Individual Work Log
Week: 1
My task for the week: Get to know members in the group, start to work on team charter
Date: 4th August
About our team: there are 7 students in our team from various backgrounds, including Mechanical Engineering, Biomedical Engineering, Finance and IT. I think this would be a great opportunity for us to experience the process of real life engineering where people use knowledge from different disciplines to build a successful product.
Notes from meeting:
• Meeting time: Wednesday 2-3pm.
• Meeting minutes: take turns to record.
My questions around the topic:
What is a guide wire? What are the criterion to judge whether a guide wire is good or not? How is the recent technology of guide wires like?
Research:
• Guide wires are used as a guide for large catheters and can also be used for supporting bone fractures [1]
• Four characters of guide wires [1]:
1. Pushability: the force generated when guide wires push through
2. Torque: “response of wires when turning by operator when navigating vessels”
3. Steerability: ability for tip navigation
4. Opacity: visibility under X-ray
• Guide wire navigation: NIOBE Magnetic Navigation System. External magnets are used to navigate guide wires. This method has great dexterity and flexibility. However, the system is pricey and bulky. Also it cannot be used on patient with obesity and claustrophobia. [2]
• Automation in guide wires: Guide wires can be navigated through an imaged based autonomous system. The feedback for the location of the wire tip is from the image. Whenever the wire is detected to be in the wrong branch, it would retract and choose another path. [2]
• Two types of guide wires:
1. Solid steel/nitinol core wires:
2. “Solid core wire wrapped with smaller wires coiled or braided”: better in “pushability, flexibility and kink resistance” [1]
Week: 2
My task for the week: Research and complete team report
Date: 9th August
Notes from meeting:
• Focus of project: Design the tip for precise travel inside soft tissues.
• Meeting clinician next week.
My questions around the challenge:
Are there any ways to improve the requirements for guidewires? How does the shape of the wire tip affect guidewire performance? According to the research that I have done last week, I think opacity and steerability should count as requirements from our design.
Research:
• Improving steerability:
Braided or coiled wires are usually better in steerability than core wires [1]
Using “micro-cut” instead of braided wires [1]
A guidewire structure with a flexible end and a rigid body would have better tip navigation and pushability. The tip would also be able to spring back after navigation. This can be done with a structure of Nitinol core braided or coiled using stainless steel. [1]
• Improving opacity:
“Radiopaque markers”: such as using “gold marker bands” or using platinum wire [1]
Fig. 1. Effects of wire diameter [3]
Fig. 2. Effects of taper length [3]
• Comparison between J-shaped wire and angled wire: angled wires are better than J-shaped wires when passing injuries in human body with complicated and angled blood vessels. Angled wires also tend to be more durable than J-shaped wires and are less prone to bend inordinately to a “U” shape [4]. However, the sharp tip of angled wires often gets stuck in the duodena [5]. While the J-shaped wire, which has a tip that is bent inwards, reduces bleeding and piercing.
Week: 3
My task for the week: Take meeting minutes and research on risks
Date: 17th August
Notes from meetings:
• Focus on designing a system to deliver wires
• Some design ideas of the team: use three wires together as a guidewire, when one of them is pulled, the guidewire would be bent. Attach a camera at the tip of the wire to observe navigation better.
• For meeting clinician, ask more about the experience of using the guidewire instead of technical questions.
Questions:
What risks might the design face? How likely is it to happen? How severe is it? How do we resolve the risks? How do we find out whether the guidewire is taking the wrong path?
Risks:
• Nickel is a common metal that would cause metal allergy, which may cause itching, bumps, rashes or more severe problems [6]. According to researches, around 17% of women and 3% of men are allergic to Nickel [7]. As so many people are allergic to Nickel, the likelihood of this risk is very high. We can reduce the use of Nickel and use stainless steel instead to make guidewires. In addition, a metal allergy testing can be carried out prior to guidewire operation. However, there are no allergy tests that can guarantee a patient would not be sensitive to metal after they have passed the test [8]. So this risk can only be reduced instead of eliminated.
• Wire fracture is a very severe problem in guidewire operations. Although the probability of guidewire fractures is low, around 0.1%-0.2%, the result can be life threatening [9]. Additional operation is also required to take the broken wire out of the body.
• There are also incidences reported of guidewires been stuck inside the soft tissue, where retraction nor reinsertion would be possible [10].
Week: 4
My task for the week: Come up with designs and talk with a clinician
Date: 23th August
Notes from meeting clinician:
• How guidewires are used: insert wire into blood vessels (J tip). Flesh (usually straight). Don’t use guidewires to push through tissues or organs.
• How long: 0.018 inch, 0.25, 0.032, 0.035, longest 2m
• Tools to insert guidewires: don’ t use tools. straight wire, angled tip wires, spiral wires,
• Endoscope to observe locations of wires
My design sketch:
Fig.3. My Design
Explanation: This is a very simple tool of inserting and rotating a guidewire. Part 1 is the complete structure of the device, which consists of a positioning plate and a rotation indicator. Part 2 is a cover that should be taken off while positioning the guidewire onto the device. The wire is first inserted into the vertical cylindrical slot. It is then bended 90 degrees to fit the horizontal cylindrical slot, after which part 2 can be attached back to the device. The guidewire would be restricted from any relative motion with reference to the device. Part 3 shows the cross section view of the positioning plate at center line. Part 4 show how the rotation indicator looks like. This device can firmly grip on to the guidewire and improves accuracy for guidewire feeding.
Requirements: This is a very simple tool of inserting and rotating a guidewire. This device meets the requirement for inserting and rotating wires. But does not tackle with bending wires. (15/30)
Risks: This device cannot deal with wire fracture problems. And it can also not tackle with problems such as sticking inside soft tissues, sudden bluntness of tips and so on. (10/30)
Deliverable: This device can be easily prototyped by 3D printing. (15/20)
Innovation: This device only involves with simple mechanism. It mainly deals with linear and rotational motion. It serves as a good grip but cannot manipulate precise circular motions. (10/20)
Advantages: Grip on to the guidewire firmly. The guidewire is restricted from any kind of motion relative to the positioning plate. Inserting and retracting in a linear way can be easily controlled and angle of rotation of the guidewire would be clearly shown on the rotation indicator.
Disadvantages: Does not provide pre-bending. Cannot control circular motion or adjust the angle of the tip once it is inside human body. Many risks still remained unresolved.
Questions:
Why didn’t clinicians use devices to feed guidewires? How is the current guidewire feeding device like?
Research:
• Single hand guidewire feeding: mainly a hook that can constrain guidewires so that feeding can be done by one hand [11].
• BowTie Guidewire Insertion device: a simple device that can connect two guidewires together or insert a smaller guidewire into a bigger one [12].
Fig.4. BowTie [12]
• This device aims to grip on guidewires and provide precise insertion of guidewires in neck surgeries [13].
Week: 5
My task for the week: Consolidate notes from clinician meeting and review design iterations in the team report
Date: 30th August
Notes from meetings:
• Important points to take note from meeting the clinician:
1. The clinician pushes the guidewire inside the body and guidewires move inside blood vessels.
2. The clinician do not use any tools for inserting and pre-shaping the wire.
3. The clinician don't really need something to insert the wire, but some device that can provide feedback on insertion.
4. There is a need for a device that can help twist the wires.
5. The current technology for guidewires are J tip wires.
6. One big challenge is turning the wires inside hearts
• Further steps:
1. Find clinical wires to test on: either buy from shops or ask from Phil
2. Clarify on our topic: guidewires or K wires?
Review on design iterations:
Design 1 is a gripping device. When the guidewire is inserted into the jig, the pins can be adjusted to lock the guidewire. The amount of torque applied during insertion can also be adjusted. However, this design does not tackle with bending and twisting of guidewires.
Design 2 is a device for wire bending. Once the guidewire is clamped on the device, the user can move the movable clamp to bend the wires. There is also an indicator showing the angle of bent. However, this design does not handle twisting and insertion.
Design 3 is a gripping device. When the wire is inserted into the device and the user squeezes the handle, the wire can be locked. The device can also provide oscillation motion to help the insertion of wires.
Design 4 is similar to design 3.
Design 5 is a device that handles pre-shaping of the wire. Wires can be bent in the middle, with small region of influence. Despite that it doesn’t handle with insertion and twisting, I think it is a very good pre-shaping device.
Design 6 is a insertion device with indicator on twisting. It uses simple mechanism and do not require external power.
I think all of our designs only deals with part of the requirements. Combining design 2,5,6 might be a good idea.
Week: 6
My task for the week: Take meeting minutes, complete Gantt chart and refine team progress report
Date: 7th September
Notes from meeting:
• Clarification of topic: Steerable K wires in bones.
• Collected a K wire from Phil, will be starting on the testing of wires in week 7, trying to push wire into different mediums using our designs
• Meeting with another clinician soon
Gantt chart:
• Things that we have done: team charter, project clarification, preliminary research ( on guidewires, probably need more research on K wires), literature review, requirement, risks, design iterations, clinician meetings
• Things in progress: review of requirements and risks, review of literature review
• Things to start on: experimentation, design finalization, CAD modeling, prototyping, material selection research, validation and verification, presentation
Questions on the topic:
Since we changed the focus to K wires, how are K wires different from guidewires? Challenges with K wires? What requirements are there for K wires that function in bones? Current technologies for K wires?
Research:
• What is a K wire: K wire works as a pin that fix a broken or displaced bones in place and would be removed after the cure of bones. [14]
• Challenges on K wires [14]:
1. Infection: The piercing through which the K wire went in may also make it easy for bacteria to go inside the body.
2. Fracture: The K wires are very thin and might not stand the moment and force adding on it, resulting in fracture.
3. Removal: Once the bone heals, the K wires should be taken out of the body. Pins that are threaded or under skins are quite difficult to remove.
4. Bone movement: Bones that are fixed by K wires are not as stable as the ones fixed by plates or rods. Bones may still be able to move under the K wire constraints.
5. Wire movement: As the body moves, wires may also experience displacement. Sometimes wires are found to slip into the bone cavities. Inspections should be done regularly to check whether the wires are still in place.
• K wire technologies:
1. Insertion:
Drilling and Hammering: hammering is better than drilling in terms of fixation. Hammering also induces a lower temperature than drilling, which causes less infection. [15]
2. Removal: A tip of the K wire is left outside for easier removal [16].
Week: 7
My task for the week: Research and plan for wire testing, review team progress report
Date: 13th September
Notes from meeting:
• Calling clinician and doing experiments next week
• First thing is to find out whether the wires we have is similar to the real K wires. We would try to find the specifications for our wires and compare it with real K wires. Otherwise, a material testing on our wires would be conducted next week.
• The objective of our experiment is to mimic the real insertion process of a K wire into Sawbones, observing the behavior of the wires and the effect of different insertion processes
• At first, we decided to test on two insertion methods: rotational and vibrational. Phil suggested us to use masonry hammer drill to push the wires in, because it is easier for path control.
Questions:
What are Sawbones? What is a masonry hammer drill? What are the K wire specifications?
Research:
• Sawbones: Sawbones is a company that produces model of bones and soft tissues [17]. Their products come in various shapes and materials for different purposes.
Fig.5. Composite Bone [18]
Fig.6. Solid Clear [18]
Fig.7. Transparent Plastic Cortical Shell [18]
The composite bone is for testing purpose and has the most similar physical properties to a real bone [18]. However, this bone is opaque, through which the path of the K wire cannot be visualized. Sawbones also produces another kinds of bone which is transparent, as shown in Fig.6 and Fig.7. However, these bones are mainly for display purposed and do not have the same properties as a real bone [18]. So I think we would be using the composite bone for our experiment and think of other ways to visualize the path of the K wire.
• Different drills:
1. Regular drills
2. Hammer drills: a regular drill plus something that hammers the back of the drill to push it inside [19]. It is good for working on hard materials, which makes it a candidate of our experiment.
3. Impact driver: larger torque and better control, but not suitable for situations where depth is critical [19], which is our situation.
4. Rotary hammer: More impact energy, better endurance, better in hardened masonry [20]
5. I think rotary hammer might be a good choice for our experiment. Both impact driver and rotary hammer performs well on hard materials, but rotary hammer does not have problem with critical depth.
• K wire specifications:
K wires are made from stainless steel. The length is usually 10 cm with diameter of 0.7 mm. The tip is trocar or diamond shape [21]
Week: 8
My task for the week: Call orthopedic surgeon, plan the experiment and finish V&V table
Date: 19th September
Notes from surgeon:
1. Orthopedic, PHD in medicine and orthopedic science
2. Size of wires: 15-20cm, with diameter of 0.8mm to 3mm
3. Use to hold the bones in place temporarily, after the bones are cured, the wires are taken out
4. Look at the bone on X ray, make a hole on the skin and insert the wire in. The wires can stay inside the body for up to six weeks
5. Materials: stainless steel
6. Pre-shape: all straight, easier to insert when spinning it in, with diamond tip or threaded tip
7. Insertion method: use hands to insert, push in by spinning
8. How to keep K wire in shape: K wires can be retained quite well in the impact area of bones
9. Better insertion: drill with a handle
10. Drill: normal drills can handle wire of 2 to 3 mm, but hard to handle thinner wires.
11. Curved wire: not many applications, but can be used for going in and coming out at the same side. He suggested that this might be a good direction for our design.
Plan for experiment:
1. Buy wires from HobbyCo, test on the material and tensile strength of the wires and compare with a K wire. Find the type of wire from HobbyCo that is most similar to a K wire
2. Insertion methods tested: hammering and drilling, test which method inserts wires easier and more controllable. We also need to find an insertion method that does not damage the bones
3. We may also test on the methods of wire removal, because K wires may get stuck between bones
4. Sawbones won’t be used for the experiment because it is too expensive.
Research:
• Risks of K wires:
1. Nerve and tendon damage [22].
2. K wires sometimes break during a surgery or during recover period of the patient. Extra retrieval process is needed to take the wire out. [23]
3. Infection and displacement after K wire removal. Around 32% of patients experienced displacement and 12.6% of patients experienced infection at the pin .[24]
Week: 9
My task for the week: Clarify project scope, research on tip geometry
Date: 4th Oct
Notes from meeting:
• Clarification of project: K wire bending, we would be coming up with designs after the wire testing
• What to test:
1. Measure the force for wire insertion, maybe using a force transducer or a pressure measuring device.
2. Drilling: the effect of rotational speed should be studied with RMPs within a certain range.
3. Hammering: the effect of hammering force and rate should be studied.
4. Resistance of wire pushing through the sawbones.
Experiment progress:
• Four wires were bought from Hobby Co, two of 1.5mm diameter and two of 1.4mm diameter.
• Each wire is to be cut to 12 shorter wires of around 20cm long. The short wires from the same original wire would be bundled together. Thus, we have 4 bundles of 20cm wires 1.5mm and 1.4mm in diameter.
• Asked Phil for sawbones.
• Decide on the wire tip geometry for testing. Would get the wires sanded by next week.
Research:
• According to a research conducted in the University of Sheffield, K wires with tips of trochar, diamond and medin were tested. The performance of the tips were evaluated by the amount of torque measured. The wear of the K wires were also measured as lifetime is also an important factor in design. Among the three kind of wires, trochar was found to generate the highest torque, around 60% higher than the other two kinds, while medin was found to produce the lowest torque. However, the wear of the medin tip was the least. After 30 rounds of insertion, the medin tip could catch up with the performance of the diamond tip. Accordingly, the temperature of the trochar tip wire during drilling was also recorded to be the highest and the medin tip wire to be the lowest. [25]
Fig.8. Tip geometry[25]
• Another study also found that K wire with trochar tips need the highest torque and load for bone penetration. And also it requires the largest strength to pull out the wire after drilling, especially when it was drilled in at a low rotational speed. The diamond tip K wire would require a same force as the trochar tip K wire to pull out of the bone 3 weeks after fixation. For a strong fixation of bone, the trochar tip K wire drilled in at a low rotational speed is recommended. [26]
Thus, trochar may be a good choice of tip geometry for our K wire testing, considering its high torque and force. However, the trochar shape has three sides and may be difficult to achieve that shape using a sanding machine. Hence, we simplified it to a one point tip.
Week: 10
My task for the week: Shape the wire tips, read through and add on to team report
Date: 10th Oct
Notes from meeting:
• Start compiling the final report
• Prepare for final presentation
• Planning to ask Peter for feedback regarding to the personal logbook, team report next week. And also to clarify for the final presentation.
Experiment progress:
• We found a lab technician who sanded one bundle of our wires using a sanding machine.
• One end of the wires are flat, the other end comes with three different tip designs: flat, one point and slanted, each of 4 wires.
• We handed the other 3 bundles of wire to Phil for the tips to be sanded into the same tips as the first bundle.
Research:
• Definition of protocol [27]: a plan and guide of clinical research. It describes what should be studied and how it should be done.
• Components of a protocol: [27]:
1. Objectives
2. Responsibilities
3. Methodology
4. Process
• Benefit of protocal [27]: for the group to review and trace the tests in the process of verification and validation.
Week: 11
My task for the week: Come up with wire tip bending device and CAD it
Date: 17th Oct
Notes from meeting:
• Goals for the project: bending the wire tip and something to insert the wire in using oscillation or hammering
• Continue to do wire testing on sawbones, to figure out which how tip geometry effects the movement of wires
• Phil mentioned about using a 3 wire system where 3 wires are inserted together and main wire would be bended by extracting two minor wires once the tip has reached the required location for bend
My design:
This a wire bending device where bending angle of the tip is indicate. The design consisted of two parts. One the semi-circular plate with a tube and handle firmly fixed to it. The other part is another tube that is able to rotate with reference to the midpoint of the plate. Before inserting the wire inside the device, the rotation tube and the fixed tube should be aligned, making sure that they are on a straight line and parallel to each other. Then, the wire can be inserted through the rotation tube and the fixed tube. The user used the left hand to hold the free end of the wire, and the right hand to hold on the handle of the device and rotate it clockwise. The angle of the bend can be read from the alignment of the free end of the wire and the readings on the plate.
A CAD of the design was done on Fusion360.
Full assembly
Assembly after 45 degrees rotation of the plate
Plate
Rotation tube
Week: 12
My task for the week: Improving the wire tip bending device
Date: 24th Oct
Notes from the meeting:
• We want to design a bearing that can stop the wire from rotation when hammer drill is used so that the wire only experience forward motion when hammer drill is used
• Continue to do the testing of the wire tips, record the trajectory of the wires inside saw bones and improve the wire tips
• Find natural materials to build the wire bending device
Design improvement:
From initial design of the wire tip bending device, we found that the once the wire is bent, the wire cannot be removed. Hence, the rotation tube was modified into a half tube with only the left half, so that the wire can be removed easily after bending.
Half tube
Assembly after the improvement
Research:
Since K wires are mostly made from stainless steel, the properties for the material should be considered.
• Stainless steel properties [28]:
Stainless steel is a relatively rigid material. It can be bent using the same equipment as bending other common materials. It experiences work hardening, so the bending should be done in a short period of time. And the radius of bend should not be smaller than the raduis of the working piece.
• Since our K wire has a very small diameter of 1.4 and 1.5 mm, thus the bending radius is definitely bigger than the wire radius.
• For wire bending jigs, it was found that aluminum is usually used to make the main body of the jig and steel is used for making the pins which stands the pressure during bending [29]
Hence, for the wire bending device, the semicircular plate and the handle can be made from aluminum. The rotational half tube and the tube fixed on the plate are required to stand critical stress and should be made from steel.
Week: 13
My task for the week: write on design iterations and update innovation case for K wires.
Date: 2nd Nov
Notes from meeting:
Anna made the prototype for the wire bending device from wood. However, the prototype deviates from the original design. In the original design, the wire should be inserted from the middle tube and then the tube attached to the handle, which is a solide block. However, in the wooden prototype, a hole was drilled from the handle all the way through to the tube attached to the handle and half the middle tube. In the prototype, the wire is bent by turning the middle tube, which produces less torque than the original design. Due to the limitation of time, we weren’t able to make a new prototype.
Design iterations:
Design 2 and 5 in the iteration table are related to K wire bending. Our first design is a protractor with two clamps. The lower clamp holds the wire while the upper clamp rotates the tip of the wire up to 90 degrees to the left or right. The second design is a device that allows bending in the middle of the wire. The K wire is placed in a slot with sponge materials underneath. Bending heads of different angles can be used to press down at various locations of the wire to make a bend of the desired angle. However, we found that K wire mostly requires tip bending and this device is more suitable for bending in the middle of the wire. In addition, it also can be difficult for the design to perform sharp bendings. Thus, we came up with our final wire bending device, which is very suitable for tip bending and can bend the tip up to 180 degrees.
K wire innovations:
• Electromagnetically tracked K wire device [30]:
A K wire with location indicator, can be applied to navigation and registration of K wires inside the body.
• IOVAD [31]:
The use of a Intraosseous Vascular Access Device as an alternative of a K wire. The inner stylet of the needle of an IOVAD device can be used to help the treatment process of a mallot finger.
Advantages: Suitable for macerated tissue
Disadvantages: Difficult to perform operations using the device without prior training.
References:
[1] D. Fornell, “The Basics of Guide Wire Technology,” DAIC, May. 2017. [Online]. Available: https://www.dicardiology.com/article/basics-guide-wire-technology. [Accessed: 2-Aug-2018].
[2] C. Ji, Z. G. Hou, and X. L. Xie, “Guidewire navigation and delivery system for robot-assisted cardiology interventions,” IEEE Xplore Digital Library, Aug. 2011. [Online]. Available: https://ieeexplore.ieee.org/document/6016161/. [Accessed: 2-Aug-2018].
[3] S. Gupta, “Guide Catheters & Guidewires: overview and case illustrations,” Metro Group of Hospitals. [Accessed: 7-Aug-2018].
[4] J. Voda, “Angled Tip of the Steerable Guidewire and Its Usefulness in Percutaneous Transluminal Coronary Angioplasty”, 1987. [Online]. Available: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ccd.1810130313. [Accessed: 7-Aug-2018].
[5] S. Omuta, I. Maetani, H. Shigoka, K. Gon, M. Saito, J. Tokuhisa and M. Naruki, “Newly designed J-shaped tip guidewire: A preliminary feasibility study in wire-guided cannulation”, World Journal of Gastroenterology, Jul. 2013. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725378/. [Accessed: 8-Aug-2018].
[6] “Nickel allergy,” Mayo Clinic, 10-Jan-2018. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/nickel-allergy/symptoms-causes/syc-20351529. [Accessed: 15-Aug-2018].
[7] J. P. Thyssen and T. Menné, “Metal allergy–a review on exposures, penetration, genetics, prevalence, and clinical implications.,” Advances in pediatrics., 15-Feb-2010. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/19831422. [Accessed: 15-Aug-2018]
[8] “Should patients be tested for metal allergies before joint replacement surgeries?,” Australian Allergy Centre, 21-Jul-2015. [Online]. Available: https://www.australianallergycentre.com.au/should-patients-be-tested-for-metal-allergies-before-joint-replacement-surgeries/. [Accessed: 16-Aug-2018].
[9] Y.-M. Hong and S.-R. Lee, “A Case of Guide Wire Fracture With Remnant Filaments in the Left Anterior Descending Coronary Artery and Aorta,” Sep-2010. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957644.[Accessed: 17-Aug-2018].
[10] N. Kumar1, S. Burman1, and A. Yadav2, “Stuck guidewire due to soft tissue imposition: a rare complication of central line catheter placement,” BMJ Case Reports, 23-May-2018. [Online]. Available: http://casereports.bmj.com/content/2018/bcr-2018-224219.abstract. [Accessed: 17-Aug-2018].
[11] United States Patent. April, 1996. [Online]. Available: https://patentimages.storage.googleapis.com/d3/e9/c5/5db55347dbec22/US5507300.pdf[Accessed: 22-Aug-2018].
[12] MeritMedical. “BowTie Guide Wire Insertion Device”. [Online]. Available: https://www.merit.com/peripheral-intervention/access/accessories/bowtie-guide-wire-insertion-device/[Accessed: 22-Aug-2018].
[13] W. Yin, H. Xu, P. Xu, T. Hu, Z. An, C. Zhang, and J. Sheng, “A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation,” Advances in pediatrics., 16-Aug-2016. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996048/. [Accessed: 22-Aug-2018].
[14] J. Cluett, “Kirschner Wire Is Used in Surgery to Hold Broken Bones,” Verywell Health, 27-Jul-2018. [Online]. Available: https://www.verywellhealth.com/what-is-a-kirschner-wire-2548523. [Accessed: 06-Sep-2018].
[15] B. Franssen, A. SCHUURMAN, A. MOLEN, and M. KON, “One century of Kirschner wires and Kirschner wire insertion techniques : A historical review,” 2010. [Online]. Available: https://pdfs.semanticscholar.org/429c/4ff83df6a794278ba202f2b0c28b3afe99fe.pdf. [Accessed: 06-Sep-2018].
[16] “K-Wire Removal for Arm Fractures,” Starship Child Health. [Online]. Available: https://www.starship.org.nz/media/532582/k-wire-removal.pdf. [Accessed: 06-Sep-2018].
[17] “Home,” 19-Jun-2018. [Online]. Available: https://www.sawbones.com/. [Accessed: 13-Sep-2018].
[18] “Materials Guide,” 29-Mar-2017. [Online]. Available: https://www.sawbones.com/models/materials-guide/. [Accessed: 13-Sep-2018].
[19] “Drills vs Hammer Drills vs Impact Drivers,” The Wood Whisperer, 20-Dec-2009. [Online]. Available: https://www.thewoodwhisperer.com/articles/drills-vs-hammer-drills-vs-impact-drivers/. [Accessed: 13-Sep-2018].
[20] “What is a Hammer Drill vs. Rotary Hammers,” Family Handyman, 12-Dec-2017. [Online]. Available: https://www.familyhandyman.com/tools/drills/drilling-into-concrete-tools-rotary-hammers-and-hammer-drills/view-all/. [Accessed: 13-Sep-2018].
[21] “Key Surgical,” Needle Holders | Key Surgical. [Online]. Available: http://www.keysurgical.com/products/wire-pin-management/k-wires-steinmann-pins. [Accessed: 13-Sep-2018].
[22] N. L. Hochwald, R. Levine, and 3 r Tornetta, “The risks of Kirschner wire placement in the distal radius: a comparison of techniques.,” Current neurology and neuroscience reports., Jul-1997. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/9260610. [Accessed: 19-Sep-2018].
[23] Wong, K. Yuen, Rosalind, Gillespie, and Patrick, “Kirschner Wire Breakage during Removal Requiring Retrieval,” Advances in Decision Sciences, 24-Oct-2016. [Online]. Available: https://www.hindawi.com/journals/cris/2016/7515760/. [Accessed: 19-Sep-2018].
[24] A. Alkhayer, “DISPLACEMENT AND INFECTION AFTER KIRSCHNER WIRE FIXATION OF DISTAL RADIAL FRACTURES: CAN WE IGNORE THEM?,” Orthopaedic Proceedings, 21-Feb-2018. [Online]. Available: https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.94BSUPP_II.BOA2005-068. [Accessed: 19-Sep-2018].
[25] M. Piska, L. Yang, and M. R. Reed, “Drilling efficiency and temperature elevation of three types of Kirschner-wire point,” ResearchGate, Feb-2002. [Online]. Available: Drilling efficiency and temperature elevation of three types of Kirschner-wire point. [Accessed: 03-Oct-2018].
[26] R. S. Namba, J. M. Kabo, and R. A. Meals, “Biomechanical effects of point configuration in Kirschner-wire fixation.,” Clinical orthopaedics and related research., Jan-1987. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/3791743. [Accessed: 03-Oct-2018].
[27] A. Al-Jundi and S. Sakka, “Protocol Writing in Clinical Research,” Journal of Clinical and Diagnostic Research: JCDR, Nov-2016. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198475/. [Accessed: 12-Oct-2018].
[28] “Aalco,” Stainless Steel – General Information – St St Fabrication. [Online]. Available: http://www.aalco.co.uk/datasheets/Stainless-Steel-St-St-Fabrication_62.ashx. [Accessed: 26-Oct-2018].
[29] “Aluminum-Body Wire Bending Jig,” Gesswein Canada. [Online]. Available: https://www.gessweincanada.com/product-p/407-13460.htm. [Accessed: 26-Oct-2018].
[30] N. D. Glossop, “Electromagnetically tracked K wire device,” US Patent, 23-Nov-2010. [Online]. Available: https://patentimages.storage.googleapis.com/b0/9e/a0/37b35420cdad7c/US7840254.pdf. [Accessed: 02-Nov-2018].
[31] Crawford and S. B., “Intraosseous Vascular Access Device as a Transarticular K-wire Alternative in Mallet Finger Laceration,” Clinical Practice and Cases in Emergency Medicine, 01-Jan-2018. [Online]. Available: https://escholarship.org/uc/item/3nz8q8x5. [Accessed: 02-Nov-2018].