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Incidence and Outcomes of Intraoperative Instrument Breakage in Orthopaedic Surgery: A Five-Year Retrospective Study
Gabriel Zihui Leow1, Edward Xian Wei Hui1, Yuet Peng Khor1
1Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore.
Background:
The intraoperative breakage and retention of surgical instruments is a recognised complication in orthopaedic surgery, with implications on patient safety, medicolegal accountability, and surgical decision-making. While the incidence of intraoperative instrument breakage has been described internationally, locoregional data from Singapore and the region is limited.
Methods:
We conducted a retrospective review of institutional incident reports for orthopaedic surgeries performed at a 700-bed regional hospital between 2019 and 2024. Cases related to broken surgical instruments were identified. Patient demographics, surgical characteristics, instrument type, anatomical site, surgeon seniority, follow-up duration, the need for secondary intervention, and disclosure practices were analysed.
Results:
Among 21,606 orthopaedic procedures, 34 cases of intraoperative breakage of surgical instruments were recorded, yielding an overall incidence of 0.16%. Incidence was highest in trauma surgeries (0.56%), compared with elective (0.06%) and spine procedures (0.06%). The majority of patients were male (61.8%), and the mean operative duration was 158 min. The femur was most frequently affected (35.3%), followed by the tibia and upper limb bones. Drill bits (38.2%), K-wires (26.5%), and screws (14.7%) were the most commonly implicated instruments. Consultants performed 70.6% of the index operations. None of the patients required a secondary procedure at the point of data extraction during a mean follow-up of 9.93 months. Open disclosure was documented in all cases within 24 h.
Conclusion:
The incidence of intraoperative instrument breakage and retention at our institution is low and comparable to international reports, with trauma procedures and drill bits most frequently involved. While most retained fragments remain clinically silent, robust prevention, detection, and reporting systems are critical for maintaining patient safety and mitigating medicolegal risk. Standardised protocols for disclosure and monitoring should be integral to orthopaedic surgical governance.