An objective assessment for bone drilling: A pilot study on vertical drilling

Abstract

The purpose of this study is to propose a quantitative assessment scheme to help with surgical bone drilling training. This pilot study gathered and compared motion and force data from expert surgeons (n = 3) and novice residents (n = 6). The experiment used three‐dimensional printed bone simulants of young bone (YB) and osteoporotic bone (OB), and drilling overshoot, time, and force were measured. There was no statistically significant difference in overshoot between the two groups (p = 0.217 for YB and 0.215 for OB). The results, however, show that the experts took less time (mean = 4.01 s) than the novices (mean = 9.98 s), with a statistical difference (p = 0.003 for YB and 0.0001 for OB). In addition, the expert group performed more consistently than the novices. The force analysis further revealed that experts used a higher force to drill the first cortical section and a noticeably lower force in the second cortex to control the overshoot (approximate reduction of 5.5 N). Finally, when drilling time and overshoot distance were combined, the motion data distinguished the skill gap between expert and novice drilling; the force data provided insight into the drilling mechanism and performance outcomes. This study lays the groundwork for a data‐driven training scheme to prepare novice residents for clinical practice.

A Data-Driven Methodology to Comprehensively Assess Bone Drilling Using Radar Plots

“…A custom-made 3D-printed bone surrogate emulating a femur shaft was chosen as a test specimen (thickness: 5 mm and diameter: 35 mm). The 3D-printed bone surrogate was manufactured using a 2-step approach, as detailed previously 10 , 14 , 15 . The base geometry was first printed using a 3D-printable plaster and then infiltrated with a commercial epoxy to mimic the hardness of a young femur.…”

“…To address these issues, the authors in a previous study introduced a hybrid drilling system 10 . The system used 3D-printed bone surrogates that replicated a healthy human cortical bone to provide realistic drilling haptics and motion/force sensors to provide quantitative data.…”

“…Although the radar plots have previously been used to comprehensively evaluate residents' clinical competency 11 and health care data 12 , 13 , their application for assessing bone drilling performance is new. In the context of drilling, the previous study had identified that overshoot, drilling time, and drilling force are effective metrics to distinguish expert and novice skill levels 10 . The current study extends on this research by incorporating stability and repeatability as additional parameters, resulting in a 5-factor radar plot for assessment.…”

Drill Bone with Both Hands: Plunge Depth and Accuracy with 4 Bracing Positions

“…The Accreditation Council for Graduate Medical Education considers bone drilling a "critical step" of core orthopaedic procedures and a Level 3 competency milestone required for graduation from an orthopaedic surgery residency 12 . Contemporary orthopaedic surgical education prioritizes instruction in bone drilling in a laboratory workshop environment using synthetic bone models or cadaveric tissue before actual performance on living patients [13][14][15][16][17][18][19][20] . Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] .…”

“…Contemporary orthopaedic surgical education prioritizes instruction in bone drilling in a laboratory workshop environment using synthetic bone models or cadaveric tissue before actual performance on living patients [13][14][15][16][17][18][19][20] . Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] . Equipment factors 1,[21][22][23][24] and surgical technique [13][14][15]17,20,21 also influence performance.…”