Jaws / Tip of Instruments

The jaws of any manual instrument are the most important as they perform the function and define he instrument itself. The three families of hand held instruments are differentiated from each other on the basis of what function in performed by their jaws. The three families in question are Scissors, Punches and Graspers.

Scissors are used to cut menisci or other soft tissue. They have extremely fine and sharp tips that cut a line into the menisci. Today’s scissors are available in a variety of shapes. Different shapes are required so that they can be maneuvered in the joint space with ease and yet reach the right part of the soft tissue. These various shapes of scissors tips are straight, upbiters, left curved and right curved alongwith their combinations. Scissors are used for resecting that part of the meniscus that is torn away from rest of the body is hinging only on points of attachment. It is best to cut at these points of attachment so that the entire torn part can be extracted out of the joint. Typically, scissors are used for resection of Bucket Handle kinds of tears.

Punches are the other family of hand held instruments that are used for meniscal resection. They are different from scissors in that they bite into the meniscus rather tan cut it. Its jaws are wider and punch into menisci. Though wider, its edges are not at all less sharp and the bites are as precise as cuts from scissors. Modern day punches are available in widest variety. As in scissors, punches are also available in straight, upbiters, curved right, curved left and their combinations. Apart from these, punches are also available in perfect left and right and also in back biter variety. Another variation in punches comes from the size of their bite and their profile. Punches are used to resect parts of menisci which hand like flaps. Typical application of punches is when there is ample attachment between the free part of tear and the main body of meniscus. Depending upon the location and extent of tear, appropriate shaped and sized punches are used.

Finally, the last family of hand held instruments is Graspers that are used for grasping the debris that is formed after usage of other surgical instruments. It is very essential to get rid of these floating debris as, if left behind, they can be extremely painful and hazardous for the patient. At times the debris is decently big enough but at times it is extremely small and has to be carefully grasped and pulled out of the joint before closing it. At times this debris is floating freely while at others it has to be grasped and then cut to avoid it getting lost in the joint. For these different reasons, Graspers also come in various tip shapes. They vary form flat and minimum traumatic to toothed and traumatic.