Instrument Fracture

Abstract

Instrument fractures during surgeries are rarely reported, and the prevalence is estimated to be 0.18–0.35% in the orthopedic literature. Intra-operative instrument fracture can be a serious complication especially during endoscopic procedures. The author has experience with one such fracture during the superior osteotomy step of an endoscopic dacryocystorhinostomy. The involved instrument was the 15°, high-speed DCR burr (Medtronic, Jacksonville, USA). During the active osteotomy, there was a sudden fracture of the instrument at the junction of its proximal two thirds and distal one third. The tip of the distal fractured bit fortunately got stuck in the frontal process of maxilla, arresting its movements, soon after the fracture. The broken end of the distal bit, which was in contact with the septum, was carefully removed, and the metallic debris that was smeared all over was gently aspirated and patiently removed. It is important to understand that the first priority soon after any instrument fracture is to make sure not to lose the fractured loose bit. A careful assessment of the tissues all along should be performed to assess any tissue damage that may need immediate attention. Every such incident needs to be documented in the OR logbook, and the causes should be ascertained. There should also be a periodic examination of all the instruments used to assess for any signs of metal fatigue or any minor distortion of shapes. It is a healthy practice to notify the manufacturers, for them also to investigate and take stock of the situation.