Abstract
Thermal osteonecrosis is the in situ death of bone tissue as a result of excessively high temperatures. While the exact temperature at which thermal osteonecrosis occurs has not yet been determined, 50°C is the accepted critical value, as bone regeneration is almost completely impaired from this point on. Thermal osteonecrosis is a significant concern in orthopedic surgery, as it can compromise the bone-implant interface in fracture fixation, which, by definition, is a complication.A literature review was undertaken of the pertinent literature concerning heat generation from bone drilling and how this heat affects bone tissue. The Pubmed, ScienceDirect, and secondary (Cochrane Library) databases were searched up to December 2017 using keywords with the appropriate use of Boolean operators. Both simple text word searching and thesaurus searching were used to maximize the number of relevant articles retrieved. Reference tracking was performed via the retrieved articles to further extend the boundaries of the search. The level of evidence was Level V.It was identified that factors affecting heat generation during bone drilling were multifactorial and did not act independently of each other. Good quality evidence exists that both bone drilling parameters and the drill itself affect heat generation in bone during bone drilling. However, external irrigation is the most important variable and should always be used to keep the bone temperature below the critical value of 50°C.Future studies should focus on how the parameters of bone drilling interact with each other and how this influences heat generation in bone drilling. There is also a lack of in vivo studies on the human bone; this too should be further investigated.
Highlights
BackgroundThe treatment of bone fractures has existed ever since the practice of medicine began
A literature review was undertaken of the pertinent literature concerning heat generation from bone drilling and how this heat affects bone tissue
High-speed bone drilling is the predominant cause of thermal bone necrosis
Summary
The treatment of bone fractures has existed ever since the practice of medicine began. Many factors have been studied in an attempt to reduce heat generation; this includes alternative drill designs, drilling parameters, and cooling techniques. These materials interact, resulting in complex thermal and physical properties, making the tissue challenging to study due to its sensitivity to specimen preparation and conditions [10] These factors do not influence bone temperature changes independently but, are all interrelated. The three-fluted drills did not, result in a reduction in heat generation or in decreased rates of screw loosening [12]. Thompson’s original study showing that drilling speed is proportional to temperature increase found that speeds of less than 250 rpm caused increased fragmentation around the surface of the drilling holes, further proving the importance of bone drilling parameters in ensuring successful osteosynthesis. While they acknowledged and explored the myriad of variables that influence bone temperature during drilling, they concluded that external irrigation with saline is the most important factor in preventing increases in bone temperature during drilling and went so far as to declare external irrigation mandatory
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