Discussion On the Shortcomings of Traditional Orthopedic Drilling

As published on Bonezone: “Surgical Drilling: Surgeon Perspective on Improving Care Standards”

July 19, 2021

As shared on Bonezonepub.com, orthopedic surgery consists of operations performed to address problems that develop in the bones, joints and ligaments of the human body. Dr. Badia provides his perspective on improving care standards in surgical drilling.

Some takeaways from the article:

• Every bone is different, and in patients with soft, comminuted or poor-quality bone, it becomes increasingly difficult to gauge the location of the second cortex to know when to stop drilling.
• Tactile feedback is subjective, and often dependent on the condition of each patient’s varying bone health, density and configuration.
• Anatomically, it is clear that critical neurovascular structures are at risk for injury while drilling the clavicle.
• Perforating one or more of these structures can lead to surgical complications, injury or even death.
• Standard drilling technique in orthopedics has not changed significantly over the years.
• The patient will benefit when cutting-edge technology is adopted in the practice of surgical drilling.

One major hazard of drilling not discussed was the issue of plunging. Plunging occurs when the drill bit penetrates beyond the far cortex of the bone. This presents a risk of “plunging” into critical structures such as nerves or vessels. In standard orthopedic drilling, surgeons depend on tactile and auditory feedback to know when to halt progression of the drill. Between doctors, patients and environmental factors, tactile and auditory feedback can be subjective; therefore, surgeons may not always sense they have penetrated the far cortex.

The findings of this study focused on the importance of curvature, sharpness and material of drill bit tips, and how small adjustments to those can make a big difference when drilling through bone.

To read the full article by Alejandro Badia, M.D., please click here.

Please call (305)227-4263 to request an appointment with Dr. Alejandro Badia.

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Alejandro Badia, MD, FACS, FRCSI is a hand and upper extremity surgeon at Badia Hand to Shoulder Center in Doral, Florida. He is past president of the International Society for Sport Traumatology of the Hand (ISSPORTH) and is a member of several orthopedic societies (AAOS, ASSH, AAHS, EWAS). He is currently focused on improving healthcare delivery in the orthopedics and sports medicine realm, including providing safe access to orthopedic care via their specialized telemedicine program at www.orthonowlive.com.