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Osteotome and Mallet

An osteotome is a chisel-like manual cutting instrument used to divide or shape bone, driven by controlled strikes of a surgical mallet. It is the oldest bone-cutting method in orthopedic surgery and gives a defined, straight cut. Blade width, curvature, bevel and handle design vary. One catalogued lateral osteotome, for example, has a 10 mm tip on a 33 cm instrument.[1]

Design​

  • Blade. Flat or curved, with a bevel on one or both sides. A single-bevel (chisel) blade cuts preferentially in one direction. A double-bevel blade is symmetrical and cuts in line with the handle axis.
  • Handle. A straight metal handle with a striking surface at the proximal end.
  • Named patterns include Lambotte, Stille and Smith-Petersen osteotomes.
  • Mallet. Metal or nylon-faced. A nylon face reduces noise and rebound. The Mead mallet is a common pattern. Use a compatible striking surface that does not mar the handle.

Use in Reconstructive Urology​

  • Partial pubectomy for urethropubic fistula with osteomyelitis: the osteotome makes the initial defined cut and a rongeur completes the removal.
  • PFUI reconstruction with inferior pubectomy: an osteotome is one described option for a defined bone cut, often used with a gouge and rongeur; another described approach removes the wedge with rongeurs alone.[2][3]
  • Inferior pubectomy to expose the membranous urethra in deep posterior urethroplasty: a straight cortical cut with the osteotome, finished with a rongeur.

Technique​

  • Expose the target bone with a periosteal elevator, stripping only as much periosteum as the cut requires.
  • Position the blade at the intended cut line before applying force, with the angle set by the desired direction. Keep control of the cutting edge and anticipate where a fragment could move.
  • Strike in controlled increments suited to the bone. A sudden heavy strike can propagate an unintended fracture or drive the blade past the planned plane.
  • Deepen progressively. If the blade binds or the cut deviates, stop and reassess the exposure, blade angle and bone before continuing.
  • Account for fragments and inspect the resulting edge and nearby tissue before continuing reconstruction.
  • Inspect the blade and handle before use, and follow the instrument's reprocessing instructions.

Comparison with a Powered Drill​

  • Edge quality. Osteotome cuts are generally taught to leave a cleaner cortical edge than a burr, which can heat and damage bone.
  • Heat and dust. An osteotome generates no heat and no aerosolized bone dust. Bone comes off in fragments.
  • Cost and availability. It is inexpensive, simple and widely available.
  • Speed. It is slower than a drill for bulk removal, and cut quality depends on mallet technique.
  • Percussion. Vibration and noise are transmitted to the patient and the room, and percussion can still cause unintended fracture or deep penetration under general anesthesia.

A drill may suit progressive contouring, and an osteotome may suit a defined cut.

See also: Air Drill, Rongeur, Periosteal Elevator, PFUI.

References​

1. FDA/NLM AccessGUDID. Osteotome, DI 10840199522283. Device description and nomenclature; accessed September 12, 2026. Device record.

2. Webster GD, Peterson AC. "Simple perineal and elaborated perineal posterior urethroplasty." Arab J Urol. 2015;13(1):17-23. doi:10.1016/j.aju.2015.01.002

3. Gomez RG, Scarberry K. "Anatomy and techniques in posterior urethroplasty." Transl Androl Urol. 2018;7(4):567-579. doi:10.21037/tau.2018.03.05