Hammering K-wires is superior to drilling with irrigation

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Surgical instrumentation

Background:

• Thermal damage during Kirschner wire insertion can occur.
• Current cooling methods during drilling may not always be effective.

Purpose of the Study:

• To compare temperature elevation, insertion time, and extraction force of three Kirschner wire insertion methods.
• To evaluate the efficacy of drilling with and without irrigation versus pneumatic hammering.

Main Methods:

• Human in vitro model using fresh cadaver metacarpals.
• Comparison of three insertion techniques: drilling without irrigation, drilling with irrigation, and pneumatic hammering.
• Measurement of temperature elevation, insertion time, and extraction force for each method.

Main Results:

• Drilling without irrigation caused significant temperature elevation (67.25°C).
• Drilling with irrigation (4.15°C) and pneumatic hammering (31.52°C) resulted in lower temperatures.
• Pneumatic hammering had the fastest insertion time (47.63s) compared to drilling methods.
• Extraction forces were highest for pneumatic hammering (62.23N) and drilling with irrigation (57.81N).

Conclusions:

• Pneumatic hammering is a faster and potentially safer alternative to drilling, especially when irrigation is not possible.
• Drilling with irrigation effectively minimizes thermal damage during Kirschner wire insertion.
• The choice of insertion method impacts operative time, thermal effects, and fixation stability.