Over the past fifty plus years nothing has really changed regarding surgical drills. While orthopedic surgical drills have moved from a hand cranked drill to line powered to cordless; that has pretty much been the innovation. At the end of the day it is essentially the same drill design you buy in a big box store and consists of a drill with a Lithium Ion Battery, a drill chuck, and drill bit.
Integra Systems is currently working with a company that is designing the next generation intelligent “SMARTdrill” www.smartmeddevices.com After attending the American Academy of Orthopedic Surgeons Annual Meeting a few weeks ago these are my observations.
Unlike drilling in steel or wood, bones in the body have different densities. Todays surgeons use their expertise and training for drilling through bone. However, there are real challenges. First bone is comprised of the cortical (hard outer) and trabecular (soft inner). The surgeon desires not to go through the entire bone (called plunge) to the other side of the distal cortical that is ideal. However; plunging is considered just what happens..it is accepted practice. When you plunge through the bone (up to many mm), you risk vascular injury, nerve damage, and compartment syndromes. To reduce plunge surgeons push less and this slows the forward momentum. The result is heat generation of which can actually kill the trabecular component causing cell death and tissue injury. So the trade off is do you back off before reaching the distal cortex and reduce plunge, or generate heat?
This new drill provides real time feedback regarding drilling energy, bone strength, bone density, and thermodynamics. The technology demonstrated provided real time depth measurement and virtually eliminated the human error component that can cause the plunge. Density determination allows for the proper technique and implant for any particular patient. Calculation of bone drilling energy and screw insertion energy will lead the way into the new era of balanced fixation. Finally, there is the ability to provide performance feedback to detect dull cutting tools such as drill bits before any thermal damage is done to the bone. This product is pending FDA approval for sales in the United States
