Get a Grip: How Hand Anthropometrics, Grip Strength, and Sex Influence Power Tool Use in Orthopaedics

Female surgeons typically have smaller hands, report negative perceptions, and experience pain and discomfort related to instrument design. The aims of this study were to determine whether orthopaedic surgeons receive teaching on power-tool handling, identify power-tool grips used, evaluate whether grip strength and hand anthropometrics influence grip choice, and examine the impact of sex on power tool perceptions.

Orthopaedic surgeons (residents and attendings) were surveyed on their power tool perceptions and teaching methods. An objective assessment was carried out which included the categorization of power tool grips, measurement of grip strength, and anthropometric measurements of the hand.

Forty-six orthopaedic surgeons (12 female, 34 male) were recruited with a response rate of 96%. No orthopaedic surgeon reported formal teaching on power tool handling. Female surgeons reported more negative experiences using the wire driver and drill. Participants demonstrated 2 variations in power tool posture, with an equal split, determined by the index finger position on either the top or bottom trigger. The index finger bottom position was associated with reduced grip strength, female sex, and smaller hand and palm length compared with the index finger top position.

Surgeons with smaller hands or lower grip strength, particularly females, were more likely to use an index finger supported grip, likely as a compensatory strategy. There is the need for early training in power-tool ergonomics and grip techniques, as well as grip strengthening initiatives. The current one-size-fits-all approach is inadequate; manufacturers should ensure designs accommodate a wide range of hand sizes, accounting for palm length and overall hand length, to accommodate all users.