ARTICLE IN PRESS

Current Orthopaedics (2004) 18, 484–490

www.elsevier.com/locate/cuor

BIOMECHANICS

The design and function of surgical drills

and K-wires
S. Karmani, F. Lam

Orthopaedic Department, 2 Dafforne Road, London SW17 8TZ, UK

KEYWORDS Summary Surgical drills and K-wires are the basic tools in any orthopaedic
Surgical drills; surgeon’s armamentarium. An understanding of their structure allows one to
K-wires; appreciates how they work and therefore how best to use them. This paper breaks
Design; down the design of surgical drills and K-wires in to their basic elements in order to
Function explain the drilling process.
& 2005 Elsevier Ltd. All rights reserved.

The drilling process The engineering structure of a twist drill

Surgical drills cut holes in bone for the insertion of
various implants. The modern drill bit is a complex
engineering tool whose various design elements
allow penetration of bone in an efficient manner,
creating reproducible channels of uniform size.
Drilling is the most fundamental surgical skill in
orthopaedics. This paper explains the structure and
function of surgical drills and K-wires.
To cut a material requires a blade to engage the
surface of a material at a critical angle, thus
shearing a layer off the surface. The process
depends on the material and structural properties
of the blade and cut surface. Optimal cutting
requires matching the physical properties of bit and
material being cut (Fig. 1).
Corresponding author.
E-mail address: karmani1@hotmail.com (S. Karmani).
A twist drill is a complex engineering tool. Its
structure can be broken down to understand the
function of its various elements (Fig. 2).
The cutting face
This is the terminal end of the twist drill where the
cutting process occurs. All cutting tools can be
simplified to a blade edge that engages a material
surface. The shape of this blade is determined by
various angles (Fig. 3).
 Rake angle: The angle at which the cutting
face is presented to the material
 Clearance angle: The angle by which the
flank (non-cutting portion of the blade)
clears the material
 Wedge angle: The angle between the cutting
face and the flank

0268-0890/$ - see front matter & 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cuor.2004.12.011
 ARTICLE IN PRESS
The design and function of surgical drills and K-wires
 Point angle: The angle between the two
cutting edges of a double edge drill,
measured in the sagital plane.
At the apex of the drill is the chisel edge, where
the two cutting edges meet. The flank is the flat
part of a drill when viewed end on. This surface is
not in contact with the material being cut, but
separated from it by the clearance angle; the large
surface area of the flank is a source of friction
between drill and cut surface. Modification of the
flank surface, by increasing the clearance angle
halfway along its surface can reduce the friction
generated by the drill flank. This is known as a split
point (Fig. 4).1
Figure 1 Simplified diagram of a cutting edge, illustrat-
ing the important design features.
HELIX ANGLE
FLUTES
Figure 2 Three views of a conventional 2-lip twist drill, showing its important geometrical properties.
485
The shaft
As a twist drill rotates and penetrates bone, chips
are formed which are channelled along the flutes of
the shaft away from the cutting edge. The flutes of
a drill curl around the tip in a helical manner. By
clearing the cutting zone flutes increases the
efficiency of drilling, by reducing the need for
‘‘woodpeckering’’ i.e. the periodic withdrawal of a
drill bit for chip removal. A drill flute needs to be
designed to clear debris without clogging, this
depends on the geometry of the flute, the
friction of the drill surface and the cutting proper-
ties of the material.2
The flute of a drill can be defined by the helix
angle. These can be slow, standard or quick, the
angle increasing from slow to quick. The angle
represents the number of turns per unit length. A
slow helix is used to drill materials from which
debris clears easily, a fast helix is required for
materials that must be cleared quickly to avoid
blocking the flutes. The length of the flute
influences the effective clearance of debris from
deep holes. 3
Flutes can be of various forms; the parabolic
flute or worm pattern helix has been shown to be
particularly efficient in the drilling of bone. It
offers improved clearance of debris and allows
higher feed rates of drill advancement (Fig. 5).2
The cutting process
The process of drilling requires a twist drill to
penetrate the surface of a material removing
through the process of shear material from the
cut surface as it advances. The process of drilling is
complex, as the various elements of the cutting tip
CHISEL EDGE
LAND WIDTH
DRILL
DIAMETER
POINT ANGLE
LIP CLEARANCE CHISEL EDGE ANGLE
MARGIN
CUTTING LIP WEB D
N
LA
CHISEL EDGE
 ARTICLE IN PRESS
486
Flute
Flank
Point angle
Figure 3 Line drawing of a standard drill bit showing the important elements of the cutting tip.
Split-point
drill bit
Lip
length
Figure 4 Comparison of a split point and standard bit.
Figure 5 Drawing showing various helix angle and worm
spiral pattern flutes.
act in different ways during drilling. The chisel
edge at the centre does not cut, but instead
displaces material ahead of it, like a wedge, as it
thrusts forward. The cutting lip engages the
material surface, producing plastic deformation
along shear planes in the material. This results in
failure of the material in shear generating a chip
that flows on the rake face of the drill tip and is
directed along the drill flutes. Most of the
mechanical work of cutting is converted into heat.
S. Karmani, F. Lam
Flank Helix angle
Wedge angle
Chisel edge
Cutting edges
Clearance
angle
Standard
point
The forces acting on the cutting lip during drilling
have been analysed (Fig. 6). The resultant cutting
force R can be resolved into three orthogonal
directions, X–Y–Z. Pz is the principal cutting force
which coincides with the cutting velocity direction
and the drilling torque is mainly due to this force.
Px is the thrust force at the cutting edge acting in
the feed direction. Py is a radial force which
balances a similar force acting on the other lip.
The presence of the chisel edge, which does not
have any cutting action, except some sort of
extrusion effect, gives rise to a considerable
amount of thrust force.2
The total thrust force of a drill consists of Px the
component due to the cutting action of the edge
and the thrust due to the extrusion effect at the
chisel edge, plus the frictional force at the edge.
The chisel edge where cutting velocity is low and
the rake angle highly negative, greatly increases
the thrust during drilling.2
The influence of drill design on
performance
Rake angle
The geometry of a double edged twist drill is
complex. The orthogonal rake angle is measured in
a plane perpendicular to the cutting edge and is the
angle between the cutting edge velocity vector and
 ARTICLE IN PRESS
The design and function of surgical drills and K-wires 487

Feed Direction

Rotation
Chip
Shear
Rake Plane
d

Drill

e
X ranc
R Clea
Bone
A Z
Pxy SEC AA
Pz
Px
So
Py
y

A
Chisel edge
Cutting Lip
Rake
2D

Figure 6 Diagram illustrating the force vectors acting at the tip of a drillbit during drilling.

tangent to the rake face. Thus the rake angle is not
constant along the cutting edge.4
An optimum rake angle facilitates cutting,
decreases deformation of material cut by the tool,
improves chip flow and reduces specific cutting
energy. Increasing the positive rake angle de-
creases the principal cutting force for bone drills,
increasing their cutting efficiency.
Point angle
The effect of various point and helix angle
combinations have been studied. Optimum point
angles have been developed by engineers for drills
used to machine metals. It is logical to assume that
an optimum design exists for stainless-steel drills
used against bone. Jacob et al.5 evaluated drill bits
with various point and helix angle combinations.
Analysis of these results has shown that larger helix
and point angles impart a positive rake angle for a
greater proportion of the cutting lip; this as
mentioned previously improves bone drills effi-
ciency. Wiggins and Malkin6 showed that a twist
drill of 1181 point angle and 281 helix angle
required much less torque per unit area of hole
and energy as well, per unit volume of bone drilled
at a given feed rate, compared to a drill with a 601
point angle.
Lip clearance angle
The optimum clearance angle of a drill to reduce
friction and improve drill efficiency relates to the
hardness of the material being drilled. The opti-
mum angle for drills used against soft metals has
been shown to be between 61 and 91. For softer
materials such as plastics with hardness similar to
cortical bone angle of 12–151 are optimal. Sana et
al.2 decided on a clearance angle of 151 at the
periphery and 181 towards the centre for a 6.35 mm
drill bit to be optimal for bone.
Helix angle
As the helix angle increases the rake angle also
increases and the torque and thrust during drilling
decrease. The clearance of bone chips which are
short flaky and broken in nature is also assisted by a
larger helix angle. The helix angle of a drill bit
varies with the drill diameter; larger angles are
used for larger diameter drills. The optimum range
for the helix angle has been reported as 24–361.2,5,7
Flute
Flutes for surgical drills have traditionally been
helical with U grooves; this is based on the
 ARTICLE IN PRESS
488
performance of drills against wood which has many
structural similarities to bone. Saha et al.2 devel-
oped a parabolic flute design which has proved to
be more effective in ejecting and smoothly remov-
ing bone chips from the cutting zone, especially
when the length of the hole was 5–6 times the drill
diameter.
The influence of bone on the drilling
process
The physical properties of bone vary with its state
and determine its behaviour when being drilled.
Dry bone is described as short chipping, as the
debris generated are small particles that are easily
cleared by the drill bit. This behaviour is similar to
brass, cast iron and hard steel. The optimal helix
angle for them is small, that is, a slow helix. At
surgery bone debris is mixed with blood and
marrow fat and in this wet state it flows differently
and tends to clog slow helix flutes; in this situation
quick helix flutes are more suitable.1
The periosteum has been shown to obstruct the
flow of chips through the drill flutes.5,8 The chisel
edge catches the periosteum and eventually carries
it to the flutes where it obstructs chip flow. A
split point design reduces this problem by imparting
a positive rake angle and cutting action to the
chisel edge.
It is not always possible to locate a flat surface
when drilling a hole in bone, nor is it practical to
use a guide. Therefore a surgical drill should be
self-centering and it should not walk when initiat-
ing a hole in the cortex of a tubular long bone. The
point angle determines a drill’s tendency to walk.2
It was Hansmann in 18869 who introduced drilling
into orthopaedics in modern times. Sneath10
developed principles for the design of orthopaedic
drills in 1964, but his recommendations had little
scientific basis. Jacob et al.5 was the first to test
different drill designs; he compared seven different
designs ranging in speed from 100 to 2360 rpm and
with feed rates of 0.254, 0.508 and 1.27 mm/min.
He recommended an optimum point angle of 901;
this was despite his data showing that a 1101 point
angle yielded less thrust and torque. Modern
surgical drills have been designed along these lines
since. Saha et al.2 developed a design in 1982 with
1181 point angle and split point flank with clear-
ance angle of 15–181; the helix angle ranged from
341 to 361 depending on the drill diameter and the
flute geometry was parabolic. This design pene-
trated at a faster rate with reduced thrust load,
than traditional designs. The peak temperature
S. Karmani, F. Lam
generated was also significantly lower. The pro-
blems of flute blockage were reduced as was
walking on the bone surface. Natali et al.1
compared various commercial drill bits with surgi-
cal drills in the drilling of bone. He also showed the
superiority of the 1181 point angle and split point
clearance angle design. From the above discussion
it can be seen that certain optimal design para-
meters exist for orthopaedic twist drills.
The design of K-wires
Kirschner first described the use of his wire in
1909.11 The design of Kirschner wires is far more
primitive than modern surgical twist drills. This is
partly because their functions are different. K-
wires are used in the stabilisation of fractures, they
are required to penetrate bone at various angles,
generating a smooth drill hole which engages and
secures the wire in position. Minimal heat genera-
tion ensures a good prolonged grip within bone.
Traditionally there have been two tip designs
(Fig. 7), the diamond tip as first described by
Kirschner and trocar tip. The cutting mechanism of
the diamond tip comprises two-angled facets end-
ing at a point, and that of the trocar tip comprises
three-angled facets ending in a point. The removal
of material from the cutting zone of a K-wire
relates to the linear velocity, the force and the rake
angle of the cutting edge. The flattened portions
proximal to the cutting edges on the diamond tip
allow for clearance of debris to a greater depth of
penetration than the trocar tip.12
K-wires are frequently required to penetrate
bone at oblique angles; in these situations there
can be a problem of the K-wire walking on the bone
surface. This skidding occurs if the tip configuration
allows preferential contact to portions of the wire
not at the centre of rotation. The lower the point
angle the less this is a problem; however, as the
point angle decreases bone drilling is effectively
performed over a small diameter, thus reducing
drilling efficiency.12,13
Figure 7 The traditional K-wire designs.
 ARTICLE IN PRESS
The design and function of surgical drills and K-wires
The performance of K-wires
Diamond and trocar tips
Diamond tip wires require the least axial load to
penetrate bone and thus generate the least heat
during drilling. The flattened portions proximal to
the diamond cutting edge improve debris clearance
and reduce friction, thus increasing drilling effi-
ciency. The holes generated by diamond tip wires
tend to be oval, reducing the immediate holding
power of the wire.12,13
Trocar tip wires require greater load to penetrate
bone and generate higher temperatures than
diamond tip wires on insertion. The trocar design
has no provision for the elimination of hot bone
chips. The trapped cutting chips are compressed
into the wall of the hole as the wires pene-
trate.12,13 This increases friction and heat genera-
tion. Trocar tip wires have superior immediate
bone holding and they produced the smallest
holes resulting in tightest fit of bone in wire.12
The superior immediate bone holding and the fact
that this remains unchanged at 3 weeks suggest
that thermal trauma may not be significant in
determining holding properties.12 The pull out
strength of the diamond tip wires at 3 weeks was
similar to the trocar wires.12 Trocar wires with their
higher rake angle and sharper point angles allow
bone penetration at more oblique angles reducing
skidding which remains a problem for diamond
tip wires.12,13
Insertion of K-wires at different drill speeds
has varying effects. Namba et al.12 studied the
effect of drill speed on holding power. Drilling
at lower speeds yielded increased holding power
with all point designs. At higher speeds the
wire may polish the cortex, affording less hold-
ing power. In addition lower load and less torque
is required for bone penetration at high drill
speeds, reflecting a more efficient drilling process.
This efficiency permits drilling of both cortices
along one axis. With lower drill speeds, less
efficient drilling may produce sites of cortical
penetration that are influenced by the surface or
substrate variations. This could result in penetra-
tion of two cortices along non-aligned axes, making
pull-out more difficult. Graebe et al.13 confirmed
the findings of improved holding power with
reduced drill speed regardless of tip design.
Insertion however was facilitated by faster drill
speeds.
Thinner K-wires generate more heat regardless of
point configuration, the time to peak temperature
is also longer. They however require less force for
insertion.14
489
New K-wire designs
Other designs of K-wire have been tested in the
literature. Namba et al.13 tested a home-made
design produced by cutting a pin obliquely with
wire cutters. This generated an eccentrically
located tip with a single oblique cutting edge.
Insertion load and torque for this design was similar
to the trocar tip. Immediate pull out strength was
inferior to both trocar and diamond tip designs.
With a wide, irregular and burred edge the cut tip
produces a hole larger than the diameter of the
wire itself, reducing frictional contact and allowing
for debris extrusion, however the hole drilled
was irregular and the holding power was there-
fore poor.
Graebe et al.13 tested the C-wire (Concept,
Largo, Florida) which on cross section is a square
with rounded corners and has a diamond tip.
Traditional K-wires have a circular cross section.
Insertion force was greater for the C-wire than for
traditional trocar and diamond tips. This appears to
be related to the orientation of the tip on the C-
wire with respect to its cross-sectional configura-
tion. The C-wire is a rounded square, it has two
diameters. The smaller one is from side-to-side
across the square and the larger one is the diagonal
from rounded corner to rounded corner. The facets
of the point are ground facing the sides rather than
the rounded corners of the wire, thus the cutting
surfaces do not extend to the full width of the
larger thickness. This equates to a higher force
requirement per unit advancement for the C-wire.
The longer diamond portion of the K-wire allows for
clearance of bone debris during drilling.
The diamond tip C-wire also had half the holding
capacity of the trocar and diamond tips. Most of
this effect can be attributed to the lack of
complete circumferential fit of the C-wire due to
its rounded square configuration. In conclusion, the
C-wire offered little advantage to conventional
designs.
By combining the lessons learnt from surgical
twist drill design to K-wire tips Piska et al.15 tested
a new point design, Medin Kwire (Medin Ac, Nove
Mesto na Morave, Czech republic), which has two
steep flutes for removal of bone fragments during
drilling and was ground with a rake angle of +201
and a clearance angle of +301. This new design
required lower thrust forces and torques for
insertion compared with traditional trocar and
diamond tip wires. It also generated lower peak
temperatures on insertion, trocar 129 1C, diamond
98 1C and Medin K-wire 66 1C. Thus it can be seen
that flutes can add considerably to the cutting
properties of a K-wire.
 ARTICLE IN PRESS
490
Conclusion
Surgical drills and K-wires are complex engineering
tools finely crafted for precision work. An under-
standing of their structure will improve ways of
using them. Every craftsmen must know his tools.
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