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which require various speeds for drilling and screw placement.
Orthopedic surgeon Jack Tierney, MD, is a no-nonsense kind of guy when it
comes to surgical instruments (or pretty much anything, for that matter). "I
want to get the job done, and will use whatever's lying around," he says in the
distinctive accent of a native Bay Stater who grew up just miles from the Boston
Out-Patient Surgical Suites in Waltham, Mass., where he currently has an owner-
ship stake.
Endearing gruff aside, Dr. Tierney says interchangeability among handpieces
and saw and drill inserts is an economic choice that adds to case efficiencies
and eases instrument set-up. He notes that surgeons want to work with smaller,
lighter tools with ergonomic grips as they toil away in one of surgery's most
physically demanding specialties. "Ergonomics, of course, makes a huge differ-
ence, especially during a long case," says Dr. Tierney. "Tools that are out of bal-
ance will make the case harder. You can get fatigued, and that's when accidents
happen."
Batteries and bits
Improvements in orthopedic technology have been less about gradual innova-
tion and more about big-impact problem-solving discoveries after periods of
static routine. "Innovation happens when things don't work," says Dr. Tierney.
"That's why we have so many instruments named after surgeons."
One recent "ah ha" development involved flexible drill bits that let surgeons
drill around corners during ACL repairs to place femoral tunnels more
anatomically accurately for more stable repairs. "For years the tunnels were
a little out of phase," says Dr. Tierney. "They were close, but they weren't per-
fect, because we were drilling with straight drill bits."
Now, says Dr. Tierney, surgeons can use Nitinol wire — which is rigid but flex-
ible — put it through a bended guide system and drill the flexible bits at 90
degrees to the intended site.
Dr. Tierney believes the next big change in power tool technology will involve
