EP0359793A1 - Variable length fixation device - Google Patents
Variable length fixation deviceInfo
- Publication number
- EP0359793A1 EP0359793A1 EP19890902684 EP89902684A EP0359793A1 EP 0359793 A1 EP0359793 A1 EP 0359793A1 EP 19890902684 EP19890902684 EP 19890902684 EP 89902684 A EP89902684 A EP 89902684A EP 0359793 A1 EP0359793 A1 EP 0359793A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- barrel portion
- variable length
- bone
- screw
- fragment
- Prior art date
- Legal status (The legal status 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 status listed.)
- Withdrawn
Links
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 78
- 239000012634 fragment Substances 0.000 claims abstract description 43
- 238000003780 insertion Methods 0.000 claims abstract description 15
- 230000037431 insertion Effects 0.000 claims abstract description 15
- 230000006835 compression Effects 0.000 claims description 16
- 238000007906 compression Methods 0.000 claims description 16
- 230000013011 mating Effects 0.000 claims description 5
- 238000000605 extraction Methods 0.000 claims description 2
- 208000014674 injury Diseases 0.000 abstract description 4
- 230000006378 damage Effects 0.000 abstract description 3
- 230000008733 trauma Effects 0.000 abstract description 3
- 210000001519 tissue Anatomy 0.000 abstract description 2
- 239000000470 constituent Substances 0.000 abstract 1
- 206010017076 Fracture Diseases 0.000 description 45
- 208000010392 Bone Fractures Diseases 0.000 description 36
- 210000000689 upper leg Anatomy 0.000 description 12
- 210000002436 femur neck Anatomy 0.000 description 10
- 238000000034 method Methods 0.000 description 7
- 230000000712 assembly Effects 0.000 description 5
- 238000000429 assembly Methods 0.000 description 5
- 230000035876 healing Effects 0.000 description 5
- 210000004197 pelvis Anatomy 0.000 description 4
- 238000010079 rubber tapping Methods 0.000 description 3
- 210000000501 femur body Anatomy 0.000 description 2
- 238000009434 installation Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 238000013508 migration Methods 0.000 description 2
- 230000005012 migration Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 210000004872 soft tissue Anatomy 0.000 description 2
- 206010065687 Bone loss Diseases 0.000 description 1
- 208000029725 Metabolic bone disease Diseases 0.000 description 1
- 206010049088 Osteopenia Diseases 0.000 description 1
- 206010034246 Pelvic fractures Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 238000001125 extrusion Methods 0.000 description 1
- 208000020089 femoral neck fracture Diseases 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 210000000528 lesser trochanter Anatomy 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 230000035515 penetration Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/74—Devices for the head or neck or trochanter of the femur
- A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8875—Screwdrivers, spanners or wrenches
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30138—Convex polygonal shapes
- A61F2002/30143—Convex polygonal shapes hexagonal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
- A61F2002/30364—Rotation about the common longitudinal axis
- A61F2002/30367—Rotation about the common longitudinal axis with additional means for preventing said rotation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
- A61F2002/3037—Translation along the common longitudinal axis, e.g. piston
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
- A61F2002/3055—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30601—Special structural features of bone or joint prostheses not otherwise provided for telescopic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
Definitions
- Variable Length Fixation Device This invention relates generally to orthopedic fixation devices and, more particularly, to a variable length fixation device which is especially well-suited for fixation of fractures of the femoral neck, tibial plateau and pelvis.
- Fractures of the type which commonly occur in the femoral neck, tibial ' plateau and pelvis require internal fixation for proper and timely healing. Such fixation is normally accomplished with nails or lag screws which hold the fractured pieces of bone together along the fracture site until healing is complete.
- the Asnis system utilizes one or more rigid lag screws which are installed across a fracture site over guide pins to rigidly secure the bone fragments in close proximity to one another.
- three or four screws are inserted through the lateral cortex of the femur, and extend across the fracture site and into the subchondral region of the femoral head. Each screw must be carefully selected for the exact size because they are "fixed length screws.”
- the rigid screws of the Asnis system may provide relatively good initial fixation of the fracture. However, during the post-operative period, resorption of bone on either side of the fracture line may occur. In this event, a fracture which has been fixed with rigid screws may no longer be firmly compressed or impacted along the fracture line. The rigid screws assume the primary load bearing function, and physiological compression which might otherwise occur at the fracture site is prevented.
- the screws may "slide" in the holes drilled in the femur as resorption occurs, and the heads of the screws will be forced outwardly away from the femur and into the surrounding soft tissues, i.e., the heads become "extruded.” Under these conditions, an extended period may be required for complete and proper healing of the fracture, or the extrusion of the screws may result in loss of the fracture fixation and/or subsequent loss of the fracture reduction which may result in the fracture failing to unite which is otherwise known as a non-union.
- screw size i.e, length
- An inventory of twenty screw sizes with lengths ranging from 35 mm to 130 mm in 5 mm increments is recommended.
- the tubular guide sleeve extends into a hole which has been drilled or reamed into the femur, and which extends along the center line of the femoral neck.
- a single lag screw or nail extends through the guide sleeve, across the fracture site and into the femoral head. The nail or screw is free to move telescopically within the guide sleeve so that contact between the bone fragments is maintained, notwithstanding the occurrence of resorption at the fracture site.
- the tubular guide sleeve of the plate which is firmly attached to the shank of the femur, provides lateral support for the nail or screw and, at least in some cases, is designed to prevent relative rotation between the bone fragment attached to the nail or screw and the shank of the femur.
- An object of the present invention is to provide a fixation device which is simple to install and to remove, and which may be installed and removed with a minimal amount of trauma and damage to surrounding tissues.
- Another object of the present invention is to provide a fixation device having a variable length which may be versatilely used in a number of fracture types and situations. A major practical advantage is one of cost since two of these screws can greatly reduce the number of device sizes which must be maintained in inventory.
- Yet another object of the present invention is to provide a fixation device which avoids or minimizes other problems associated with prior art devices, while offering advantageous features to both surgeon and patient in the treatment of many types of fractures.
- variable length fixation device for insertion into an opening formed in one or more bone fragments which comprises a barrel portion, means for securing the barrel portion to an interior surface of the opening in the bone fragments, and a fastener element.
- the fastener element is telescopically mounted to the barrel portion and extends into a distal one of the bone fragments for preventing lateral movements of the distal fragment relative to the barrel portion and a proximal one of the fragments.
- the opening in the bone fragments extends along a line which is substantially transverse to a plane of fracture between the fragments, and the telescopically mounted fastener means allows axial relative movements (i.e., movements parallel to the longitudinal axis of the fastener) of the fragments along the transverse line of the opening.
- the means for securing the barrel portion to the interior surface of the opening comprises a plurality of locking rings formed on an outer surface of the barrel portion. The locking rings interact with a surface of the opening in the proximal bone fragment to prevent axial movements (i.e., migration into or out of the opening) of the barrel portion subsequent to insertion of the device.
- the fastener element preferably comprises a screw portion having a plurality of threads on a first end thereof for fastening to the distal bone fragment, and having means on a second end thereof for slidably mounting the screw portion to the barrel portion.
- the screw portion has a hexagonally-shaped cross-section and outer surface.
- the barrel portion is hollow and has a hexagonally-shaped inner surface. The hexagonally-shaped outer surface of the screw portion is slidably mounted within the hollow barrel portion in an adjacent and mating relationship to the hexagonally- shaped inner surface, such that the screw portion is rotationally fixed relative to the barrel portion.
- a preferred embodiment of the present invention includes means for detachably connecting a wrench to the barrel portion to allow the barrel portion to be rotated which automatically advances the screw portion into the distal fragment.
- This means is preferably a hexagonally-shaped recess in a proximal end of the barrel portion.
- the barrel portion and the fastener element are cannulated (i.e., hollow) and are adapted for insertion over a guide pin positioned along the transverse line of the opening.
- the barrel portion and fastener element are preferably permanently assembled to form a unitary fixation device.
- An especially preferred embodiment of the invention is termed a Variable Length Compression (VLC TM) bone screw assembly which comprises a barrel portion and a screw portion.
- VLC TM Variable Length Compression
- the barrel portion is provided with means for securing the barrel portion to an interior surface of the opening in the proximal fragment to prevent # axial movements of the barrel portion subsequent to insertion.
- the screw portion has a first end which is provided with means for fastening the screw portion to the distal bone fragment, and a second end which is mounted to the barrel portion.
- the screw portion is axially movable, but rotationally fixed, relative to the barrel portion and is preferably cannulated (i.e., hollow).
- the barrel portion is hollow and the second end of the screw portion is telescopically mounted within the barrel portion.
- the second end of the screw portion has a hexagonal cross-section, and an internal shape of the hollow barrel portion has a matching hexagonal cross-section such that, when the two hexagonal cross-sections are placed together in mating relationship with each other, relative rotation of the barrel portion and screw portion is prevented.
- the cannulated screw portion is further provided with threads on at least a portion of an internal surface to provide a means for connecting the screw portion to a compression tool.
- the means for fastening the first end of the screw portion to the distal bone fragment comprise a plurality of cancellous screw threads. Self-cutting flutes are provided on either end of the threads for easing insertion into and extraction from the distal bone fragment.
- the barrel portion and the screw portion are preferably permanently assembled by a swaging technique to form the complete bone screw assembly.
- a preferred method of installing the bone screw assembly of the present invention includes a first step of placing a guide pin across the fracture site to define the desired location for placement of the bone screw assembly.
- a cannulated reamer is used to widen at least an outer portion of the hole to accommodate the barrel of the bone screw assembly. If desired or required, the remaining portion of the hole may be tapped to reduce the effort required for insertion of the screw portion into relatively dense bone tissue.
- the bone screw assembly is inserted into the hole, and a tool is used to turn the barrel portion, causing the barrel portion to twist the screw portion into the bone fragment.
- the screw portion is advanced under fluoroscopic control until the desired level of penetration has been achieved.
- the fracture may be compressed or impacted, as desired.
- the design of the bone screw assembly of the present invention permits physiological compression at the fracture site during the post-operative period, notwithstanding the possible occurrence of resorption of bone tissue along the fracture. Accordingly, firm fixation is dynamically maintained throughout the period of fracture healing.
- Other advantages include ease of installation and removal, reduced trauma to surrounding bone and soft tissues, greater versatility resulting from the variable length feature, and reduced cost for inventory requirements.
- Figure 1 shows a side view of the barrel portion of a preferred embodiment of the variable length fixation device of the present invention.
- Figure 2 shows a side view of the screw portion of a preferred embodiment of the variable length fixation device of the present invention.
- Figure 3 shows a side view of a preferred embodiment of the variable length fixation device of the present invention.
- Figures 4-11 illustrate the steps of a preferred method of using the preferred embodiment of Figure 3 in treating a fracture of the femoral neck.
- FIG. 1 shows a side view of barrel portion 11 of -li ⁇ the present invention.
- Barrel portion 11 is a generally elongate hollow structure having a head portion 12 on a first end thereof.
- the opposite end 14 of barrel portion 11 is open to receive the screw portion (30 in Figure 2) of bone screw assembly 10, as described in detail below.
- Inner surface 16 of barrel portion 11 is hex-shaped throughout at least a portion (and preferably the entire length) of barrel portion 11. Hex-shaped interior surface 16 extends all the way through head portion 12 or, alternatively, a hex-shaped recess 18 is provided in the end of head portion 12 to receive a detachable tool or wrench which is used to rotate barrel portion 11 and, in the preferred embodiment, the rest of bone assembly 10.
- Outer surfaces 20 and 22 of head portion 12 are spherical in shape, such that the overall shape of head portion 12 is that which would result from the intersection of portions of two spherical bodies.
- the overall diameter of the widest point of head portion 12 (i.e., the intersection of spherical surfaces 20 and 22) is only slightly larger than the diameter of the remaining portions of barrel portion 11.
- Barrel portion 11 is further provided with three equally spaced locking rings 24 immediately adjacent head portion 12. As will be explained below, locking rings 24 are intended to prevent outward migration of barrel portion 11 after placement of bone assembly 10 within a hole formed in a bone.
- FIG. 2 shows screw portion 30 of bone screw assembly 10.
- Screw portion 30 has a first end 32 which is provided with a plurality of threads 34 for fastening screw portion 30 to bone tissue.
- a plurality of cutting flutes 36 are provided on the outer end of threads 34 to ease the process of inserting or threading screw portion 30 into bone tissue.
- Cutting flutes 38 are also provided on the opposite end of threads 34 to ease the process of extracting bone screw assembly 10 after healing of the fracture is complete.
- a second end 40 of screw portion 30 preferably has a hexagonally-shaped outer surface 42 which extends axially along at least a portion of the outer surface of screw portion 30.
- Hex-shaped outer surface 42 is intended to mate with hex-shaped inner surface 16 of barrel portion 11, such that when the two portions 11 and 30 are joined, relative axial rotation between the two is prevented.
- the mating relationship between surfaces 16 and 42 is such that axial relative movement between portions 11 and 30 is uninhibited.
- Screw portion 30 is cannulated (i.e., hollow) and a portion of the inner surface of screw portion 30 is provided with threads 44 for purposes of compressing a fracture, as will be described in additional detail below.
- Figure 3 shows a side view of bone screw assembly 10 after barrel portion 11 and screw portion 30 have been joined.
- Barrel portion 11 and screw portion 30 are preferably permanently joined by swaging end portion 14 of barrel portion 11 to form an inwardly extending lip 15 around the circumference of end portion 14, subsequent to insertion of screw portion 30 within barrel portion 11, to prevent subsequent disassembly.
- mating hex-shaped surfaces 16 and 42 prevent relative rotational movement between portions 11 and 30.
- arrow 46 relative axial movements between portions 11 and 30 are uninhibited.
- Figures 4-11 illustrate a preferred method of using bone screw assembly 10.
- bone screw assembly 10 is especially well-suited for fixation of fractures occurring in the femoral neck, the tibial plateau, and pelvis.
- Figures 4-11 describe the use of bone screw assembly 10 for fixation of a fracture of the femoral neck.
- guide pin 50 is introduced through the lateral cortex of the femur.
- Guide pin 50 will be used to ensure proper lateral placement of bone screw assembly 10.
- Two additional guide pins 52 and 54 are placed below guide pin 50 in spaced apart relation and in parallel to guide pin 50 to form a preferred triangular configuration.
- the triangular configuration of holes 50', 52* and 54*, each of which accept a corresponding guide pin, is shown in Figure 6.
- Each pin extends through the lateral cortex and across the fracture site into an acceptable position and depth in the femoral head.
- All guide pins and screw assemblies are preferable kept at or above the level of the lesser trochanter (indicated by dotted line 56 in Figures 5 and 6) to prevent the possible creation of stress risers which might jeopardize the integrity of the femoral shaft at the subtrochanteric level.
- a direct measurement gauge 60 is used to determine the correct VLC TM screw size.
- An advantage to the present invention is that the variable length feature of bone screw assembly 10 allows for a drastic reduction in the required number of screw sizes. At present, two screw sizes are contemplated. The first will range from 59 mm to 76 mm
- a cannulated reamer 62 is placed over the guide pins to form three parallel holes in the proximal bone fragment (i.e., the femur) which will receive barrel portion 11 of bone screw assembly 10 (see Figure 8). Each hole is drilled along a line which extends generally transversely to a plane which extends, in a generally coplanar relationship, across the fracture site in the femoral neck.
- a groove 64 on the body of reamer 62 indicates proper depth for reaming. Reaming beyond the depth indicated by groove 64 may cause unnecessary bone loss and prevent proper screw fixation.
- a cannulated bone tap 66 may be used over the guide pins when hard, dense bone is encountered in the femoral head.
- screw portion 30 may be threaded directly into the distal bone fragment (i.e, the femoral head) without tapping or reaming this portion in advance.
- bone screw assembly 10 is inserted into each of the holes (see Figure 10) .
- a T-shaped hex wrench 68 is used to rotate barrel portion 11 and, consequently, screw portion 30 into position over the guide pin.
- Screw portion 30 When wrench 68 is pushed and rotated in a clockwise direction, threads 34 of screw portion 30 will engage the bone tissue and screw portion 30 will telescopically advance out of barrel portion 11 along the guide pin. Screw portion 30 is advanced under fluoroscopic control to the subchondral level of the joint, or until desired placement is achieved. After a screw assembly has been placed in each of the three holes, locking rings 24 on the barrel of each assembly are seated into the lateral cortex by tapping on the handle of wrench 68 (see Figure 11) which drives the rings into the cortex. The rings serve to prevent the barrel from backing out of the upper femoral shaft.
- a compression tool 70 may be used to compress the fracture.
- a compression rod extends through the hollow barrel portion 11 of the screw assembly and is threaded into internal threads 44 of screw portion 30. The compression rod is then placed in tension, while barrel portion 11 is held in place, to draw the bone fragments together by drawing screw portion 30 into barrel portion 11 to firmly compress the fracture. This is especially valuable for bringing together the two major fragments of bone in femoral neck fractures, tibial plateau fractures, and pelvic fractures.
- an impaction tool (72 in Figure 11) may be placed against the femur in the area immediately adjacent the bone screw assemblies, and firm impaction of the fracture can be achieved by tapping on the end of the impaction tool.
- Impaction tool 72 preferably has recessed holes 74 which are placed over the heads of the bone screw assemblies to allow the impaction forces to be equally distributed on the lateral cortex of the femur around the screws.
- fixation device of the present invention is shown and discussed with reference to a particular type of fracture, and although the specific embodiment shown is particularly well-suited for treating certain types of fractures, use of the invention is not limited to these applications.
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Neurology (AREA)
- Surgical Instruments (AREA)
Abstract
Un dispositif de fixation (20) à longueur variable destiné à être inséré dans un trou percé dans un ou plusieurs fragments d'os comprend une partie de cylindre (11) ainsi qu'un élément de fixation (30). La partie de cylindre (11) est fixée sur une surface intérieure du trou dans un fragment d'os proximal. L'élément de fixation (30) est monté de manière téléscopique sur la partie de cylindre (11) et est extensible jusque dans un des framents d'os. L'ensemble empêche les mouvements latéraux du fragment distal, par rapport au fragment proximal, tout en permettant les mouvements relatifs axiaux (c'est-à-dire, les mouvements linéaires le long de l'axe longitudinal de l'élément de fixation) d'avoir lieu. Dans un mode de réalisation préféré, l'élément de fixation (30) est une vis d'os tubulée comportant une section transversale hexagonale (42) sur une extrémité, laquelle est reçue de manière télescopique à l'intérieur hexagonal (16) de la partie de cylindre creux (11). Les deux constituants sont de préférence unis en permanence afin de former un ensemble unitaire dont la longueur globale est variable. On peut insérer le dispositif de fixation de la présente invention, dans son intégralité, dans le trou situé en travers du site de fracture, et l'installer avec un minimum de trauma et de dommage pour l'os et les tissus tendres environnants.A variable length fixation device (20) for insertion into a hole drilled in one or more bone fragments comprises a cylinder part (11) as well as a fixation element (30). The cylinder portion (11) is fixed to an interior surface of the hole in a proximal bone fragment. The fastening element (30) is telescopically mounted on the cylinder part (11) and is extendable into one of the bone framents. The assembly prevents lateral movements of the distal fragment, relative to the proximal fragment, while allowing relative axial movements (i.e., linear movements along the longitudinal axis of the fastener) to take place. In a preferred embodiment, the fastener (30) is a tubular bone screw having a hexagonal cross section (42) on one end, which is received telescopically inside the hexagonal (16) of the part of hollow cylinder (11). The two constituents are preferably permanently united in order to form a unitary unit whose overall length is variable. The fixation device of the present invention can be inserted, in its entirety, into the hole located across the fracture site, and installed with minimal trauma and damage to the surrounding bone and tender tissue.
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US15194788A | 1988-02-03 | 1988-02-03 | |
US151947 | 1988-02-03 |
Publications (2)
Publication Number | Publication Date |
---|---|
EP0359793A1 true EP0359793A1 (en) | 1990-03-28 |
EP0359793A4 EP0359793A4 (en) | 1990-10-10 |
Family
ID=22540929
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP19890902684 Withdrawn EP0359793A4 (en) | 1988-02-03 | 1989-02-02 | Variable length fixation device |
Country Status (2)
Country | Link |
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EP (1) | EP0359793A4 (en) |
WO (1) | WO1989006940A1 (en) |
Families Citing this family (22)
Publication number | Priority date | Publication date | Assignee | Title |
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USRE33348E (en) * | 1985-11-07 | 1990-09-25 | Zimmer, Inc. | Bone screw |
US5122133A (en) * | 1990-10-26 | 1992-06-16 | Smith & Nephew Richards Inc. | Compression screw for a joint endoprosthesis |
FR2674119B1 (en) * | 1991-03-22 | 1993-06-18 | Fixano Productions | DEVICE FOR GUIDING THE SLIDING OF OSTEOSYNTHESIS SCREWS FOR INTRA-CAPSULAR FRACTURE OF THE FEMUR'S NECK. |
FR2677876B1 (en) * | 1991-06-18 | 1995-04-28 | Lepine Groupe | OSTEOSYNTHESIS DEVICE FOR REDUCING A FRACTURE OF THE FEMUR'S NECK. |
IL105183A (en) * | 1993-03-28 | 1996-07-23 | Yehiel Gotfried | Surgical device for connection of fractured bones |
US7207993B1 (en) | 2000-02-03 | 2007-04-24 | Pioneer Laboratories, Inc. | Apparatus and method for repairing the femur |
DE10348932B4 (en) | 2003-10-18 | 2006-01-19 | Intercus Gmbh | System for the minimally invasive treatment of a proximal humeral or femoral fracture |
US7862502B2 (en) | 2006-10-20 | 2011-01-04 | Ellipse Technologies, Inc. | Method and apparatus for adjusting a gastrointestinal restriction device |
US8382756B2 (en) | 2008-11-10 | 2013-02-26 | Ellipse Technologies, Inc. | External adjustment device for distraction device |
US9248043B2 (en) | 2010-06-30 | 2016-02-02 | Ellipse Technologies, Inc. | External adjustment device for distraction device |
US8852187B2 (en) | 2011-02-14 | 2014-10-07 | Ellipse Technologies, Inc. | Variable length device and method |
US10743794B2 (en) | 2011-10-04 | 2020-08-18 | Nuvasive Specialized Orthopedics, Inc. | Devices and methods for non-invasive implant length sensing |
WO2013066946A1 (en) | 2011-11-01 | 2013-05-10 | Ellipse Technologies, Inc. | Adjustable magnetic devices and methods of using same |
DE202012005594U1 (en) | 2012-06-11 | 2013-06-24 | Merete Medical Gmbh | Bone screw assembly of variable length |
WO2014070681A1 (en) | 2012-10-29 | 2014-05-08 | Ellipse Technologies, Inc | Adjustable devices for treating arthritis of the knee |
US9545276B2 (en) | 2013-03-15 | 2017-01-17 | Aristotech Industries Gmbh | Fixation device and method of use for a lapidus-type plantar hallux valgus procedure |
US10751094B2 (en) | 2013-10-10 | 2020-08-25 | Nuvasive Specialized Orthopedics, Inc. | Adjustable spinal implant |
JP6626458B2 (en) | 2014-04-28 | 2019-12-25 | ニューヴェイジヴ スペシャライズド オーソペディクス,インコーポレイテッド | System for information magnetic feedback in adjustable implants |
JP6847341B2 (en) | 2014-12-26 | 2021-03-24 | ニューベイシブ スペシャライズド オーソペディックス,インコーポレイテッド | Systems and methods for extension |
WO2016134326A2 (en) | 2015-02-19 | 2016-08-25 | Nuvasive, Inc. | Systems and methods for vertebral adjustment |
EP4275631A3 (en) | 2015-12-10 | 2024-02-28 | NuVasive Specialized Orthopedics, Inc. | External adjustment device for distraction device |
KR20180107173A (en) | 2016-01-28 | 2018-10-01 | 누베이시브 스페셜라이즈드 오소페딕스, 인크. | System for osteotomy |
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SE439429B (en) * | 1982-09-29 | 1985-06-17 | Nils Rydell | HELP TOOLS FOR TELESCOPIC NIKES FOR ORTHOPEDIC USE |
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CA1227902A (en) * | 1984-04-02 | 1987-10-13 | Raymond G. Tronzo | Fenestrated hip screw and method of augmented internal fixation |
US4640271A (en) * | 1985-11-07 | 1987-02-03 | Zimmer, Inc. | Bone screw |
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- 1989-02-02 WO PCT/US1989/000430 patent/WO1989006940A1/en active Application Filing
- 1989-02-02 EP EP19890902684 patent/EP0359793A4/en not_active Withdrawn
Non-Patent Citations (2)
Title |
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No further relevant documents have been disclosed. * |
See also references of WO8906940A1 * |
Also Published As
Publication number | Publication date |
---|---|
WO1989006940A1 (en) | 1989-08-10 |
EP0359793A4 (en) | 1990-10-10 |
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