57 results match your criteria bicortical drilling


Anterior Odontoid Screw Fixation for Pediatric and Adolescent Odontoid Fractures: Single-Center Experience Over a Decade.

World Neurosurg 2021 Jun 21. Epub 2021 Jun 21.

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Objective: Management of pediatric odontoid fractures is tricky and controversial. This study will enrich world literature with intricacies of anterior odontoid screw (OS) fixation in the pediatric population learned over the last decade.

Methods: In this retrospective study, all patients with pediatric odontoid fracture who underwent anterior odontoid screw fixation from January 2010 to December 2019 were included and evaluated for surgical outcome. Read More

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Arthroscopic Biceps Tenodesis by Bicortical Drilling Technique.

Arthrosc Tech 2021 Apr 2;10(4):e941-e948. Epub 2021 Mar 2.

Department of Orthopaedics, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.

Pain arising from the long head of biceps tendon can cause significant disability of the shoulder. In young and physically demanding patients, biceps tenodesis is advised, in which the biceps tendon is cut from the native origin and fixed distally. Many methods have been proposed for this. Read More

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In-vitro trabecular bone damage following mono- and bicortical mini implants anchorage in mini-implant assisted rapid palatal expansion (MARPE).

Int Orthod 2021 Jun 30;19(2):243-251. Epub 2021 Mar 30.

Federal university of Rio de Janeiro, Department of Pedodontics and Orthodontics, Rio de Janeiro, Brazil. Electronic address:

Objectives: To assess in-vitro trabecular bone damage following mono- and bicortical mini-implant (MI) anchorage in mini-implant assisted rapid palatal expansion (MARPE).

Material And Methods: Sixteen self-drilling MI (four MARPE appliances) were distributed in two groups according to bone insertion (monocortical and bicortical) in bovine rib. The device was activated five times (0. Read More

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Miniscrew-assisted rapid palatal expansion (MARPE): how to achieve greater stability. In vitro study.

Dental Press J Orthod 2021 22;26(1):e211967. Epub 2021 Mar 22.

Universidade Federal do Rio de Janeiro, Departamento de Odontopediatria e Ortodontia (Rio de Janeiro/RJ, Brazil).

Objective: Assess the influence of mono- and bicortical anchorage and diameter of mini-implants (MIs) on the primary stability of these devices.

Methods: 60 self-drilling MIs were distributed in six groups according to diameter (1.5mm, 1. Read More

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Do Resident Surgical Volumes and Level of Training Correlate with Improved Performance on Psychomotor Skills Tasks: Construct Validity Testing of an ASSH Training Platform (STEP)?

JB JS Open Access 2021 Jan-Mar;6(1). Epub 2021 Feb 19.

Johns Hopkins Department of Orthopaedic Surgery, Baltimore, Maryland.

The Surgical Training and Educational Platform (STEP) was developed by the American Society for Surgery of the Hand (ASSH) as a cost-effective set of surgical simulation modules designed to assess critical skills in hand surgery. Previous study demonstrated that STEP can differentiate between novice trainees and board-certified, certificate of added qualification hand surgeons. The purpose of this study was to assess construct validity of STEP by testing its ability to differentiate psychomotor skill level among intermediate trainees. Read More

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February 2021

A Biomechanical Comparison of Locked Unicortical with Non-Locking Bicortical Screws for Metacarpal Shaft Fractures in a Randomized Human Cadaveric Model.

J Hand Surg Asian Pac Vol 2021 Mar;26(1):10-16

Auckland Regional Plastic, Reconstructive and Hand Surgery Unit, Middlemore Hospital, Auckland, New Zealand.

Locking plate fixation is widely used in large long bone fixation and is now available for small "long" bones in the hand. Potential advantages of unicortical locked fixation are reduced risk of over-drilling and therefore reduced risk of damage to surrounding structures and reduced risk of irritation from proud screws. Furthermore, unicortical fixation may be used where bicortical fixation is technically impossible. Read More

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Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy.

BMC Musculoskelet Disord 2021 Feb 8;22(1):157. Epub 2021 Feb 8.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Background: The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO. Read More

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February 2021

Plunging Dangerously: A Quantitative Assessment of Drilling the Clavicle.

Orthopedics 2021 Jan 7;44(1):e36-e42. Epub 2020 Dec 7.

Bicortical drilling of the clavicle is associated with risk of iatrogenic damage from plunging given the close proximity of neurovascular structures. This study determined plunge depth during superior-to-inferior clavicle drilling using a standard drill vs drill-sensing technology. Two orthopedic surgeons drilled 10 holes in a fresh cadaveric clavicle with drill-sensing technology in freehand mode (functions as standard orthopedic drill) and another 10 holes with drill-sensing technology in bicortical mode (drill motor stops when the second cortex is breached and depth is measured in real time). Read More

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January 2021

Feed rate control in robotic bone drilling process.

Proc Inst Mech Eng H 2021 Mar 24;235(3):273-280. Epub 2020 Nov 24.

Orthopedic and Trauma Clinical Centre, Ministry of Interior, Sofia, Bulgaria.

The bone drilling process is characterised by various parameters, the most important of which are the feed rate (mm/s) and the drill speed (rpm). They highly reflect the final effects and results of the drilling process, such as mechanical and thermal damages of bone tissue and hole quality. During manual drilling, these parameters are controlled by the surgeon based on his practical skills. Read More

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Establishing Validity of a Comprehensive Hand Surgical Training and Educational Platform (STEP).

J Hand Surg Am 2020 Dec 30;45(12):1105-1114. Epub 2020 Sep 30.

Departments of Orthopaedic Surgery, University of California, Irvine, Irvine, CA.

Purpose: The purpose of this study was to develop and perform the initial validation for the Surgical Training and Educational Platform (STEP), a cost-effective psychomotor training and assessment instrument designed to teach and evaluate fundamental skills considered critical to competency in hand surgery.

Methods: An American Society for Surgery of the Hand (ASSH) taskforce of 13 board-certified hand surgeons developed 8 skills considered fundamental to competency in hand surgery including: (1) lag screw fixation of an oblique fracture, (2) depth of plunge during bicortical drilling, (3) central axis scaphoid fixation, (4) phalangeal fracture pinning, (5) flexor tendon repair, (6) microsurgical suturing, (7) full-thickness skin graft harvest, and (8) wrist arthroscopy. The tasks were developed from commercially available, nonclinical supplies at low cost. Read More

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December 2020

A Dual-Motor Drill Reduces Plunge, Simultaneously Gauges Depth, and Saves Time When Placing Orthopedic Screws.

Orthopedics 2020 Sep 5;43(5):e465-e470. Epub 2020 Jun 5.

The technique for placement of orthopedic hardware remains unchanged despite technological advances. The surgeon controls drill bit speed and advancement, which risks drill bit overpenetration, or plunge. Measurement is performed as an additional step, introducing measurement error and increasing operative time. Read More

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September 2020

Suprapectoral biceps tenodesis with bicortical drilling procedures: anatomic analysis of chondral and axillary nerve risk with transhumeral pin guide.

J Shoulder Elbow Surg 2020 Jul 26;29(7):1435-1439. Epub 2020 Feb 26.

Clinica Las Condes, Santiago, Chile.

Background: Many biceps tenodesis (BT) procedures are described for treating proximal biceps pathology. Axillary nerve injury has been reported during BT using bicortical drilling techniques with variable results depending on the location. In addition, there is a risk of potential articular damage during suprapectoral BT. Read More

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Using Laser Range-finding to Measure Bore Depth in Surgical Drilling of Bone.

Clin Orthop Relat Res 2019 Nov;477(11):2579-2585

D. Demsey, N. J. Carr, Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada J. P. G. Arrunategui, A. J. Hodgson, Biomedical Engineering Program, University of British Columbia, Vancouver Campus, Vancouver, BC, Canada P. Guy, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.

Background: Measuring drilled bore depth in bone is an important part of osteosynthesis surgery. Current methods have substantial limitations in terms of reliability, leading to placement of incorrectly sized screws and unsatisfactory user experience.

Questions/purposes: (1) Can a prototype laser range-finder measure bore depth in bone as well as or better than a conventional depth gauge in terms of accuracy and precision (that is, variability)?

Methods: A conventional analog orthopaedic surgical depth gauge was compared with a laser range-finder-based prototype. Read More

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November 2019

A Novel Approach for Assessing and Training the Drilling Skills of Orthopaedic Surgeons.

J Bone Joint Surg Am 2019 Aug;101(16):e82

Department of Mechanical Engineering, New Mexico Tech, Socorro, New Mexico.

Background: Although experiences in the operating room can help surgeons to learn simple bone-drilling techniques, outside training may be better suited for complex procedures. We adapted a rotary handpiece to evaluate the bone-drilling skills of orthopaedic resident physicians during the 2017 Southwest Orthopaedic Trauma Association (SWOTA) motor skills course.

Methods: Twenty-five postgraduate year (PGY)-1 orthopaedic residents from 7 institutions were asked to perform a bicortical drilling task 3 times both before and after attending a motor skills course. Read More

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Real-Time Monitoring with a Controlled Advancement Drill May Decrease Plunge Depth.

J Bone Joint Surg Am 2019 Jul;101(13):1213-1218

Texas Scottish Rite Hospital for Children, Dallas, Texas.

Background: Although drill use is fundamental to orthopaedic surgery, the risk of plunging past the far cortex and potentially damaging the surrounding soft tissues remains unavoidable with conventional drilling methods. A dual motor drill may decrease that risk by providing controlled drill-bit advancement and real-time monitoring of depth and energy expenditure. We hypothesized that using the dual motor drill would decrease plunge depth regardless of the user's level of experience. Read More

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Drilling Technique Can Minimize Plunging.

J Orthop Trauma 2019 Aug;33(8):e309-e312

Department of Orthopaedic Surgery, University of California San Francisco.

Purpose: Vibratory and acoustic feedback, drill sharpness, and material density have each been shown to influence the depth of plunging when drilling through bicortical bone. We hypothesized that drilling technique can also influence the depth of plunging.

Methods: Six subjects of various training levels (PGY1 to 16-year experienced surgeon) were asked to drill through a cortical bone surrogate, third-generation Sawbones tube with similar density and compressive modulus of healthy cortical bone. Read More

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Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy.

Knee Surg Sports Traumatol Arthrosc 2020 May 5;28(5):1372-1379. Epub 2019 Mar 5.

Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Purpose: To assess the risk of injury to the neurovascular bundle on the interosseous membrane of the leg during drilling for distal screw insertion in open-wedge high tibial osteotomy (OWHTO), and to investigate the possible influence of the method of plate placement on the risk.

Methods: This retrospective study involved, 55 patients (32 with a TomoFix plate, 23 with a TriS plate) who underwent postoperative CT scanning of the knee following OWHTO between 2009 and 2018. The angle and position of the locking plate, and the direction of screw insertion relative to the interosseous membrane were analysed. Read More

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Anatomic Single-Incision Repair of Distal Biceps Tendon Ruptures Using Intramedullary Soft Anchors.

Arthrosc Tech 2018 Nov 22;7(11):e1177-e1180. Epub 2018 Oct 22.

Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A.

Distal biceps tendon ruptures are uncommon injuries responsible for only 3% of all injuries to the biceps tendon. For most of these cases, unless the patient is elderly or infirm, conservative management should be avoided and the injury should be treated with a surgical procedure to reattach the bicep tendon to the radial tuberosity. In this Technical Note and accompanying video, we describe an anatomic single-incision technique using 2 intramedullary soft anchors, which decreases the likelihood of complications associated with bicortical drilling and metal suspensory fixation. Read More

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November 2018

How to Avoid Posterior Interosseous Nerve Injury During Single-Incision Distal Biceps Repair Drilling.

Clin Orthop Relat Res 2019 02;477(2):424-431

D. Becker, N. Hammer, Anatomy Department, University of Otago, Dunedin, New Zealand F. A. Lopez-Marambio, Hamilton Hospital, Hamilton, New Zealand N. Hammer, Department of Orthopedic and Trauma Surgery, University of Leipzig, Germany Fraunhofer IWU, Dresden, Germany D. Kieser, Orthopaedics Department, Christchurch Public Hospital, Christchurch, New Zealand.

Background: The posterior interosseous nerve (PIN) is occasionally damaged during distal biceps tendon repair. But to our knowledge, no studies have examined the position of the PIN in relation to the bicipital tuberosity in full supination, which is the recommended position during single-incision distal biceps repair or reconstruction QUESTIONS/PURPOSES: (1) What is the anterior safe zone when exposing the anterior tuberosity with the arm in supination? (2) When drilling the radial tuberosity for bicortical button placement in full supination, how should the drill be angled to avoid PIN injury?

Methods: Fifteen adult cadaver elbows had the PIN dissected around the proximal radius. The position of the PIN was measured relative to the most ulnar aspect of the radius at three sites in full supination: at the bicipital tuberosity (bicipital tuberosity-PIN), 10 mm proximal to the bicipital tuberosity (bicipital tuberosity-proximal), and 10 mm distal to the bicipital tuberosity (bicipital tuberosity-distal). Read More

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February 2019

Posterior Interosseous Nerve Proximity to Cortical Button Implant for Distal Biceps Repair With Single and 2-Incision Approaches.

J Hand Surg Am 2019 Jul 6;44(7):613.e1-613.e6. Epub 2018 Oct 6.

Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY. Electronic address:

Purpose: Fixation with a cortical button is the biomechanically strongest surgical approach for distal biceps repair, and utilization of the 2-incision approach may provide a more anatomical repair and improved terminal supination strength. The risk of injury to the posterior interosseous nerve (PIN) associated with this approach requires further investigation.

Methods: A distal biceps repair with a cortical button was performed on 10 cadavers, 5 utilizing the single-incision approach and 5 utilizing the 2-incision approach. Read More

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Comparing biomechanical strength of unicortical locking plate versus bicortical compression plate for transverse midshaft metacarpal fracture.

J Orthop Surg (Hong Kong) 2018 May-Aug;26(3):2309499018802511

Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Purpose: Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Read More

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October 2019

Subpectoral biceps tenodesis using a novel anterior cortical button technique.

Shoulder Elbow 2018 Oct 4;10(4):292-295. Epub 2018 Jun 4.

Upper Limb Unit, Wrightington Hospital, Wigan, UK.

Background: Various surgical treatments are described in the literature for biceps pathology.

Method: The techniques currently described for subpectoral tenodesis involve the use of suture anchors, interference screws, bicortical suture buttons or unicortical suture buttons.

Results: A review of 31 patients with a subpectoral biceps tenodesis using the anterior cortical button technique is presented. Read More

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October 2018

Insertion Torque of Variable-Thread Tapered Implants in the Posterior Maxilla: A Clinical Study.

J Prosthodont 2019 Feb 4;28(2):e788-e794. Epub 2018 Sep 4.

Department of Periodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Lebanon.

Purpose: Primary stability is a key factor for successful implant osseointegration, especially in poor bone quality and early/immediate loading. In the immediate loading protocol, insertion torque values (ITVs) have been suggested to be the most valid prognostic factor for osseointegration of maxillary implants. The objectives of this study were to: (1) evaluate ITVs achieved by a variable-thread tapered implant in the posterior maxilla; and (2) assess the impact of bone quality, implant dimensions, bicortical anchorage, and implant location on ITVs. Read More

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February 2019

Monocortical fixation of the coracoid in the Latarjet procedure is significantly weaker than bicortical fixation.

Knee Surg Sports Traumatol Arthrosc 2019 Jan 13;27(1):239-244. Epub 2018 Jan 13.

Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Purpose: A crucial step of the Latarjet procedure is the fixation of the coracoid process onto the glenoid. Multiple problems associated with the fixation have been described, including lesions of the suprascapular nerve due to prominence of the screw or bicortical drilling. The purpose of the present study was to evaluate whether monocortical fixation, without perforating the posterior glenoid cortex, would provide sufficient graft stability. Read More

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January 2019

Unicortical self-drilling external fixator pins reduce thermal effects during pin insertion.

Eur J Trauma Emerg Surg 2018 Dec 14;44(6):939-946. Epub 2017 Dec 14.

Institute of Biomechanics, Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany.

Introduction: External fixation is associated with the risk of pin loosening and pin infection potentially associated to thermal bone necrosis during pin insertion.

Objective: This study aims to investigate if the use of external fixator systems with unicortical pins reduces the heat production during pin insertion compared to fixators with bicortical pins.

Methods: Porcine bone specimens were employed to determine bone temperatures during insertion of fixator pins. Read More

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December 2018

Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation.

J Surg Educ 2017 May - Jun;74(3):471-476. Epub 2016 Nov 7.

Department of Orthopaedic Surgery Carolinas Medical Center, Charlotte, North Carolina. Electronic address:

Introduction: Financial pressures and resident work hour regulations have led to adjunct means of resident education such as surgical simulation. The purpose of this study is to determine the effectiveness of a hands-on training session in orthopaedic drilling technique educational model during a surgical simulation on reducing drill plunging depth and to determine the effectiveness of senior residents teaching a hands-on training session in orthopaedic drilling technique.

Methods: A total of 13 participants (5 orthopaedic interns and 8 medical students) drilled until they penetrated the far cortex of a synthetic bone model and the plunging depth (PD) was measured. Read More

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Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study.

Surg Radiol Anat 2017 Feb 13;39(2):135-140. Epub 2016 Jun 13.

Orthopaedic and Traumatology Surgery Department, Hospital Clínic Barcelona, Barcelona, Spain.

Purpose: The aim of this study was to measure the cortical thickness and bone density of the different parts of the bicipital tuberosity, to evaluate the importance of these variables on resistance to pulling out of distal biceps tendon reinsertion implants.

Methods: Sixteen cadaveric arms were used for this study. A multiple detector computed tomography was performed in each proximal radius. Read More

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February 2017

Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction.

Clin Orthop Surg 2016 Mar 13;8(1):110-4. Epub 2016 Feb 13.

Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. Read More

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Complications resulting from tracker pin-sites in computer navigated knee replacement surgery.

Acta Orthop Belg 2015 Dec;81(4):708-12

Intra-osseous pin sites used in Computer Navigated knee Arthroplasty are known to cause complications including infection, neurovascular injury, thermal necrosis and peri-prosthetic fracture. Many studies have looked at ways of reducing these risks to improve results in computer-navigated surgery. We present our complication rates and techniques used to reduce complications in a retrospective study of 321 patients performed by a single surgeon in between 2009 and 2013. Read More

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December 2015

Strain induced in the condyle by self-tapping screws in the Biomet alloplastic temporomandibular joint: a preliminary experimental study.

Int J Oral Maxillofac Surg 2015 Nov 17;44(11):1376-82. Epub 2015 Jul 17.

Université de Bordeaux, Institut de Mécanique et d'Ingénierie, CNRS UMR 5295, Talence, France.

The main aim of this study was to analyze how screws affect the strain concentration induced on the mandibular condyle during implantation, screwing, and drilling, as well as after condylar loading. A clean cadaveric mandible was analyzed experimentally in the intact state and was then implanted with a Biomet/Lorenz Microfixation temporomandibular joint (TMJ) implant with seven bicortical self-tapping screws. The external surface of the mandible was instrumented with three strain gauges. Read More

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November 2015