For the placement of screws and pins to stabilize complex bone fractures, some surgical procedures apply the drilling of holes through the cortical bone. Do surgeons make use of drill guides, and does anyone know which drilling angles can be applied without slipping sideways over the bone surface?
Any cues related to tools and procedures are very welcome.
I am not sure about every orthopaedic surgeon, but i always use drill guides
Ms Leferink,
If you would like to have a basic answer of your question you should find and read the classic book of the AO by M. Mueller et al. See below.
https://books.google.bg/books?id=CYrGD9ucnyMC&printsec=frontcover&dq=manual+of+internal+fixation&hl=bg&sa=X&ei=_noJVe_7DsHOaKPjgIAM&redir_esc=y#v=onepage&q=manual%20of%20internal%20fixation&f=false
I am also using always drill guides, because with them you can do more precize op.
Drill guides are used frequently by surgeons I've worked with and by myself. For a very oblique angle, you start the drill hole with the drill aimed in a direction that won't slip then change the direction once the drill tip has a 'foot-hold' in the bone.
the AO manual demands the use of drill guides always when drilling for plate screws
the drill guide center the hole in the plate hole and also avoid soft tissue damage , and a more pricesi drill , without wobbling the drill bit and make a bigger hole
The use of drill guides in orthopedic surgery is intended for 2 purposes: first to avoid a damage too the surrounding soft tissues, second to have more precise positioning of the perforation. When you drill a surface the slipping of the tip of the drill bit is due to many aspects: the hardness of the surface (more frequent if you drill a compact bone of a young subject), the curve of the surface (more frequent on convex surfaces), the diameter of the bit (worse if large), the speed of the drill (worse if veri vast), the pressure you can exert on the drill, the incident angle of the rill bit, the stability of the hands that hold the drill (it depends often on the weight of the drill, the angle of perforation, the strength of the driller...).
The use of a drill guide can give generally only more stability in holding the position, but not on the other aspect, unless the guide has some spikes to fix it on the bone surface.
If your need is only to avoid a slipping of the tipi, you can use this simple strategy: with a very sharp and hard punch make a little incision where you want to do the perforation. The tip of the bit, if you start slowly with the drilling (a drill with a speed regulator is essential) will not go out of the little indentation you did and the perforation will be exactly where you want.
I totally agree with all of the responses.
Not everybody use drill guides, but it's an error to not use it !
- more precise gesture
- protection of soft tissues
- center, or not the hole in the hole plate (compression plates)
- perfectly center the guide in the biggest hole (proximal cortical) when drilling the distal cortical with the smaller drill, for a compression screw
Every explanations in the AO books
agree! only the surgeons with highest self-esteem dont use drill guides.
I agree with you the only reason to do not use a guide drill is indolence.
The use of a drill guide always makes easier to drill the bone.
Nonetheless if you want to make a hole with a sharp angle it is necessary sometimes to have a very sharp point to make, without any motorized rotation, an initial little perforation.
The angles where slippage starts to occur depend in part on how new the bit is - the centre "tooth" starts very sharp in a new bit and means one can angle one's hands quite a lot before it disengages and allows the bit to slip. Once a bit's blunted, it's less forgiving and slips more readily, which is a good reason to have it in a guide.
Of course!
Drill guides are very important first of all for tissue protection, secondly - an that is your concern - to stabilize the drill / secure the angle. In this respect pointed drill guides are helpful. However, there are also special drill guides for plate plate osteosynthesis (e.g. for DC plates- and even more important for locking plates.
We have to differentiate between drill guide and the sleeve for drill pit.
Drill guide is used when I am applying the screw in the plate specially DCP. they have 2 types: centric guide to make the screw central in the oval hole of the DCP and eccentric guide to make the screw eccentric in the oval screw of the DCP (to obtain the axial compression.
Drill sleeve: used if I want to apply the screw to the bone without Plate (e.g lag screw) but also sometimes with plate. The sleeve protect the soft tissue , helping to prevent the slippage of the drill pit ( through the spikes at its front. for each size of the drill pit there is size-matching sleeve and this used to make perfect lag screw without missing the far cortex during the tightening of the lag screw.
regarding the prevention of the slippage of the drill pit during application of an angled screw :The use of drill sleeve will help if you have experience to control the both hands at same time because sometimes especially for the less experienced colleagues the drill pit and the sleeve slipped. What can man do is, use the sleeve and the pit at 1st perpendicular to the bone ( easier to compress the sleeve against bone) and drill few turns to make rough point and then angel the drill and the sleeve to the desired angel. you will find that the drilling will be easier.
- Badges
- Science topic
- Similar topics
- Biological Science
- Physiology
- Physiological Processes
- Stress