WO2020202217A1 - Advanced pediatric spica table - Google Patents

Abstract

The present invention discloses an advanced spica table which has a base plate (1) for the patient head and upper torso support and adjoining adjustable arm support (3). Base plate (1) accommodates sliding platform (2) utilized to support lower torso. Foot and Traction Unit Support (Right-16, Left- 17) is provided to fix foot position firmly with shoes (22) attached on the foot plate (21) located on both sides. External Rotation and Foot Height Adjuster (14, 15) helps in foot height adjustment as required. Traction Unit (19) mounted on a traction unit mount (18), is an element to hang traction bucket (20) and to fix it with sliding puller (19b). A bi-axial angle measuring instrument (9) is installed at the counter-traction bar (8) for simultaneous measurement of hip abduction and flexion angle.

Description

ADVANCED PEDIATRIC SPICA TABLE

FIELD OF INVENTION

The present invention relates generally to the field of orthopedics and related apparatus and equipment. More specifically, this invention pertains to advanced pediatric spica table which is used to apply Spica Cast to treat Femur Bone Fractures , after Close & open reduction of DDH(Developmental dysplasia of Hip) and immobilize hip joint after hip surgeries in Children.

BACKGROUND OF THE INVENTION

About Femur Bone Fractures: Femur bone, also called thigh bone, is the strongest and longest bone in human body. Despite the size and strength of the femur, it gets fractured in adults and in children. It may be due to vehicle accident on road, a fall from bed or in playground or accidental hitting with a piece of furniture at home or anything which might result in broken leg. The severity of fracture may vary from hairline crack to complex injury involving damage to surrounding soft tissues as well. Methods of treating Femur bone fractures in children: While treating such fractures in children, some unique factors and considerations must be kept in mind. These factors include the configuration of the fracture, level of fracture, patient’s size and age as well as adjoining soft tissue injury. Sometimes shortening of bone is also a cause of concern while treating fracture.

Available solutions: L Pavlik harness (Prior art Fig 1) - Fractures in these very young children and in infants are usually treated by placing the child in a Pavlik harness, (Prior art Fig 1) a cloth brace that helps hold the thigh in the proper position while it heals.

2, The Spica Cast (Prior art Fig 2) - Among children in this age group, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. This procedure takes place in the operating room. The Spica cast usually extends from mid-chest down the length of the affected leg and halfway down the other leg. This is the most acceptable treatment method of fracture shaft femur in age group six months to five years. Children remain in the spica cast for a period ranging from six weeks to three months. It continues to be the safest and least complicated method for treating fractures among this age group and yields excellent results. 3. Elastic Stable Intramedullary Nails(ESIN) or Rods (Prior art Fig 3) - Pediatric

orthopedists have started using intramedullary nails or rods made from strong, lightweight, and flexible titanium to stabilize femur fractures in children aged five and older. After using this nail or rod, generally no casting is required.

4. Rigid Intramedullary Nails and external fixators are used for children above the age of 10. (Ref: https://www.hss.edu/conditions femur-fractures-in-children-broken-thish.asp)

We restrict our description towards Spica cast and method of fixation of spica cast using Spica table.

We hereby explain various anatomical terms related to movement of limbs for better understanding of the invention relating to spica table. Anatomical terms related to movement of limbs:

Anatomical terms of movement are used to describe the actions of muscles on the skeleton. Muscles contract to produce movement at joints, and the subsequent movements can be precisely described using the terminology below. As for anatomical terms of location, the terms used assume that the body starts in the anatomical position. Flexion and extension (Prior art Fig 3) are movements that occur in the sagittal plane. They refer to increasing and decreasing the angle between two body parts:

Flexion refers to a movement that decreases the angle between two body parts. When the knee flexes, the ankle moves closer to the buttock, and the angle between the femur and tibia gets smaller. Extension refers to a movement that increases the angle between two body parts. Extension of the knee straightens the lower limb.

Abduction and adduction (Prior art Fig 4) are two terms that are used to describe movements towards or away from the midline of the body.

Abduction is a movement away from the midline, just as abducting someone is to take them away. For example, abduction of the shoulder raises the arms out to the sides of the body.

Adduction is a movement towards the midline. Adduction of the hip squeezes the legs together. In fingers and toes, the midline used is not the midline of the body, but of the hand and foot respectively. Therefore, abducting the fingers spreads them out.

Medial and lateral rotation (Prior art Fig 5) describe movement of the limbs around their long axis.

Medial rotation is a rotational movement towards the midline. It is sometimes referred to as internal rotation. To understand this, we have two scenarios to imagine. Firstly, with a straight leg, rotate it to point the toes inward. This is medial rotation of the hip. Secondly, imagine you are carrying a tea tray in front of you, with elbow at 90 degrees. Now rotate the arm, bringing your hand towards your opposite hip (elbow still at 90 degrees). This is internal rotation of the shoulder.

Lateral rotation is a rotating movement away from the midline. This is in the opposite direction to the movements described above.

(Ref: https://teachmeanatomy.info/the-basics/anatomical-terminology/terms-of-movement/)

Different levels of fracture require different angles of hip flexion abduction and external rotation of hip and sustained in-line traction in this position for proper alignment of fracture fragments, same time application of spica require unsupported area(Bare area) from lower torso (below nipple) to down till ankle in affected lower limb and UP to knee in opposite lower limb .

Therefore a stability and maneuverability while applying a hip spica cast in the treatment of pediatric fractures and dislocations is a requirement. To do so, we need to have a table or platform where the child can be rested and his positioning can be maneuvered. In order to understand the method of fixation of spica cast in kids, one can check out at following video link. (Ref: https://www.youtube.com/watch?v=DR5W6T8w7Ss)

ABOUT SPICA TABLE Spica table is a table or a platform which provides both stability and maneuverability while applying a hip spica cast in the treatment of pediatric femur bone fractures , Close and open Reduction of developmental dysplasia of Hip and immobilization hip joint after surgeries aroud hip joint. Therefore it should be adjustable, efficient and user friendly. Currently available Spica Tables can be seen in prior art fig 6, 7, 8, 9 and 10. A few companies are selling these tables under trade names like PELVI PEDAL and ORTHOPEDIATRICS SPICA TABLE

( Ref: http://pediatricspicatables.com/pediatric-spica-table/ http://tstsan.eom/en/urun/i/112/pelvi-pedal-hip-spica-cast-table.html https://www.orthopediatrics.com/op_site/product-detail/spica-table)

LIMITATIONS OF EXISTING SPICA TABLES

The currently available spica tables are either much costly with complex mechanism or are technically less effective. All kinds of limb movements which are required to fix the fracture are not easily achievable with existing Spica Tables. A lot of innovation is being put by manufacturers of Spica table but the best is yet to come. None of existing spica table has the important features of inbuilt abduction and flexion measuring instrument, effective in-line traction in desired hip flexion , abduction and specially controlled external rotation, which is very important because fracture femur remodeling during fracture healing is minimal for rotational mal alignment. Also none of current devices has sliding lower torso platform due to which a patient is given anesthesia on a different table and later on he is shifted to spica table after induction. This results in a lot of burden on anesthetist as there may be chances of slippage of intubation tube and it also requires additional men power to shift the patient from one table to the spica table. Therefore existing devices require 3-4 persons to apply spica cast.

Most of places in India and moreover so other developing courtries, orthopaedician dealing with pediatric fracture patients has to use some kind of self-suitable techniques such as using two sand bags, two parallel bar etc. to support and position patient body. Such methods are not only ineffective but also may cause serious complications like accidental fall or Spica cast syndrome. INNOVATIVE SOLUTION PROPOSED BY INVENTORS

One of the inventor being an orthopedic surgeon himself, has made a deep analysis on the basic requirements and fundamental functioning of the device and the other inventor who is a mechanical engineer simplified its design and material. Almost all the limitations of existing tables have been overcome and some exclusive features are added to this spica table which additionally makes it very innovative.

PRIOR ART AND ITS DRAWBACKS

Various doctors and researchers have been working to solve the problem as cited above. Some close patents are discussed in the patents below:

Patent application no. US 8,001,633 B2 discloses a spica table, collapsible for storage, which includes stabilizing legs, a separate adjustable Support for the upper body and the buttock, to accommodate patients of differing sizes and individual infinitely adjustable leg and foot supports.

Patent application no. US 2012/0180797 A1 discloses a modular table for supporting a patient during application of a spica cast. The table has a support for the patient's upper body and a separate support for the patient's lower body. The supports have coupling members that interface with existing examination or operating tables, or with additional members attached thereto. The coupling members may be placed into features shaped to receive them in one or more spaced-apart positions, or in other embodiments may slide through T-shaped slots or tracks that guide relative alignment of the Supports. The tracks for the two supports may be the same or different; straight or curved; and parallel, perpendicular, or skew. Additional fixtures attach to the table or additional members to assist in applying traction to the patient during the application.

Patent application no. US 4,342,451 discloses a generally upright open framework, having patient forearm and hand supports and having a horizontal seat intermediate its height, is supported by a platform mounted on a vertically adjustable pedestal base. Back and torso support members, telescopically received by sockets on the platform, form a back rest when the frame is in cast chair position. Base supported universal joint connected foot rests support the feet and legs of a seated patient. The back and torso members are movable to a second position on the platform to form a torso and head support for a supine patient. Telescopic tube extensions are supported by other sockets on the platform and include universal joint connected feet enveloping members for supporting the feet and legs of a supine patient when the frame is in spica table position. Substantially all components forming the frame and supports for a patient or his limbs are movable toward and away from the platform and relative to each other when supporting a patient, either seated or supine, for casting, splinting or bandaging the torso and/or limbs.

All the above close patents have one or two common features of the invention but none of them is a complete solution to the limitations as explained above. None of them has any arrangement to measure various angles of Flexion and rotational movements which is a requirement. Bi-axial angle measuring device is absent in these but present invention solves this critical problem too. Either the Sliding platform is not fitted or it is in the shape of chair. Although shoe support is provided in one of these but it's a fixed cured bar over which shoes with its sliding elements slide but it has a fixed curve headed towards a fixed center geometrically, which will not provide correct positioning for patients with different age or height. This may cause improper positioning of the fracture bone alignment. In present invention, this is duly taken care of and the headed center is always patient limb joint. Traction unit assembly in one of these is for adults bone fracture that tracts whole leg (foot-tibia-thai bone-limb) when applying implant into the bone(for adults) and is not suitable for children. "EXTERNAL ROTATION" of the limb can't be perform on this tables. Moreover, in even if the foot abduction system is provided, both the foot travel together, so we can't give different abduction and flexion angle movement and height to a single leg. Therefore the patient with different type of fracture (needs different degree of adjustment each one) may not be operatable on these tables. In comparison, the present invention provides individual foot stability and angle movement.

Hence it is clear that none of the available patents or commercially available products are able to achieve the desired results as achieved by the present invention.

OBJECTS OF THE PRESENT INVENTION

1. The main objective of present invention is effectively reduction of fracture femur in acceptable alignment and apply spica cast in desired position of hip flexion, abduction and external rotation. To achieve this we need all desired degree of freedom of hip joint movement (flexion, abduction & external rotation) and independent knee flexion (not dependent on hip joint flexion) we designed our lower limb unit with traction unit in a way so that our machine full-fill all these functional demands

2. Another object of the present invention is to disclose a spica table which has means to provide accurate and reproducible measurement of angle of hip abduction and flexion.

3. Another object of the invention is to disclose a spica table which has means to provide sustained in-line traction in desired hip abduction and flexion.

4. Yet another object of the present invention is to disclose a spica table which has means to allow controlled external rotation so that distal fracture fragment rotationally aligned with proximal fragment, hence avoiding a least remodeling potential rotational mal union.

5. Yet another object of the present invention is to disclose a spica table which has sliding lower torso platform so that anesthesia induction can be perform on this spica table itself.

6. One more object of the present invention is to disclose a spica table which reduces manpower.

7. One more object of the present invention is to disclose a spica table which is comparatively low in cost despite providing all these exclusive and fundamental desired features.

SUMMARY OF THE INVENTION The present invention discloses an advanced spica table which has inbuilt bi-axial angle measurement instrument with the help of which accurate and reproducible values of hip abduction and flexion can be taken. A traction unit which provides sustained in-line traction in desired hip abduction and flexion and external rotation is also part of the spica table. The spica table of present invention has means to allow controlled external rotation so that distal fracture fragment rotationally aligned with proximal fragment, hence avoiding a least remodeling potential rotational mal union along with a sliding platform to support lower torso so that anesthesia induction can be perform on this spica table itself.

BRIEF DESCRIPTION OF DRAWINGS:

Fig 1: Prior art - Pavlik harness on a child with developmental hip dysplasia

Fig 2: Prior art - Spica cast on a child which immobilizes the leg after realignment.

Fig 3: Prior art - X-ray showing flexible intramedullary nails in place.

Fig 4: Prior art - Medial and lateral rotation

Fig 5: Prior art - Abduction and adduction movement

Fig 6: Prior art - Currently available Spica Table

Fig 7: Prior art - Currently available Spica Table

Fig 8: Prior art - Currently available Spica Table

Fig 9: Prior art - Currently available Spica Table

Fig 10: Prior art - Currently available Spica Table

Fig 11- Isometric View (Full extended Advanced Spica Table)

Fig 12- Isometric View (Advanced Spica Table with slightly open sliding platform)

Fig 13- Folded (Compact) Isometric View

Fig 14- Isometric View (Without Traction and Foot Support Unit)

Fig 15- Compact Isometric View (Without Traction and Foot Support Unit)

Fig 16- Detail View of Bi- Axial Angle Measuring Instrument

Fig 17- Detail View of Foot and Fall Angle Measuring Scale

Fig 18 - Detail View of Foot Height Measuring Scale

Fig 19 - External Rotation and Foot Height Adjuster

Fig 20- Right External Rotation and Foot Height Adjuster Fig 21- Left External Rotation and Foot Height Adjuster

Fig 22- Representation of Device External Rotational Movement

Fig 23 - 3D Model Representation of Spica Table

Numbering Details:

DETAILED DESCRIPTION OF THE INVENTION

The advanced spica table of present invention is a complete solution with adjustable features in many ways keeping in view the child age group 6 months to 5 years. While setting the spica cast, first of all we need to provide a platform or support for the patient’s head neck and upper torso and sacrum. We also need to provide support to both the feet. Then there is a requirement of flexion, abduction and external rotation movement of hip joint and independent flexion of knee (not dependent on hip flexion) for proper reduction of the fracture and apply spica cast in acceptable position. Advanced Spica Table of present invention is capable of providing all these movements effectively, precisely and values are reproducible increasing validity of machine. There is also need of measurement of accurate hip abduction and flexion angle which is presently done in a manual manner by the doctor or his assistant. It sometimes causes human error and the accuracy is compromised. But the

Present invention overcomes this limitation by having a detachable bi-axial angle measuring instrument which is the heart of this invention.

Constructional Details of the invention:

The main frame of the table is rested on a foundation (4) with legs (5) fitted with hinge (27) and Foundation rear support (6) for improved stability of the table.

Various elements of the spica table are as below:

1. For supporting the head and torso:

A base plate (1) for the patient head and upper torso support and adjoining adjustable arm support (3) on both sides, is provided. The arm supports (3) are adjustable as per age and height of patient. Patient’s arms can be put on these supports (3). It further consists of sub elements (la, lb, lc, Id and le). Base plate (1) also accommodates sliding platform (2) which is utilized to support lower torso till patient induced by anesthetist.

A sliding sacral support unit (7) which can be adjusted to support pelvis as according to the patient age or height and can be locked at that position is also provided.

2. For providing support and positioning of both the feet:

Foot and Traction Unit Support (Right-16, Left- 17) is provided to fix foot position firmly with shoes (22) attached on the foot plate (21) located on both sides.

With the help of the same element, the required external rotation of the hip can be adjusted for the accurate alignment and position of the broken femur bones. There is a groove (15c) that limits this angle of rotation to be safe and effective. Since the Foot and Traction Unit Support (Right-16, Left- 17) also acquires traction unit (19) so traction unit (19) also turns with the same angle thus maintaining the in-line position with the femur accurately for effective traction.

Elements (like foot and traction unit support, traction unit mount, and traction unit, foot plate with shoes) are supported and positioned with the help of the External Rotation and Foot Height Adjuster (14, 15). With this, foot height can be adjusted as required and the height measurement can be read on the respective height scale. Also, External Rotation and Foot Height Adjuster (14, 15) allows the foot and traction unit support (Right-16, Left- 17) to rotate within a limited angle and the angular value can be read on the respective angular scale placed just above the groove (2b). Traction Unit (19) mounted on a traction unit mount (18), is an element to hang traction bucket (20) and to fix it with sliding puller (19b). Traction Bucket (20) is a medium to transfer the generated traction force from the traction unit (19) to the femur by grabbing and puling (in-line) tibia just near to the knee joint. Counter-

Traction Bar (8) is attached to counter the force created by the traction unit (19) during the femur alignment procedure.

3. For measurement of various angles of movements:

A bi-axial angle measuring instrument (9) is installed at the counter-traction bar (8) for simultaneous measurement of hip abduction and flexion angle which helps in reproducible values of hip angulation to correct fracture alignment.

The same bi-angular measuring instrument (9) is also used to measure the angle of Abduction angle of the patient hip which is varied with the help of Abduction setter (10) which is supported with the help of support setter (11).

The same bi-angular measuring instrument (9) is also used to measure patient’s hip flexion angle which is adjusted with the help of Flexion-Extension Sliding controller

(FESC: Right-12, Left- 13).

To fix all these elements and for tightening of these elements, we need various types of bolts and nuts (23, 24, 25, 26).

With the above constructional features, we achieve a platform or support for the patient’s head as well as Torso. We also achieve support to both the feet and also achieve various movements such as Flexion, abduction and rotation to the foot as well as leg for proper reduction of the fracture. Advanced Spica Table of present invention is capable of providing all these movements without the help of any extra manpower.

Most importantly, we can easily measurement of hip abduction and flexion angle with the help of specially designed and developed bi-axial angle measuring instrument (9) which is detachable and various scales of angle measurement are so positioned such that it can measure hip abduction and flexion angles. This instrument can be easily detached whenever it is not required during the cast fitting so that it does not obstruct in doctor’s working. But it is so designed such that it gets fitted into the counter-traction bar (8) through mount (9f) during use.

There are the following advantages of the solution proposed by the present invention:

·/ Technically advanced to meet functional fundamental demands in totality in single Spica Table. ·/ Accurate and reproducible angle measurement

·/ In-line traction in desired hip flexion abduction and even in external rotation

·/ Reduced required man-power

Reduces anesthetist’s burden

·/ Allows on table C-arm visualization to monitor fracture reduction

S Cost effective

Device is foldable (demands less space for storage and facilitate portability)

Primarily used material for the complete spica table of the present invention is Stainless steel or

Mild Steel. But some components such as Base Plate (1), Sliding Platform (2) Machine

Foundation (4) and abduction setter (10) are made of Carbon Fiber.

In another embodiment of the present invention, the machine Foundation (4) may also be designed in form of solid rectangular flat plate in place of hollow rectangular tube.

In yet another embodiment of the present invention, the present invention is Semi-automatic as Base place (1) Height, Sliding Sacral Support central Unit (7) height, Sliding platform (2), Abduction Setter (10) and Right & Left Flexion - Extension Sliding Controller -FESC (12&13) are automatically operated while the rest components/elements are manually operated.

NOVELTY:

The novelty of the present invention lies in a complete working solution to the doctor in the form of advanced spica table. This table can provide all kinds of limb movements which are required to reduce Femur bone fracture in children, can measure all fundamental angles during fixation whenever required, can provide stabilization of either foot at desired angle and height, can also provide inline traction and adjustment in traction whatever is required and lastly, can provide lower torso sliding platform that enables on- spica table anesthesia. None of the existing similar spica tables have all these features in single table. Some of the cited prior art tables have a few common features but the manner in which these are achieved is different than the present invention.

INVENTIVE STEP:

It is not easy for person skilled in art to just juxtapose all the elements of the present invention as it needed a lot of understanding of the complete procedure of spica cast fitting and the need of various features in a spica table. Specially designed bi-axial angle measuring instrument (9) is the heart of this invention without which the spica table of present invention is incomplete.

During surgeries and fracture fixing, angle measurement is a mandatory requirement so that the bone is not fitted at any wrong angle. Angles of movement during hip flexion abduction and in external rotation of limb done manually while holding the limb, may result in inaccuracy as well as additional manpower. This also increased the time of complete procedure.

None of the existing similar spica tables have all these features in single table. To give a complete solution, sliding lower torso support, in line traction unit in desired hip flexion abduction and external rotation, foot position adjustment mechanism, all desired degree of freedom of hip joint movement- flexion, abduction, external rotation, independent knee flexion, accurate angle measurement instrument, all have to be fitted in a careful manner. So designing of the advanced Spica table is done keeping in view all engineering aspects as to what types of channels and grooves and where they must be provided, what type of nuts and bolts and where they must be provided. Mounting of traction unit along with Foot and Traction Unit Support (Right-16, Left- 17) so that traction unit (19) also turns with the same angle thus maintaining the in-line position with the femur accurately for effective traction, is also a well thought over step to reduce human effort. Due arrangement is made for providing External Rotation and Foot Height Adjustment with the help of Sliding Tube (14a, 15a) which enables the said unit to slide vertically to adjust the left foot height and knee joint flexion. In all, there are many inventive efforts put in by the inventors to provide this complete solution of Spica table.

INDUSTRIAL APPLICATION:

The present invention is developed keeping in view the applicability in pediatric orthopedics. The Spica cast is used for treatment of fractures of femur bone, DDH, immobilization after Surgeries around hip in children. To put a Spica cast, a Spica table is needed. Everywhere in the world, spica cast is used so is the spica table. Hence the industrial applicability in medical field is undoubted. The invention duly clears this test as it can be manufactured at industrial scale and has a market too.

In the preceding detailed description, the invention is described with reference to exemplary drawings thereof. Various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention as set forth in the description. The specification and drawings are accordingly, to be regarded in an illustrative rather than a restrictive sense. Thus without analysis, the foregoing will so fully reveal the gist of the present invention that others can, by applying current knowledge, readily adapt it for various applications without omitting features that from the standpoint of prior art, fairly constitute essential characteristics of the generic or specific aspects of this invention.

Claims

WE CLAIM:

1. An foldable advanced pediatric spica table consisting of

A main frame of the table rested on a foundation (4) with legs (5) fitted with hinge (27) and Foundation rear support (6) for improved stability of the table ;

A base plate (1) for the patient head and upper torso support along with a sliding platform (2);

Adjustable arm support (3) on both sides of the base plate (1) for patient’s arms;

A Sliding Sacral Support Central Unit (SSSCU) (7) which can be adjusted to support pelvis as according to the patient age or height and can be locked at that position, further consisting of Sliding Base (7a) for multiple adjustment of the sacral support (7d) depending upon the patient age or height, Mounting Tube (7b) for positioning the sacral support (7d) to a proper height, Support Plate (7c) for the support of the sliding platform(2a) and Sacral Support (7d) for the rest of the patient;

Foot and Traction Unit Support (Right-16, Left- 17) further consisting of traction Unit (19), provided to fix foot position firmly with shoes (22) attached on the foot plate (21) located on both sides and a groove (15c) that limits external rotation angle of the hip achieved with the help of Foot and Traction Unit Support (Right-16, Left- 17);

Abduction Setter (10) and support bracket (11) to set the abduction angle of the hip (foot outward rotation);

A bi-axial angle measuring instrument (9) installed at the counter-traction bar (8) for simultaneous measurement of hip abduction and flexion angle which helps in reproducible values of hip angulation to correct fracture alignment;

Right Flexion-Extension Sliding Controller (FESC) (12) further consisting of Sliding Base (12a), Mounting Tube (12b), Foot Height (Vertical) Scale (12c);

Left Flexion-Extension Sliding Controller (FESC) (13) further consisting of Sliding Base (13a), Mounting Tube (13b), Foot Height (Vertical) Scale (13c); Right External Rotation and Foot Height Adjuster (14) further consisting of Sliding Tube (14a) to enable the unit to slide vertically to adjust the right foot height and knee joint flexion, Rotation Scale (14b) to indicate the right hip rotation angle, Rotation Range Groove (14c) to enable & limits the external and internal rotation angle of the right hip joint, and Threaded Hole (14d) for knob; and

Left External Rotation and Foot Height Adjuster (15) further consisting of Sliding Tube (15a) to enable the unit to slide vertically to adjust the left foot height and knee joint flexion, Rotation Scale (15b) to indicate the right hip rotation angle, Rotation Range Groove (15c) to enable & limits the external and internal rotation angle of the left hip joint, and Threaded Hole (15d) for knob.

2. The advanced pediatric spica table as claimed in claim 1 WHEREIN the required external rotation of the hip is adjusted for the accurate alignment and position of the broken femur bones using Foot and Traction Unit Support (Right-16, Left- 17) thereby turning the traction unit (19) with the same angle of rotation which is limited by a groove (15c) to be safe and effective, maintaining the in-line position with the femur accurately for effective traction.

3. The advanced pediatric spica table as claimed in claim 1 WHEREIN Right Foot and Traction Unit Support (16) further consists of Support Tube (16A) to enable the right traction unit mounting element (18a) to slide within to adjust the traction force line of action in-line with the patient femur, Foot Plate Angular Scale (16 b) and foot Plate Attachment (16c) to give support to the foot plate (21).

4. The advanced pediatric spica table as claimed in claim 1 WHEREIN Left Foot and Traction Unit Support (17) further consists of Support Tube (17a) to enable the right traction unit mounting element (18a) to slide within to adjust the traction force line of action in-line with the patient femur, Foot Plate Angular Scale (17 b) and foot Plate Attachment (17c) to give support to the foot plate (21).

5. The advanced pediatric spica table as claimed in claim 1 WHEREIN the Traction Unit (19) mounted on a traction unit mount (18) consists of : Base (Mounting) Tube (19a) to house the other parts and free to rotate; a traction bucket (20) fixed with sliding puller (19b) and hanged with Traction Pin (19 c) , to transfer the generated traction force from the traction unit (19) to the femur by grabbing and puling (in-line) tibia just near to the knee joint;

Counter-Traction Bar (8) attached to counter the force created by the traction unit (19) during the femur alignment procedure; and

Handle (19d) to drive the traction unit (19).

6. The advanced pediatric spica table as claimed in claim 1 WHEREIN foot and traction unit support (Right-16, Left- 17), traction unit (18) mount, and traction unit (19), foot plate (21) with shoes (22) are supported and positioned with the help of the External Rotation and Foot Height Adjuster (14, 15) with the help of which the foot height can be adjusted as required and the height measurement can be read on the respective height scale.

7. The advanced pediatric spica table as claimed in claim 1 WHEREIN External Rotation and Foot Height Adjuster (14, 15) allows the foot and traction unit support (Right-16, Left- 17) to rotate within a limited angle and the angular value can be read on the respective angular scale placed just above the groove (2b).

8. The advanced pediatric spica table as claimed in claim 1 WHEREIN the bi-axial angle measuring instrument (9) installed at the counter-traction bar (8) measures the angle of Abduction of the patient hip which is varied with the help of Abduction setter (10) supported with the help of support setter (11).

9. The advanced pediatric spica table as claimed in claim 1 WHEREIN the bi-axial angle measuring instrument (9) installed at the counter- traction bar (8) measures patient’s hip flexion angle which is adjusted with the help of Flexion-Extension Sliding controller

(FESC: Right-12, Left- 13).

10. The advanced pediatric spica table as claimed in claim 1 WHEREIN the base plate (1) further consists of Head and Torso Support Base (la) for the head and upper torso patient support, Groove (lb) to enable the arm supports to slide within for multiple adjustments, Groove 1 (c) to enable the platform to slide within, Cut Section (Id) to enable the arm supports (3) to be fold and Attachment Bolt (le) for fix attachment with foundation (4).

11. The advanced pediatric spica table as claimed in claim 1 WHEREIN the Sliding Platform (2) consists of Platform (2a) for the patient rest till the casting starts and Groove (2b) to enable the sacral support mounting tube (7b) to travel midway.

12. The advanced pediatric spica table as claimed in claim 1 WHEREIN Adjustable Arm Support (3) consists of Support Plate (3a) to give space for the arm rest, Groove (3b) for straps attachment to make arm positioned during the casting procedure, sliding pin (3c) to enable the arm support (3) for multiple settings depending upon the patient’s age.

13. The advanced pediatric spica table as claimed in claim 1 WHEREIN Bi-Axial Angle Measuring Instrument (9) consists of Flexion Scale (9a) to indicate the flexion angle of the patient hip, Left Abduction Scale (9b) to indicate the abduction angle of the patient left hip (foot outward rotation), Pivot Pin (9c) to place the abduction scale to a proper distance where it is much closer to hip joint, Positioning Arm (9d) for detecting the femur angular movement and transferring it to the scale for its measurement, Right Abduction Scale (9e) to indicate the abduction angle of the patient right hip (foot outward rotation) an Mount (9f) for the mounting of the instrument to the counter-traction bar.

14. The advanced pediatric spica table as claimed in claim 1 WHEREIN material used for the elements/components of spica table is Stainless steel or Mild Steel.

15. The advanced pediatric spica table as claimed in claim 1 WHEREIN as Base Plate (1), Sliding Platform (2) Machine Foundation (4) and abduction setter (10) are made of Carbon Fibre.

16. The advanced pediatric spica table as claimed in claim 1 WHEREIN the machine Foundation (4) is designed in form of solid rectangular flat plate.

17. The advanced pediatric spica table as claimed in claim 1 WHEREIN the same is Semi-automatic as Base place (1) Height, Sliding Sacral Support central Unit (7) height, Sliding plateform (2), Abduction Setter (10) and Right & Left Flexion - Extension Sliding Controller -FESC (12&13) are automatically operated while the rest components/elements are manually operated.