What Is an Orthopaedic Freer Elevator?
Share
What Is an Orthopaedic Freer Elevator?
It is a two-ended instrument for surgery, typically used to lift soft tissue — particularly periosteum — from bone surfaces in tight or fragile regions. Each EndEnd is normally equipped with a teardrop shape, with one EndEnd sharp to allow for dissection at the beginning, while the opposite EndEnd is sharp to facilitate delicate separation.
The tool was originally designed for septal surgery; however, it has evolved to become a common tool for orthopedic, general, ENT, and neurosurgical procedures.
Most of it is made from medical-grade stainless steel. It's very robust, simple to clean, and suitable for repeated use. Dimensions vary—common lengths range between 18 and 22 cm (7-8.5 inches), with blade widths ranging from 5 to .5 millimeters.
Historical Origins: Otto Freer and the Dental Spatula
Named after Dr. Otto Tiger Freer (1857-1932), a Laryngologist from Chicago, the elevator was a modification of a dental spatula that he used to elevate the mucoperiosteum during nasal septum surgery.
The tool was based on Ephraim Ingals' work. Freer refined the tool between 1902 and 1903 before publishing a comprehensive description of it.
The modern Freer elevator has a basic concept: a sharp edge to cut the first time and a rounded blade to facilitate gentle peeling.
Design and Anatomy of the Instrument
Dual Blade Configuration
An elevator of the classic type from Freer comes with the following:
- Sharp End (chisel-like) to cut through fascia or cut through tissues.
- Blunt-ended round to allow blunt dissection when tissue planes are available.
Handle Design
A majority of them have a smooth, rounded handle to provide a secure grip, even in gloved or wet conditions. Some feature ridges or serrations to offer more control.
Blade Curvature
Most often, they are slightly curled to fit anatomical contours, with angles tailored to particular procedures (e.g., nasal septum as opposed to osteoperiosteum).
Materials
Constructed of stainless steel, it is sometimes equipped with German and CE certifications. Surgical-grade versions typically come with lifetime warranties.
Primary Surgical Uses in Orthopaedics
1. Periosteal Elevation
It is used to remove the periosteum from bone surfaces during the repair of fractures or the installation of plates. Sharp End begins the elevation process; the blunt End continues without a hitch.
2. Nail Extraction
Freer identified its function in nail-bed procedures by placing the tip of the nail to lift it from the bed with no trauma.
3. Confined Bone Work
The ideal procedure for delicate and tight spaces, such as spinal laminas or deep sinuses, where precise separation of soft tissues is required.
4. Neurosurgical Applications
Used in cranial flap elevation and dissection of soft tissues due to its capability to blend sharp and blunt edges.
5. ENT Procedures
Perfect for septal flap elevation (septoplasty/submucosal resection), turbinate medialization, mastoid surgery, and myringoplasty.
Advantages of the Freer Elevator
Versatility
The dual ends of the instrument allow it to serve as a one-tool solution for cutting, dissection, and scraping.
Precision
The curvature of the blade enables greater precision within anatomically sealed chambers.
Reduced Trauma
Blunt dissection reduces bleeding and tissue damage. It is crucial for delicate regions.
Durability & Reusability
The stainless steel can withstand repeated sterilization and use. A solid warranty backs CE-certified versions.
Variants and Modifications
Many models meet the needs of a specific group:
Standard Double-Ended Models
Usually available in 18-22 cm lengths and 5-6.5 millimeter blades.
Obwegeser-Style
Longer (~210 millimeters) with teardrop ends, Canadian adaptation to German steel, and CE conformity
Curved Elevators
Hu-Friedy's "Freer Curved Elevator" is specifically designed to help with bone contouring.
Suction-Integrated
Some models come with suction channels to enhance field vision during ENT operations.
Economic Floor-Grade
Non-sterile bulk sets manufactured in Pakistan — cost-effective options for high-turnover environments.
How to Choose the Right Freer Elevator
1. Intended Use
- Orthopedic cases tend to favor gentle or straight curves with strong blades.
- ENT methods might benefit from suction or a specific curvature.
2. Blade Size
5mm blades are typical; however, wider (6.5mm) or narrower options are a great way to prevent excessive trauma.
3. Instrument Length
The shorter tools are utilized in areas with fine lines, such as the nasal septum. Longer tools fit well with bone spines or deep exposes.
4. Material Quality
Premium German steel, or CE-marked steel, offers durability, passivation, and long-lasting durability.
5. Handle Grip
The use of textured or serrated edges can improve handling, particularly in wet surgical environments are wet.
6. One vs. Reusable
Economy tools that are non-sterile in bulk are reusable; sterilizable versions are better to ensure longevity.
Handling and Technique Tips
- Hold the handle firmly, using your index finger or thumb on the crest of the handle.
- The sharp edge should be oriented towards the dissection plane. Use gentle pressure.
- Switch to the blunt side after releasing the initial pressure to raise the flap or strip tissue to reduce the risk of damage.
- Use anatomical planes — avoid pushing or piercing through tissue layers.
- Clean often, particularly during bone scraping, to ensure visibility.
- Be aware of the depth to prevent bone perforation. Keep an eye on the floor.
Maintenance and Sterilization
- Cleaning After use, rinse immediately to eliminate bone and blood debris. Ultrasonic baths work well
- Sterilization Autoclave by the protocol and ensure that steam penetrates all curved areas.
- Inspection: Examine the tips for damage or dulling. Sharpen or replace as necessary.
- "Passivation": German models are usually chemically treated to avoid corrosion
- Warranty: Many high-end versions (CE, German stainless) offer a long-term warranty.
Common Issues and Solutions
- Blunt advice on the use for re-sharpening or switching to a brand new instrument.
- Corrosion: Use caution when using harmful chemicals. Perform regular passivation.
- Manage slippage. Utilize designs with serrated grips or wrap a tensioning bandage.
- Curvature is wrong. Select curved models like Hu-Friedy for the best shape fit.
Comparisons: Freer vs. Cottle Elevator
Reddit Otolaryngologists note:
"Freer is wider and longer curvature, worse in the nose; Cottle sharper and gentler."
"Cottle has finer spade end; Freer is older and broader; many surgeons consider Cottle a refined version."
In orthopedics, the wider Freer tool can be useful in cases where delicate dissection of bone surfaces, rather than nasal surgery, is the primary goal.
Innovations and the Future
- Models that incorporate suction simplify small-field surgery.
- Specialized and curved versions are now tailored to specific anatomical regions.
- Economy versions that can be discarded enhance cost efficiency in environments with high volumes of use.
The expected trends include the use of advanced alloys, ergonomic improvements, and sterile single-use inserts to prevent cross-contamination.
Summary
Its orthopedic Freer elevator can be an extremely useful and versatile instrument for raising the periosteum, making tissue sections, and performing precise work in tight spaces. Based on its long-standing history, as well as its dual-ended design and adaptability, it's common across all surgical specialties, from neurosurgery and orthopedics to ENT and general surgery.
The right choice of (blade size, curvature, material, and Grip for the handle) and using the correct techniques and maintenance will guarantee safety and durability. Suction channels, for instance, and ergonomic improvements continue to enhance the user's experience.
FAQs
Does the elevator free the strip of periosteum from the bone floor?
Yes — it's ideal for gently lifting periosteum in deep areas, where the curvature of the blade and its blunt edge aid in the safe separation of tissues.
Do I have to sharpen the dull edge frequently?
No — use the sharp tip to cut and the blunt tip for separating. Sharp ends should not be sharpened deliberately.
Is the Freer elevator autoclavable?
Absolutely — medical-grade stainless steel tolerates autoclaving; use ultrasonic cleaning, then sterilize according to guidelines.
What's the best choice between Freer and Cottle?
In orthopedics, use the Freer to create broader bone and tissue planes. When it comes to ENT, Cottle offers finer curves for nasal dissection.
Can a suction model aid?
Yes — ENT-specific suction-integrated models help keep the field clear, which in turn helps maintain clarity and effectiveness.