Introduction: Low bone density complicates the surgical management of fractures. Screw stripping in osteoporotic bone leads to decreased fixation strength and weakening of the fixation construct. If low density could be detected during drilling, augmentation may be performed to prevent screw stripping. Furthermore, continuous monitoring of the drill bit depth and bone density can allow detection of the far cortex where density suddenly increases, providing immediate and accurate screw length measurement and reducing the risk of overpenetration or plunge in osteoporotic bone. Therefore, a dual motor drill was created to calculate bone density and pull-out force in real time. The purpose of this study was to determine whether real-time monitoring of drill bit torque and depth could be used to estimate bone density and pull-out force. We hypothesized that the calculated drilling energy could be used to determine density and would correlate with pull-out force.
Methods: Drilling and screw insertion were performed using a validated composite unicortical bone model. Screws of 5-, 10-, and 20-mm length were placed into blocks of known densities (10, 20, 30, and 40 pounds per cubic foot). During creation of holes by the dual motor drill, drilling energy was recorded and used to calculate density. Calculated bone density was then compared with the known density of the block. The drill bit was exchanged for a screwdriver, and screw insertion energy was recorded in a similar fashion during screw placement. Screws were then subjected to maximal axial pull-out force testing with a material testing device. Recorded drilling energy and screw insertion energy were then correlated with the measured pull-out force.
Results: Calculated bone density correlated very strongly with the known control density, confirming the accuracy of density calculations in real time. Drilling energy and screw insertion energy correlated very strongly with the measured pull-out force by destructive testing confirming ultimate pull-out force could be quantified during drilling or placement of a screw.
Discussion: Our results confirmed that a dual motor drill can accurately and immediately allow determination of bone density and screw pull-out force before placing a screw. This knowledge could allow a surgeon to perform augmentation or alter surgical technique to prevent screw stripping and loss of fixation as well as detect the far cortex and prevent overpenetration in osteoporotic bone.