Daniel Demsey1, Juan Pablo Gomez Arrunategui, Nicholas J Carr, Pierre Guy, Antony J Hodgson. 1. D. Demsey, N. J. Carr, Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada J. P. G. Arrunategui, A. J. Hodgson, Biomedical Engineering Program, University of British Columbia, Vancouver Campus, Vancouver, BC, Canada P. Guy, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: Measuring drilled bore depth in bone is an important part of osteosynthesis surgery. Current methods have substantial limitations in terms of reliability, leading to placement of incorrectly sized screws and unsatisfactory user experience. QUESTIONS/PURPOSES: (1) Can a prototype laser range-finder measure bore depth in bone as well as or better than a conventional depth gauge in terms of accuracy and precision (that is, variability)? METHODS: A conventional analog orthopaedic surgical depth gauge was compared with a laser range-finder-based prototype. Experiments were conducted on four pig hind limbs, with bicortical holes drilled in the femur and the tibia. Two surgeons alternated drilling bores in three different clinically relevant conditions: straight drilling through the diaphysis, angled drilling through the diaphysis, and straight drilling through the metaphysis. Depth measurements were taken with the laser range-finder-based prototype, and the conventional depth gauge and compared against depth measurements obtained from a CT image that served as the reference measurement. RESULTS: In straight diaphyseal drilling the laser range-finder-based prototype had a larger mean error of 1.34 mm (± 0.7 mm) compared with a mean error of -0.06 mm (± 1.38 mm) using the conventional gauge (95% CI 0.824 to 1.976; p < 0.001). In angled diaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (1.66 ± 0.86 mm) and the conventional gauge (2.36 ± 3.79 mm [95% CI -2.338 to 0.938]; p = 0.393). In straight metaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (2.11 ± 0.8 mm) and the conventional gauge (1.51 ± 3.19 mm [95% CI -0.500 to 1.700]; p = 0.280). The laser range-finder-based prototype had greater precision (smaller variance) than the conventional depth gauge in straight diaphyseal drilling (p < 0.001), angled diaphyseal drilling (p < 0.001), and straight metaphyseal drilling (p < 0.001). CONCLUSIONS: A laser range-finder-based prototype mounted on a conventional surgical drill demonstrated overall similar accuracy and better precision in measuring drilled bore depth in bone compared with the conventional depth gauge. CLINICAL RELEVANCE: A device based on this concept could improve the reliability of bore depth measurement in surgical practice and could therefore reduce the frequency of screw replacement and associated complications.
BACKGROUND: Measuring drilled bore depth in bone is an important part of osteosynthesis surgery. Current methods have substantial limitations in terms of reliability, leading to placement of incorrectly sized screws and unsatisfactory user experience. QUESTIONS/PURPOSES: (1) Can a prototype laser range-finder measure bore depth in bone as well as or better than a conventional depth gauge in terms of accuracy and precision (that is, variability)? METHODS: A conventional analog orthopaedic surgical depth gauge was compared with a laser range-finder-based prototype. Experiments were conducted on four pig hind limbs, with bicortical holes drilled in the femur and the tibia. Two surgeons alternated drilling bores in three different clinically relevant conditions: straight drilling through the diaphysis, angled drilling through the diaphysis, and straight drilling through the metaphysis. Depth measurements were taken with the laser range-finder-based prototype, and the conventional depth gauge and compared against depth measurements obtained from a CT image that served as the reference measurement. RESULTS: In straight diaphyseal drilling the laser range-finder-based prototype had a larger mean error of 1.34 mm (± 0.7 mm) compared with a mean error of -0.06 mm (± 1.38 mm) using the conventional gauge (95% CI 0.824 to 1.976; p < 0.001). In angled diaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (1.66 ± 0.86 mm) and the conventional gauge (2.36 ± 3.79 mm [95% CI -2.338 to 0.938]; p = 0.393). In straight metaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (2.11 ± 0.8 mm) and the conventional gauge (1.51 ± 3.19 mm [95% CI -0.500 to 1.700]; p = 0.280). The laser range-finder-based prototype had greater precision (smaller variance) than the conventional depth gauge in straight diaphyseal drilling (p < 0.001), angled diaphyseal drilling (p < 0.001), and straight metaphyseal drilling (p < 0.001). CONCLUSIONS: A laser range-finder-based prototype mounted on a conventional surgical drill demonstrated overall similar accuracy and better precision in measuring drilled bore depth in bone compared with the conventional depth gauge. CLINICAL RELEVANCE: A device based on this concept could improve the reliability of bore depth measurement in surgical practice and could therefore reduce the frequency of screw replacement and associated complications.