Mechanical and thermal damage in cortical bone drilling in vivo

Recently, the failure rate of fracture fixation to fractured bone has increased. Mechanical and thermal damage to the bone, which influences the contact area and cell growth between the bone and the screw, is the primary reason for fixation failure. However, research has mainly focused on force and temperature in bone drilling. In this study, the characteristics of hole edges, microcracks, empty lacunae, and osteon necrosis were investigated as viewed in the transverse and longitudinal sections after drilling. Drilling force and temperature were also recorded for comparing the relationship with mechanical and thermal damage. Experiments were conducted in vivo using five different drill geometries under the same drilling parameters. Characteristics of the hole wall were detected using computed tomography. Microcracks and necrosis were analyzed using the pathological sectioning method. The maximum microcrack was approximately 3000 and 1400 μm in the transverse section and longitudinal section, respectively, which were much larger than those observed in previous studies. Empty lacuna and osteon necrosis, starting from the Haversian canal, were also found. The drill bit geometry, chisel edge, flute number, edges, and steps had a strong effect on bone damage, particularly the chisel edge. The standard and classic surgical drill caused the greatest surface damage and necrosis of the five drill bit geometries studied. The microstructural features including osteons and matrix played an important role in numbers and length of microcracks and necrosis. More microcracks were generated in the transverse direction, while a greater length of the empty lacuna was generated in the longitudinal direction under the same drilling parameters. Microcracks mainly propagated in a straight manner in and parallel to the interstitial bone matrix and cement line. Drilling forces were not directly correlated with bone damage; thus, hole performance should be considered to evaluate the superiority and inferiority of drill bits rather than the drill force alone.