Drilling around the corner: a comprehensive literature review of steerable bone drills.

Abstract

Introduction: Orthopedic procedures often require drilling of tunnels through bone, for instance for the introduction of implants. The currently used rigid bone drills make it challenging to reach all target areas without damaging surrounding anatomy. Steerable bone drills are a promising solution as they enable access to larger volumes and the creation of curved tunnels thereby reducing the risk of harm to surrounding anatomical structures.

Method: This review provides a comprehensive overview of steerable bone drill designs identified in patent literature via the Espacenet database and in scientific literature accessed via the Scopus data base. A Boolean search combined with pre-set inclusion criteria returned 78 literature references describing a variety of drill designs.

Results: These drill designs could be categorized based on how the drilling trajectory was defined. Three methods to influence the drilling trajectory were identified: (1) the device (57% of the sources), (2) the environment (15% of the sources): the path is defined based on the tissue interaction forces with the surrounding bone or (3) the user defines the drilling trajectory (28% of the sources).

Discussion: The comprehensive overview of steerable drilling methods provides insights in the possibilities in drill design and may be used as a source of inspiration for the design of novel steerable drill designs.