On the importance of precision in cortical bone drilling: Integrating experimental validation and computational modeling.

Background: Cortical bone drilling is integral to orthopedic and dental surgeries, yet challenges such as thermal necrosis persist. Previous finite element (FE) models may overlook critical parameters, impacting accuracy. This study aims to integrate experimental and computational approaches to predict essential parameters-initial temperature, point angle, and spindle speed-enhancing precision in cortical bone drilling. Methods: Bovine cortical samples were utilized to systematically investigate the impact of four independent parameters on maximum temperature (MT) and maximum thrust force (MTF). Parameters included drill bit initial temperature (IT), diameter, point angle, and spindle speed (225-2700 rpm, feed rate 0.5-3 mm/s). Experimental procedures involved an orthopedic handpiece with titanium drill bits. DEFORM-3D V6.02 facilitated FE simulation, with the validated model developed for the second stage of the drilling process. Results: The validated model highlighted the significant impact of drill bit IT on MT, predicting a 26.14 % decrease in final bone temperature as IT decreased from 25 to 5 °C. Increasing the point angle from 70 to 120° resulted in a 13.1 % MT increase and a 26.9 % decrease in MTF. Spindle speed variations exhibited a 48.3 % temperature increase and an 82.8 % MTF decrease. Conclusions: Integrating experimental validation and computational modeling offers a comprehensive approach to predict drilling parameters. Precision in cortical bone drilling can be optimized by selecting specific parameters, including lower drill bit IT, smaller point angles, and controlled spindle speeds. This optimization reduces the risk of bone necrosis and thermal damage, thereby enhancing surgical outcomes.

Replacement of Destructive Pull-out Test with Modal Analysis in Primary Fixation Stability Assessment of Spinal Pedicle Screw.

Background: Pedicle screw fixation devices are the predominant stabilization systems adopted for a wide variety of spinal defects. Accordingly, both pedicle screw design and bone quality are known as the main parameters affecting the fixation strength as measured by the pull-out force and insertion torque. The pull-out test method, which is recommended by the standards of the American Society for Testing and Materials (ASTM), is destructive. A non-destructive test method was proposed to evaluate the mechanical stability of the pedicle screw using modal analysis. Natural frequency (ωn) extracted from the modal analysis was then correlated with peak pull-out force (PPF) and peak insertion torque (PIT). Methods: Cylindrical pedicle screws with a conical core were inserted into two different polyurethane (PU) foams with densities of 0.16 and 0.32 g/cm3. The PIT and PPF were measured according to the well-established ASTM-F543 standard at three different insertion depths of 10, 20, and 30 mm. Modal analysis was carried out through recording time response of an accelerometer attached to the head of the screw impacted by a shock hammer. The effect of the insertion depth and foam density on the insertion torque, natural frequency, and pull-out force were quantified. Results: The maximum values of ωn, PIT, and PPT were obtained at 2,186 Hz, 123.75 N.cm, and 981.50 N, respectively, when the screw was inserted into the high-density foam at the depth of 30 mm. The minimum values were estimated at 332 Hz, 16 N.cm, and 127 N, respectively, within the low-density PU at the depth of 10 mm. The higher value of ωn was originated from higher bone screw stability and thus more fixation strength. According to the regression analysis outcomes, the natural frequency (ωn) was linearly dependent on the PIT (ωn=14 PIT) and also on the PPF (ωn=1.7 PPF). Coefficients of variation as the results of the modal analysis were significantly less than those in conventional methods (i.e. pull-out and insertion torque). Conclusion: The modal analysis was found to be a reliable, repeatable, and non-destructive method, which could be considered a prospective alternative to the destructive pull-out test that is limited to the in-vitro application only. The modal analysis could be applied to assess the stability of implantable screws, such as orthopedic and spinal screws.

Evaluation of the efficacy of modal analysis in predicting the pullout strength of fixation bone screws.

Background: Pilot hole preparation has been shown to have an impact on the short and long-term stability of the screw fixation constructs. Purpose: Investigation and comparison of two nondestructive modal analysis methods with conventional insertion torque (IT) and pullout tests in optimum pilot hole diameter detection. Methods: Twenty conical core titanium screws were embedded in high-density polyethylene blocks with different pilot hole diameters. The maximum IT was recorded for each screw during implantation. Then, two modal analysis methods including accelerometer (classical modal analysis [CMA]) and acoustic modal analysis (AMA) were carried out to measure the natural frequency (NF) of the bone-screw structure. Finally, stiffness (S), pullout force (Fult), displacement at Fult (dult) and energy dissipation (ED) were obtained from the destructive pullout test. Results: The IT increased, as the pilot hole diameter decreased. The maximum value of IT was observed in the smallest pilot hole diameter. The same trend was found for the Fult and the first NF derived from both modal methods except for 5.5 mm pilot hole diameter. The natural NFs derived from CMA and AMA showed high correlations in different groups (R2 = 0.94) and did not deviate from y = x hypothesis in linear regression analysis. The Fult, dult, and ED were measured 4800 ± 172 N, 3.10 ± 0.08 mm and 14.23 ± 1.10 N.mm, respectively. Discussion: No significant change was observed in "S" between the groups. The highest Fult and first NF were obtained for the 5.5 mm pilot hole diameter. Both CMA and AMA were found to be reliable methods and can promote the undesirable contradiction between Fult and IT.

Homogenized finite element models can accurately predict screw pull-out in continuum materials, but not in porous materials.

BACKGROUND AND OBJECTIVE: Bone screw fixation can be estimated with several test methods such as insertion torque, pull-out, push-in and bending tests. A basic understanding of the relationship between screw fixation and bone microstructure is still lacking. Computational models can help clarify this relationship. The objective of the paper is to evaluate homogenized finite element (hFE) models of bone screw pull-out. METHODS: Experimental pull-out tests were performed on three materials: two polyurethane (PU) foams having a porous microstructure, and a high density polyethylene (HDPE) which is a continuum material. Forty-five titanium pedicle screws were inserted to 10, 20, and 30 mm in equally sized blocks of all three materials (N = 5/group). Pull-out characteristics i.e. stiffness (S), yield force (Fy), peak pull-out force (Fult) and displacement at Fult (dult) were measured. hFE models were created replicating the experiments. The screw was modeled as a rigid body and 5 mm axial displacement was applied to the head of the screw. Simulations were performed evaluating two different conditions at the bone-screw interface; once in which the screw fitted the pilot hole exactly ("free-stressed") and once in which interface stresses resulting from the insertion process were taken into account ("pre-stressed"). RESULTS: The simulations representing the pre-stressed condition in HDPE matched the experimental data well; S, Fy, and Fult differed less than 11%, 2% and 0.5% from the experimental data, respectively, whereas dult differed less than 16%. The free-stressed simulations were less accurate, especially stiffness (158% higher than the pre-stressed condition) and dult (30% lower than pre-stressed condition) were affected. The simulations representing PU did not match the experiments well. For the 20 mm insertion depth, S, Fy and Fult differed by more than 104%, 89% and 66%, respectively from the experimental values. Agreement did not improve for 10 and 30 mm insertion depths. CONCLUSIONS: We found that hFE models can accurately quantify screw pull-out in continuum materials such as HDPE, but not in materials with a porous structure, such as PU. Pre-stresses in the bone induced by the insertion process cannot be neglected and need to be included in the hFE simulations.