Effects of Continuous Irrigation During Burring on Thermal Necrosis and Fusion Strength in a Rabbit Arthrodesis Model

Haddad, Steven L.; Hsu, Andrew R.; Templin, Cary R.; Ren, Yupeng; Stewart, Bruce; Kohli, Navjot; Zhang, Liqun

doi:10.1177/1071100714535767

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…This arrangement may have led to errors in temperature measurement as the ultimate location of the sensor tips could not be verified independently. Previous studies have reported that cooled saline might be more effective for minimizing temperature elevations during drilling 15,31 . The present study however did not evaluate effect of different irrigation saline temperatures in order to limit the number of variables in the study.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies have reported that cooled saline might be more effective for minimizing temperature elevations during drilling. 15,31 The present study however did not evaluate effect of different irrigation saline temperatures in order to limit the number of variables in the study. Bur type, rotation speed, and applied pressure are all factors that have been reported to influence temperature elevation during drilling.…”

Section: Discussionmentioning

confidence: 99%

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Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

Dongaonkar

Aoki

Zwueste³

et al. 2021

Veterinary Surgery

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Objective: To determine the influence of continuous and intermittent bolus irrigation on vertebral canal temperature during thoracolumbar hemilaminectomy. Study Design: Ex vivo study. Sample Population: Ten canine cadavers.Methods: Six consecutive thoracolumbar hemilaminectomies starting at T12-13 with alternating left-or right-side selection, and alternating continuous or intermittent bolus irrigation were performed in each dog resulting in 30 hemilaminectomies per irrigation technique. Drilling was performed for 15 s followed by a 10-s pause and resumed until completion of hemilaminectomy.Continuous irrigation consisted of saline delivered at 15 ml/min during drilling. Bolus irrigation consisted of manual delivery of 10 ml saline during the pause. Temperatures were recorded with two sensors placed within the vertebral canal adjacent to target hemilaminectomy site and compared between techniques with a linear mixed model. Results: Intermittent bolus irrigation was associated with lower peak vertebral canal temperatures (mean 15.7 C; range 9.4-23.3 C) than continuous irrigation (mean 16.7 C; range 9.6-27.6 C, p = .003) (mean difference of 1.1 C, p = .006). Similarly, mean vertebral canal temperatures remained lower when hemilaminectomies were performed under intermittent rather than continuous irrigation (mean difference of 0.48 C, p = .006, linear mixed model). Conclusion:Lower vertebral canal temperatures were maintained during hemilaminectomy with intermittent bolus rather than continuous irrigation. Clinical Significance: Both intermittent bolus and continuous irrigation are suitable to prevent elevations in canine vertebral canal temperature during hemilaminectomy.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

Dongaonkar

Aoki

Zwueste³

et al. 2021

Veterinary Surgery

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“…Although the use of continuous irrigation, such as with arthroscopy, may help decrease the risk of bone thermal necrosis and thereby reduce a risk factor for nonunion, irrigation would also wash away the bone slurry that may promote bony union. 7 Other techniques can also be used to reduce the risk of bone thermal necrosis, such as not using a tourniquet to allow patient blood flow to disperse the heat, as well as taking multiple pauses to avoid long durations of continuous burring. Second, with MIS joint arthrodesis, fixation constructs are frequently inserted through small incisions, thereby limiting hardware to screws or intramedullary nails.…”

Section: Discussionmentioning

confidence: 99%

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

et al. 2022

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Background: Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. Methods: Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. Results: Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. Conclusion: The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. Clinical Relevance: MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.

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“…In addition, it is known from studies by Haddad et al that cooling bones prior to deburring has a tendency to increase the fusion rate and bone strength after the healing process. It is therefore questionable whether cooling not only limits damage but also promotes bone healing [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Local heat generation during screw insertion into diaphyseal bone: a biomechanical study on different conditions (e.g. screw type, material, mode of insertion)

Paul

Frank

Raschke

et al. 2021

BMC Musculoskelet Disord

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Background The implantation of screws is a standard procedure in musculoskeletal surgery. Heat can induce thermal osteonecrosis, damage the bone and lead to secondary problems like implant loosening and secondary fractures. The aim of this study was to investigate whether screw insertion generates temperatures that can cause osteonecrosis. Methods We measured the temperature of twenty human femur diaphysis in a total of 120 measurements, while screws of different material (stainless steel and titanium alloy) and different design (locking and cortex screw) were inserted in three different screwing modes (manual vs. machine screwing at full and reduced rotational speed) with 6 thermocouples (3 cis and 3 trans cortex). Each was placed at a depth of 2 mm with a distance of 1.5 mm from the outer surface of the screw. Results The screw design (cortical > locking), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (hand insertion > machine insertion) have an influence on the increase in bone temperature. The screw material (steel > titanium), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (machine insertion > hand insertion) have an influence on the time needed to cool below critical temperature values. The combination of the two parameters (maximum temperature and cooling time), which is particularly critical for osteonecrosis, is found only at the trans-cortex. Conclusion Inserting a screw hast the potential to increase the temperature of the surrounding bone tissue above critical values and therefore can induce osteonecrosis. The trans-cortex is the critical area for the development of temperatures above the osteonecrosis threshold, making effective cooling by irrigation difficult. It would be conceivable to cool the borehole with cold saline solution before inserting the screw or to cool the screw in cold saline solution. If possible, insertion by hand should be considered.

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Effects of Continuous Irrigation During Burring on Thermal Necrosis and Fusion Strength in a Rabbit Arthrodesis Model

Abstract: Continuous chilled irrigation during bone preparation with burring may have a positive effect on fusion rate and fusion mass strength for arthrodesis procedures.

Cited by 12 publications

References 27 publications

Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

Local heat generation during screw insertion into diaphyseal bone: a biomechanical study on different conditions (e.g. screw type, material, mode of insertion)

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