Orthopedic instruments at a glance
A useful list of orthopedic instruments should do more than name tools. It should explain what each instrument does, where it fits in a surgical set, and where procedure-specific variation begins. Orthopedic surgery may involve soft tissue exposure, bone cutting or shaping, fracture reduction, drilling, implant placement, measurement, irrigation, and wound closure. For that reason, instruments are usually easier to plan and manage when they are grouped by function rather than alphabetically.
This guide groups the main orthopedic instruments used in trauma, reconstruction, joint, hand, foot, ankle, and spine-related workflows. The final tray configuration, however, must still follow the surgeon’s preference card, the facility protocol, and the manufacturer’s instructions for use. For more instrument-focused articles, visit our Instruments section.
How orthopedic instruments are commonly grouped
Orthopedic sets are usually built around the work that must be done to bone, joints, and surrounding soft tissue. General surgical instruments such as scalpels, forceps, clamps, scissors, needle holders, suction tips, and retractors may appear in many orthopedic cases. Orthopedic-specific trays then add heavier and more specialized tools for exposure, reduction, drilling, sawing, chiseling, reaming, bone holding, implant handling, and removal of bone fragments.
Function-based grouping is useful for both operating room teams and sterile processing teams. A scrub team member can anticipate the next instrument by following the surgical sequence: incision, exposure, dissection, reduction, fixation, verification, irrigation, and closure. A sterile processing team can inspect instruments more consistently when they know which tools have cutting edges, box locks, ratchets, lumens, torque interfaces, or delicate working tips.
Names vary by country, training program, hospital, and manufacturer. Some tools are known by descriptive names, such as bone holding forceps or periosteal elevator. Others are known by eponyms, such as Hohmann retractor, Cobb elevator, Kocher clamp, Lambotte osteotome, Steinmann pin, Kirschner wire, or Verbrugge forceps. A 2017 orthopedic review in The Iowa Orthopaedic Journal noted that several eponymous tools remain common in daily orthopedic practice, even when descriptive terminology may be clearer for teaching and standardization.
Core list of orthopedic instruments by function
The table below is a practical reference for commonly encountered orthopedic instruments. It is not a universal tray list. Procedure, anatomy, implant system, surgeon preference, hospital policy, and regulatory requirements all affect the final set.
| Instrument group | Common instruments | Typical use in orthopedic surgery |
|---|---|---|
| Cutting and dissection | Scalpel handles, blades, Mayo scissors, Metzenbaum scissors, dissecting scissors | Skin incision, soft tissue dissection, fascia trimming, and preparation of the operative field before deeper orthopedic work begins. |
| Bone cutting and shaping | Osteotomes, chisels, gouges, bone saws, Gigli saws, bone cutters | Cutting, contouring, or dividing bone during osteotomy, fracture exposure, deformity correction, or implant-related procedures. |
| Bone removal and smoothing | Rongeurs, Kerrison rongeurs, Leksell rongeurs, bone nibblers, bone rasps, files, curettes | Removing small pieces of bone, smoothing sharp edges, clearing bone cavities, or preparing spaces for reduction or fixation. |
| Elevation and periosteal work | Periosteal elevators, Cobb elevators, Freer elevators, raspatories | Elevating periosteum, mobilizing soft tissue from bone, and exposing the surface needed for reduction, plating, or joint work. |
| Grasping and holding | Adson forceps, toothed forceps, tissue forceps, Kocher clamps, towel clips, bone holding forceps | Holding soft tissue, fascia, capsule, or bone fragments while maintaining control of the operative field. |
| Bone reduction | Reduction forceps, pointed reduction clamps, Verbrugge forceps, Kern forceps, Lane forceps, bone hooks | Aligning fracture fragments and maintaining temporary reduction before definitive fixation. |
| Retracting and exposure | Hohmann retractors, Bennett retractors, Army-Navy retractors, Langenbeck retractors, Gelpi retractors, Weitlaner retractors, self-retaining retractors | Holding soft tissue away from bone and joint structures to improve visualization and access. |
| Drilling and guide instruments | Drill bits, drill sleeves, drill guides, depth gauges, taps, countersinks | Preparing bone for screws, measuring screw length, guiding drill trajectory, and preparing threads where needed. |
| Fixation and implant handling | Screwdrivers, torque-limiting handles, plate benders, plate holders, screw forceps, implant trays | Placing, adjusting, tightening, or removing orthopedic plates, screws, and related implant components. |
| Wires, pins, and temporary fixation | Kirschner wires, Steinmann pins, wire drivers, pin cutters, wire twisters | Temporary fixation, fracture stabilization, traction-related use, and assistance with definitive fixation techniques. |
| Measuring and alignment | Rulers, calipers, depth gauges, alignment rods, trial components, templates | Confirming dimensions, screw length, alignment, implant sizing, and bone preparation. |
| Closure and hemostasis support | Needle holders, suture forceps, hemostats, suction tips, irrigation cannulas | Controlling bleeding, clearing the field, irrigating debris, and closing tissue layers after fixation or reconstruction. |
Common orthopedic instrument categories explained
Retractors
Retractors are central to orthopedic exposure because bones and joints are surrounded by muscle, fascia, vessels, nerves, tendons, and skin. Hand-held retractors, including Hohmann, Bennett, Army-Navy, and Langenbeck designs, are commonly used when exposure must be adjusted throughout the case. Self-retaining retractors, such as Gelpi and Weitlaner types, can maintain exposure without constant manual traction, but they still require careful placement to avoid excessive pressure on soft tissue.
Specialty retractors may be developed for a specific anatomical region. AO Foundation educational materials and approved solution descriptions, for example, discuss dedicated retractors for shoulder, foot, ankle, and minimally invasive plating approaches. This highlights a practical point: a retractor is not just a hook or blade. Its size, curvature, tip design, handle angle, and compatibility with the surgical approach all affect visualization and tissue protection.
Osteotomes, chisels, and mallets
Osteotomes and chisels are used for controlled bone cutting or shaping. They are commonly paired with a mallet, although power instruments may replace manual tools in some steps. Osteotomes are often described by width, blade shape, bevel, curvature, and handle design. A narrow osteotome may be useful in small bone or joint work, while larger osteotomes may be selected where more bone must be divided or shaped.
Because these tools have cutting edges, inspection is important. A dull, bent, chipped, or mushroomed instrument can reduce control and increase procedural difficulty. Facilities typically separate damaged instruments for repair or replacement according to local policy.
Rongeurs, curettes, rasps, and files
Rongeurs remove bone in small bites. They may be straight, curved, angled, single-action, or double-action. Kerrison-style rongeurs are frequently associated with spine and small-space bone removal, while heavier rongeurs and nibblers are used where larger fragments must be removed. Curettes are spoon-shaped tools used to scrape tissue or bone cavities. Rasps and files help smooth bony edges or refine contours after cutting.
These instruments often have hinges, sharp jaws, serrations, or recessed surfaces that require careful cleaning and inspection. The FDA emphasizes that reusable medical devices require device-specific reprocessing regimens, and instruments with moving parts or difficult-to-clean features demand particular attention.
Bone holding and reduction forceps
Bone holding forceps and reduction clamps are used to bring fragments into alignment and hold them while fixation is applied. Pointed reduction forceps can compress fragments at a focal point. Verbrugge, Kern, Lane, and other bone forceps designs are selected according to bone size, fragment pattern, and the desired direction of force. These instruments must grip firmly without crushing or slipping.
For fracture work, reduction instruments are not interchangeable with ordinary soft tissue forceps. Their jaws, teeth, ratchets, and handle leverage are designed for stronger contact with bone. Correct selection can reduce the need for repeated manipulation and may help protect the surrounding soft tissue envelope.
Drills, guides, taps, and screwdrivers
Drilling and fixation instruments connect the surgical plan to the implant system. Drill bits, drill sleeves, guides, taps, depth gauges, screwdrivers, and torque-limiting handles must match the intended plate and screw family. A small mismatch can affect screw purchase, implant seating, or instrument performance. For this reason, many facilities keep implant-specific trays separate and verify compatibility during case preparation.
Depth gauges and drill guides deserve close attention because they influence screw length and direction. A depth gauge that does not move freely, a worn hook, or an incorrect guide may create measurement errors. Similar problems can occur with worn screwdriver tips, stripped screw interfaces, or handles that no longer engage reliably.
Procedure-specific orthopedic trays are not identical
A basic fracture fixation tray, a total joint tray, a hand surgery tray, a foot and ankle tray, and a spine tray may contain instruments that look familiar, but the details can differ substantially. A distal radius set may include small fragment instrumentation, K-wires, small retractors, fine forceps, small osteotomes, and implant-specific drill guides. A hip or knee arthroplasty workflow may include larger retractors, saw blades, alignment guides, trial components, reamers, broaches, mallets, and specialized extraction tools. A spine set may include Kerrison rongeurs, pituitary forceps, nerve hooks, curettes, distractors, and implant-specific drivers. See also: Implants.
That is why a general list of orthopedic instruments should be treated as a map, not a packing list. The final tray should be based on the planned procedure, surgeon preference card, patient anatomy, implant system, and facility policy. Loaner trays and vendor-managed sets require especially clear coordination because they may arrive with multiple layers, specialty drivers, trial components, and manufacturer-specific instructions.
Naming adds another layer of complexity. One facility may call a tool by an eponym, another by a descriptive name, and another by a manufacturer catalog name. A practical instrument list should therefore include both the common name and the function. For example, listing only Hohmann may be less clear than Hohmann retractor for bone and soft tissue exposure.
Reprocessing and sterility considerations for orthopedic instruments
Orthopedic instruments are often reusable, heavy, and mechanically complex. Some have hinges, cannulations, ratchets, cutting teeth, textured grips, or modular parts. These features can improve performance in the operating room, but they also affect cleaning, inspection, packaging, sterilization, and storage.
The CDC’s disinfection and sterilization guidance uses the Spaulding classification, where instruments that enter sterile tissue or the vascular system are considered critical items and require sterilization. Orthopedic surgical instruments that contact bone or sterile tissue generally fall into this high-risk category. The CDC also states that cleaning is necessary before disinfection or sterilization because retained soil can interfere with the later process. For heat- and moisture-resistant critical instruments, CDC guidance identifies steam sterilization as the preferred method when suitable.
The FDA describes reprocessing of reusable medical devices as a multistep process that includes cleaning and then disinfection or sterilization, depending on the device and intended use. It also emphasizes that each reusable device needs specific instructions. In practice, instrument teams should not rely on appearance alone. They need the manufacturer’s instructions for use, validated cleaning steps, recommended detergents or brushes, disassembly requirements, sterilization cycle parameters, drying requirements, and any limits on repeated processing.
AAMI’s ST79 standard is widely referenced by sterile processing departments for steam sterilization and sterility assurance practices in healthcare facilities. While facilities may follow different local policies and regulatory expectations, the practical message is consistent: orthopedic instruments should be cleaned promptly, opened or disassembled as instructed, inspected before packaging, arranged to allow sterilant contact, dried adequately, and protected from damage during transport and storage.
How to evaluate an orthopedic instrument list before use
A reliable orthopedic instrument list should be evaluated from clinical, operational, and reprocessing perspectives. The following checks help convert a list of names into a usable set plan.
- Match the procedure. Confirm whether the case is trauma, arthroplasty, sports medicine, spine, hand, foot and ankle, pediatric orthopedic, or implant removal. Each category changes the tray design.
- Confirm implant compatibility. Drill bits, taps, guides, drivers, torque handles, and depth gauges must match the plate, screw, nail, or prosthesis system.
- Include exposure tools. A fixation set without adequate retractors, elevators, and suction may be difficult to use even if the implant tools are complete.
- Inspect working ends. Cutting edges, rongeur jaws, screwdriver tips, clamp teeth, ratchets, and moving joints should be checked for wear, corrosion, cracks, looseness, and misalignment.
- Check reprocessing instructions. Instruments with cannulations, detachable parts, insulated surfaces, or torque features may have specific cleaning and sterilization requirements.
- Standardize names where possible. Add descriptive labels beside eponyms to reduce confusion during training, picking, counting, and handoff.
- Keep count sheets current. Instrument lists should be updated when sets are revised, repaired, replaced, or matched to a new implant platform.
A common weakness in generic online lists is lack of context. A list that only names rongeurs, forceps, retractors, and osteotomes does not tell the reader why one design is selected over another. Function, anatomy, compatibility, and processing requirements are what make the list useful.
Frequently asked questions
What are the most common orthopedic instruments?
Common orthopedic instruments include scalpels, scissors, forceps, retractors, periosteal elevators, osteotomes, chisels, mallets, rongeurs, curettes, bone holding forceps, reduction clamps, drills, drill guides, taps, depth gauges, screwdrivers, K-wires, Steinmann pins, suction tips, and needle holders. The exact set depends on the procedure.
What is the difference between general surgical instruments and orthopedic instruments?
General surgical instruments are used across many specialties for cutting, grasping, clamping, retracting, and suturing soft tissue. Orthopedic instruments include many of those tools but add stronger or more specialized devices for bone cutting, fragment reduction, implant placement, joint preparation, and hardware removal.
Are orthopedic instruments always reusable?
No. Many orthopedic instruments are reusable, but some items may be single-use, sterile-packed, implant-specific, or limited-use depending on manufacturer labeling and facility policy. Reusable instruments must be processed according to the manufacturer’s instructions and applicable healthcare standards.
Why do orthopedic trays vary so much between hospitals?
Variation comes from surgeon preference, procedure type, implant system, patient population, training background, local policy, and available equipment. Even when two hospitals perform the same procedure, their retractors, drivers, trials, and reduction tools may not be identical.
Can one list be used as a purchasing checklist?
A general list can support planning, education, or comparison, but it should not be used alone as a purchasing checklist. Buyers and clinical teams should confirm procedure requirements, regulatory status, material specifications, cleaning instructions, sterilization compatibility, warranty terms, and implant-system compatibility before procurement.