Page 18 - ISAKOS 2018 Newsletter Volume 2

PEARLS & PITFALLS
Extraction of Broken Drill Bit During Hip Arthroscopy: A Technical Note
Pearls
1. Checking the tip of the instruments prior to use is important in order to recognize a broken instrument.
2. An awareness of the traction time is important in order to prevent additional complications when trying to retrieve the broken drill bit. Consider revisiting the broken bit after addressing all other pathologies that had already been present preoperatively.
3. Wash out the involved area and remove the debris from round the broken drill bit hole in order to estimate the extent of embedment.
4. The new holes should be placed on the extra-articular side of the failed hole to ensure an intact articular side wall for the final hole.
5. When levering the embedded drill bit from the new hole, slightly shallowing and combining the entrances of both holes is important in order to avoid excessive levering forces against the walls of the combined holes.
6. Levering of the broken drill bit should be started with a 30° microfracture awl, proceeding to a 45° awl if needed.
7. During all steps, washing out the debris with a suction shaver is important in order to more clearly visualize the end of the broken drill bit.
8. In order to achieve a good trajectory without penetrating a second cortex or forcing the drill bit in difficult angles, consider additional portals.
9. In muscular patients, intraoperative muscle relaxation is crucial in order to obtain adequate distraction and handling.
Introduction
Allston J. Stubbs, MD
Wake Forest University
School of Medicine
Winston Salem, UNITED STATES
Halis Atil Atilla, MD
Ankara, TURKEY
Labral repair is one of the most commonly performed procedures during hip arthroscopy1, and labral reconstruction continues to be on the rise. Suture anchors are routinely used to secure the labrum back onto the acetabulum, but their use presents certain technical challenges2,3,4. Reported intraoperative complications associated with the use of implants and instrumentation during hip arthroscopy include breakage of the tip of the arthroscope, grasper, and guide wire; articular cartilage damage; penetration of the labrum; and fixation failure5,6,7. To our knowledge, breakage of the drill bit during predrilling for anchor placement and subsequent retrieval of the retained drill bit from the acetabular rim during hip arthroscopy has not been reported.
This article and accompanying video demonstrate a technique for the extraction of a broken drill bit from the acetabular rim with use of standard hip arthroscopy equipment. The described technique demonstrates that replacing the broken drill bit with a bigger anchor is a potential salvage option.
10. 11.
The hole left behind after extraction of the broken drill bit can be salvaged with a larger-diameter anchor for labral repair.
Consider using magnetic instruments for the retrieval of broken instruments.
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