title: Cortical bone drilling and thermal osteonecrosis.
abstract: BACKGROUND
  Bone drilling is a common step in operative fracture treatment and reconstructive surgery. During drilling elevated bone temperature is generated. Temperatures above 47°C cause thermal osteonecrosis which contributes to screw loosening and subsequently implant failures and refractures.
  
  
  METHODS
  The current literature on bone drilling and thermal osteonecrosis is reviewed. The methodologies involved in the experimental and clinical studies are described and compared.
  
  
  RESULTS
  Areas which require further investigation are highlighted and the potential use of more precise experimental setup and future technologies are addressed.
  
  
  CONCLUSIONS
  Important drill and drilling parameters that could cause increase in bone temperature and hence thermal osteonecrosis are reviewed and discussed: drilling speed, drill feed rate, cooling, drill diameter, drill point angle, drill material and wearing, drilling depth, pre-drilling, drill geometry and bone cortical thickness. Experimental methods of temperature measurement during bone drilling are defined and thermal osteonecrosis is discussed with its pathophysiology, significance in bone surgery and methods for its minimization.
authors.affiliation: University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Goran
authors.initials: G
authors.lastname: Augustin
authors.forename: Tomislav
authors.initials: T
authors.lastname: Zigman
authors.forename: Slavko
authors.initials: S
authors.lastname: Davila
authors.forename: Toma
authors.initials: T
authors.lastname: Udilljak
authors.forename: Tomislav
authors.initials: T
authors.lastname: Staroveski
authors.forename: Danko
authors.initials: D
authors.lastname: Brezak
authors.forename: Slaven
authors.initials: S
authors.lastname: Babic
mesh_terms: D001842:Bone and Bones / Q000293:injuries* / Q000503:physiopathology*; D002056:Burns / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008954:Models, Biological; D010020:Osteonecrosis / Q000209:etiology* / Q000503:physiopathology*; D010027:Osteotomy / Q000009:adverse effects*