The Publications Book
The Heidari Publications
94 publications · 23 years of research · click or drag a page corner to turn
Royal College
British Orthopaedic
AO Trauma
Churchill
Limb Recon
Specialist Reg.
Clement H, Heidari N, Grechenig W, Weinberg AM, Pichler W.
IntroductionDrilling is an integral part of almost all boney operations. Various anatomical structures coursing close to the bone are at risk if the drill bit projects beyond the far cortex. Aim of this study was to evaluate and quantify the depth to which surgeons over drill beyond the far cortex.Materials and methodsDuring an AO course 153 (41 females, 112 males) surgeons and physicians were invited to participate in this study. Each participant performed 3 bicortical drillings on generic artificial bone. Polystyrene plates were mounted on the far cortex of the bone to allow for exact measurement of the over penetration of the drill bit.ResultsA total of 462 bicortical drilling manoeuvres were analysed. The average projection of the drill bit beyond the far cortex was 6.31 mm. No significant statistical correlation was noted between the specialty or the experience of the participant and depth of over drilling.ConclusionsIt is remarkable that the mean and the range of far cortex over-penetration was quite similar amongst surgeons of differing grades and experience. The results of this study should return to mind to pay attention when drilling particularly in anatomical sites where nerve and vessels coursing close to the far cortex.
What did we look at?
How far the drill bit actually plunges past the far side of the bone when surgeons drill a hole during fracture surgery — and whether more experienced surgeons are any better at controlling that overshoot than less experienced ones.
Why did we look at it?
Drilling is one of the most ordinary steps in orthopaedic surgery, but on the far side of the bone there are often nerves, blood vessels and tendons. If the drill bit travels too far, those structures can be damaged. We wanted to measure, in a controlled setting, how big a problem this really is.
What did we find?
153 surgeons and doctors at a training course each performed three drillings on artificial bone with a sensor-plate fitted on the far side. On average, the drill bit projected just over 6 mm beyond the far cortex. There was no clear improvement with seniority — trainees and experienced surgeons over-drilled by similar amounts.
What does this mean for patients?
This is a small but real source of unintended injury during fracture surgery. The lesson for surgeons is to drill with deliberate care — particularly in places where important nerves and vessels lie just behind the bone. For patients, the message is that complications from over-drilling are recognised, and modern technique pays close attention to managing them.
Injury 2012;43(6):950-2. doi:10.1016/j.injury.2011.11.017