DE102008022952A1 - Non-invasive extension-, reposition and/or retention device for e.g. retention of e.g. ankle joint, has alignment device provided with two rotary degrees of freedom and/or transverse degrees of freedom - Google Patents

Abstract

The device has a proximal section (5) including a fixing device (5a) for temporary fixing of the proximal section at a proximal fractured body part of a patient. A distal section (2) has an immobilization device (2a) for immobilization of a distal fractured body part. An extension device (4) extends the distal section opposite to the proximal section along a longitudinal axis (L). An alignment device (1) temporarily aligns the distal body part, where the alignment device has two rotary degrees of freedom and/or transverse degrees of freedom that is aligned transverse to the longitudinal axis. An independent claim is also included for a method for extension, reposition and/or retention of extremities with an extension-, reposition and/or retention device.

Description

FIELD OF THE INVENTION

The The invention relates to an extension, reposition or retention device and an extension, reduction or retention method, in particular for treatment of jumps or wrists with a dislocated Fracture dislocation. It particularly concerns a non-invasive Device for temporary extension, reduction and / or Retention, in particular, of a dislocated dislocation fracture of the upper one Ankle in the context of preoperative treatment.

TECHNICAL BACKGROUND

A Luxation is a complete or incomplete one Contact loss of joint-forming bone ends. A dislocation poses basically a serious injury to a joint Moreover, if the fracture fragments no longer exist be in the right orientation, so be dislocated the malposition of the bone (s) by a reduction by Pressing is usually eliminated by pulling. such Dislocated dislocation fractures often occur in joints such as the ankle, the wrist and the finger joints as well the joint-like long bones such as the lower leg, the Forearm or the finger bone on.

After this the ankle will carry the entire body burden and at every step on the ground, it counts the most heavily loaded joints of the human body, resulting in a variety of injury options, affecting the ligamentous apparatus and / or the bones. So belong Ankle injuries to the most common sports injuries and may be inadequate or inadequate Treatment for some irreversible damage such as joint instability or osteoarthritis. According to the Federal Statistical Office include fractures of the lower leg including of the upper ankle in women (82,617) as men (74,650) to the twenty most common main diagnoses full-time treated patients (as of 2006). It is estimated that the dislocation of the ankle and the dislocated distal lower leg fracture, in particular for an extension treatment in question come, with a share of 10-20% are represented. There An operative joint reconstruction usually only after swelling the affected area of the patient can be done in many Invasive, temporary stabilization cases of the joint by means of the so-called 'external fixator' or by means of a wire extension treatment required.

Ankle orthoses for immobilization of the ankle are known. The in the patents EP 0 619 102 . EP 0 705 581 . US 4280489 and US 4844094 described ankle orthoses can preferably be absorbed by a normal shoe.

In the US 5342288 a splint with two parallel bars is disclosed, which can be applied for temporary stabilization and extension along the side of a fractured limb, wherein the length of the bars of the rail is telescopically adjustable.

Other generic devices are from the publications US 3942521 . US 4174709 . US 4649907 . US 3,477,428 and US 4328794 the two latter patents have at the distal end of the rail a pawl traction device and a lanyard whose ends are secured to the pawl traction device and whose central part is adapted to be passed around the back of the patient a tensile force acting in the longitudinal direction of the leg can be exerted and maintained.

Subject of the publication US 2007/0167893 is an orthosis for applying a dynamically adjustable force in flexion and extension of a joint.

The publication EP 0 264 303 relates to an orthopedic splint comprising two retainer members, each of which is attachable to a body part of the patient and which are connectable to each other by a machine part, wherein the machine part whose length is adjustable and which comprises two axially mutually displaceable spindles and active means to Irrespective of the will of the patient, pump impulses that tend to change their relative axial position can be imparted to the spindles. The free end of each of these spindles is connected to a ball joint, which is rotatably mounted in a spherical shell which is fixedly connected to the corresponding holding member and which is blockable in a selected position in advance by means of a locking screw.

The publication JP 2005 204 987 describes a device for automatic, program-controlled extension of a bone, comprising an external fixation arrangement consisting of two sleeves, which are attached to bone fragments, and a helical or worm-shaped drivable extension arrangement for adjusting the distance between the two sleeves, respectively between the bone fragments to provide ,

SUMMARY OF THE INVENTION

It the object of the present invention is an alternative or improved extension, reduction or retention device and a corresponding extension, reduction or retention method provide.

These The object is achieved with the subject of the claims.

The Invention relates in particular to a non-invasive extension, reduction or retention device. This is especially for Fractures on extremities, such as in an ankle, lower leg, Wrist, forearm and / or in fingers beneficial as painful Interventions can be prevented and no sources of inflammation caused by wounds. An inventive Device has a proximal portion with a fixing device or Fixierkomponente for temporarily fixing the proximal Section at a proximal to a fracture, especially in a and / or a wrist, located body part of a Patients on. In the exemplary case of treatment of an ankle the fixation device is provided on the lower leg and / or thigh of the affected leg to be temporarily arranged so that it is firmly attached to it without slipping significantly or to be moved.

Farther is a distal section with an immobilization device or immobilization component for temporary immobilization a part of the body distal to the fracture, such as a foot or a hand provided by the patient. In case of a fracture of the ankle is the immobilization device trained, the foot in a position to be determined to immobilize the affected proximal region of the patient and while extending the fracture.

With the device according to the invention and the invention Procedures can be in addition to the ankle and wrist also finger joints as well as joint-near long bones, like the Lower leg, forearm or one or more finger bones be treated.

A Extension device or extension component serves for extension of the aforementioned distal portion over the above said proximal portion along a longitudinal axis. It has the extension, reposition or retention device Further, an alignment device for up to three-dimensional Aligning (= "reduction") of the distal to the Fracture located body part, the at least two rotatory Degrees of freedom and / or at least one substantially transverse to Longitudinal axis aligned translational degree of freedom having. In other words - in the aforementioned Example of an ankle fracture - the foot is not only be twisted in one direction, but above it out in a second direction. These have twisting directions Rotational axes which are transverse to said longitudinal axis can. Furthermore, the foot can also be one-dimensional or two-dimensionally moved transversely to the longitudinal axis, so a misalignment in a reduced fracture fracture correct and individually optimized extension or retention to enable.

In an embodiment, the inventive Device a Fußteilaufnehmer, one with the Fußteilaufnehmer releasably connectable foot part with means for receiving and fixation of a foot, two parallel telescopic rods with a distal and a proximal end, the distal end the telescopic rods connected to the Fußteilaufnehmer is and the proximal end of the telescopic rods with means for fixing the Lower leg communicates, on. Next, the device one with two telescopic rods in operative connection, preferably computer-controlled Extension motor or drive for setting a defined Extension between the foot and the lower leg to bridge the Have fracture zone.

In an embodiment has the foot part and / or the Fußteilaufnehmer with respect to the distal ends of Telescopic rods three translational and / or three rotary Degrees of freedom for patient-specific alignment of the fractured ankle, advantageously under X-ray control. In another preferred embodiment, the fixation of the lower leg by means of attachable in the area of the proximal ends of the telescopic rods, with a vacuum pump system operatively connected, evacuatable chambers.

The Alignment device may further at least three rotational Degrees of freedom, such as one with a rotation axis around or parallel to the longitudinal axis and two, each with a rotation axis substantially transverse to the longitudinal axis, and / or at least two translational Have degrees of freedom substantially transverse to the longitudinal axis.

In a further embodiment, which would be suitable, for example, for the treatment of wrist fractures, an immobilization device similar to a fingerless glove for the immobilization of a hand is formed on the adjustable or adjustable a hand partially or completely surrounding alignment device is arranged. With an adjustment the immobilization device relative to the alignment device already result in translational and rotatotrische degrees of freedom when operating the entire device. A fixation device is substantially immobile or not displaceable, for example, on a forearm of a patient. Between fixing device and alignment device extension elements, such as motor-driven telescopic rods, may be arranged to ensure the orientation and extension of the hand against the forearm.

The Fixing device of the proximal portion and / or the Immobilisationseinrichtung can in a conventional manner a vacuum device for fixing or immobilizing, preferably on a top and / or Lower leg or on one upper and / or lower arm or on one Foot or one hand. This is before an evacuation one or more loose cuffs o. Ä., For example slipped around a lower leg, moved to a suitable location and then evacuated to fix the device. This puts down the cuff tightly around the lower leg, but prevents it not the distal blood circulation.

The Extension device can have at least one motor, the for generating, maintaining or changing a force controllable between the proximal portion and the distal portion or can be regulated. The engine can be an electric motor. He Can be fixed or via a coupling with the device be releasably coupled. The latter embodiment has the advantage that the coupling is made of a material which X-ray, CT, ultrasound and / or MRI-compatible. Before such an investigation can then the Engine are removed, with the force applied by the engine over a per se known locking mechanism, such as latch mechanism, Lockable screws, self-locking teeth, etc., maintained can be. However, it could also be an x-ray, CT, ultrasound and / or MRI-compatible motor use.

Of the Engine can be electronically maintained a preset or determined force or a pre-set or determined force profile can be controlled or regulated. This can be over a computer-controlled electronics and corresponding sensors are made.

The Extension device also has a guide device, preferably at least one or more preferably two, three or more telescopic poles, on. These ensure a relative movement of the proximal portion to the distal portion away from the distal portion, with a preset Orientation of the alignment device is maintained.

The Extension device has at least one detection device or sensor for determining at least one by the extension device applied force or stress or strain or one of them caused extension path or an extension rate, preferably in or on a guide device. The stretching or force, for example, by built-in strain gauges be determined. Such signals can be used to control or rules of the extension device serve when maintaining a force should be or should be driven off a force profile.

It may further include a programmable controller, like a computing device, to control at least the extension device and / or the alignment device provided be. For this the desired parameters are entered or partially or completely by an expert system determined and then corresponding signals to the actuators of Extension device and / or alignment device passed.

The The invention additionally or additionally relates to a Extension, reduction or retention device for Extremities with at least one intermediate Section for bridging the proximal section for temporary fixation at a proximal to a fracture located body part and the distal portion of the temporarily immobilizing a distal to the fracture Body part in the area of the fracture. At least the intermediary Section is made of a material and designed, that he is X-ray, CT, ultrasound and / or MRI-capable is or substantially no interfering artifacts Radiological diagnostics and thereby essentially in imaging techniques such as X-ray, computed tomography, ultrasound and / or Magnetic resonance imaging causes. In other words, it is at least the section of the device in the area of the fracture from a such material, so no artifacts in the area of the fracture should one of these investigations take place. However, other sections of the device may also be used made of a material, the same material or other materials, be made to allow these other sections, as the whole Device, for example without significant interference in an X-ray, CT, ultrasound and / or MRI device can be introduced. At least those can be immediately provided to a patient Components made of a material such as CFK, manufactured and designed be.

Furthermore a remote control device may be provided to at least the extension device and / or the alignment device wirelessly or, for example wired with fiber optics, to remote control so that X-ray, CT, ultrasound and / or MRI fitness is guaranteed or substantially no disturbing artifacts in the radiological diagnosis and thereby essentially in imaging methods, such as X-ray, computed tomography, Ultrasound and / or magnetic resonance imaging, caused.

The The present invention also relates to a method of extension, Reduction or retention of extremities, in particular with an extension, reduction or retention device. A fracture in a foot- or wrist extends and extends along a longitudinal axis a corresponding foot or hand at least two rotational degrees of freedom and / or at least a substantially transverse to the longitudinal axis aligned translational degree of freedom at least temporarily aligned.

at This method allows temporary alignment by at least three rotational degrees of freedom, such as one with a rotation axis around or parallel to the longitudinal axis and two with each a rotation axis substantially transverse to the longitudinal axis, and / or by at least two translatory degrees of freedom substantially take place transversely to the longitudinal axis.

The The invention also relates to the use of a previously or hereinafter described device or a method, in particular for extension, reduction or retention of a jump or wrist.

BRIEF DESCRIPTION OF THE FIGURES

The Figures are intended to exemplify embodiments of the invention illustrate.

It demonstrate:

1 a perspective view of an inventive extension, Repositions- or retention device for the treatment of a leg of a patient according to the invention;

2 a perspective view of an arm of a patient with a partial representation of an embodiment of a device according to the invention;

3 a partial perspective view of the embodiment according to the invention according to 2 with additional elements; and

4 a perspective view of the embodiment according to the invention 2 and 3 ,

DETAILED DESCRIPTION OF THE EMBODIMENTS

In the 1 a device is shown in particular for treating a fracture of the ankle. The foot of a patient is in an alignment device 1 . 1a by an immobilization device 2a at the distal section 2 fixed. In the illustrated embodiment, this immobilization device has 2a a sandal-like structure to bring in and immobilize the foot clearly and comfortably. Other embodiments are also suitable, such as an individual or adaptive embodiment, as long as the possibility of movement of the foot is limited.

This immobilization device 2a can be on or on an alignment device 1 . 1a permanent or couplable. In the illustrated embodiment, the alignment device comprises a base plate 1 and a relatively adjustable support plate 1a on, at the immobilizer 2a is arranged. Between the base plate 1 and the retaining plate 1a There is a mechanism for temporary adjustment of the positions of the holding plate 1a to the base plate 1 , The holding plate 1a may in the illustrated position, for example, in at least one direction substantially parallel to the base plate 1 be moved. If necessary, it can additionally be displaceable and fixable in not only one direction but also in a second direction in the sense of an xy movement. Alternatively or additionally, at least two rotatory movements (only one of which is shown) can be made possible. The illustrated rotary motion has a first axis of rotation which is substantially transverse to the longitudinal axis L. For this purpose, at least one further rotational movement with a second axis of rotation is provided, which extends essentially transversely to the longitudinal axis L and substantially transversely to the first axis of rotation. Thus, the foot is immobilized according to its natural rotational mobility to compensate for a dislocated or to be reduced fracture fracture can. The adjustability of the retaining plate 1a to the base plate 1 is realized by an xy adjustment mechanism and two hinges or a ball head. It is also an adjustment with three in height and partially fixable in slots threaded bolt conceivable.

The base plate 1 is via a fixable swivel joint with two telescopic rods 3 connected. At the proximal section 5 is a fixing device 5a shown. In the embodiment shown this is a cuff 5a , which can be fixed to a lower leg of a patient (not shown). It virtually forms an abutment for the device according to the invention on the lower leg. Alternatively or additionally, a cuff or the like may be provided for a thigh of a patient. Preferably, at least parts of the sleeve 5a evacuable, for easy attachment of the cuff 5a to enable the patient. On the cuff are also ends of the telescopic rods 3 firmly arranged.

In an overlapping area of the telescopic poles 3 is preferably an extension device 4 like an electric motor 4 , intended to be able to extend or retract the two telescopic rods coordinated.

In an intermediate area, in the illustrated 1 between the engine 4 and the immobilizer 2a In the case of an ankle fracture, the fracture is when the device is applied to a patient. At least in this area, the device according to the invention may consist of an X-ray, CT, ultrasound and / or MRI-compatible material.

The 2 to 4 show an embodiment of the invention for the treatment of a wrist fracture. In this case, the proximal section 15 with the fixing device 15a on a forearm 10 be arranged and fixed with it. The distal section 12 with the immobilization device 12a is striped over a hand. It can be seen that the immobilizer 12a like a fingerless glove over the hand base of one hand 20 is striped and arranged substantially immovable. This can be done by an already mentioned evacuation. Other measures, such as curing of a customized material, eg. As resin, are also possible. The Immobilisierungsseinrichung shown 12a also extends over a base of a thumb shown, for a recess in the Immobilisationseinrichung 12a can be provided. Not shown, but still conceivable, are further recesses for the patient's fingers or other embodiments.

In the 3 is the alignment device 11a shown. In the embodiment shown, it completely surrounds the immobilization device 12a and is connected to it via several bolts. Of the bolts may be at least one or more or all adjustable or telescopic to the central position of the immobilization 12a to the alignment device 11a to be able to change. The adjustment can be done in a similar manner as in a commercial Christmas tree stand, which also has a tree trunk surrounding ring through which extend radially inward screws to ensure the fixation and location of the tree. In the illustrated invention, thus also individually adapted to a patient immobilization facilities 12a (similar to fingerless gloves or a metacarpal / thumb orthosis), which may differ in shape and size from each other, are fixed and in the situation individually variable. As a result, two translatory degrees of freedom and two rotational degrees of freedom can already be made possible in a device according to the invention. This arrangement is in particular for the translational adjustment of the hand or immobilization device 12a essentially transversely to the longitudinal axis (not shown) responsible.

4 shows a further embodiment possibility of the device according to the invention. This may be from the alignment device 11a to the fixing device 15a in the distance or length adjustable elements, here telescopic rods 13 , extend. The telescopic rods are to the alignment device 11a at least axially fixed. They can be hinged or passed through the alignment device and prevented at the free end by a (not shown) securing device, such as a nut, a bolt, etc., from slipping. Due to the presence of several telescopic poles 13 In particular, the rotation of the hand or immobilization device 12a be made possible to or about the longitudinal axis. A rotation about the longitudinal axis would in particular be due to a staggered arrangement of the telescopic rods 13 possible. In this case, for example, at least one of the fixing device 15a anchored telescopic rods at a position on the alignment device 11a be hinged along the circumference of the alignment device 11a angularly offset from the illustrated embodiment would be. Due to the extension or contraction of this telescopic rod, a force component would likewise contribute to a torsion or twisting of the hand relative to the forearm.

The motors 14 could then by different extension or contraction of the corresponding telescopic rods 13 a different orientation of the hand or immobilization device 12a or cause a twist and an extension.

The The invention also includes individual features in the figures, also if they are shown there in connection with other features and / or are not mentioned above or below.

The The invention also includes embodiments with any Combination of features that are above or below to different Embodiments are called or shown.

The Invention also includes the exact or exact terms, Features, numerical values or ranges, etc., if above or below these expressions, features, numerical Values or ranges associated with expressions such as z. B. "about, about, in essence, in general, at least ", etc. were called (ie" about 3 "should also" 3 "or" im Essentially transverse "should also include" across "). Of the Expression "or" also means "and / or".

QUOTES INCLUDE IN THE DESCRIPTION

This list The documents listed by the applicant have been automated generated and is solely for better information recorded by the reader. The list is not part of the German Patent or utility model application. The DPMA takes over no liability for any errors or omissions.

Cited patent literature

• - EP 0619102 [0004]
• EP 0705581 [0004]
• - US 4280489 [0004]
• - US 4844094 [0004]
• - US 5342288 [0005]
• US 3942521 [0006]
• - US 4174709 [0006]
• US 4649907 [0006]
• - US 3477428 [0006]
• US 4328794 [0006]
• US 2007/0167893 [0007]
• EP 0264303 [0008]
• - JP 2005204987 [0009]

Claims (15)

A non-invasive extension, reduction or retention device, comprising: (a) a proximal portion ( 5 ; 15 ) with a fixing device ( 5a ; 15a ) for temporarily fixing the proximal portion ( 5 ; 15 ) on a body part of a patient located proximal to a fracture, (b) a distal portion (FIG. 2 ; 12 ) with an immobilization device ( 2a ; 12a ) for temporarily immobilizing a body part of the patient distal to the fracture, and (c) an extension device ( 4 ; 14 ) for extension of the distal section ( 2 ) opposite the proximal section ( 5 ; 15 ) along a longitudinal axis (L), (d) wherein the extension, repositioning or retention device comprises an alignment device ( 1 . 1a ; 11a ) for temporarily aligning the body part located distally to the fracture, which has at least two rotational degrees of freedom and / or at least one translational degree of freedom aligned substantially transversely to the longitudinal axis (L). An extension, reduction or retention device according to claim 1, wherein the alignment device ( 1 . 1a ; 11a ) has at least three rotational degrees of freedom, such as one having an axis of rotation about or parallel to the longitudinal axis (L) and two each having an axis of rotation substantially transverse to the longitudinal axis, and / or at least two translational degrees of freedom substantially transverse to the longitudinal axis. An extension, reposition or retention device according to at least one of the preceding claims, wherein the fixing device ( 5a ; 15a ) of the proximal section ( 5 ; 15 ) and / or the immobilization device ( 2a ; 12a ) has a vacuum device for fixing or immobilizing, preferably on an upper and / or lower leg or on an upper and / or lower arm or on a foot or a hand or one or more finger (s). An extension, reposition or retention device according to at least one of the preceding claims, wherein the extension device ( 4 ; 14 ) at least one engine ( 4 ; 14 ) for generating, maintaining or changing a force between the proximal portion (FIG. 5 ; 15 ) and the distal section ( 2 ; 12 ) is controllable. An extension, reduction or retention device according to claim 4, wherein the at least one motor ( 4 ; 14 ) is controllable or controllable electronically for maintaining or changing a preset or determined force or a preset or determined force profile. An extension, reposition or retention device according to at least one of the preceding claims, wherein the extension device ( 4 ; 14 ) a management facility ( 3 ; 13 ), preferably at least one or more preferably two, three or more telescopic rods ( 3 ; 13 ) having. An extension, reposition or retention device according to at least one of the preceding claims, wherein the extension device ( 4 ; 14 ) at least one detection device for determining at least one by the extension device ( 4 ; 14 ) applied force or tension or elongation or an extension path caused thereby or an extension speed, preferably in or on a guide device ( 3 ; 13 ), preferably for controlling or regulating the extension device ( 4 ; 14 ), having. An extension, reduction or retention device according to at least one of the preceding claims, wherein it has a programmable control device, such as a computer device, for controlling or regulating at least the extension device ( 4 ; 14 ) and / or the alignment device ( 1 . 1a ; 11a ) having. An extension, reduction or retention device comprising: (a) at least one intermediate section for bridging a proximal section ( 5 ; 15 (b) at least the intermediate portion being made of a material and designed to be x-rayed, for temporarily immobilizing on a body part proximal to a fracture and a distal portion for temporarily immobilizing a body part located distal to the fracture in the area of the fracture; , CT, ultrasound and / or MRI-capable or substantially no disturbing artifacts in the radiological diagnosis and thereby essentially in imaging methods such as X-ray, computed tomography, ultrasound and / or magnetic resonance tomography causes. Extension, reduction or retention device according to claim 9 and at least one of the preceding claims. Extension, reduction or retention device according to at least one of the preceding claims, wherein at least the components to be directly provided to a patient made of a material such as CFK, and are designed or essentially no disturbing artifacts in the radiological Diagnostics and thereby essentially in imaging techniques such as X-ray, computed tomography, ultrasound and / or Cause magnetic resonance imaging. An extension, reduction or retention device according to claim 11, further comprising a remote control device for at least the extension device ( 4 ; 14 ) and / or the alignment device ( 1 . 1a ; 11a ) wirelessly or, for example, with glass fibers, wired to operate remotely, so that X-ray, CT, ultrasound and / or MRI capability is ensured or substantially no disturbing artifacts in the radiological diagnosis and thereby essentially in imaging techniques as X-ray, computed tomography, ultrasound and / or magnetic resonance imaging cause. Method for extension, reduction or retention of extremities, in particular with an extension, reduction Retention device according to at least one of the preceding Claims comprising the following steps: a. extension a fracture in an ankle joint, wrist, finger joint (s) or joint-near long bones, such as lower leg, forearm or one or more finger bones along a longitudinal axis (L); b. temporary alignment of a corresponding Foot, a corresponding hand or a corresponding Finger by at least two rotational degrees of freedom and / or at least one substantially transverse to the longitudinal axis (L) aligned translational degree of freedom. The method of claim 13, wherein in step (b) the temporary alignment by at least three rotational Degrees of freedom, such as one with a rotation axis around or parallel to the longitudinal axis and two, each with a rotation axis in Substantially transverse to the longitudinal axis, and / or at least two translational degrees of freedom substantially transverse to the longitudinal axis takes place. Use of a device or a method according to at least one of the preceding claims for extension, Reduction or retention of an ankle, wrist, finger joint (s) or of joint-like long bones, such as lower legs, Forearm or one or more finger bones.