Analysis of the process parameters affecting the bone burring process: An in‐vitro porcine study

Thermal Damage in Orthopaedics

There are numerous potential sources of thermal damage encountered in orthopaedic surgery. An understanding of the preclinical mechanisms of thermal damage in tissues is necessary to minimize iatrogenic injuries and use these mechanisms therapeutically. Heat generation is a phenomenon that can be used to a surgeon's benefit, most commonly for hemostasis and local control of tumors. It is simultaneously one of the most dangerous by-products of orthopaedic techniques as a result of burring, drilling, cementation, and electrocautery and can severely damage tissues if used improperly. Similarly, cooling can be used to a surgeon's advantage in some orthopaedic subspecialties, but the potential for harm to tissues is also great. Understanding the potential of a given technique to rapidly alter local temperature-and the range of temperatures tolerated by a given tissue-is imperative to harness the power of heat and cold. In all subspecialties of orthopaedic surgery, thermal damage is a relevant topic that represents a direct connection between preclinical and clinical practice.

Bone cutting efficiency and heat generation using a traditional fluted Burr and a novel fluteless resurfacing tool

BACKGROUND

Powered instrumentation is often used for bone preparation and/or removal in many orthopaedic procedures but does risk thermogenesis. This study compares biomechanical properties of a fluted burr and a novel fluteless resurfacing tool.

METHODS

Twenty cadaveric metatarsals were tested with four predetermined cutting forces to evaluate heat generation and cutting rate for the fluted burr and fluteless resurfacing tool over 40 s or until a depth of 4 mm was reached. Cutting rate was calculated from displacement transducer data. Heat generation was measured by thermocouples placed in the bone adjacent to the burring site. Assuming a body temperature of 37 °C, a 10 °C increase in heat was used as the threshold of inducing osteonecrosis.

FINDINGS

At 1.0 N and 1.7 N, the thermal osteonecrosis threshold was reached at comparable times between burrs, while the bone removed by the resurfacing tool was on average five times greater than fluted burr at 1.0 N and over twice as great at 1.7 N. Statistical analysis of these common cutting forces showed the resurfacing tool had significantly higher cutting rates (P < 0.01). As a result, the fluted burr produced higher temperatures for the same amount of bone removal (P < 0.01).

INTERPRETATION

In a cadaveric study, the fluteless resurfacing tool demonstrated higher bone cutting rates and lower heat generation for the same amount of bone removed than a traditional fluted burr.

Assessment of heat generation and risk of thermal necrosis during bone burring by means of three-dimensional dynamic elastoplastic finite element modelling

During bone burring, the heat generated due to friction at the bone-burr interface may cause thermal damage to the bone. Therefore, it is necessary to assess bone temperature distribution around a burring site and identify high-risk regions for thermal necrosis due to bone burring. In this study, a three-dimensional (3-D) dynamic elastoplastic finite element model for the burring process was developed and experimentally validated to investigate the influence of burring parameters (rotational speeds: 3,000, 10,000, 15,000 and 60,000 rpm; feed rates: 0.5, 0.9, 1.5 and 3.0 mm/s) on heat generation and evaluate the risk region for thermal necrosis. Calculated bone temperatures were compared with experimental values and found to be in good agreement with them. The analytical results demonstrated a linear relationship between the burring time and friction energy. In addition, the friction energy increased with the bone temperature. The high-risk thermal necrosis zone was measured from the edge of burring (y-direction) at feed rates of 0.5, 0.9, 1.5 and 3.0 mm/s and was found to be 7.8, 7.3, 6.6 and 5.5 mm, respectively. When the burr rotational speed increased from 3,000 to 60,000 rpm, the high-risk zone for thermal necrosis increased from 4.5 to 8.1 mm. We concluded that both the friction energy and the bone temperature increased in proportion with the burr rotational speed. Reducing burr rotational speeds and/or increasing feed rates may decrease the rise in bone temperature, thus decreasing the potential for thermal necrosis near the burring site. Our model can be used to select the optimal surgery parameters to minimise the risk of thermal necrosis due to bone burring and to assist in the design of optimal orthopaedic drill handpieces.

In vivo evaluation of machining forces, torque, and bone quality during skull bone grinding

This study investigates neurosurgical bone grinding with varying parameters on skull bone using a miniature grinding burr. Three process parameters, namely, rotational speed, feed rate, and depth of cut, have been investigated at three different levels in the terms of tangential force, thrust force, and torque generated during grinding. The results revealed that as the rotational speed is increased, the cutting forces and torque showed a decreasing trend. Nevertheless, the increase in feed rate and depth of cut leads to the escalation in response characteristics. The best parametric combination for minimum cutting forces and torque is as follows: rotational speed = 55,000 r/min, feed rate = 20 mm/min, and depth of cut = 0.50 mm. Morphological analysis reveals cracks in the bone’s surface at a higher feed rate. Furthermore, delamination and cutting streaks are also visible on the surface of the bone after grinding. Energy-dispersive spectroscopy and elemental mapping of the tool after bone grinding indicate the accumulation of the bone chips in the successive diamond abrasives. The outcomes of the study will be beneficial for the neurosurgeons in understanding the effect of various process parameters on cutting force, toque, microcracks, and bone’s regeneration ability during surgical bone grinding.