[Histonet] Re: bone saws

[Robert Richmond]

Mike Pence recommends this bone saw:
This is the saw we use for just that purpose.
http://www.thermo.com/com/cda/product/detail/1,,10121267,00.html

This or a very similar device is called a "Saw Bones" and consists of
a clamp and two parallel hacksaws that cut a slab of bone of the right
thickness for histologic examination.

I've used such a saw and recommend it highly. The only drawback is
that since it costs around $500 and is something the pathologist
actually has his hands on, the answer from management is usually no.

Pathology service policies vary widely on how femoral heads and
specimens from total knee replacements are processed. Some hospitals
allow the orthopedist to throw them away. In my experience these
specimens need a gross examination to verify the arthritic changes for
the high school dropout who determines whether the orthopedist gets
paid or not (this really happened to an orthopedist of my
acquaintance).
My standard sign-out is
head of left femur (total joint replacement): eburnation and
osteophyte formation, consistent with end stage osteoarthritis.

I insist on decalcified sections of hip fracture specimens, since
unexpected metastatic cancer with "pathologic fracture" is something
you see every now and then (actually, I've seen it three times in my
life). Osteoarthritis specimens are much denser and more difficult to
saw, and the yield of significant observations is lower, but doing
microscopy on these specimens is a revenue producer for the
pathologist and/or the hospital, by upping the CPT code from 88300 to
88305 and 88311. (Don't expect to cost-justify the Saw Bones with this
argument though - they teach you in M.B.A. school not to think like
that).

(Now I'll get flamed, not by Leica, but by the likes of Harvard
Business School.)

Bob Richmond
Samurai Pathologist
Knoxville TN