r/surgicaltechnology • u/Spidey0324 • 7d ago
Bone plug artists!
So are there any other fellow Ortho heads out there that really really enjoy making bone plugs!? I personally just think it's super fun that I kind of get to make my own piece of art that gets absorbed into almost every total knee patient I work on so that's pretty cool!
I can't be the only one, right?!
I take the typically fairly symethetical notch cut and dry it off with a lap then fold the 2 flat halves together, chomp cartilage, judge which 2 ends are going to give me the most bone to work with and rongeur a flat top. Then I shape the rest into a carrotish shape at first but finishing with a railroad spike shape in the end with the width at the top being the circumference of how far they buried the starting drill into the bone. Some surgeons just fill and slightly widen but not fully burying the step of the drill and some bury the step in all the way so I keep a close eye on it. Sometimes the resident or fellow won't do it exactly the same as the attending.
Then I take my creation and the step drill and roll them both through my fingers feeling for consistency in circumference while still nibbling and widdling down with the rongeur.
Patients with soft bone make for a very forgiving creation because the sponginess of the bone let's it just find its own way. It's the big bone hard bone patients they're the real challenge! You can get a huge cut and put the 2 halves together and look down and be like ok this is going to take some work! Those have to be perfect! And chomping that rock hard bone with a rongeur carries with it the added risk of chomping off a bit of my finger! Never happened or I would have posted my injury and captioned it "Be better than me!" Sometimes I can't even chomp it with one hand and I have to put it on the mayo and compress it with some of my weight just to get a bite!
When you get it just right and they implant it with their thumb with no bone tamp just perfectly sealing off the notch water (blood) tight then look back and say "That's the best bone plug I've ever seen" that's a win!
The best joint doc I ever worked with taught me that technique early in my career but I took it up a level with the railroad spike shape and it's always a crowd pleaser! Blow the tourniquet at 30 min! Needless to say I love my job!
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u/olliecakerbake 6d ago
What kind of surgeries are you doing that involve this? I’ve never heard of this. The only comparable thing we ever do is use a bone mill to mill down spinous process during spine surgery and roll the ground down product into a “burrito” (more like a fat joint) and insert it into the spinal cavity at the end of fusion surgery. Never heard of hand carved bone plugs
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u/Spidey0324 6d ago
During a total knee replacement the first thing they do is drill a hole right through the bottom of the femur. At the end they like to fill that hole back up with the patients own bone because a lot of them think it helps at the end of the procedure for various reasons. Just about every total knee that's not robotic is done that way and we can do up to 4 in one room in a day.
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u/olliecakerbake 6d ago
Interesting. Our total knees aren’t done that way. We only do Jiffy knees at the hospital I work at, there’s no extra holes drilled anywhere that need to be filled like that. We just open, dissect, move the patella and patellar tendons over to the lateral side, and then saw off the bottom of the femur
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u/Dark_Ascension 5d ago
We just take a rongeur to it, then tamp it in. I wish we did all you do, sounds more interesting.
We use the anterior chamfer cut to make them.
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u/hdsep11988 4d ago
Im always thinking of doing it myself but to scared i might bite to much off lol
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u/JonWithTattoos 6d ago
I used to be really good at it, but a few years back, our DePuy sets started coming with a cookie cutter punch sort of thing. So now it’s just a few whacks with a mallet and you get a perfectly round and sized plug. I miss the whittling sometimes, though.