Cortical bone drilling and thermal osteonecrosis

Background Bone fracture treatment usually involves restoring of the fractured parts to their initial position and immobilizing them until the healing takes place. Drilling of bone is common to produce hole for screw insertion to fix the fractured parts for immobilization. Orthopaedic drilling during surgical process causes increase in the bone temperature and forces which can cause osteonecrosis reducing the stability and strength of the fixation. Methods A comprehensive review of all the relevant investigations carried on bone drilling is conducted. The experimental method used, results obtained and the conclusions made by the various researchers are described and compared. Result Review suggests that the further improvement in the area of bone drilling is possible. The systematic review identified several consequential factors (drilling parameters and drill specifications) affecting bone drilling on which there no general agreement among investigators or are not adequately evaluated. These factors are highlighted and use of more advanced methods of drilling is accentuated. The use of more precise experimental set up which resembles the actual situation and the development of automated bone drilling system to minimize human error is addressed. Conclusion In this review, an attempt has been made to systematically organize the research investigations conducted on bone drilling. Methods of treatment of bone fracture, studies on the determination of the threshold for thermal osteonecrosis, studies on the parameters influencing bone drilling and methods of the temperature measurement used are reviewed and the future work for the further improvement of bone drilling process is highlighted.

Drilling of bone: A comprehensive review.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jor.20905

Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair.

https://www.cell.com/biophysj/pdf/S0006-3495(11)00479-6.pdf

Thermal denaturation studies of collagen by microthermal analysis and atomic force microscopy

From a wide range of bibliography (148 publications composed by books, guidelines, scientific papers, and other documents), the study presents a critical review of the use of the infrared thermography (IRT) survey in the building energy audit. After explaining its historical growth, the applicability of passive and active approaches has been described, considering well-established and emerging techniques, general procedures, types of IR-camera used, technical issues, and limitations. The passive approach is the most common to detect thermally significant defects. Thus, a specific procedure for the energy audit has been reported, matching different standards, guidelines, and professional advice. Similarly, recurring energy related problems are toughly presented (i.e. thermal characterization of buildings; thermal bridging, insulation level, air leakage and moisture detection; indoor temperature and U-value measurements; human comfort assessment). Finally, advantages and potential sources of errors as well as future trends in the use of IRT for the energy audit have been described. The research aims to serve as a reference for energy auditors and thermographers, to decide upon the best procedure for detecting specific energy defects.

Applications of the infrared thermography in the energy audit of buildings: A review

During the drilling of the bone, the temperature could increase above 47°C and cause irreversible osteonecrosis. The result is weakened contact of implants with bone and possible loss of rigid fixation. The aim of this study was to find an optimal condition where the increase in bone temperature during bone drilling process would be minimal. Influence of different drill parameters was evaluated on the increase of bone temperature. Drill diameters were 2.5, 3.2 and 4.5 mm; drill speed 188, 462, 1,140 and 1,820 rpm; feed-rate 24, 56, 84 and 196 mm/min; drill point angle 80°, 100° and 120° and external irrigation with water of 26°C. Combinations of drill speed and drill diameter with the use of external irrigation produced temperatures far below critical. Without external irrigation, temperature values for the same combination of parameters ranged 31.4–55.5°C. Temperatures above critical were recorded using 4.5 mm drill with higher drill speeds (1,140 and 1,820 rpm). There was no statistical significance of different drill point angles on the increase or decrease of bone temperature. The higher the feed-rate the lower the increase of bone temperature. The external irrigation is the most important cooling factor. With all combinations of parameters used, external irrigation maintained the bone temperature below 47°C. The increase in drill diameter and drill speed caused increase in bone temperature. The changes in drill point angle did not show significant influence in the increase of the bone temperature. With the increase in feed-rate, increase in bone temperature is lower.

Thermal osteonecrosis and bone drilling parameters revisited

During the drilling of the bone, the temperature could increase above 47°C and cause irreversible osteonecrosis. The spatial distribution of increase in bone temperature could only be presumed using several thermocouples around the drilling site. The aim of this study was to use infrared thermographic camera for determination of spatial distribution of increase in bone temperature during drilling. One combination of drill parameters was used (drill diameter 4.5 mm; drill speed 1,820 rpm; feed-rate 84 mm/min; drill point angle 100°) without external irrigation on room temperature of 26°C. The increase in bone temperature during drilling was analyzed with infrared thermographic camera in two perpendicular planes. Thermographic pictures were taken before drilling, during drilling with measurement of maximal temperature values and after extraction of the drill from the bone. The thermographic picture shows that the increase in bone temperature has irregular shape with maximal increase along cortical bone, which is the most compact component of the bone. The width of this area with the temperature above critical level is three times broader than the width of cortical bone. From the front, the distribution of increase in bone temperature follows the form of the cortical bone (segment of a ring), which is the most compact part and causes the highest resistance to drilling and subsequent friction. Thermography showed that increase in bone temperature spreads through cortical bone, which is the most compact and dense part, and generates highest frictional heat during drilling. The medullar cavity, because of its gelatinous structure, contributes only to thermal dissipation.

Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report.

This paper describes a knowledge-based system for the non-destructive diagnostics of facade isolation. The system uses the fusion of information extracted from images obtained from two electromagnetic wavebands: from low-resolution IR images (320x240 pixels; [email protected] wavelength), and from high-resolution visual RGB images (3264x2448 pixels; [email protected] wavelength). The fusion of the information is a perquisite for the design of an efficient knowledge-based system for non-destructive testing and facade diagnostics. In the paper, special attention is devoted to the following knowledge-based system components: system-core components (the database, the knowledge base, the inference engine, and the user interface) and application-specific components (image acquisition, the resolution pyramid, image pre-processing and feature extraction, image registration, object segmentation, fusion, and data analysis). Examples of the non-destructive testing and the facade diagnostics obtained with the system are presented.

https://bib.irb.hr/datoteka/327508.SCI-clanak.pdf

A knowledge-based system for the non-destructive diagnostics of façade isolation using the information fusion of visual and IR images

Bone drilling is a frequent procedure applied as a first step for immobilisation of bone fracture. The next step is insertion of immobilization screws and plates. The drilling is performed with surgical drills. If the amount of heat, generated by drilling process, increases the temperature of the bone tissue above the critical limit, possible outcome (it may result in) is thermal necrosis. This paper presents the results of research conducted in order to establish a distribution of temperature fields in the region around drilled bore .Obtained results confirm the ranking of different drill types established by comparing cutting forces and maximal bone drilling temperature.

Denis Stjepan Vedrina

Papers

Thermal osteonecrosis and bone drilling parameters revisited

Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report.

A knowledge-based system for the non-destructive diagnostics of façade isolation using the information fusion of visual and IR images

Termographic measurement at bone drilling process