The forward & reverse (F&R) modes (Kirschner Wire Driving Modes) of the power tool are used while drilling with surgical power tools in orthopedic operations. In this mode, the direction of rotation can be changed to right (forward) and left (reverse) with the help of a button.
The driving of the Kirschner wire can be done in the F&R mode with the help of the wire driver attachment. However, some of the surgical power tools offer a special mode for this procedure (oscillation mode). In oscillation mode, the direction of rotation changes automatically as one right and one left.
Anderson et al. (2018) investigated the effect of these modes on the heat generated on bone. ANOVA test results in the trials were as follows; When using a 0.062 inch Kirschner wire, the average temperature increase in F&R mode and oscillation mode is 14.0 ± 5.5 ° C and 8.8 ± 2.6 ° C, respectively. In case 0.045 inch Kirschner wire is used, the average temperature increase in F&R mode and oscillation mode is 11.4 ± 2.6 ° C and 7.1 ± 1.9 ° C, respectively.
As a result of this experiment, it can be concluded that the oscillation mode generates less heat and causes less thermal necrosis on the bone. But, a more comprehensive study in this area by Luo et al. in 2019 revealed that there is no difference between these two modes in terms of the risk of bone necrosis.
In the experiment conducted by Luo et al. (2019), they compared the highest temperature obtained and the time to perform the desired drilling process for two modes. In the ANOVA test, 95 successful trials showed a lower temperature peak point in oscillating mode than in F&R mode again. But when looking at the drilling times, the F&R mode is finished the drilling process in a much shorter time than oscillation mode. (Figure 1)
Figure 1: Impact of drilling mode on: (a) peak bone temperature and (b) drilling time (error bar represents standard deviation). (Luo et al., 2019)
ANOVA results show that the oscillation drill mode produces 13% lower average peak bone temperature increase than the F&R mode and has a 46% longer drilling time. Since the oscillation drilling mode has a lower average angular velocity due to the periodical oscillations of the surgical motor, the rotational power and heat generation rate is lower. But since it does not constantly turn to the same direction, the speed of removing bone material is lower. Although it has a lower peak temperature, it is exposed to temperature rise for a longer time due to the longer drilling time. (Luo et al., 2019)
As a result, shortening the drilling time will be the primary goal for surgeons. The first thing that comes to mind about shortening this period is to increase the thrust force. In the trials in Luo’s experiment, in both drilling modes, excessive thrust force increased the risk of breaking / burning bone and bending of the K-wire. High thrust force could also result in plunging the K‐wire into surrounding soft tissue after penetrating the bone, which leads to collateral tissue injury. (Gao Y. et al., 2017). In view of these results, Luo et al. recommend applying moderate thrust in both drilling modes.
Click for the article named Historical Remarks on Martin Kirschner and the Development of the Kirschner (K)-wire via PubMed.
Luo et al. tried 4 techniques used by surgeons in K-wire insertion procedures. (2019)
Figure 2 : Four types of drilling techniques utilized by different surgeons under (a) F&R and (b) oscillation drilling modes. (Luo et al., 2019)
According to the results, continuous and pecking drilling methods should not be preferred for shorter drilling time and less heat generation.
The oscillation mode did not gain an advantage over the F&R mode in terms of temperature increase in the bone. It can even be said that the F&R mode is more advantageous in terms of shorter drilling time. The most efficient result was obtained with the intermittent drilling method for both modes. Whichever mode is used, the surgeon’s guidance and the drilling method used by surgeon will be very effective to prevent necrosis in bone cells.
In order to ensure sterility, knowledge of the levels and types of contamination in used surgical instruments is a primary requirement. Sterility is determined by
Product Recall; It is a voluntary withdrawal or recall from the market by the manufacturer of the device for technical and medical reasons, depending on
Stress (tension) is one of two measurable engineering quantities important in understanding the durability or fatigue life of a product. Surgical power tool systems are
Errors resulting from the cleaning process of surgical power tool systems not only pose risks to the patient. Users also have losses. In this article,
Surgical Power Tool Systems are devices that complete their preparation for use by sterilising at 135 degrees due to their area of use and design.
