In vitro assessment of aiming bias in the frontal plane during orthopaedic drilling procedures

Abstract

Drilling trials were performed using drilling boards incorporating pairs of 22 mm polyethylene tubes mounted horizontally. The tubes were premarked with 20, 0.5 mm deep notches along the centre of their upper surface representing the starting point for each drilling trial. Volunteers were instructed to drill 20 straight holes across the tube until they penetrated both walls. Kirschner wires were inserted through each of the drill holes until they made indentations into the base board. Deviation of each mark from mid-line was measured using digital callipers. The measured values were used to calculate deviation angles to the left (negative values) or right (positive values). Trials were performed with the drill and guide held in the surgeon's line-of-sight (LOS) and with 300 mm offset (OFF). A systematic error (aiming bias) was identified in all individuals. Overall, left-hander's drilling action was skewed to the left and right-hander's drilling action was skewed to the right. Using LOS technique, mean overall bias was 2.3° (range 0°-7.7°) to the left for left-handers and 1.5(o) (range 0.3°-3.1°) to the right for right-handers. Surprisingly, aiming bias was greater for LOS than for OFF, although the difference for this comparison was not statistically significant.

Can a surgeon drill accurately at a specified angle?

“…Another recent study assessed the ability of 14 qualified veterinary surgeons to drill holes free hand at 90° from the horizontal ( Sparrow and others 2015 ). They identified a systematic error in all individuals and found that left-handed individuals had a mean aiming bias of 2.3° (range 0–7.7°) to the left and right-handed individuals had a mean aiming bias of 1.5° (range 0.3–3.1°) to the right.…”

Minimally invasive lag screw fixation of sacroiliac luxation/fracture using a dedicated novel instrument system: Apparatus and technique description

“…Currently established MIO techniques may still result in screw malalignment subsequent to human errors as the surgeon is attempting to manually maintain the initial position and orientation of the drill guide during drilling . Human error while drilling has been identified as a source of inaccuracy in orthopedic surgery and neurosurgery . Although they are not specific to a surgical procedure, drilling inaccuracies may be increasingly relevant in the case of SIL/F repair because of small size and dimensions of the safe sacral implantation corridor .…”

“…2,3,9 Human error while drilling has been identified as a source of inaccuracy in orthopedic surgery and neurosurgery. 20 Although they are not specific to a surgical procedure, drilling inaccuracies may be increasingly relevant in the case of SIL/F repair because of small size and dimensions of the safe sacral implantation corridor. [15][16][17] Poorly oriented screws may cause iatrogenic damage to the cauda equina dorsally, the lumbosacral intervertebral disc space cranially, or the lumbosacral plexus and median sacral vessels ventrally.…”

“…Furthermore, although fluoroscopic guidance enables confirmation of initial drill guide orientation, successful screw placement ultimately relies on the surgeon's ability to maintain this optimal orientation while drilling. Aiming errors are a well‐recognized source of inaccuracy during drilling and represent an additional and critical limitation of current MIO repairs of SIL/F.…”

“…Furthermore, although fluoroscopic guidance enables confirmation of initial drill guide orientation, successful screw placement ultimately relies on the surgeon's ability to maintain this optimal orientation while drilling. Aiming errors are a well-recognized source of inaccuracy during drilling 17,20 and represent an additional and critical limitation of current MIO repairs of SIL/F. If safe and optimal results are to be consistently achieved with MIO of SIL/F, a procedure designed to provide stable reduction and accurate sacral screw placement while reducing exposure to radiation is warranted.…”