Methodical Approach for Determining the Length of Drill Channels in Osteosynthesis.

ABSTRACT

In order to fix a fracture in osteosynthesis, it is necessary to attach screws bicortically to the bone. The length of the screws must be selected correctly in 1-mm increments otherwise, injury to the surrounding tissue structure or insufficient fixation will result. The drill channel length can only be determined preoperatively to a limited extent and with insufficient accuracy and is therefore determined intraoperatively with a mechanical caliper gauge. This length determination is error-prone, which often leads to a false screw selection and at the same time to considerable complications in the healing process. A novel approach based on a sensory drive train was pursued, with which all mechanical drilling parameters were recorded and evaluated in combination with a length measurement that allows for determining the drill channel length. In order to overcome the limitations of previous drill concepts, a precise length measurement of the drill channel was introduced. The amplitude of a stimulated linear oscillation of the drill was monitored for drilling channel length measurements in order to reliably detect the beginning of the drilling process. The method provides the information required for handheld drilling without the limitation of constant drilling parameters. With initial results from laboratory tests with pig bones, the measurement method for the drill channel length has been validated on a test bench of the drilling machine. With the laboratory tests, a measurement uncertainty of 0.3 mm was achieved, so screws with a 1-mm step width can be reliably selected.