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Aims During the COVID-19 pandemic, drilling has been classified as an aerosol-generating procedure. However, there is limited evidence on the effects of bone drilling on splatter generation. Our aim was to quantify the effect of drilling on splatter generation within the orthopaedic operative setting. Methods This study was performed using a Stryker System 7 dual rotating drill at full speed. Two fluid mediums (Videne (Solution 1) and Fluorescein (Solution 2)) were used to simulate drill splatter conditions. Drilling occurred at saw bone level (0 cm) and at different heights (20 cm, 50 cm, and 100 cm) above the target to simulate the surgeon ‘working arm length’, with and without using a drill guide. The furthest droplets were marked and the droplet displacement was measured in cm. A surgical microscope was used to detect microscopic droplets. Results Bone drilling produced 5 cm and 7 cm droplet displacement using Solutions 1 and 2, respectively. Drilling at 100 cm above the target produced the greatest splatter generation with a 95 cm macroscopic droplet displacement using Solution 2. Microscopic droplet generation was noticed at further distances than what can be macroscopically seen using Solution 1 (98 cm). Using the drill guide, there was negligible drill splatter generation. Conclusion Our study has shown lower than anticipated drill splatter generation. The use of a drill guide acted as a protective measure and significantly reduced drill splatter. We therefore recommend using a drill guide at all times to reduce the risk of viral transmission in the operative setting. Cite this article: Bone Jt Open 2021;2(9):752–756.

Drilled hole quality is a significant parameter for successful orthopedic surgery. The present investigation is an effort to reduce the delamination produced drilling with state-of-the-art hybrid drilling i.e. ultrasonically-assisted drilling. A comparative analysis has carried out as per experimental design to assess the ultrasonic drilling with conventional drilling. The novelty of the work is the use of coordinate measuring machine (CMM) for characterization of the delamination during bone drilling. The results revealed that ultrasonically-assisted drilling caused lesser delamination than conventional drilling. The maximum percentage delamination during conventional drilling was found to be 9.153% and 8.541% during ultrasonically-assisted drilling.

Efficacy and outcomes of osteosynthesis depend on various factors including types of injury and repair, host factors, characteristics of implant materials and type of implantation. One of the most important host factors appears to be the extent of bone damage due to the mechanical force and thermal injury which are produced at cutting site during bone drilling. The temperature above the critical temperature (47 °C) produces thermal osteonecrosis in the bones. In the present work, experimental investigations were performed to determine the effect of drilling parameters (rotational speed, feed rate and drill diameter) and techniques (conventional surgical bone drilling and rotary ultrasonic bone drilling) on cutting force and temperature generated during bone drilling. The drilling experiments were performed by a newly developed bone drilling machine on different types of human bones (femur, tibia and fibula) having different biological structure and mechanical behaviour. The bone samples were procured from male cadavers with the age of second to fourth decades. The results revealed that there was a significant difference ( p

Objective: The aim of this study was to improve muscle flaps and to evaluate surgical outcomes with the use of a novel specialized retractor, which is a surgical instrument used to locate and shape a bony seat for minimally invasive cochlear implantation. Methods: 50 patients aged 1–75 years with sensorineural hearing loss who required cochlear implantation were recruited. A small incision (

INTRODUCTION: The performance of the drilling process depends on the characteristics of the drilling equipment and surgeon’s skill. To our knowledge, no research has focused on multi-parameter analysis of the dynamic behaviour of drills during the drilling process. This study aimed to characterise the physical changes and effects of different drills attached to a robotic arm during drilling of artificial bones in a standardised experimental setup. MATERIALS AND METHODS: Drilling processes using three brands of drills attached to a robotic arm were compared in terms of thrust force, vibration, noise level, speed deviation, and temperature. A standardised experimental setup was constructed, and measurement data were analysed statistically. Identical artificial bones were drilled 10 times with each drill. RESULTS: Thrust force measurements, which varied through the cortex and medulla, showed expressive differences for each drill for maximum and mean values (p

Background Bone drilling is a procedure that demands a high level of dexterity, fine motor skills and spatial awareness from the operating surgeon. An important consideration when drilling bone is minimising soft tissue damage. There are numerous causes of drilling associated soft tissue injury, of which most concerning is drilling into the tissue beyond the far cortex as unseen injury can occur. This is known as plunging. Objectives The objective of this study was to evaluate the impact of haptic feedback in virtual reality (VR) simulation-based training. The acquisition of drilling skill was assessed by changes to their drill plunge depth. Study Design & Methods The participants in the study were medical students, doctors and biomedical scientists. Participants were randomly allocated into two groups. One group had simulation with haptic feedback as part of their VR simulated learning, whereas the second group undertook the same VR simulation but did not receive haptic feedback during the simulation. Following completion of the simulated bone drilling protocol, a bone drilling exercise took place. Each participant was allowed to drill a synthetic tibia bone five times and then the plunge depth was measured. We quantified outcome in the form of plunge depth. Results There were four participants in each group. The average plunge distance in the group who were able to practice with haptic assisted VR simulation was 46mm (range: 37-56mm), the average plunge distance in the non-haptic group was 79mm (range: 44-136mm). Results showed an average reduction of 33mm in plunge depth from users in the haptic group compared to the non-haptic group. Conclusion Bone drilling simulation with haptic feedback may be an effective simulator of the motor skills that would be required to perform this action on a live patient. The study results suggest that there could be a reduction in soft tissue damage for users trained in VR simulations with haptic feedback.

The orthopedic manipulation “bone drilling” is the most executed one in the orthopedic surgery concerning the operative treatment of bone fractures. The drilling process is characterized by a number of input and output parameters. The most important input parameters are the feed rate [mm/s] and the drill speed [rpm]. They play significant role for the final result (the output parameters): thermal and mechanical damages of the bone tissue as well as hole quality. During the manual drilling these parameters are controlled by the surgeon on the base of his practical skills. But the optimal results of the manipulations can be assured only when the input parameters are under control during an automatic execution of the drilling process. This work presents the functional characteristics of the handheld robotized system ODRO (Orthopedic Drilling Robot) for automatic bone drilling. Some experimental results are also shown. A comparison is made between the similar systems which are known in the literature, some of which are available on the market. The application areas of ODRO in the orthopedic surgery practice are underlined.

Assessment techniques for orthopedics training are primarily subjective, and often based on qualitative metrics. In this paper, we propose an analytical approach for the quantitative assessment of orthopedic surgery training, specifically, bone drilling. Our goal in this paper is to help improve orthopedics training by providing a means to assess the resident training progress. To this end, we introduce a novel metric that assigns a unique signature to an individual’s drilling activity based on their drilling trajectory, and we compare it with the signatures of expert surgeons. We conduct a simple bone-drilling experiment with surgeons (experts) and novice users on a hybrid (physical - digital) setup consisting of 3D printed bone surrogates that emulate physical and perceptual properties of a human bone across the young and old age groups. We create expert models using our drilling signature metric to evaluate drilling performance for novice users with respect to expert orthopedic surgeons. Our preliminary analysis of drilling signatures across expert and novice users showcases a perceivable distinction across two different bone types highlighting some fundamental insights on the drilling setup, bone material, and user response to each bone type. Our results indicate that the drilling signature helps capture not only a novice user’s drilling behavior, but also their relative expertise as they progress with training.

Introduction: The aetiological factors of dental fear include negative information, witnessing or having a bad experience, and negative conditions related to periodontal treatment. Modified Dental Anxiety Scale Nepali version, is one of the tools used in epidemiological studies to measure dental anxiety in adults. The objective was to find out the prevalence of anxiety among dental patients visiting for periodontal therapy in a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among patients visiting for periodontal therapy from November 2020 to January 2021 at a tertiary care dental hospital. Ethical clearance from Institutional Review Committee (Reference no. 0311202001) was taken before the study. Convenient sampling was done. A standard questionnaire for dental anxiety was used for data collection after receiving informed consent from the participants. Data were entered and analyzed in Microsoft Excel Sheet. Descriptive data are presented as means, standard deviations, frequencies, and percentages. Results: Among a total of 311 participants visiting for periodontal therapy, 297 (95.49%) (92.57-97.42 at 95% Confidence Interval) were having anxiety. Among total patients, 113 (36.33%) were fairly anxious, 111 (35.69%) were slightly anxious, 62 (19.94%) very anxious and 11 (3.54%) were extremely anxious. Majority of males 54 (17.36%) were slightly anxious while most females 67 (21.54%) were fairly anxious. Mean Modified Dental Anxiety Scale-Nepali score of all the participants was 11.59±3.808. Extreme dental anxiety was observed in 11 (3.54%) participants 7 (2.25%) females; 4 (1.29%) males. Conclusions: The prevalence of anxiety among patients visiting for periodontal therapy in this study was found to be higher compared to other studies done in similar settings.

This study aimed to explore the effects of drilling rotational speed and feed-rate on the stability of dental implants through in-vivo and ex-vivo experiments. To this end, a total of 16 identical dental implants were inserted in the mandible of four dogs. The osteotomies were made with two drilling rotational speeds, i.e., 800 and 1500 rpm, and two different feed-rates, i.e., 1 and 2 mm/s. Implant stability quotients (ISQs) were recorded immediately after inserting implants and then each week for four subsequent weeks. Then, all animals were euthanized, and a bone sample containing the implants was extracted from each hemi-mandible for the pull-out test. A two-way ANOVA was performed for ISQs, and pull-out strengths (PoS), and the significance level was set to 0.05). Increasing the rotational speed from 800 to 1500 rpm significantly increased both ISQ and PoS values at the end of the 4th week after the implantation (P = 0.022 and P = 0.001, respectively). Moreover, by decreasing the feed-rate from 2 to 1 mm/s, a significant increase in PoSs of the dental implants was observed four weeks after the implantation (P = 0.019). Results of this study showed that either by increasing drilling rotational speed, here from 800 to 1500 rpm, or by reducing feed-rate, here from 2 to 1 mm/s, the secondary stability would be reinforced. Further investigations are needed to see if and how the conclusions made in this study can be generalized.

Retrograde Anbohrung des nekrotischen Areals im Huftkopf, um den intraossaren Druck zu senken und ein Einwachsen von neuen Blutgefasen zu ermoglichen. Atraumatische Huftkopfnekrose im ARCO-Stadium I (reversibel) und ARCO-Stadium II (potenziell reversibel) mit idealerweise einem medialen oder zentralen Nekroseareal 30 %, Infektionen. Ruckenlage. Darstellung des Nekroseareals mittels Bildwandler, Wahl des Zugangs durch aufgelegten Kirschner-Draht, laterodorsaler Hautschnitt auf Hohe des Drahtes, Tractusspaltung, Langsspaltung des M. vastus lateralis, Kirschner-Draht (2–3 mm) in die Nekrosezone vorbohren, evtl. durch weitere Drahte erganzen oder mithilfe einer Hohlfrase ausraumen, Wundverschluss. Teilbelastung (ca. 20 kg) fur 6 Wochen wegen der Gefahr einer Fraktur, anschliesend sollte fur weitere 6 Wochen Springen sowie Sprinten vermieden werden. Physiotherapeutische Beubung ab dem 1. postoperativen Tag, Thromboseprophylaxe bis zur Vollbelastung. Die Ergebnisse sind abhangig vom ARCO-Stadium und in den fruhen Stadien erfolgversprechend.

Introduction: Many orthopaedic procedures require drilling of bone, especially fracture repair cases. Bone drilling results in heat generation due to the friction between the bone and the drill bit. A high-level of heat generation kills bone cells. Bone cell death results in resorption of bone around bone screws.Methods: We searched in the literature for data on parameters that influence drilling bone and could lead to thermal necrosis. The points of view of many orthopaedists and neurosurgeons based upon on previous practices and clinical experience are presented.Results: Several potential complications that lead to thermal necrosis are discussed and highlighted.Discussion: Even in the face of growing evidence as to the negative effects of heat induction during drilling, simple and effective methods for monitoring and cooling in real-time are not in widespread usage today. For that purpose, we propose some suggestions for the future of bone drilling, taking note of recent advances in autonomous robotics, intelligent systems and computer simulation techniques.Conclusions: These advances in prevention of thermal necrosis during bone drilling surgery are expected to reduce the risk of patient injury and costs for the health service.

Purpose: Thermal injury to the optic nerve is a potential complication of bony decompression of the orbital apex. An animal model was used to compare and contrast temperature change while removing ...

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the main technical challenge of endoscopic middle ear surgery. The accompanying video describes the detailed protocol of a constant-suction bone-drilling technique and the procedure of endaural exclusive endoscopic atticoantrotomy (retrograde mastoidectomy) using this technique. The main components of this bone-drilling technique include a soft and flexible suction tube, which is placed into the tympanic cavity to provide constant suction, and a soft sleeve, which is wrapped around the drill shaft to prevent the high-speed rotating shaft from damaging the lens of the endoscope. With these simple modifications, the traditional otological electrodrill can be used for drilling a tiny endaural incision in endoscopic middle ear surgery. Based on this bone-drilling technique, endaural endoscopic atticoantrotomy (retrograde mastoidectomy) can be successfully established for the removal of various amounts of bone, depending on the extent of the lesion. The short-term postoperative outcome seems promising.

Having a trusted and useful system that helps to diminish the risk of medical errors and facilitate the improvement of quality in the medical education is indispensable. Thousands of surgical errors are occurred annually with high adverse event rate, despite inordinate number of devised patients safety initiatives. Inadvertently or otherwise, surgeons play a critical role in the aforementioned errors. Training surgeons is one of the most crucial and delicate parts of medical education and needs more attention due to its practical intrinsic. In contrast to engineering, dealing with mortal alive creatures provides a minuscule chance of trial and error for trainees. Training in operative rooms, on the other hand, is extremely expensive in terms of not only equipment but also hiring professional trainers. In addition, the COVID-19 pandemic has caused to establish initiatives such as social distancing in order to mitigate the rate of outbreak. This leads surgeons to postpone some non-urgent surgeries or operate with restrictions in terms of safety. Subsequently, educational systems are affected by the limitations due to the pandemic. Skill transfer systems in cooperation with a virtual training environment is thought as a solution to address aforesaid issues. This enables not only novice surgeons to enrich their proficiency but also helps expert surgeons to be supervised during the operation. This paper focuses on devising a solution based on deep leaning algorithms to model the behavior of experts during the operation. In other words, the proposed solution is a skill transfer method that learns professional demonstrations using different effective factors from the body of experts. The trained model then provides a real-time haptic guidance signal for either instructing trainees or supervising expert surgeons. A simulation is utilized to emulate an operating room for femur drilling surgery, which is a common invasive treatment for osteoporosis. This helps us with both collecting the essential data and assessing the obtained models. Experimental results show that the proposed method is capable of emitting guidance force haptic signal with an acceptable error rate.

STUDY DESIGN An experimental investigation of a robot-assisted ultrasonic osteotome applied to vertebral cancellous bone. OBJECTIVE The aim of this study was to investigate the effect of various ultrasonic parameter settings on temperature in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonically assisted bone drilling in spinal surgery. SUMMARY OF BACKGROUND DATA A robot-assisted ultrasonic osteotome device may be safe and effective for spinal drilling. METHODS Sixty specimens of bovine vertebral cancellous were randomly assigned to one of six groups, which varied by mode of ultrasonic vibration (L-T and L) and feed rate (one percent [0.8 mm/s], two percent [1.6 mm/s], and three pecent [2.4 mm/s]). Maximum temperature in the drilling site and penetration time was recorded. RESULTS Maximum temperature in the drilling site decreased as output power increased for L-T and L modes, was significantly lower for L-T compared to L mode at each feed rate and power setting, was significantly different at feed rates of 1.6 mm/s versus 0.8 mm/s and 2.4 mm/s versus 0.8 mm/s for L-T mode at an output power of 60 W and 84 W, but was not influenced by feed rate for L mode. Penetration time did not significantly improve as output power increased for both L-T and L modes, was significantly decreased with increased feed rates, but was not significantly different between L-T and L modes. CONCLUSION The optimal parameters for applying a robot-assisted ultrasonic osteotome to vertebral cancellous bone are L-T mode, maximum output power of 120 W, and maximum feed rate of 2.4 mm/s.Level of Evidence: 4.

Having a trusted and useful system that helps to diminish the risk of medical errors and facilitate the improvement of quality in the medical education is indispensable. Thousands of surgical errors are occurred annually with high adverse event rate, despite inordinate number of devised patients safety initiatives. Inadvertently or otherwise, surgeons play a critical role in the aforementioned errors. Training surgeons is one of the most crucial and delicate parts of medical education and needs more attention due to its practical intrinsic. In contrast to engineering, dealing with mortal alive creatures provides a minuscule chance of trial and error for trainees. Training in operative rooms, on the other hand, is extremely expensive in terms of not only equipment but also hiring professional trainers. In addition, the COVID-19 pandemic has caused to establish initiatives such as social distancing in order to mitigate the rate of outbreak. This leads surgeons to postpone some non-urgent surgeries or operate with restrictions in terms of safety. Subsequently, educational systems are affected by the limitations due to the pandemic. Skill transfer systems in cooperation with a virtual training environment is thought as a solution to address aforesaid issues. This enables not only novice surgeons to enrich their proficiency but also helps expert surgeons to be supervised during the operation. This paper focuses on devising a solution based on deep leaning algorithms to model the behavior of experts during the operation. In other words, the proposed solution is a skill transfer method that learns professional demonstrations using different effective factors from the body of experts. The trained model then provides a real-time haptic guidance signal for either instructing trainees or supervising expert surgeons. A simulation is utilized to emulate an operating room for femur drilling surgery, which is a common invasive treatment for osteoporosis. This helps us with both collecting the essential data and assessing the obtained models. Experimental results show that the proposed method is capable of emitting guidance force haptic signal with an acceptable error rate.

The advanced tendency in development of robots oriented to orthopedic manipulations is maximally simplification of their mechanics. So called Handheld Robotized Systems appear. Here handheld bone drilling robotized system ODRO (Orthopedic Drilling Robot) is considered. The purpose is to compare its functional characteristics with the similar systems known in the literature. Experimental results are presented for porcine femur drilling by new drill module. The stop drilling decision is taken automatically. The information about experiments concerning the different modes is shown on the display after the drilling end. Handheld robotized systems can perform the accuracy and precise work like the stationary multifunctional robots. They do not need special software, pre-operative planning procedures, calibration, registration and systems for intraoperative navigation. In the same time they are much cheaper, accessible for usage, convenient for work and maintenance which will facilitate their mass application in the orthopedic surgery practice.

Background During drilling of bone, which is common in clinical surgeries, heat generation increases local temperature in the drilling site. Transmission of excessive heat to the surrounding bone tissue can cause thermal osteonecrosis. Consequently, it may lead to failure of implants and fixation screws or delay in healing process. Using cooling is a method for limiting temperature elevation. Materials and methods In this study, through comparing three conditions of drilling without cooling, external cooling with normal saline, and external cooling with OpSite spray, the efficiency of OpSite as coolant is studied. In this regard, 2 drill bit diameters, 3 drilling speeds, and 3 drilling feed-rates are considered as drilling variables in the experiments. Results For the whole experiments, while cooling with normal saline resulted in lower maximum temperatures than without cooling condition, OpSite had even better results and limited the temperature elevation during drilling of bone efficiently. Conclusion OpSite spray, which has lower infection risks than normal saline on one hand and lower maximum temperature rise with all combinations of drilling parameters on the other hand, can be considered in clinical surgeries for cooling applications.

In orthopedic and trauma surgical operations, drilling of bone is one of the commonly used procedures performed in hospitals and is a clinical practice for fixing the fractured parts of human bones. Force, torque and temperature play a significant role during the bone drilling and decide the stability of the medical implants. Therefore, it is necessary to minimize force, torque and temperature while drilling to avoid the thermal necrosis and osteosynthesis. This study focused on studying the influence of various types of bone drilling parameters (rotational speed, feed rate, drill diameter and ultrasonic amplitude), tools (solid tool, hollow tool and conventional twist drill bit) and techniques (conventional surgical drilling, rotary ultrasonic bone drilling and rotary bone drilling) on force, torque, temperature and microcracks produced in the drilled surface of the bone. The experimental investigations were conducted on porcine bone samples to perform the comparative study. Results revealed that increasing the diameter of drill tool and feed rate results in the increase in force, torque and temperature, while low rotational speed (500 r/min) generated a low temperature, high cutting force and torque for all types of drilling processes and tools evaluated in this study. Experimental results also revealed that rotary ultrasonic bone drilling with hollow tool generated the lowest cutting force, torque, temperature (

Bone drilling is an important step in orthopedic surgeries for the reconstruction and repair of fractured bones. The main concern in bone drilling is to create holes without causing minimum damage to the bone tissues. It is well reported that high temperature and high force in drilling cause bone thermal necrosis leading to the delayed bone healing and implant failure. In the past, a significant amount of research has been conducted to understand and mitigate the issues in bone drilling. However, the current practice in bone drilling is that medical surgeons still rely on their own experience and feeling, which often causes unwanted damage to the bone. The present paper aims to provide a comprehensive review of surgical bone drilling and impending factors affecting drilling and biological performance of the bone. Current protocols and practices in tackling issues around drilling are discussed and assessed in terms of results obtained in both experimental and computational domains. This pragmatic discussion will signify the importance and challenges ahead in empowering medical surgeons to enable improved surgical outcome. Furthermore, the findings of this extensive review are expected to drive further exploration of new opportunities for developing advanced bone drilling system integrated with intelligent sensors and control technology.

Osteotomy is a common step in oncological, reconstructive, and trauma surgery. Drilling and elevated temperature during osteotomy produce thermal osteonecrosis. Heat and associated mechanical damage during osteotomy can impair bone healing, with consequent failure of fracture fixation or dental implants. Several ex vivo studies on animal bone were recently focused on heating production during osteotomy with conventional drill and piezoelectric devices, particularly in endosseous dental implant sites. The current literature on bone drilling and osteotomic surface analysis is here reviewed and the dynamics of bone healing after osteotomy with traditional and piezoelectric devices are discussed. Moreover, the methodologies involved in the experimental osteotomy and clinical studies are compared, focusing on ex vivo and in vivo findings.

Background Bone drilling is a mandatory process in orthopedic surgery to fix the fractured bones. Excessive heat is generated due to the shear deformation of bone and friction energy during the drilling process. Objective This paper is carried out to optimize the bone drilling parameters to prevent thermal bone necrosis. The main contribution of this work is instead of only consider the influence of rotational speed and feed rate, the effect of tool diameter and drilling hole depth are also incorporated for optimization study. Methods Response surface methodology (RSM) was used to develop a temperature prediction model. Drilling experiments were performed using finite element software DEFORM-3D. Analysis of variance (ANOVA) was conducted to investigate the drilling parameters' effect. Desirability function in RSM was used to determine the optimum combination of drilling parameters. Results Results indicated that one applicable combination of drilling parameters could increase the bone temperature by less than 0.03%. To avoid thermal bone necrosis, eight reasonable combinations of drilling parameters were proposed. 3.3∘C residuals between in-vitro experiments and predicted values were demonstrated. Conclusions It is envisaged that finite element simulation with RSM can simplify tedious experimental works and useful in the clinical application to avoid bone necrosis.

Anterior clinoidectomy is a difficult yet essential technique in skull base surgery. Two main techniques (extradural and intradural) with multiple modifications have been proposed to increase efficiency and avoid complications. In this study, the authors sought to develop a hybrid technique based on localization of the optic strut (OS) to combine the advantages and avoid the disadvantages of both techniques.Ten cadaveric specimens were prepared for surgical simulation. After a standard pterional craniotomy, the anterior clinoid process (ACP) was resected in 2 steps. The segment anterior to the OS was resected extradurally, while the segment posterior to the OS was resected intradurally. The proposed technique was performed in 6 clinical cases to evaluate its safety and efficiency.Anterior clinoidectomy was successfully performed in all cadaveric specimens and all 6 patients by using the proposed technique. The extradural phase enabled early decompression of the optic nerve while avoiding the adjacent internal carotid artery. The OS was drilled intradurally under direct visualization of the adjacent neurovascular structures. The described landmarks were easily identifiable and applicable in the surgically treated patients. No operative complication was encountered.A proposed 2-step hybrid technique combines the advantages of the extradural and intradural techniques while avoiding their disadvantages. This technique allows reduced intradural drilling and subarachnoid bone dust deposition. Moreover, the most critical part of the clinoidectomy—that is, drilling of the OS and removal of the body of the ACP—is left for the intradural phase, when critical neurovascular structures can be directly viewed.

The current array of shoulder repair anchors, techniques, and constructs vary greatly and offer many choices to optimize soft-tissue healing to bone. The widely used all-suture anchor designs represent an innovative option that allows for versatile delivery and a low-profile anchor construct that minimizes bone drilling and preserves native bone. Various reports of tissue reactions to copolymer and biocomposite materials and now all-suture anchors have been published raising concerns in some cases over safety, adverse events, and clinical performance. Other studies have described reactions in which the clinical correlative significance remains unclear. Determination of what matters and what is significant will help to decide if radiographic tunnel enlargement does occur over time and if it changes our clinical decision-making and choice of which anchors to use.

The Kirschner wire (K-wire) is a common bone drilling tool in orthopedic surgery to affix fractured bone. Significant heat is produced due to both the cutting and the friction between the K-wire and the bone debris during drilling. Such heat can result in high temperatures, leading to osteonecrosis and other secondary injuries. To reduce thermal injury and other high-temperature associated complications, a new K-wire design with three notches along the three-plane trocar tip fabricated using a thin micro-saw tool is studied. These notches evacuate bone debris and reduce the clogging and heat generation during bone drilling. A set of four K-wires, one without notches and three notched, with depths of 0.5, 0.75, and 1mm, are evaluated. Bone drilling experiments conducted on bovine cortical bone show that notched K-wires could effectively decrease the temperature, thrust force, and torque during bone drilling. K-wires with notches 1mm deep reduced the thrust force and torque by approximately 30%, reduced peak temperatures by 43%, and eliminated blackened burn marks in bone. This study demonstrates that a simple modification of the tip of K-wires can effectively reduce bone temperatures during drilling.

Purpose The purpose of this paper is to examine the application of low-end, low-fidelity (gaming/consumer-level) haptic devices for medical-based, surgical skills development (surgical bone-based drilling in particular) with serious games and virtual simulations as an affordable training solution with the potential of complementing current and traditional training methods. Design/methodology/approach The authors present the adaptation of two low-end haptic devices (Novint Falcon and Geomagic 3D Touch) to simulate a surgical drill drilling through bone for a serious game developed for total knee arthroplasty training. The implementation was possible through the analysis of the bone drilling mechanics. The authors provide a quantitative comparison of both haptic devices with respect to forces, movements, and development. Findings Although further testing is required, the initial results demonstrate that the low-end, consumer-level haptic devices can be incorporated into virtual environments/serious games to allow for the simulation of surgical drilling. The authors also believe that the results will generalize and allow these devices to be used to simulate a variety of technical-based medical procedures. Originality/value In contrast to previous work where the focus is placed on cost-prohibitive haptic devices, this approach considers affordable consumer-level solutions that can be easily incorporated into a variety of serious games and virtual simulations. This holds promise that haptic-based virtual simulation and serious games become more widespread, ultimately ensuring that medical trainees are better prepared before exposure to live patients.

A three-dimensional dynamic elastoplastic finite element model was constructed and experimentally validated and was used to investigate the parameters which influence bone temperature during drilling, including the drill speed, feeding force, drill bit diameter, and bone density. Results showed the proposed three-dimensional dynamic elastoplastic finite element model can effectively simulate the temperature elevation during bone drilling. The bone temperature rise decreased with an increase in feeding force and drill speed, however, increased with the diameter of drill bit or bone density. The temperature distribution is significantly affected by the drilling duration; a lower drilling speed reduced the exposure duration, decreases the region of the thermally affected zone. The constructed model could be applied for analyzing the influence parameters during bone drilling to reduce the risk of thermal necrosis. It may provide important information for the design of drill bits and surgical drilling powers.

The drilling bone may potentially cause excessive frictional heat, which can lead to local bone necrosis. This heat generation and local necrosis has been suggested to contribute to the resorption of bone around the placed screws, ending in loss of screw purchase in the bone and inadvertent loosening and/or the bone-implant construct. In vivo studies on this subject have inherent obstacles not the least of which is controlling the variables and real time bone temperature data acquisition. Theoretical models can be generated using computer software and the inclusion of known constants for the mechanical properties of metal and bone. These known Data points for the variables (drill bit and bone) enables finite element analysis of various bone drilling scenarios. An elastic-plastic three-dimensional (3D) acetabular bone mode was developed and finite element model analysis (FEA) was applied to various simulated drilling procedures. The FEA results clearly indicate that the depth of drilling and the drill speed both have a significant effect on the temperature during drilling procedures. The reduction of the feeding speed leads to a reduction in bone temperature. Our data suggests that reducing the feeding speed regardless of RPMs and pressure applied could be a simple useful and effective way to reduce drilling temperatures. This study is the first step in helping any surgeon who drills bone and places screws to better understand the ideal pressure to apply and drill speed to employ and advance rate to avoid osteonecrosis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2386-2391, 2017.

Presutti and Marchioni's transcanal exclusive endoscopic transpromontorial approach represents a new surgical technique to remove diseases that involve cochlea and fundus of internal auditory canal in selected cases, thus avoiding extensive bone drilling, brain, meningeal, and neurovascular manipulation. The advantage of this endoscopic technique is that direct access to internal auditory canal allows the creation of a minimally invasive route through the cochlea with a consequent improved safety during intraoperative and postoperative management. Surgeons who start with this surgical procedure must possess some fundamental prerequisites, like confidence with other inner ear techniques and previous experience with endoscopic middle ear surgery and endoscopic cadaveric dissections. Owing to the reduced invasiveness of the transpromontorial transcanal approach, there is no need for an intensive care unit stay after the operation and patient hospitalization is shorter.

Far cortex detection during the bone-drilling process is a specific task in orthopaedic surgery. Any errors in its execution could damage the cortex wall from the inside, which often causes additional trauma even with a fatal result. Here we present some functionality enhancements of the drilling orthopaedic robot ODRO concerning the solution of the far cortex detection problem. The solution is based on software control of the thrust force applied to the bone during the drilling process. A new algorithm is created and its software realisation is provided. Experimental results are presented which verify and confirm the new functional characteristics of the robot. The risk of far cortex damage may be avoided by robot application and such precise operations may guarantee better success.

This paper presents magnetic-field-assisted femtosecond laser drilling of bone with deep drilling depth, good surface quality and high removal rate. In this study, the feasibility of producing deep cavity under magnetic field condition is investigated. When magnetic field is introduced, the depth of drilling hole is increased from 236μm to 483μm, and the removal rate is increased from 3.04×10-3 mm3/s to 5.46×10-3 mm3/s. Moreover, no thermal damage including carbonization is observed during laser drilling process.

SUMMARY Bone drilling causes focal temperature rise due to metal-to-bone contact, which may result in thermal osteonecrosis. Newly constructed internally cooled medical drill of an open type decreases temperature rise at a point of metal-to-bone contact although standard sterilization of such a drill could be inadequate due to bacteria retention within the drill lumen. The aim of this pilot study was to examine the effectiveness of sterilization and to propose sterilization recommendations for internally cooled open type bone drills. Unused internally cooled medical steel bone drills were tested. Drills were contaminated with Pseudomonas aeruginosa, Bacillus sp., beta-hemolytic Streptococcus sp., Enterobacter sp. and methicillin-resistant Staphylococcus pseudintermedius and then incubated for 24 hours at 37 °C. Afterwards, drills were autoclaved for 15, 20 and 30 minutes at 132 °C and 2.6 bar. When 15-minute sterilization was used, one out of 16 drills was contaminated with Pseudomonas aeruginosa, while the other 15 drills were sterile. Extended cycle sterilization in autoclave lasting for 20 and 30 minutes resulted in 100% sterility of all drills tested. In conclusion, lumened drills should be exposed to extended sterilization times in autoclave. Minimal recommended time for sterilization of lumened drills is 20 minutes.

Thermal osteonecrosis is the in situ death of bone tissue as a result of excessively high temperatures. While the exact temperature at which thermal osteonecrosis occurs has not yet been determined, 50°C is the accepted critical value, as bone regeneration is almost completely impaired from this point on. Thermal osteonecrosis is a significant concern in orthopedic surgery, as it can compromise the bone-implant interface in fracture fixation, which, by definition, is a complication. A literature review was undertaken of the pertinent literature concerning heat generation from bone drilling and how this heat affects bone tissue. The Pubmed, ScienceDirect, and secondary (Cochrane Library) databases were searched up to December 2017 using keywords with the appropriate use of Boolean operators. Both simple text word searching and thesaurus searching were used to maximize the number of relevant articles retrieved. Reference tracking was performed via the retrieved articles to further extend the boundaries of the search. The level of evidence was Level V. It was identified that factors affecting heat generation during bone drilling were multifactorial and did not act independently of each other. Good quality evidence exists that both bone drilling parameters and the drill itself affect heat generation in bone during bone drilling. However, external irrigation is the most important variable and should always be used to keep the bone temperature below the critical value of 50°C. Future studies should focus on how the parameters of bone drilling interact with each other and how this influences heat generation in bone drilling. There is also a lack of in vivo studies on the human bone; this too should be further investigated.

In bone drilling, the temperature and the level of stresses at the bone tissue are function of the drilling parameters. If certain thresholds are exceeded, irreversible damages may occur on the bone tissue. One of the main challenges in the drilling process is to control the associated parameters and even more important, to avoid the surrounding tissue damage. In this study, a dynamic numerical model is developed to determine the thermo-mechanical stresses generated during the bone drilling, using the finite element method. The numerical model incorporates the geometric and dynamic characteristics involved in the drilling processes, as well the developed temperature inside the material. The numerical analysis has been validated by experimental tests using polyurethane foam materials with similar mechanical properties to the human bone. Results suggest that a drill bit with lower drill speed and higher feed rate can reduce the strains and stresses in bone during the drilling process. The proposed numerical model reflected adequately the experimental results and could be useful in determination of optimal drilling conditions that minimise the bone injuries.

Conventional surgical drills are rigid straight instruments used to make holes in bones. They lack the ability to follow a curved pathway, making them impractical for several surgical procedures. For this reason, there is a continuous need for improved devices for surgical drilling of curved holes.This review provides a comprehensive overview and classification of the patent literature of surgical drills able to produce a curved hole. The goal is to identify the fundamental mechanical designs of the drills. The medical section of the Web of Science Derwent Innovation Index was scanned combining keywords for both steering and drilling. Overall, 41 unique patents were reviewed and categorized.Drills were subdivided in four groups based on the capability of either drilling a single curved path or a multi-curved path and on their ability to adjust the path after insertion of the drill into the bone. We found patents describing instrument designs for all these four groups. The insight in the drilling capabilities and in the mechanical designs described in the patents may serve as a source of inspiration for the design of novel surgical drills and the development of new surgical procedures.

The Gekkou-drill® is an industrial drill that is highly efficient due to reduced cutting resistance resulting from its characteristic drill point shape. In this experiment, we compared the degree of thermal damage to bone tissue caused by conventional medical drills and these same drills with Gekkou modifications. Holes were created in the tibias of living pigs using two different 3.2-mm diameter drills and their modified versions. Regarding the drilling parameters, the thrust force was 10 N and the drilling speeds were 800 revolutions per minute (rpm) and 1500 rpm. We compared the original and modified drills in terms of the bone temperature around the drill bit and the total time necessary to create each hole, the latter calculated using imaging data captured during drilling. In histopathological examination, the percentages of empty lacunae in osteocytes of the cortical bone beneath the periosteum were evaluated at 400 × magnification with an optical microscope. Compared to the original drills, the modified drills required significantly less time to create each hole and caused a significantly lower temperature rise during bone drilling. With the modified drills, the percentages of empty lacunae around the drilling holes were about 1/2–1/3 of those with the original drills, and were significantly lower for both drilling speeds. Gekkou-modified medical drills shortened drilling times despite low thrust force, and histopathological assessment demonstrated a significant reduction in osteocyte damage.

In this chapter, the topic is switched from metal drilling in the factory to bone drilling in the operation room at the hospital. Orthopaedic surgeons perform bone drilling in daily surgical operations. Bone drilling is common for screw placement, microfracture, or for surface preparation to aid in joint fusion, in which multiple sequential passes are made. This chapter studies and compares the heat generation among different surgical drills and investigates the sequential drilling of bone using a clinically relevant environment. The heat generated by standard drills has been studied, including the effects of the drill diameter, speed, and feed rate. The experimental methods, sample preparation, and analysis method for cadaveric bone drilling are elaborated.

In orthopaedics, ‘bone drilling’ is a universal surgical method generally employed in internal fracture fixation, install implants, or to carryout reconstructive surgery. The main purpose of bone drilling is to produce holes for fixing screws, wires and plates to fasten the fractured parts for immobilisation. Investigation on drilling of bones have found importance in recent times to reduce bone tissue damage i.e. osteonecrosis (ON) and unwanted complications for successful surgery. This review aims to provide an overview on the work reported by various authors in the area of bone drilling and addresses valid clinical problems. The determination of optimal process variables found beneficial to perform surgical operations more efficiently.

Implant screw fixation and bone drilling are the two one after another processes. If certain operating parameters are not observed, necrosis may result. Necrosis can be explained as an unfavorable form of cell injury whereby integrity of cell membrane is lost and the extracellular space if filled with an uncontrolled release of products of cell death. This process starts an inflammatory response in the surrounding tissue which attracts leukocytes and phagocytes which remove the dead cells. However, collateral damage to surrounding tissues by microbial damaging substances released by leukocytes inhibits the healing process and lengthens patient rehabilitation period or even unsuccessful implant fixation and post-operative complications. This research work is initiated with review work, as the literature on this topic is having contrary conclusions and so review of previous investigators experimentation’s on the effects of spindle speed, depth of drilling and feed rate on temperature distribution and correlation among them is made. Conclusions based on histopathological analysis and bone mineral density with in vitro study are very important. This review work attempts to organize the previous work on bone drilling parameters and its correlation with necrosis.

We experimentally demonstrate a carbide-free femtosecond laser bone drilling with real-time parameter optimization based on on-line spectral monitoring after second-harmonic-generation green positioning, indicating a simple bone processing scheme.

Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand.

Bone drilling is one of the steps in a typical surgical operation that is performed around the world for reconstruction and repair of the fractured bone. During the last decade, various techniques, such as two-step drilling, ultrasonic-assisted bone drilling and laser drilling, have been introduced to control the level of forces and torque during bone drilling. In this research, rotary ultrasonic bone drilling has been successfully attempted to minimize the forces and torque during bone drilling. The drilling experiments were planned and carried out on pig bones using the design of experiments (response surface methodology). Analysis of variance was carried out to find the effect of process factors such as rotational speed, feed rate, drill diameter and ultrasonic vibrational amplitude on the force and torque. Statistical models were developed for the force and torque with 95% confidential interval, and confirmation experiments have been carried out to validate the models. Microcracks developed during drilling process were characterized by scanning electron microscopy. The results revealed that rotary ultrasonic bone drilling process offered a lower force and torque making it a potential process for bone drilling in orthopedic surgery.

We measured the rise in the intraosseous temperature caused by freehand drilling or drilling through a surgical guide, by comparing different temperatures of irrigation fluid (10°C, 15°C, and 20°C), for every step of the drilling sequence (diameters 2.0, 2.5, 3.0, and 3.5mm) and using a constant drilling speed of 1200rpm. The axial load was controlled at 2.0kg. Bovine ribs were used as test models. In the guided group we used 3-dimensional printed surgical guides and temperature was measured with a thermocouple. The significance of differences was assessed with the Kruskal-Wallis analysis of variance. Guided drilling with 10°C irrigation yielded a significantly lower increment in temperature than the 20°C-guided group. When compared with the 20°C freehand group, the reduction in temperature in the 10°C guided group was significantly more pronounced at all diameters except 3.5mm. Finally, when the 10°C-guided group was compared with the 15°C groups, the temperature rise was significantly less at 2.5 and 3.0mm than with the guided technique, and at 3.0mm compared with the freehand technique. We suggest that the use of 10°C pre-cooled irrigation fluid is superior to warmer fluid for keeping temperature down, and this reduces the difference between guided and freehand drilling.

Objective The “unilateral approach” is widespread in surgery for spinal degenerative pathologies. However, it is seldom used for resection of spinal intradural lesions. We present two cases where the “quadrantectomy approach”, a sub-category of the unilateral approach, was used for resection of spinal ependymoma and propose a new classification system of the unilateral approach regarding bone drilling and describe the use of the Balak ball-tipped water jet dissector in this procedure. Patients and methods Two patients who underwent surgical treatment of spinal intradural tumor are presented. The tumors were resected using microscopic dissection techniques and neuro-monitoring. An instrument specifically designed for the dissection of the cauda equina nerve roots was used. The surgical technique is presented with stepwise photographs. Results Contrast enhanced magnetic resonance imaging scans obtained on the second day after surgery showed that the tumors in both cases had been totally removed and the nerve roots had regained their natural shape. Histopathological diagnosis was a myxopapillary ependymoma in both cases. There were no postoperative neurological deficits and both patients recovered completely. At two-year and one-year follow-up respectively after surgery, the patients were perfectly well. Conclusion A quadrantectomy approach, which preserves the facet joints and midline structures, should be regarded as a safe subtype of unilateral approaches to spinal intradural lesions. This new terminology will be helpful in proper comparison of the results of various surgical approaches in terms of postoperative spinal instability. The ball-tipped water jet dissector is a beneficial tool for surgery in the cauda equina region.

Mandible plastic surgery plays an important role in conventional plastic surgery. However, its success depends on the experience of the surgeons. In order to improve the effectiveness of the surgery and release the burden of surgeons, a mandible plastic surgery assisting robot, based on an augmented reality technique, was developed.Augmented reality assists surgeons to realize positioning. Fuzzy control theory was used for the control of the motor. During the process of bone drilling, both the drill bit position and the force were measured by a force sensor which was used to estimate the position of the drilling procedure.An animal experiment was performed to verify the effectiveness of the robotic system. The position error was 1.07 ± 0.27 mm and the angle error was 5.59 ± 3.15°. The results show that the system provides a sufficient accuracy with which a precise drilling procedure can be performed. In addition, under the supervision's feedback of the sensor, an adequate safety level can be achieved for the robotic system.The system realizes accurate positioning and automatic drilling to solve the problems encountered in the drilling procedure, providing a method for future plastic surgery.