1. Orthopedic surgery deals with injuries and disorders of bones, joints, ligaments, tendons, nerves and muscles. 2. A scrub nurse assists surgeons in the operating room by handling instruments. 3. Common orthopedic cases include CRPP with K-wires, debridement, skin grafting, arthrotomy, tenotomy, implant removal, and various spine and joint procedures.

1. Fundamentals of Orthopedic Surgery
for Scrub Nurses PART I
Orthopedic Surgery Introduction
List of cases in Orthopedic Surgery
General Introduction of cases and instruments
used.

3. Introduction
Orthopedic surgery is a speciality which deals with acute
injuries,congenital and acquired disorders and overuse
conditions of the bones, joints and their associated soft
tissues including ligaments, tendons, nerves and muscles.
Scrub Nurse
Scrub nurse is a specially trained individual (registered
nurse) to assist surgeons in the operating room and who
serves as a part of the surgically clean medical team
handling instruments during operation.

4. Most common Ortho Cases
Minor Cases
• CRPP with K-wires
• Debridement
• Skin graft
• Arthrotomy
• Tenotomy
• Implant Removal

5. Major Cases
Spine cases
• Decompression and stabilization with posterior
instrumentation
• Discectomy and fusion
• ACCF (Anterior Cervical Corpectomy and Fusion)
• ACDF (Anterior Cervical Discectomy and Fusion)
• MIOLD (Minimally Invasive Open Lumbar Discectomy)
• TLIF (Transforaminal Lumbar Interbody Fusion)
• PLF (Posterior Lumbar Fusion)

6. Other Cases
• ORIF with Plate and Screws
• DHS (Dynamic Hip Screw)
• CCS (Cannulated Cancellous Screws)
• DCS (Dynamic Compression Screw)
• Arthroscopy
• ACL reconstruction
• HRA with AMP
• IMIL nailing
• THR
• TKR

7. Most Commonly used surgical
Instruments
• Sponge holder
• Towel clips
• Surgical knives( 22,10,15,11)
• Retractors(small, broad,long,right angled,
medium)
• Allies
• Kochers
• Needle holders

8. • Artery (straight, curved)
• Mosquito
• Scissors(Dissecting, suture cutting)
• Currette
• Suction
• Forceps(adson,tooth, non-tooth)
• Bone nibbler

9. (Note: Surgical knife 22 is used as skin knife , 10
as deep knife , 11 as arthroscopy knife and in
spine cases , 15 is used for children and incision
to be made is small.)

10. For Spine cases
Apart from general instruments, other instruments
are:
• Ronzer(upcutting,downcutting, 90° ,45°)
• Pituitary/disk forceps (straight,curved)
• Curettes of different sizes
• Microsuctions
• Cobb dissector
• Cloward retractor in cervical cases
• Nerve hook

11. • Bone graft set {osteotome(curved, straight)} ,
hammer , impactor
(Note: most commonly used sutures are Vicryl 2-0
RB,1-0 RB,1RB, 1OS, 3-0RB, ethilon 2-0CB, 3-0 CB,
Mersilk 2-0 CB, Prolene 1 ).

12. Apart from general surgical instruments,
implants are the back bone of orthopedic
surgery.

13. 1. CRPP with K -wires
Closed reduction and percutaneous Pin fixation is a technique
used by the surgeons for the stabilization of unstable fractures.
Insertion of metal pins called kirschner wires or K-wires through
the skin into bone fragment is done under imaging.
Instruments used
• Painting set (sponge holder, gallipot,gauze pieces,betadine)
• Towel clips (2-3)
• Artery
• Mosquito
• Scissors
• Forceps
• Knife handle

14. • K-wires of different sizes as per site of
fracture( generally 1.5,1.8,2,2.5 mm are used)
• K-wire cutter
• K-wire bender / twister
• Drill (synthes/Zimmed/manman)
• Stapler/sutures
(Since image is used, lead jacket is a must)

15. In case,reduction is not obtained open reduction
is done.

16. 2.Debridement and skin graft
Debridement is the removal of dead, damaged or
infected tissue to improve healing potential of the
remaining healthy tissue.
Instruments
• Knife (22,10)
• Forceps (Toothed and non-toothed)
• Scissors
• Curette
• Dressings

17. Skin Graft
It is a surgical operation in which a piece of healthy skin is
transplanted to a new site on a patients’ body. It is done if a
part of body has lost its protective coverings of skin due to
burns , injury , illness.
Instruments
• Knife (22,15)
• Forceps( tooth and non-tooth)
• Scissors
• Humby knife
• Wooden block

18. • Gauze pieces soaked in normal saline with
adrenaline
• Vaseline gauze
• Mupirocin ointment

19. 3. Arthrotomy
It is the creation of an opening in a joint that may be
used in drainage. Incision is made exploration is done.

20. 4. Tenotomy
It is a surgical procedure which involves release
of tendon by cutting them.It is specially used as
a remedy for club foot.
Instruments
• Painting set
• Small retractors
• Knife (15)
• Mosquito

21. 5. Implant Removal
It is the surgical procedure for the removal of
the used implants which can be screws, plates ,
k-wires, nails .
Instruments
• Painting set
• Towel clips
• Knife (22)
• Retractors depending on site of surgery

22. • Scissors (tissue cutting, suture cutting)
• Artery
• Mosquito
• Forceps( Adsons, tooth , non-tooth)
• Needle holders
• Screw drivers of size 3.5 , 4.5
• Bone nibbler
• Sutures/stapler

23. For nail removal
• General set
• Screw driver
• Universal nail extractor
• Sutures / stapler.

24. Thank you…. Still more coming..

27. Introduction
• Orthopedic surgery is a speciality