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WO1993009726A1 - Dispositif orthopedique - Google Patents

Dispositif orthopedique Download PDF

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Publication number
WO1993009726A1
WO1993009726A1 PCT/IE1992/000022 IE9200022W WO9309726A1 WO 1993009726 A1 WO1993009726 A1 WO 1993009726A1 IE 9200022 W IE9200022 W IE 9200022W WO 9309726 A1 WO9309726 A1 WO 9309726A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone
pins
frame
reaction members
reaction
Prior art date
Application number
PCT/IE1992/000022
Other languages
English (en)
Inventor
John Peter Corrigan
Original Assignee
John Peter Corrigan
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by John Peter Corrigan filed Critical John Peter Corrigan
Publication of WO1993009726A1 publication Critical patent/WO1993009726A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6425—Devices extending alongside the bones to be positioned specially adapted to be fitted across a bone joint
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/645—Devices extending alongside the bones to be positioned comprising a framework
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B2017/606—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors with resilient spring element

Definitions

  • This invention relates to an orthopaedic device for use generally in osteoplasty and osteosynthesis.
  • the device according to the invention has particular application in the management of complicated fractures, in the correction of deformities in bone and in the extension of bones for the controlled lengthening of limbs, especially the lengthening of leg bones.
  • External fixation employing various types of external fixation systems is a classical surgical procedure. External fixation is commonly used in leg lengthening for the correction of congenital defects, for the correction of deformities arising from illness, for example poliomyelitis or after accidental fracture.
  • U.S. Patent No. 4,365,624 discloses an external fixation system wherein bone fixation is achieved principally by the transfixing kind of fixation which means that the pins pass through the bone. In the non- transfixing kind of fixation, the pins enter into the bone but do not pass therethrough.
  • U.S. Patent No. 4,784,125 is stated to enlarge the possibilities of application of the system disclosed in U.S. Patent No. 4,365,624 by modifying the assembly of the rods, pins, and other connecting parts and members on the arcuate element disclosed therein, which in use encircles the bone partially or completely.
  • the devices of U.S. Patent Nos. 4,365,624 and 4,784,125 allow for a combination of transfixing pins with transfixing wires held under tension.
  • the procedure of bone lengthening may be achieved by the techniques of epiphyseal separation or by corticotomy of the cortex.
  • Epiphyseal separation can be used in growing bone but corticotomy is the more usual method used for lengthening at all ages.
  • a suitable external fixation apparatus is applied to the limb to be lengthened.
  • a traction force is induced between the epiphysis and metaphysis across the growth cartilage which eventually severs and the epiphysis is thereby separated from the metaphysis.
  • the bone is then subjected to distraction until the required lengthening is achieved.
  • a hematoma forms in the gap between the epiphysis and the metaphysis.
  • the hematoma progressively changes to fibrous tissue and thence to osseous tissue, whereby a new cortex is formed.
  • the procedure of bone lengthening involves surgically breaking or cutting the bone and, by means of an external fixation or lengthening device, moving the cut ends apart at a predetermined rate (usually 1mm per day).
  • the cut ends produce new bone material but, at this stage, it is not fully consolidated.
  • the bone is allowed to consolidate and the device is removed.
  • the maximum lengthening achievable is circa 15cm which takes on the average 1 year.
  • Typical lengthening devices can be classified as two types: half- pin; and full pin as follows -
  • the bone is drilled in two or more places, both above and below the proposed break site.
  • Metal fixator half-pins (A) are screwed into the bone (B) (see Fig. 1) such that they protrude through the skin (C).
  • the lengthening device (D) is attached to the pins as indicated.
  • the load carrying ability thereof is transferred to the lengthening device (D) through the pins (A).
  • the axial force (F) required to stretch the muscle and soft tissue has been reported as being of the order of 250N.
  • a second lengthening device see Fig. 3
  • This entails drilling the bone (B) as before, but in this case the pins (A3) are passed right through the limb, puncturing the skin (C) on both sides, and a lengthening device (D) is fixed to each end of the pins (A3).
  • the lengthening devices are spaced an equal distance from the bone they will each transport half of the muscle force (i.e. F/2).
  • F/2 half of the muscle force
  • the resulting moments being of opposite sense will act on the bone such that they cancel each other out. Therefore the bone will only experience an axial force and will not rotate as before.
  • the disadvantage of this procedure is that the number of wounds is doubled with the consequent risk of infection.
  • a variation on the above procedure is the use of a system such as that described in U.S. Patent Nos. 4,365,624 and 4,784,125 which employs solid rings or part rings and the pins are replaced by tensioned wires which still pass through the limb.
  • the purpose of the rings is to give suitable anchor points to which the tensioned wires can be attached.
  • the invention provides an orthopaedic device for use in osteoplasty and osteosynthesis of the type comprising an external fixation arrangement employing half -pins, said device comprising a frame to be applied to a part of a body and affixed to a given bone by means of said half -pins mounted on said frame, said frame having at least two reaction members disposed in use with their respective longitudinal axes parallel to the longitudinal axis of the bone and connected by bridging pieces in a manner such that any axial force acting along the bone is reacted by said reaction members, while minimizing any resulting bending moment on the bone and reducing pull-out forces at the pin-bone interface.
  • orthopaedic is intended to embrace associated surgical procedures involving fitting of the device and subsequent treatment therewith.
  • half-pins are used to effect attachment to a bone; however, by reacting the bone and muscle forces in a predetermined way, the bending moments experienced by the bone can substantially cancel each other as with the known full pin devices.
  • the device according to the invention can be adapted to impart a bending moment, if required, as hereinafter described.
  • the reaction members can be adapted for longitudinal adjustment.
  • the reaction members are rod-shaped and comprise separate tubular elements with an internal thread or a threaded section mounted on a threaded shaft for longitudinal movement relative to said shaft.
  • the reaction members will normally be disposed equidistantly about the application site and thus the bone to which the device is affixed.
  • the pins can be mounted either on the reaction members or on the bridging pieces, as required.
  • the length of each reaction member can be adjusted independently of the or each other reaction member.
  • At least one set of half pins is mounted on the frame for movement parallel to the longitudinal axis thereof.
  • reaction members are pivotally mounted on the frame such that unequal longitudinal adjustment of the reaction members causes them to pivot out of their position parallel to the longitudinal axis of the bone so as to impart a bending moment.
  • a bridging piece is suitably movably mounted between the free ends of the reaction members, the movable bridging piece having a set of half pins mounted thereon, such that movement of the bridging piece results in longitudinal adjustment of the or each reaction member.
  • Such devices are particularly suited to bone lengthening.
  • the device according to the invention can be adapted for spanning a joint and includes a locking mechanism for preventing articulation at said joint when in a locked position.
  • a set of pins downstream of said locking mechanism is pivotally mounted on said device in a manner so as to permit limited articulation when in the unlocked position.
  • the various components of the device will suitably be formed of a suitable metal or metal alloy, except where otherwise specified.
  • the pins will suitably be stainless steel pins 4-6mm in diameter.
  • the bridging pieces will suitably comprise semi-circular shaped metal bands, because the device according to the invention will most usually be applied to a limb.
  • the device will suitably include at least two such bridging pieces.
  • the bridging pieces may be formed of a carbon fibre composite material permeable to X-rays and moulded to a suitable shape for application to the body.
  • the device will usually have band or hoop-like bridging pieces to facilitate access to the device by an attending surgeon.
  • the pins are clamped on the device as required by suitable clamping devices or pin blocks known per se and conventionally used in known external fixation devices.
  • the structure of the device according to the invention is such that loosening of the pins is minimised due to the mode in which the axial load is applied. With conventional devices the axial load is applied eccentrically.
  • the bridging pieces tend to add rigidity to the overall structure of the device.
  • Fig. 1 is a schematic representation of a known external fixation device employing half -pins in situ following surgical cutting of a bone;
  • Fig. 2 is a schematic representation of the device of Fig. 1 during a bone lengthening procedure
  • Fig. 3 is a schematic representation of a known external fixation device employing full pins in situ following surgical cutting of a bone
  • Fig. 4 is a schematic representation of a bone and the forces encountered during distraction using the device of Fig. 3;
  • Fig. 5 is a schematic representation of a first embodiment of an orthopaedic device according to the invention.
  • Fig. 6 is a schematic representation of a second embodiment of an orthopaedic device according to the invention.
  • Fig. 7 is a front elevation of a third embodiment of an orthopaedic device according to the invention.
  • Fig. 8 is an end elevation of the device depicted in Fig. 7;
  • Fig. 9 is a plan view of the device depicted in Fig. 7;
  • Fig. 10 is a further front elevation of the device depicted in Fig. 7 adjusted to impart a bending moment
  • Fig. 11 is a front elevation of a fourth embodiment of an orthopaedic device according to the invention in situ in a locked position;
  • Fig. 12 shows the device of Fig. 11 in the unlocked position
  • Fig. 13 is an end elevation of the device in the position shown in
  • an orthopaedic device for use in lengthening of a bone 11 following surgical cutting, the cut being indicated at 12.
  • the device 10 comprises a frame, indicated generally at 13, having two longitudinal reaction members 14a and 14b connected by bridging pieces 15.
  • a set of half- pins 16, 17 is mounted on the reaction member 14b one on either side of the cut 12.
  • the length of each reaction member 14a,14b is adjustable and the cut ends of the bone are progressively separated by moving the sets of pins 16, 17 apart in conventional manner. Any tendency towards bending, discernible by X-ray examination, can be counteracted by appropriate adjustment of the length of the reaction members 14a, 14b.
  • Adjustment of the length of the reaction member 14a can be used to reduce the bending of the reaction member 14b. Such adjustment results in an increase in the overall stiffness of the device and also reduces the pull-out forces acting at the pin-bone interface.
  • the sets of pins 16 and 17 are mounted on the bridging pieces 15a and 15b, respectively; the set of pins 16 being mounted on a pin clamp 18 which may be adjusted relative to the bridging piece 15a, in a direction parallel to the bone axis.
  • longitudinal movement of the sets of pins 16, 17 relative to each other and thus the bone ends may also be achieved by adjustment of the length of the reaction members 14a, 14b.
  • the frame 13 is positioned relative to the bone 11 such that the axes of the reaction members 14a, 14b and the bone lie in the same plane.
  • the bone/muscle force (F) (see Fig. 5) acting along the axis of the bone 11 is transmitted into the frame 13 and reacted by the reaction members 14a, 14b.
  • the bending moment M can be reduced because the force FR 2 in the reaction member 14a acts in the opposite direction thereto, resulting in a reduction in the compressive stress at the pin-bone interface and a reduction in the angulation of the bone segments that can give rise to problems in clinical practice.
  • reaction member 14a will be reduced due to the attachment of reaction member 14a to reaction member 14b by means of the bridging pieces 15, although by how much depends on the relative stiffness of the material from which the bridging pieces are constructed.
  • accurate analysis depends on the extent of bending of the reaction member 14a. In qualitative terms, if a force is applied to the device 10, then the reaction member 14a will bend, which will, at least partly, be responsible for a push-and-pull arrangement of forces on the bone cortex. If bending of the reaction member 14a is reduced, then the push-and-pull forces will be reduced also.
  • Some adjustment of the device 10 can be carried out by "Differential Tweaking" by which is meant that reaction member 14a, which is unconnected to the pins 16, 17, can be distracted to a greater length than the reaction member 14b which is connected to said pins 16, 17.
  • Such adjustment will increase FR 2 relative to FR] and, thereby, reduce M and peak axial stresses transmitted across the pin-bone interface. Furthermore, such adjustment will also reduce, possibly completely, bending of the reaction member 14a and thus minimising shear pull-out of the pins 16, 17.
  • FIGs. 7-10 there is illustrated an orthopaedic device indicated generally at 20 by means of which bending of a bone, more especially straightening of an already bent bone, can be achieved, with or without simultaneous lengthening.
  • the device 20 comprises a first part consisting of a frame 21 comprising a pair of fixed length spacers 22, 23 connected by bridging pieces 24, 25.
  • a position adjusting mechanism 26 carrying a set of half- pins 27 by means of a pin block 28 is connected at either end to one of said bridging pieces 24, 25.
  • the second part, indicated generally at 29, is an extension of the frame 21 and comprises a pair of adjustable length reaction members 30, 31, adjustable by nuts 32, pivotally mounted on the spacers 22, 23, respectively by means of hinges 33.
  • the reaction members 30, 31 are connected by a further bridging piece 34 carrying a set of half -pins 35 by means of a pin block 36.
  • the position adjusting mechanism 26 allows for the movement of the pins 27 relative to the pins 35 in a direction parallel to the bone axis.
  • increasing the effective length of one of the adjustable length reaction members 30, 31, while reducing the length of the other of said reaction members 30, 31 will cause the second part 29 and the section of bone attached thereto to rotate relative to the other section of bone thus effecting a bend.
  • the position adjusting mechanism 26 can be operated to achieve such lengthening in the manner hereinbefore described for the embodiments depicted in Figs. 5 and 6 of the Drawings.
  • reaction members 26 can be replaced by a non-adjustable member and lengthening achieved by simultaneous lengthening of reaction members similar to reaction members 30, 31. Lengthening combined with bending is possible in this embodiment by non-equal, simultaneous lengthening of the reaction members.
  • FIG. 11-13 there is indicated generally at 40 an orthopaedic device for use in wrist fracture management and shown in situ in Figs. 11 and 12.
  • the fixator With conventional fixator devices for use in wrist fracture management, the fixator, the axis of which is not coincident with the bone at the fracture site, causes a bending moment at the fracture site when a distraction force is applied.
  • the device 40 is modified relative to the known fixator by inclusion inter alia of two 'horse shoe' shaped bridging pieces 41, 42 disposed so that a narrow gap 43 is defined therebetween.
  • the bridging pieces 41, 42 each carry a set of half-pins 44, 45 by means of elongated pin blocks 46,47, respectively, mounted thereon.
  • the bridging pieces 41, 42 are movable relative to each other by means of clamp screws 48.
  • the device 40 includes a locking mechanism 49 which includes a tapered wedge 50 adapted for locking engagement with an end 51 of the pin block 47. In the unlocked position the pin block 47 is free to rotate to a limited degree about a ball joint 52 (see Fig. 12).
  • the device 40 is attached to the radius and to the metacarpal of the index finger by means of the sets of half-pins 44, 45, respectively.
  • the hand is held in an inclined position, as indicated by engaging the tapered wedge 50 of the locking mechanism 49 in the locked mode. Distraction is achieved by increasing the gap 43 intermediate the bridging pieces 41, 42 by means of the clamp screws 48. After approximately two weeks the tapered wedge 50 is disengaged allowing the hand to return to its natural position. By means of the ball joint 52 some articulation of the wrist is afforded to the patient.
  • the device according to the invention has application generally in orthopaedics and to associated surgery for altering bone shape, especially elongation thereof, and in fracture management.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un dispositif orthophédique (10), utilisé en ostéoplastie et en ostéosynthèse du type comprenant un agencement de fixation externe faisant usage de demi-broches (16, 17), comprend une structure (13) devant être appliquée à une partie du corps et fixée à un os donné (11) par l'intermédiaire des demi-broches (16, 17) montées sur la structure (13). Cette dernière (13) comprend au moins deux éléments produisant une réaction (14a, 14b) qui sont disposés, lors de leur utilisation, de façon que leur axe longitudinal soit parallèle à l'axe longitudinal de l'os (11), et qui sont reliés par des éléments d'accouplement (15), de telle façon que toute force axiale agissant le long de l'os (11) rencontre une réaction provenant des éléments produisant une réaction, alors que tout couple de courbure agissant sur l'os est réduit au minimum et les forces de traction au niveau de l'interface broche-os sont réduites. Dans le cas d'un allongement de l'os, l'on obtient ainsi les avantages présentés par les dispositifs à demi-broches ou à broches entières connus, notamment l'allongement de l'os avec une courbure minimale, à moins qu'une courbure ne soit requise, alliés à un nombre réduit de sites de lésions.
PCT/IE1992/000022 1991-11-15 1992-11-12 Dispositif orthopedique WO1993009726A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IE398091 1991-11-15
IE3980/91 1991-11-15

Publications (1)

Publication Number Publication Date
WO1993009726A1 true WO1993009726A1 (fr) 1993-05-27

Family

ID=11039259

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IE1992/000022 WO1993009726A1 (fr) 1991-11-15 1992-11-12 Dispositif orthopedique

Country Status (2)

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AU (1) AU2910792A (fr)
WO (1) WO1993009726A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002007620A3 (es) * 2000-07-17 2002-04-25 Davila Jorge P Flores Dispositivo y metodo para la fijacion, compresion y distraccion osea

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2076657A (en) * 1980-05-31 1981-12-09 Atkins Brian Norman Apparatus for external fixation of part of the human or animal skeletal structure
GB2101488A (en) * 1981-06-03 1983-01-19 Rizk Shoukry Abdel Masseih External fixation frames and fixing pins therefor
GB2146533A (en) * 1983-09-09 1985-04-24 Clyburn Terry Dynamic external fixator
EP0146872A2 (fr) * 1983-12-17 1985-07-03 Schewior, Thomas, Dr.med. Appareil pour ostéosynthèse

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2076657A (en) * 1980-05-31 1981-12-09 Atkins Brian Norman Apparatus for external fixation of part of the human or animal skeletal structure
GB2101488A (en) * 1981-06-03 1983-01-19 Rizk Shoukry Abdel Masseih External fixation frames and fixing pins therefor
GB2146533A (en) * 1983-09-09 1985-04-24 Clyburn Terry Dynamic external fixator
EP0146872A2 (fr) * 1983-12-17 1985-07-03 Schewior, Thomas, Dr.med. Appareil pour ostéosynthèse

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002007620A3 (es) * 2000-07-17 2002-04-25 Davila Jorge P Flores Dispositivo y metodo para la fijacion, compresion y distraccion osea

Also Published As

Publication number Publication date
AU2910792A (en) 1993-06-15

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