To Improve Your Surgical Drilling Skills, Make Use of Your Index Fingers

Abstract

Background Surgery has greatly benefited from various technologic advancements over the past decades. Surgery remains, however, mostly manual labor performed by welltrained surgeons. Little research has focused on improving osseous drilling techniques. The objective of this study was to compare the accuracy and precision of different orthopaedic drilling techniques involving the use of both index fingers. Questions/purposes (1) Does the shooting grip technique and aiming at the contralateral index finger improve accuracy and precision in drilling? (2) Is the effect of drilling technique on accuracy and precision affected by the experience level of the performer? Methods This study included 36 participants from two Dutch training hospitals who were subdivided into three groups (N = 12 per group) based on their surgical Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Intraoperative Kirschner Wire Breakage in a Pediatric Supracondylar Humerus Fracture

“…As per Aernout and co-authors, positioning the index finger of the opposite hand just behind the aimed exit point when drilling in the bone improves the results due to the benefit of proprioception [ 9 ]. Also during drilling, if the angle is kept more than 45° measuring from the horizontal articular surface (also called the minimal critical angle), it avoids slippage of the wires over the opposite cortex.…”

CORR Insights®: To Improve Your Surgical Drilling Skills, Make Use of Your Index Fingers

“…I suspect we all can agree that whatever we can do to make this important technical skill safer will be effort well spent. Langeveld and colleagues [4] have given us a good start. Remaining unanswered questions include whether and how to adjust drill technique when drilling perpendicularly or at an angle to cortical bone or when working with bones that are especially convex (which can result in skiving of the bit [1]), how to minimize soft-tissue damage during drilling in different anatomic regions, and how to prevent cortical blowout on the far side of a bone when drilling, which can reduce the strength of internal fixation constructs.…”

“…Regarding the protection of soft tissues, if one were to adopt the technique represented by Langeveld and colleagues here [4], new designs for protective drill sleeves may be needed;…”

“…T he mentor-apprentice relationship seen as the basis of surgical training 30 years ago has given way to technological advancements like surgical simulation training, which is becoming more-commonly integrated into some residency programs' curricula [5]. I believe the logical, practical study by Langeveld and colleagues [4] is another such advancement.…”

“…Enter Langeveld and colleagues [4], who conducted an intuitive study on bone models (Sawbones ® , Malmo, Sweden) that could change the way we teach drilling to our trainees. The authors tested four different drilling techniques, all of which involved the index fingers of both hands and found that drilling results were improved most by aligning the index finger with the drill bit and using the middle finger to pull the trigger while drilling toward the index finger of the opposite hand [4]. By advising to use the pointing fingers of both hands, Langeveld and colleagues have indirectly advocated for the principles of triangulation and improved drilling results in the study confirmed that the human brain can be trained to navigate better in a threedimensional (3-D) space.…”