Sequential drilling and drill angulation reduce the accuracy of drill hole start location in a synthetic bone model

The accuracy of drill hole location is critical for implant placement in orthopaedic surgery. Increasing drill bit size sequentially has been suggested as a method for improving the accuracy of drill hole start location. The aim of this study was to determine whether sequential drilling or drill angulation would alter accuracy of drill hole start location. Three specialist veterinary surgeons drilled holes in synthetic bone models either directly, or with sequentially increasing drill bit sizes. Drilling was performed at 0^o, 10^o and 20^o to perpendicular to the bone models. Three synthetic bone models were used to mimic canine cancellous and cortical bones. Sequential drilling resulted in greater inaccuracy in drill hole location when assessing all drilling angles together. There was no influence of surgeon or synthetic bone density on drilling accuracy. The combination of drill angulation and sequential drilling increased inaccuracy in drill hole start location. We conclude that sequential drilling decreased accuracy of drill hole location in the synthetic bone model when drilling was angled. Inaccuracy associated with the drill hole start location should be taken into account when performing surgery, although the magnitude of inaccuracy is low when compared with other sources of error such as angulation.