The evaluation of bone strength

Bone drilling is a major part of orthopaedic surgery performed during the internal fixation of fractured bones. At present, information related to drilling force, drilling torque, rate of drill bit penetration and drill bit rotational speed is not available to orthopaedic surgeons, clinicians and researchers as bone drilling is performed manually. This research demonstrates that bone drilling force data if recorded in-vivo, during the repair of bone fractures, can provide information about the strength/quality of the bone. Drilling force does not give a direct measure of bone strength; therefore it has been correlated with the shear strength and screw pullout strength to determine the efficacy in estimating the bone strength. Various synthetic bone material densities and animal bones have been tested to demonstrate the use of drilling force data. A novel automated experimental test rig, which enables drilling tests, screw insertion and screw pullout tests to be carried out in a controlled environment, has been developed. Both drilling and screw pullout tests have been carried out in a single setting of the specimen to reduce the experimental errors and increase repeatability of the results. A significantly high value of correlation (l>0.99) between drilling force & shear strength and also between drilling force & normalised screw pullout strength in synthetic bone material was found. Furthermore, a high value of correlation (l = 0.958 for pig bones and l = 0.901 for lamb bones) between maximum drilling force & normalised screw pullout strength was also found. The result shows that drilling data can be used to predict material strength. Bone screws are extensively used during the internal fixation of fractured bones. The amount of screw been tightened is one of the main factor which affects the bone-screw fixation quality. Over tightening of screw can result into the loss of bone-screw fixation strength, whereas under tightening can result in the screw loosening. Therefore, optimum tightening of the screw is important to achieve the maximum bone-screw fixation strength. At present, optimum tightening of the screw is entirely dependent upon the skill and judgment of the surgeon, which is predominantly based on the feel of the screw tightening torque. Various studies have been reported in the literature to develop an algorithm to set an optimum tightening torque value to be used in surgery. A method which is based on the use of rotation angle of the screw while tightening, rather than using screw insertion/tightening torque, to optimise the bone-screw fixation strength is proposed in this research. The effectiveness of the proposed method has been successfully demonstrated on the synthetic bone material using the designed test rig. The optimum angle for the tested screw was found to be 120° which is equivalent to 33% of the screw pitch.