Bone-cutting instruments.

Abstract

In 1837, a French surgeon observed that, under a microscope, fine scalpel blades have a serrated appearance (as do all knife blades). To divide tough cortical bone, however, strong force (delivered manually or mechanically) requires saws made of steel sheets with visible serrations or teeth. These latter may be offset individually, alternative teeth being slightly angled away from each other to create a grooved incision in the wet bone. This broader incision helped prevent the saw jamming. Often pushing the saw more strongly than equal pull-and-push allowed more careful and controlled bone division. In previous times, the strong manual measured to-and-fro movement has been supplanted by a safer oscillating power-driven cut using smaller blades. Care had to taken not to damage soft tissue and to obtain a clean excision, with little or no splintering of bone ends. Before the advent of anaesthesia, the sawing of a limb bone was reputedly one of the most painful and challenging experiences of an amputation. Saw blades became jammed between the bone ends or jerked the limb painfully with rough handling. Before the introduction of these modern instruments and over time, the tenon saw with a reinforced steel strip along its back proved more robust than bow or frame saws, whose thin blades frequently snapped (Fig. 1).