I came across some information about PB Swiss Tool’s Operace surgical tools, designed for working with implantable screws.
These are not the kinds of tools you or I would buy, but I found the details to be fascinating nonetheless.
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I don’t even want to think about how much any of these tools cost.
Depicted here, PB Swiss makes driver bits designed for the installation of such screws. As with the other examples, it’s suggested that these are used with implantable devices, such as when strengthening broken bones with metallic plates.
But what happens if a screw is damaged and the recess is fully stripped? They make extractor bits for that.
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Do I want to even ask how such screws are going to be stripped out like that in the first place?
What happens of the fastener is stripped out, and stuck int he screw head? I suppose that’s how the recesses can be stripped.
Alternatively, the socket head can be drilled into, just enough for it to cut the link between the plate and bone.
But what happens if the screw head is sheared off? Or what do you do with the remainder of the screw after the head and plate are separated from the bone?
Ah, there’s a different kind of extractor for that. It drills out the bone around the threaded section, with the threaded section wedged into the extractor cavity. At a certain point, the threaded stem breaks loose and rotates until it is removed from the bone.
I’m going to be honest and say that I have no idea what’s going on here. It was a caption-less example in the promo video (embedded below).
How does an implanted screw break like that? With healing and growth of the bone?
Want to see more? Here’s a video about how the different tool styles are used:
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Rock Hound - (J.Sutter)
Neat! Thank you for sharing!
samr
But what’s the medical solution for finding your 10 mm socket when you’re operating?
Brian M
Xray…or MRI and see where it’s buldging and where the patient says there’s a lot of pain.
Pete
…………… i guess a MRI would work if you have a plastic or ceramic socket….
Brian M
Did you stop reading at “MRI” because you clearly didn’t get the joke.
Pete
oh…. ok… i guess it was a joke. I would think it would tear out? I have no idea how much force MRIs can create.
B-Rad
Heh, 500 pounds of force on a wrench, 2,000 on a chair! Fun stuff:
https://youtu.be/6BBx8BwLhqg
KeithInKC
I wouldn’t mind some more information about quality extraction kits fore non surgical uses. All of mine are of the “wasted my money” variety.
Whiskey and Wood
Same here! I’m decent at getting stripped heads out, but the ones with broken heads in critical places that can’t be drilled out and retapped at a larger size are always a puzzler for me!
Frank
I really like this set from ridgid: https://www.ridgid.com/us/en/10-screw-extractor-set
Honestly I never use the drill guides, but you just drill into the screw maybe 3/4 inch or so (more for larger screws), tap in the extractor with a hammer, slide the turn-nut over the extractor and use a wrench to turn the nut. These are better than the tapered-style extractor because they engage the drilled hole for the entire depth, and everything is together in one box so you don’t have to dig around and eyeball out a drill bit.
Diamond Dave
Agreed, I have a few different sets of screw extractors and honestly have no idea why I cannot get them to work? I even tried a left turning drill bit as I read somewhere with no luck! Just can’t drill into the screws far enough for the extractors to bite. I have a couple of bolt extractors for strippped heads and a Craftsman screw extractor set that worked awesome on my rusted BBQ screws, changing out the burners. The Craftsman screw extractor Set looks almost like a Nut Driver Set but has the grip knurling on the inside similar to the bolt extractors. You do need to have some of the head above the material to grab onto for this set to work. If the head has snapped off no luck!
Brian M
My insurance isn’t that good so my doctor just gets his tools from HF.
Whiskey and Wood
As long as he sticks them in the fire and gives you something to bite down on, you’re good!
ktash
Whiskey, you know you can use whiskey for both an anesthetic and to sterilize the tools ;).
Koko The Talking Ape
Fascinating. So are they demo rated?
tim Rowledge
No, but I bet they do a version with a black tacti-cool finish to go with the tactical pen and bottle opener.
Seth
I work on the insertion side of things – making drivers that doctors use to implant/drive these surgical screws in the first place.
A good many of them are built into torque-limiting assemblies, and it doesn’t take a doctor to see why. Overtorquing a fastener until it strips and requires extensive removal would be a pain in the scrubs for an active OR doctor. I never considered the need for surgical fastener removal tools before today, but it’s interesting to see examples of them.
FWIW, none of the drivers I make are hex, draw your own assumptions.
John S
Phillips? Hah I’m just kidding or I sure hope not 😉
Whiskey and Wood
There are some applications where the materials need to be removed after a time, also, what happens when a patient is in an accident after having a plate installed, or in the case of dental implants (not sure if these go small enough for that type of work) when a tooth is broken or shifts with wisdom teeth, orthodontics, etc. I imagine the use-case is uncommon, but there is still a need for the product in the market place. I think hex sometimes gets a bad rap because of the quality of manufacturing, when made well (PB Swiss and many other Manufacturers) hex is quite good!
Zack
I know much of their tools are expensive but when it comes to metals, machining, and such, those Swiss sure know what they are doing. Everything I own from Swiss manufacturing (which isn’t a lot) is of high quality. Like much of the tools of yesteryear they are built well enough to pass down for Generations.
satch
I recently had two dental implants ‘installed’, for lack of better descriptor, and it was fascinating to talk to the dentist about it.
Each implant(the threaded metal insert your crown will attach to) is sized according to your jawbone size, tooth size, and bone density. I had two 8mm implants put in. One one the upper right and one lower left.
The dentist actually drills and taps your jawbone to insert the threaded implant into your jaw. It is essentially one and done. No screwups allowed. If the imlkant comes loose you usually have to have it removed and desl with some other solution or nothing at all. After the implant installation is done and you are healed for a few months, they install the crown.
He told me all the inserts and tools are completely proprietary to the brand they are installing. And they sell multiple brands depending upon patient need. When the crown is installed installed it has a hollow from top to bottom and has a machine screw that runs through it into the implant. They use a special wrench that looks like a tiny torque wrench to tighten it down. Fill the top with a composite white filling. Done. One of mine came loose and I was afraid it was the part in the bone. They drilled out the filling( no need for anaesthetic, yeah) were able to tighten it up, refilled done.
The tools all looked like precision, superb quality machined and pretty flawlessly finished. I don’t want to know how much they cost. I already know what my half of the procedure cost!
fred
I too had some (5 for me) dental implants installed over the years and I talked to the oral surgeon several times about the similarity to some other mechanical processes and even carpentry. I’ve also talked to one of my former scouts – who did his residency at Hospital for Joint Diseases and a fellowship at Hospital for Special Surgery – about how knee replacements have similarities to some woodworking and machining processes. My only quip – when making such comparisons is to note that I strive to undertake my woodworking without any bloodletting.
satch
Righto, Fred! Definitely no blood letting wanted but we sometimes get it.
D
I’ve seen a lot of orthopaedic surgery first hand. It’s a lot like working with wood. Their drills are usually pneumatic and they always drill pilot holes. Sometimes they may also ream the hollow inside of a bone (e.g. Femur, Tibia) to fit a long “nail” through it. And how do they put a 1.5 foot nail down the inside of the Tibia? They use a mallet. It’s not a gentle process either.
Most people think surgeons always use scalpels to make incisions but they rarely do. They use a device called a “diathermy” that uses electricity to arc and cut the tissue. The advantage is that it slightly cooks the skin which stops it from bleeding.
Stuart
Good to know, but boy do I wish I didn’t read this before going to bed.
I wonder how much such a mallet costs!
D
Apologies.
It was fascinating to see. They had a plethora of tools for cutting, drilling, fastening, clamping, measuring, grinding, and usually organised on trays that were on trolleys. Most of them could be sterilised and reused. Some surgeons would bring their own personal tools and have their own specific tray setups. Others just used the standard hospital tools which were organised on trays according to a set protocol so they knew where to find them quickly.
It’s generally very Male dominated. I only ever saw one Female orthopaedic surgeon. I’m certain it’s the most physically demanding type of surgery. Sometimes the surgeon would break a sweat or need to catch their breath.
The type of mindset those surgeons have, the way they approach and solve problems, and their ability to use tools, they’d certainly have no issues doing DIY or woodworking. It would absolutely translate.
satch
D, I know when I had my dental implants it was anything but gentle. Well deadened to be sure but the doctor was a bit ham handed and by the time he was done, I was jaw-sore from him keeping my mouth pried open for a couple of hours. I had him do both implants at the same time. I didn’t want him to futz around with multiple trips to do it. If you want a permanent solution you need to be willing to deal with discomfort for a while.
Mick
in ’05 I had a lumbar spinal fusion and went back to work nine months later. During the process of removing the bolts from a 12″ face mill, I broke one of the screws in my back. The surgeon didn’t even try to remove it. He said its like a nail in a tree, there for the duration. It’s interesting to see some tools they use to remove hardware from those “oops” moments
thomas vikoren
The device depicted is generically known as a “locking plate”. It is different than a mending plate used to repair a piece of furniture. In a locking plate the screw head locks into the plate which is also threaded as the screws is fully tightened down. (sometimes the plate is not threaded but the screw is designed to cut threads into the plate) Biomechanically this causes the screw/plate to be locked together and no longer relies upon friction between the plate and the bone to ensure the construct is rigid. In a traditional plate if the pressure between the screw head, plate and bone is relieved all rigidity is immediately lost, especially if the plate holes are larger than the screw diameter, which they always are.
Locking plates are always made out of either stainless steel or titanium/al/vanadium alloy and both of which are very prone to galling so removal of locking plates can be very difficult hence the tools depicted. The titanium plates are especially difficult because the titanium is very soft and prone to stripping of the heads. There are pros and cons of the different materials, the stainless is extremely strong and takes a great deal of work until failure. Titanium’s main advantage is that it is much more ductile which reduces stress shielding of bone — the process by which bone density is lost due to load being carried by the plate. The ductility of the titanium plates also aids in bone healing because bone healing is stimulated by the bone being loaded. Finally, most plates are scalloped so that the metal is thinner between the screw holes so that the screw holes are not the weakest area and thus prone to breakage of the plate. If bending a plate you would see it bend in a smooth arc rather than crease at one of the screw holes as would occur with a mending plate from the hardware store.
Lots of good biomechanics and engineering in orthopedic surgery!
Stuart
Thank you for the fantastic insights!
Nathan
I have a best friend that is an orthopedic surgeon and we used to talk about work until one day I told him about allowable damage on aircraft and then we agreed not to discuss work ever again.
One of the makers of implants is in my town and I know a few of the engineers overthere. Many of their screw tools are a version of torx and their tolerance allowance is slim. I’d call one of their screws a quad lobe for lack of a better term. It might have a name. Picture a torx that is missing one of the points and the other 4 aren’t symmetrical exactly but all ends are rounded and so is the bit. The screw will not only stay on the bit – but it holds tight enough that it stays on the bit and maintains alignment. They make their own hardware and tools so even the screw design isn’t standards. IE diameter vs thread pitch won’t match a known standard. Supposedly optimized holding power which I could see.
But asking my buddy about screw/bolt extractors and the like – he has used them but not on installs – repairs. guy with a hip replacement takes a spill on skis 3 years later and not only damages the bone but it releases one of the implant bits. You might want to remove all hardware – before attempting to size the bone remaining for a new fit. Yes I put down my coffee while he told me this.
Adam
My dad was surgeon. I have a lot of his forceps (great for fishing), stainless steel drill bits, ss pry bars (at least that’s what they look like), manual drill, and other asorted tools that I’ve kept more knowing what they are made out of. Most of it is German made. All 20+ years old, and look great.
fred
Now it seems that Pakistan is the place where a lot of medical instruments are made.
George Curtis
Well, I got screw loose. Really, screw in a plate holding my thumb together has come loose. Big bump but no pain so doc says leave it alone. Now if I had an extractor like that and a few extra painkillers, I could do it myself !
Jesse
Am I the only one who always mistakes toolguyd posts about PB Swiss as being about the bike wheel parts brand DT Swiss?
Raoul
Maybe. I’m a bike guy and very familiar with PB and DT Swiss and I have never correlated the two. That however could be due to my fondness of peanut butter and not reading it as PB Swiss but rather Peanut Butter Swiss.
Altan
I wish they were with E6.3 1/4″ hex shank and I would buy one full set. PB Swiss is good quality but like festool generally uses a specific shank type, their colour coding system is fantastic