An overview of thermal necrosis: present and future

Abstract

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 heat generation kills bone cells. Bone cell death results in resorption of bone around bone screws. Materials and methods: Many points of view of orthopaedists and neurosurgeons based upon on previous practices and clinical experience are presented. Results: Several potential complications are discussed and highlighted that lead to thermal necrosis. Discussion: Even in the face of growing evidence as to the negative effects of heatinduction during drilling, simple and effective methods for monitoring and cooling in realtime 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.

Translational medicine: Challenges and new orthopaedic vision (Mediouni-Model)

“…There are several key design and simulation approaches available to researchers, engineers, and analysts, including Computer-Aided Design (CAD). Finite Element Analysis (FEA) [18,19] is a numerical method which can calculates stresses and forces during the contact between structures. Using FEA, to avoid the problems of osteonecrosis, we can measure the temperature by estimating the parameters during drilling such as: speed of drill bit, feed rates, forces applied by the users (see A pelvic model and FEA defined variables to reduce heat generation and its consequence (threshold is 50°C), bone necrosis.…”

Surgical Drill Bit Design and Thermomechanical Damage in Bone Drilling: A Review

“…Over the years, researchers have published numerous bone drilling research, focusing on the drilling parameters, including several excellent review papers. 18,99,113,126,142,183 However, none has compiled and updated the works related to the development of drill bit design despite the growing interest in this topic.…”

“…140 In bone drilling, the bone structure is disrupted and exposed to the high temperature. Extreme heat limits the blood flow to the bone cells-elevated temperature coagulate blood and cause infarction loss to the blood flow 126 -which eventually kill the bone cells and induce thermal osteonecrosis (irreversible death of bone 67,121 ). This phenomenon exposes the bone to severe infection, 64 bone sequestra, 134 and absorption, 54,117 which lead to loosening the screws, 17 bone refracture, 44 and implant failure.…”

“…6 Many thermal osteonecrosis cases have been reported in orthopedics, dentistry, and neurosurgery. 94,116,120,126,135,154 The critical temperature (where thermal osteonecrosis starts) is both temperature and time-dependent. 55 The critical temperature level, where thermal osteonecrosis starts, has been a controversial point widely discussed in the literature.…”

Comprehensive analysis on orthopedic drilling: A state-of-the-art review

“…However, in the orthopedic field, costeffective and easy-to-apply systems are deficient in the application. 103 Larsen 22 used an irrigation flow rate of 10-80 mL/min and observed the temperature variation by changing the flow rate. The results have shown 80 mL/min as the optimal flow rate for minimum heat.…”