Notched K-wire for low thermal damage bone drilling

Liu, Yao; Belmont, Barry; Wang, Yiwen; Tai, Bruce L.; Holmes, James R.; Shih, Albert J.

doi:10.1016/j.medengphy.2017.04.001

Cited by 22 publications

(16 citation statements)

References 18 publications

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“…The orbital motion of the rotating K‐wire helped evacuation of bone debris, which carried away portion of heat from the cutting area. Heat reduction mechanism of this drilling technique was similar to the modified K‐wires with notched or fluted cutting tips . Due to the oscillation and vibration nature of the oscillatory mode, shaky drilling was spontaneous even if the surgeon tried to apply constant thrust force on the hand drill.…”

Section: Discussionmentioning

confidence: 98%

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Evaluation of Heat Generation in Unidirectional Versus Oscillatory Modes During K‐Wire Insertion in Bone

Luo

Chen

Finney

et al. 2019

Journal Orthopaedic Research

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Heat generation during insertion of Kirschner wires (K-wires) may lead to thermal osteonecrosis and can affect the construct fixation. Unidirectional and oscillatory drilling modes are options for K-wire insertion, but understanding of the difference in heat generation between the two modes is lacking. The goal of this study was to compare the temperature rise during K-wire insertion under these two modes and provide technical guidelines for K-wire placement to minimize thermal injury. Ten orthopedic surgeons were instructed to drill holes on hydrated ex vivo bovine bones under two modes. The drilling trials were evaluated in terms of temperature, thrust force, torque, drilling time, and tool wear. The analysis of variance showed that the oscillatory mode generated significantly lowered peak bone temperature rise (13% lower mean value, p = 0.036) over significantly longer drilling time (46% higher mean time, p < 0.001) than the unidirectional mode. Drilling time had significant effect on peak bone temperature rise under both modes (p < 0.001) and impact of peak thrust force was significant under oscillatory mode (p < 0.001). These findings suggest that the drilling mode choice is a compromise between peak temperature and bone exposure time. Shortening the drilling time was the key under both modes to minimize temperature rise and thermal necrosis risk. To achieve faster drilling, technique analysis found that "shaky" and intermittent drilling with moderate thrust force are preferred techniques by small vibration of the drill about the K-wire axis and slight lift-up of the K-wire once or twice during drilling.

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Section: Discussionmentioning

confidence: 98%

“…Also, they found that trocar tip K‐wires generated higher temperature than diamond tip ones. Liu et al modified trocar tip K‐wires with notches for debris evacuation and reported reduced bone temperature rise.…”

mentioning

confidence: 99%

Evaluation of Heat Generation in Unidirectional Versus Oscillatory Modes During K‐Wire Insertion in Bone

Luo

Chen

Finney

et al. 2019

Journal Orthopaedic Research

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“…These shapes facilitate the evacuation performance of bone chips. 119,187 For example, a conventional flute (flute area of 45-55% compared to diameter) is sufficient to remove chips in the general drilling. 171 A parabolic flute provides broader flute space than the conventional flute and, therefore, improves the chip evacuation.…”

Section: Flutementioning

confidence: 99%

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

Akhbar

Sulong

2020

Ann Biomed Eng

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As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a onestop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.

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“…C) and notches (Fig. D) to improve the debris evacuation and lower bone temperature rise was observed using these modified K‐wires . Learning from surgical twist drills, Piska et al developed a new point configuration called the Medin K‐wire, as shown in Figure E.…”

mentioning

confidence: 99%

“…1D) to improve the debris evacuation and lower bone temperature rise was observed using these modified K-wires. 11,12 Learning from surgical twist drills, Piska et al 13 developed a new point configuration called the Medin K-wire, as shown in Figure 1E. Two short segments of steep flutes were created at the drill tip to change the rake geometry and evacuate the bone debris during drilling.…”

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confidence: 99%

Hollow Notched K‐Wires for Bone Drilling With Through‐Tool Cooling

Luo

Chen

Shih

2019

Journal Orthopaedic Research

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Kirschner wire (K‐wire) is a common tool in clinical orthopedic surgery for bone fracture fixation. A significant amount of heat is generated in bone drilling using K‐wires, causing bone thermal necrosis and osteonecrosis. To minimize the temperature rise, a hollow notched K‐wire in a modified surgical hand drill with through‐tool cooling was developed to study the bone temperature, debris evacuation, and material removal rate. The hollow notched K‐wire was fabricated by grinding and micro‐milling on a stainless steel tube. Bone drilling tests were conducted to evaluate its performance against the solid K‐wires. Results showed that compared with solid K‐wires, hollow notched K‐wire drilling without cooling reduced the peak bone temperature rise, thrust force, and torque by 42%, 59%, and 62% correspondingly. The through‐tool compressed air reduced the peak bone temperature rise by 48% with the forced air convection and better debris evacuation. The through‐tool water cooling decreased the bone temperature by only 26% due to accumulation and blockage of bone debris in the groove and channel. This study demonstrated the benefit of using the hollow notched K‐wire with through‐tool compressed air to prevent the bone thermal necrosis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2297–2306, 2019

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Notched K-wire for low thermal damage bone drilling

Cited by 22 publications

References 18 publications

Evaluation of Heat Generation in Unidirectional Versus Oscillatory Modes During K‐Wire Insertion in Bone

Evaluation of Heat Generation in Unidirectional Versus Oscillatory Modes During K‐Wire Insertion in Bone

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

Hollow Notched K‐Wires for Bone Drilling With Through‐Tool Cooling

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