Grip Strength in Orthopaedics - Why the Cement Gun is Causing Problems
Authors:
A Denning, S Saleem
Hospital:
Hampshire Hospitals Foundation Trust
Introduction
An orthopaedic surgeon’s grip is integral to operating and using surgical instruments. During hip arthroplasty, cementing and stem placement are crucial steps, yet we continue to use cement guns surgeons notoriously struggle with. We measured grip strength in our registrar population at different distances to try to understand why the cement gun is so troublesome. With increasing diversity within orthopaedics we also identify any discrepancy between sexes or hand sizes.
Methods
We measured the grip strength of orthopaedic registrars with a dynamometer at 4cm, 5cm, 6cm, 7cm and 8cm. We noted the participants demographics and attitudes towards orthopaedic surgical instruments.
Results
We included 26 orthopaedic registrars. 50% felt the cement gun was the most difficult instrument to use, with a higher proportion of female registrars noting this. When measuring the grip strength of participants at various distances, at 4cm the average was 31kg, at 5cm it was 46kg, at 6cm it was 49kg, at 7cm it was 46kg and at 8cm it was 37kg. Males were stronger than females throughout. However, every single surgeon lost grip strength above 7cm. Inter-prong distance of the cement gun handle is 7.5cm.
Conclusion
All surgeons lose grip strength above 7cm, some much lower. The inter-prong distance of a cement gun handle is 7.5cm. This explains its difficulty to use. In our attempt to identify why surgeons, particularly women and smaller hand size surgeons experienced issues cementing, we discovered the inter-prong distance of cement guns was creating difficulties for all of us.