Effect of Drilling Techniques on Microcracks and Pull-Out Strength of Cortical Screw Fixed in Human Tibia: An In-Vitro Study.

Abstract

The strength between the cortical screw and bone following an orthopaedic implant surgery is an important determinant for the success of osteosynthesis. An excessive axial cutting force during drilling produces microcracks in the bone surface, resulting in reduced strength between the screw and bone, resulting in loosening of implant. The present work, investigates the influence of drilling parameters on microcracks generated in the drilled surface and pull-out strength of screw fixed in cortical bone of human tibia. The holes were drilled by two different techniques: conventional surgical bone drilling (CSBD) and rotary ultrasonic bone drilling (RUBD), by a recently developed operation theatre (OT) compatible machine. Cutting force generated in drilling of human tibia using RUBD was 30-40% lesser than that of CSBD. Scanning electron microscopy (SEM) also revealed that RUBD produced significantly lesser and thinner microcracks than that of CSBD in human bones. Biomechanical pull-out test results showed that, the pull-out strength of screws inserted into drilled holes by RUBD was much higher (100-150%) than that of CSBD. A significant difference in pull-out strength (p < 0.05) between RUBD and CSBD was revealed by statistical analysis at 95% confidence interval.