use ordi- nary eIectric driIIs in our surgica1 work. The first motor functioned satisfactoriIy and withstood steriIization by baking very weI1. This motor was larger and more powerful than necessary. It aIso was a high speed type, consequently one of us (L. W. B.) began to use a smaI1 eIectric driI1. (Fig. I.) This driI1 turns at a Iow speed. It can be stopped during fuI1 speed by strong pressure of the fingers on the rotating chuck without danger. Even so it has sufficient power to operate any size bone driI1 or saw. It has a handIe and can be heId secureIy and in a balanced position for a11 types of work. This motor has functioned SatisfactoriIy for four years in continuous use.

Three changes were necessary before this driI1 was first used in the operating room. First it was dismantled. The outer she11 and meta fixtures incIuding a11 parts of the chuck were plated with nickel. At the eIectric motor repair shop, the arma- ture wiring was painted with insuIating ename1 and baked in order to provide adequate resistance to moisture. A three wire cabIe was substituted for the con- ventiona1 two-wire cord so that the motor couId be grounded during operations. The dangers resulting from a short circuit were thus avoided. The finished product has the appearance of a good surgical instrument and can withstand steam autocIaving.

DRILL POINTS

These were purchased from the IocaI dime store. In our experience they do not break as easiIy as the high carbon variety. A complete set can be obtained at an amazingIy Iow price.

SAW

Two bIades were purchased from a surgical suppIy house. One bIade had a diameter of one and one-haIf inches. The other had a diameter of three-fourths of an inch. The spindIes were designed for the motor, and a machine shop manufactured them exactIy as we desired.

KIRSCHNER WIRE DRILL GUIDE

A motor driven driI1 point operates much better than a driI1 point which is driven

I$2 American Journal of Surgery Basom, Breck-DriII, Saw, DriII Guide APRIL. ,943

manualIy. Therefore, an attempt was the Kirschner wire driI1 guide extends made to devise an attachment by which a from two to three inches beyond the chuck Kirschner wire could be driven smoothly of that instrument. This smal1 Iength of in place. The coIIapsibIe out rigger type wire does not “whip” during rotation.

FIG. I. Photograph of the electric driII with the large and smaII circuIar saw attach- ments, a set of driIl points, a wrench to stab&e the motor shaft when the chuck is being tightened. At the upper right is pictured the Kirschner wire driII guide instru- men; with a Kirschner w&e in place.

of guide for a Kirschner wire is at times cumbersome and diffIcuIt to operate in a smaI1 incision or near another wire. The foIIowing instrument was therefore designed :

This instrument was made from a rod of iron, which was seven inches Iong and three-eighths of an inch in diameter. A hoIe one-eighth inch in diameter was driIIed throughout its entire Iength. From the dime store, a smaI1 chuck was purchased and a11 of its parts were pIated with nicke1. Threads to match this chuck were cut on one end of the iron rod. On the other end of the rod, the diameter was reduced to one-fourth inch for a distance of one-haIf inch so as to adapt the rod easiIy to the chuck of the eIectric driI1. Thus when this instrument is fastened to the motor, there is formed a Iong hoIIow shaft into which the Kirschner wire can be placed. The smaI1 chuck on the end of the rod can be tightened and the wire is thus firmIy heId. The average wire, when fuIly sunk into

In fact we usuaIIy aIIow the point of the wire to project that distance beyond the chuck of the Kirschner wire driI1 guide when wire is first being driIIed into the bone.

This Kirschner wire driI1 guide wiI1 aIso fit the average hand driI1 and can be operated manuaIIy if desired.

There are three imperfections to this instrument: First, the Kirschner wire must be gripped aIong its shaft by the chuck. This part of the Kirschner wire must necessariIy be round. Thus, if the chuck is not tightened firmIy, it wiI1 slide around the wire. If a11 parts of the chuck are kept smooth and Iubricated, it wiI1 function satisfactoriIy. Second, after the wire is driIIed in up to the chuck it is necessary to Ioosen the chuck, sIip a short Iength of wire out of the instrument, and re-tighten the chuck if the wire must be driIIed deeper than three inches. Third, the shaft of the motor has a sIight degree of instabiIity. During the operation of the driI1 point or

NEW SERIES VOL. LX, No. I Basom, Breck-DriII, Saw, DriII Guide A merican Journnl of Surpcry I53

saw bIades, this is not noticeable. How- ever, the Kirschner wire driI1 guide extends the shaft for sufficient distance to cause the point of the wire to form a smaI1 circIe during rotation. If the wire point is pIaced into the tissue to be driIIed and then put in motion, this factor Iikewise is unimportant.

The small number of imperfections can be tolerated easiIy when one considers that

the whoIe expense amounts to onIy $26.25.

CONCLUSIONS

A satisfactory surgica1 instrument has been constructed from an ordinary eIectric hand driI1.

An account was given of steps necessary to procure driI1 points and saw attachments.

A Kirschner wire driI1 guide was pre- sented.

The cost of the compIete set was only $26.25.

ANKYLOSIS of a joint or stiffness of the adjacent soft parts is due not to immobiIization but to pathoIogic changes. Such changes in turn are due to irritation, inflammation, issue destruction, and scar formation.

The brief exerpts in this issue have been taken from “Wounds and Fractures,” by H. Winnett Orr (CharIes C. Thomas).