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.

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

Cortical bone is semi-brittle and anisotropic, that brings a challenge to suppress vibration and avoid undesired fracture in precise cutting process in surgeries. In this paper, a novel analytical model is proposed to represent cortical bone cutting processes. The model is utilized to predict the chip formations, material removal behavior and cracks propagation under varying bone osteon cutting angles and depths. Series of orthogonal cutting experiments were conducted on cortical bone to investigate the impact of bone osteon cutting angle and depth of cut on cutting force, crack initialization and propagation. The observed chip morphology highly agreed with the prediction of chip formation based on the analytical model. The curly, serrated, grainy and powdery chips formed when the cutting angle was set as 0°, 60°, 90°, and 120°, respectively. Cortical bone were removed dominantly by shearing at a small depth of cut from 10 to 50 μm, and by a mixture of pealing, shearing, fracture and crushing at a large depth of cut over 100 μm at different bone osteon angles. Moreover, its fracture toughness was calculated based on measured cutting force. It is found that the fluctuation of cutting force is suppressed and the bone material becomes easy to remove, which attributes to lower fracture toughness at bone osteon cutting angle 0°. When the cutting direction develops a certain angle to bone osteon, the fracture toughness increases then the crack propagation is inhibited to some extent and the fluctuation of cutting force comparatively decreases. There is a theoretical and practical significance for tools design and operational parameters choice in surgeries.