[Histonet] Re: Bone Saw

[Bob Richmond]

Mike Pence (where?) asks:
>>I am trying to see what everyone is using at your grossing station for
bone saw to cut femoral heads and toes for osteo. If you are using a
Stryker saw how are you holding the specimens to make good thin sections?<<

>>Three suggestions were:

>>Mopec ZawBones double-bladed saw
http://media3.mopec.com/media/pdf/AutopsyAccessories%28Page76%29.pdf

>>Dremel tool

>>We use a small [table-top] band saw from MAR-MED. cuts through a femoral
head like a hot knife through soft butter. You let the blade do the job,
don't force the bone. Just very little consistent pressure.<<

Well, I've worked in about 80 pathology services, mostly small ones, in the
last 50 years, and here's what I've observed. Good Management Practice is
of course to deny the pathologist all but the most basic grossing tools.

The cowboy way is to do no sawing at all. Jiss chuck the femoral head or
tibial plateau into Decal for a few weeks, then cut it with a scalpel. Of
course the sections are uninterpretable, IHC is impossible, and you
probably can't bill successfully after so long. Pathologists who insist on
microscopic examination (to run up the bill) do the decalcification the
cowboy way, in my experience.

Most common saw is the Satterlee amputation saw (Google it for an
illustration). Tried and true - I've seen them in Civil War re-enactments,
chrome plating and all. You're fortunate if you have one - they cost about
$100 each, so you couldn't get one today. Google it for an illustration.
We're having an ice storm here in east Tennessee this week, and yesterday I
sawed four femoral heads from little old ladies who'd slipped on the ice.
(You hold the femoral head in a wad of paper towels.)

If a pathology service doesn't have any kind of a saw, I go to a hardware
store and buy whatever hacksaw they have on the shelf, for about $7. They
don't last very long.

I've once used one of the double-bladed hacksaws, like the MOPEC ZawBones
mentioned earlier. Made for medical use, they cost around $500, so no, you
can't have one.

Some pathologists use the Stryker oscillating saw they use at the autopsy
table, but there's no way to immobilize a loose specimen (such as a femoral
head) safely, and it's likely to fly up in your face. Also, the Stryker saw
overheats the specimen and damages the histology.

Band saws and scroll saws are often recommended, but I've never seen one
used. They're heavy, have a large footprint on the table, and cost several
hundred dollars, so, no, you can't have one.

Femoral heads from fractures need microscopic examination, to look for
metastatic cancer (pathologic fracture). Osteoarthritis can be gross-only,
as can most knee replacement specimens. Most fracture specimens are
osteoporotic and easy to cut - I record the difficulty of sawing in the
gross description - "the femoral head is slabbed with a hand saw without
much difficulty/with considerable difficulty".

Bob Richmond
Samurai Pathologist
Maryville TN