Orthogonal cutting of cancellous bone with application to the harvesting of bone autograft

Characterization of an artificial skull cap for cranio-maxillofacial surgery training

Cranial grafts are favored to reconstruct skeletal defects because of their reduced resorption and their histocompatibility. Training possibilities for novice surgeons include the "learning by doing" on the patient, specimens or simulators. Although the acceptance of simulators is growing, the major drawback is the lack of validated bone models. The aim of this study was to create and validate a realistic skull cap model and to show superiority compared to a commercially available skull model. Characteristic forces during machinery procedures were recorded and thickness parameters from the bony layers were obtained. The thickness values of the bone layers of the developed parietal bone were comparable to the human ones. Differences between drilling and sawing forces of human and artificial bones were not detected using statistical analysis. In contrast the parameters of the commercially available skull model were significantly different. However, as a result, a model-based simulator for tabula externa graft lift training, consisting of a brain, skull bone cap and covering soft tissues was created. This simulator enables the training of all procedural steps of a "split thickness graft lift". In conclusion, an artificial skull cap suitable for parietal graft lift training was manufactured and validated against human parietal bones.

Parameters affecting mechanical and thermal responses in bone drilling: A review

Surgical bone drilling is performed variously to correct bone fractures, install prosthetics, or for therapeutic treatment. The primary concern in bone drilling is to extract donor bone sections and create receiving holes without damaging the bone tissue either mechanically or thermally. We review current results from experimental and theoretical studies to investigate the parameters related to such effects. This leads to a comprehensive understanding of the mechanical and thermal aspects of bone drilling to reduce their unwanted complications. This review examines the important bone-drilling parameters of bone structure, drill-bit geometry, operating conditions, and material evacuation, and considers the current techniques used in bone drilling. We then analyze the associated mechanical and thermal effects and their contributions to bone-drilling performance. In this review, we identify a favorable range for each parameter to reduce unwanted complications due to mechanical or thermal effects.

Effect of coring conditions on temperature rise in bone

Coring is a surgical procedure in bone biopsy retrieval and dental/orthopaedic procedures, which may cause thermal damage to bone tissues adjacent to the coring zone. This study was performed to determine the temperature rise in bone by coring using a semi-empirical thermocouple approach. Concurrently, a custom-made dynamometer was used to measure the cutting and thrust forces during coring bovine cortical bone samples. The experimental results indicated that the cutting force, cutting speed, and depth of cut significantly affect the temperature rise in the cutting zone during coring process. In addition, acute temperature rises in the cutting zone occurred when the cutting speed exceeded threshold levels. The limited capacity of heat dissipation during coring is most likely responsible for such a sharp temperature rise with increasing cutting speed. Moreover, it was observed that the maximum size of potential thermal damage zone could reach to 3.0 mm in depth from the surface of the coring hole, assuming that thermal damage would occur when the temperature is greater than 47°C. Thus, proper cutting conditions need to be selected to avoid the potential thermal damage to bone during the coring procedures.

Reducing temperature elevation of robotic bone drilling

This research work aims at reducing temperature elevation of bone drilling. An extensive experimental study was conducted which focused on the investigation of three main measures to reduce the temperature elevation as used in industry: irrigation, interval drilling and drill bit designs. Different external irrigation rates (0 ml/min, 15 ml/min, 30 ml/min), continuously drilled interval lengths (2 mm, 1 mm, 0.5 mm) as well as two drill bit designs were tested. A custom single flute drill bit was designed with a higher rake angle and smaller chisel edge to generate less heat compared to a standard surgical drill bit. A new experimental setup was developed to measure drilling forces and torques as well as the 2D temperature field at any depth using a high resolution thermal camera. The results show that external irrigation is a main factor to reduce temperature elevation due not primarily to its effect on cooling but rather due to the prevention of drill bit clogging. During drilling, the build up of bone material in the drill bit flutes result in excessive temperatures due to an increase in thrust forces and torques. Drilling in intervals allows the removal of bone chips and cleaning of flutes when the drill bit is extracted as well as cooling of the bone in-between intervals which limits the accumulation of heat. However, reducing the length of the drilled interval was found only to be beneficial for temperature reduction using the newly designed drill bit due to the improved cutting geometry. To evaluate possible tissue damage caused by the generated heat increase, cumulative equivalent minutes (CEM43) were calculated and it was found that the combination of small interval length (0.5 mm), high irrigation rate (30 ml/min) and the newly designed drill bit was the only parameter combination which allowed drilling below the time-thermal threshold for tissue damage. In conclusion, an optimized drilling method has been found which might also enable drilling in more delicate procedures such as that performed during minimally invasive robotic cochlear implantation.

Influence of a non-biodegradable porous structure on bone repair

Pore and interconnection size are two key structural parameters for bone tissue engineering scaffolds.

Sagittal Bone Saw With Orbital Blade Motion for Improved Cutting Efficiency

Sagittal bone saws are used by orthopedic surgeons for resection of bone; for example in total joint arthroplasty of the hip and knee. In order to prevent damage to surrounding tissue, sagittal saw blades typically oscillate through a small angle, resulting in reduced cutting rates due to short stroke lengths. To improve bone cutting efficiency, sagittal saws oscillate at high speeds, but this creates frictional heating that can harm bone cells. The focus of this research was to design a new sagittal sawing device for improved cutting efficiency. It was hypothesized that the addition of an impulsive thrust force during the cutting stroke would increase cutting rates in cortical bone. A cam-driven device was developed and tested in bovine cortical bone. The impulsive thrust force was achieved by creating a component of blade motion perpendicular to the cutting direction, i.e., orbital blade motion. At the start of each cutting stroke, the mechanism drove the saw blade into the surface of the bone, increasing the thrust force with the intention of increasing the depth of cut per tooth. As each cutting stroke was completed, the blade was retracted from the surface for the purpose of clearing bone chips. The design parameters investigated were cutting stroke length, thrust stroke length, and blade oscillation frequency. A three-factor, two-level design of experiments approach was used to simultaneously test for the effect of design parameters and their interactions on volumetric cutting rate (n = 32). The addition of orbital blade motion to the sagittal saw improved bone cutting rates over traditional oscillatory motion, especially at lower cutting stroke lengths and higher oscillation frequencies (p < 0.05). However, the magnitude of orbital blade motion based on thrust stroke length was limited by a threshold value of approximately 0.10 mm that when exceeded caused the sagittal saw to rebound from the surface of the bone causing erratic cutting conditions. The factor with the greatest positive effect on cutting rate was oscillation frequency. Cutting rates in cortical bone can be improved with the proposed orbital action sagittal saw.

Rounded Cutting Edge Model for the Prediction of Bone Sawing Forces

A new analytical model to predict bone sawing forces is presented. Development of the model was based on the concept of a single tooth sawing at a depth of cut less than the cutting edge radius. A variable friction model was incorporated as well as elastic Hertzian contact stress to determine a lower bound for the integration limits. A new high speed linear apparatus was developed to simulate cutting edge speeds encountered with sagittal and reciprocating bone saws. Orthogonal cutting experiments in bovine cortical bone were conducted for comparison to the model. A design of the experiment’s approach was utilized with linear cutting speeds between 2600 and 6200 mm/s for depths of cut between 2.5 and 10 μm. Resultant forces from the design of experiments were in the range of 8 to 11 N, with higher forces at greater depths of cut. Model predictions for resultant force magnitude were generally within one standard deviation of the measured force. However, the model consistently predicted a thrust to cutting force ratio that was greater than measured. Consequently, resultant force angles predicted by the model were generally 20 deg higher than calculated from experimental thrust and cutting force measurements.

An intelligent method for identifying otological drill slippage

An otological drill is a fundamental apparatus used for bone-milling in ear surgery. A common problem in bone-milling is that the drill bit slips on the bone surface. To improve the operational safety of such a surgery, this article presents a new apparatus combined with an intelligent method for identifying drill slippage. A two-axis force sensor is installed on a modified drill, and it detects the force of the bone's reaction to the drill bit. By integrating the unit reaction forces of the bone and the drill bit on the contact area, the functions of the force signals are deduced, which can reflect changes in the milling parameters. Based upon these functions, the slippage force, which is an important factor in drill slippage, is then extracted. An adaptive filter is specially designed to suppress interference in the slippage force. Drill slippage can be identified by calculating the variations in the filtering results. Five surgeons were invited to carry out an experiment in which they used this method on calvarian bones. Their average recognition rate of drill slippage was 86%, and only 1% of normal millings were identified as milling faults.

An evaluation of the processing conditions, structure, and properties (biaxial flexural strength and antibacterial efficacy) of sintered strontium–zinc–silicate glass ceramics

The use of artificial bone grafts has increased in order to satisfy a growing demand for bone replacement materials. Initial mechanical stability of synthetic bone grafts is very advantageous for certain clinical applications. Coupled with the advantage of mechanical strength, a material with inherent antibacterial properties would be very beneficial. A series of strontium-doped zinc silicate (Ca–Sr–Na–Zn–Si) glass ceramics have been characterized in terms of their crystalline structure, biaxial flexural strength and antibacterial efficacy based on the identification of optimum sintering conditions. All three glass ceramics, namely, BT110, BT111, and BT112 were found to be fully crystalline, with BT111 and BT112 comprising of biocompatible crystalline phases. The biaxial flexural strengths of the three glass ceramics ranged from 70 to 149 MPa and were shown to be superior to those of clinically established ceramics in dry conditions and following incubation in simulated physiological conditions. The bacteriostatic effect for each glass ceramic was also established, where BT112 showed an inhibitory effect against three of the most common bacteria found at implantation sites, namely, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa. The results of the evaluation suggest that the materials studied offer advantages over current clinical materials and indicate the potential suitability of the glass ceramics as therapeutic bone grafts.

Analysis of Forces and Temperatures in Conventional and Ultrasonically-Assisted Cutting of Bone

Bone cutting is a frequently used procedure in orthopaedic and neuro surgeries. Current research on bone cutting is concerned with the efforts to decrease the forces generated during cutting the bone as well as temperature to avoid mechanical and thermal damage (bone necrosis) induced by surgical tools. The paper presents results of finite-element simulations of conventional cutting (CC) and ultrasonically-assisted cutting (UAC) of bone in order to understand thermomechanics of the process. The study was aimed at investigating the levels of tool-penetration force and temperatures induced in the bone when a hard cutting tool penetrates into it in both types of cutting. The models allow the quantitative analysis of forces and temperatures produced during the cutting process. The use of UAC reduces the tool penetration force and temperature in the cutting region