EP0732898A1 - Clou de verrouillage - Google Patents

Clou de verrouillage

Info

Publication number
EP0732898A1
EP0732898A1 EP94931593A EP94931593A EP0732898A1 EP 0732898 A1 EP0732898 A1 EP 0732898A1 EP 94931593 A EP94931593 A EP 94931593A EP 94931593 A EP94931593 A EP 94931593A EP 0732898 A1 EP0732898 A1 EP 0732898A1
Authority
EP
European Patent Office
Prior art keywords
locking nail
elongated body
nail according
bone
screw
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Withdrawn
Application number
EP94931593A
Other languages
German (de)
English (en)
Inventor
Ludwig Schroeder
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Endocare AG
Original Assignee
Endocare AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Endocare AG filed Critical Endocare AG
Publication of EP0732898A1 publication Critical patent/EP0732898A1/fr
Withdrawn legal-status Critical Current

Links

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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • 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
    • A61B17/72—Intramedullary pins, nails or other devices
    • 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
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices

Definitions

  • the invention relates to a locking nail for the treatment of bone fractures according to the preamble of claim 1.
  • Locking nails are generally known. In the
  • EP-0 118 778 B1 describes a locking nail which comprises an elongated, hollow body which is rounded at the front end and has an impact end with an extension.
  • at least two transverse bores are provided in the elongated body for receiving one bone screw each.
  • the cross-sectional profile of the elongated body is closed in a ring over its circumference.
  • the hollow design of the locking nail results in a large overall cross section when there is a predetermined stability requirement.
  • a channel has to be prepared, in particular pre-drilled, in the bone. The nail is then inserted or hammered into this hole.
  • the locking nail according to G 91 09 883 Ul has a nail section with an axial longitudinal slot. This one too
  • the nail For the purpose of sufficient stability, the nail must have a large cross-section so that the destabilization of the nail caused by the slot can be compensated for.
  • the object of the invention is to provide a locking nail of the type mentioned at the outset, which has sufficient stability with a small cross section and which can be inserted or screwed through the cross holes without problems in the case of bone screws. This object is achieved by the features in the characterizing part of claim 1.
  • the elongated body is made of solid material, a small cross section is sufficient for a predetermined stability of the locking nail. It is not necessary to pre-drill a hole to insert the locking nail into the bone.
  • the slim nail according to the invention can thus be hammered in without any pretreatment of the bone. The risk of circulatory disorders is correspondingly low.
  • the screw can also be screwed in at an angle to the central axis of the transverse bore.
  • An annular web is preferably formed between the two funnel-shaped openings. This can be a thread be formed, which interacts with the thread of the bone screw.
  • the ring web - in particular to dimension it - in such a way that it interacts with a self-tapping bone screw, in particular a Cortalis screw, in such a way that unintentional loosening of the screw is prevented.
  • a self-tapping bone screw in particular a Cortalis screw
  • This is especially important for the bones of old people who are porous. With such porous bones, loosening of the screw can easily occur. This risk must be kept as low as possible to avoid complaints for the patient.
  • the cross section of the transverse bore is approximately oval in the area of the ring land.
  • the largest diameter preferably extends in the longitudinal direction of the locking nail. Due to the dimension of the ring web and the formation of the funnel-shaped opening, a predetermined angular range for the bone screw - i.e. screwing them in at an angle to the axis of the transverse bore - defined. For example, angles between the bone screw and the aforementioned axis in the range of ⁇ 10 ° axially and ⁇ 5 ° radially are possible.
  • a particularly advantageous embodiment of the locking nail according to the invention is characterized in that a plurality of spaced apart, in particular equidistantly spaced transverse bores is provided over the length of the elongated body. This ensures greater flexibility in fixing a locking nail, for example in the treatment of a debris fracture.
  • transverse bores are preferably also arranged close to the impact-side or proximal and / or distal end, so that both a distal and a proximal le fixation - that is, a fixation on the head of the bone - can be carried out.
  • the drive-in end of the locking nail is preferably designed such that a target device, a drive-in and drive-out bolt or a similar device can be attached to the nail.
  • the proximal turning end comprises an attachment surface which is formed on the end face, a blind bore with a thread and / or a groove.
  • the attachment area serves, among other things, for the full-area transmission of forces and the mutual alignment of the locking nail and the respective attachment instrument.
  • the instrument to be attached is screwed into the pocket bore and thus fixed to the locking nail.
  • the groove enables the target device to be precisely aligned, a projection arranged on the target device or on a position socket interposed between the target device and the locking nail being received in a precisely defined position in the groove.
  • FIG. 1 shows a schematic side view of an exemplary embodiment of a locking nail
  • Figure 2 is a schematic, compared to the representation of
  • FIG. 1 side view of the locking nail rotated by 90 °
  • FIG. 3 shows a top view of the locking nail from FIGS. 1 and 2
  • FIG. 4 shows an enlarged partial sectional view of a transverse bore with funnel-shaped openings and ring web
  • FIG. 5 shows a schematic illustration of a further exemplary embodiment of a locking nail
  • FIG. 6 shows a side view of the locking nail rotated by 90 ° with respect to the view shown in FIG. 5,
  • Figure 7 is a schematic partial sectional view of the upper or proximal end of the locking nail according to
  • Figure 8 is a schematic partial sectional view of the upper or proximal end of the locking nail according to
  • FIG. 9 shows a schematic overall view of a locking nail according to FIG. 1, to which a target device is attached, through the bores of which a drill sleeve with drill and a sleeve for a thread cutter can be guided, and
  • Figure 10 is a schematic representation of an embodiment of a drive-in and drive-out pin.
  • a first exemplary embodiment of a locking nail 10 is described below with reference to FIGS. 1 to 4.
  • the locking nail 10 comprises an elongated body 12 which is rounded at its lower or distal end 14 and has an opposite proximal impact end 18.
  • the impact end 18 has a slightly widened head 16.
  • a contact surface 20 is formed approximately perpendicular to the longitudinal axis of the locking nail 10.
  • a pocket bore 26 with a thread is provided in the contact surface 20 or in the proximal driving end 18 of the locking nail 10, the axis of the blind bore extending approximately in the longitudinal direction of the locking nail 10 and perpendicular to the contact surface 20.
  • a groove 22 which intersects the blind bore 26 is formed at the impact end 18. The functions of contact surface 20, groove 22 and blind hole 26 are described further below.
  • the locking nail 10 of the embodiment according to FIGS. 1 to 4 is slightly kinked in an area which is approximately 2/5 of the total length of the locking nail from the upper end.
  • the kink can also be arranged further up or down on the locking nail 10 or can be omitted entirely.
  • the curvature is arranged ventrally in the sagittal plane. Due to the formation of the kink, matched to the bone to be treated in each case, the locking nail 10 can be guided over its entire length in the central region of the bone.
  • a plurality of transverse bores 28 are formed over the length of the elongated body 12, the center axes of which are identified by the reference number 24.
  • a transverse bore 28 is arranged near the proximal and the distal end of the locking nail 10. In the present exemplary embodiment, all transverse bores 28 are equidistant from one another. distant. Alternatively, other distances between the transverse bores 28 can also be selected.
  • the central axes 24 of the transverse bores 28 run approximately perpendicular to the longitudinal direction of the elongated body 12. In the present exemplary embodiment, they are aligned parallel to one another.
  • axes 24 not aligned parallel to one another are also conceivable, such that the transverse bores 28 - viewed in the longitudinal direction of the elongated body 12 - each intersect at an angle or that they are not aligned perpendicular to the longitudinal direction of the elongated body 12.
  • the transverse bores 28 comprise funnel-shaped openings 30 at both ends, which widen outwards. These can have the shape of a truncated cone or can also be hemispherical or tulip-shaped. The only thing that is essential is the widening of the opening to the outside, so that the bone screw to be guided through the respective transverse bore 28 - or the drill during predrilling - can also be assigned to the corresponding transverse bore 28 if the connection is inaccurate.
  • each transverse bore 28 The two funnel-shaped openings 30 of each transverse bore 28 are separated from one another by an annular web 32 (FIG. 4).
  • annular web 32 As can be seen from FIG. 2, the cross section of each cross bore 28 in the area of the ring web 32 is approximately oval. The largest diameter extends in the longitudinal direction of the locking nail 10.
  • the locking nail 10 is made of solid material and can be circular in cross section (FIGS. 5 to 8), oval or approximately rectangular (FIGS. 1 to 4).
  • An oval or rectangular cross-section has the advantage that a medullary space is created along the flat side of the nail, into which medullary tissue substance escapes when the nail is driven into it can. This greatly reduces the risk of fat embolism.
  • the locking nail 10 By executing the locking nail 10 from a solid material, its cross section can be kept small, so that the locking nail 10 is of slim dimensions. Accordingly, it can be driven into the bone to be treated without the need for pretreatment of the bone, for example drilling. Since the risk of circulatory disorders increases with the size of the part to be inserted in the bone, this risk is greatly reduced in the case of a locking nail 10 according to the present exemplary embodiment.
  • An inaccurately positioned drill is inserted into the corresponding transverse bore 28 through the funnel-shaped opening of each transverse bore 28.
  • An inaccurate placement of the drill is therefore less of a problem than in the prior art.
  • the aforementioned angular area is larger in the axial direction than in the radial direction.
  • the bone screw can be screwed in with respect to the transverse bore axis 24 up to an angle of ⁇ 10 ° axially and ⁇ 5 ° radially.
  • the ring web 32 cooperates with an associated bone screw to fix the locking nail 10. It is also possible to provide a thread in the ring web 32 which corresponds to the thread of the bone screw. Alternatively, the ring web 32 can be designed and dimensioned such that a connection is created with a self-tapping bone screw which does not loosen or loosen itself. This alternative is particularly important in the case of non-solid and porous bones, as they occur in old people. Loosening the screws could cause complaints for the patient.
  • FIGS. 5 to 8 A further exemplary embodiment of a locking nail is indicated in FIGS. 5 to 8.
  • This locking nail differs from that of the first embodiment only in that the elongated body 12 has a round cross section and that the upper or proximal end is not widened.
  • the locking nail 10 is slightly bent over its entire length.
  • a hammer-in and hammer-out bolt 40 is used, as shown in FIG. 10.
  • This comprises a bolt body 42 which has a support surface 43 on its lower end face.
  • a screw pin 44 is formed coaxially on this support surface 43.
  • this At the upper end of the drive-in and drive-out bolt 40, this has a striking head 45 with a lower and an upper striking surface 46.
  • the screw pin 44 of the driving-in and driving-out bolt 40 is screwed into the above-mentioned blind hole 26 of the locking nail 10 until the support surface 43 on the upper or proximal Contact surface 20 of the elongated body 12 or locking nail 10 rests over the entire surface. Then the locking nail 10 is driven into or out of the bone with the aid of a hammer tool while the lower or upper striking surface 46 is applied.
  • the use of the drive-in and drive-out pin 40 has the advantage that, on the one hand, the upper or proximal drive-in end 18 of the locking nail 10 is not damaged by the action. Secondly, the bolt body 42 maintains a certain distance from the patient's bone and tissue, so that the risk of the hammer tool hitting parts of the patient is reduced.
  • the locking nail 10 hammered into the bone is fixed with bone screws. With the aid of a target device 50, this is inserted into the above-mentioned transverse bores 28.
  • An embodiment of such a target device is shown in FIG. With the interposition of a position bushing 54, the target device is attached to the locking nail 10.
  • the position bushing 54 is positioned on the contact surface 20 at the upper driving end 18.
  • a projection (not shown) at the lower end of the position bushing 54 enters the above-mentioned groove 22 such that a clear and exact alignment of the locking nail 10 and the position bushing 24 is ensured.
  • the target device 50 is also attached in a precisely aligned manner.
  • the aiming device 50, position sleeve 54 and locking nail 10 are fixed to one another by a screwable screw into the blind bore 26 at the impact end 18 of the locking nail 19
  • Screw 52 which is preferably designed as a hexagon socket screw.
  • the target device 50 has a perpendicularly arranged Neten guide web 58, which extends approximately parallel to the longitudinal direction of the locking nail 10.
  • a multiplicity of bores 60 are formed in the guide web 58, each bore 60 being aligned with an associated transverse bore 28 in the locking nail 10 due to the precise alignment of the target device 50.
  • a drill sleeve 62 or a sleeve 64 for a thread cutter 68 can be guided in such a way that a device assigned to the respective sleeve, namely a drill 66 or a thread cutter 68, is aligned as coaxially as possible with an associated transverse bore 28 in an elongated manner Body 12 of the locking nail 10 can be supplied.
  • the skin and the muscles in the area of the bone in which the locking nail is to be driven in are removed.
  • the locking nail 10 is driven into the bone using the drive-in bolt 40 and using the hammer tool.
  • the drive-in bolt 40 is removed and the aiming device, with the interposition of the position bushing 54, arranged precisely aligned on the locking nail 10.
  • the position bushing 54 ensures that there is a free space of, for example, 30 mm between the upper end of the locking nail 10 and the crosspiece 56 of the target device 50, in which the tissue arranged between bone and in the crosspiece 56, namely skin and muscles , is recorded.
  • a stab incision is first made, whereby the sleeve 62 for the drill 66 is guided through a bore 60 in the guide web 58 and the tissue arranged over the bone is led to the surface of the bone.
  • the axis of the bushing 62 is oriented approximately coaxially to the axis of the associated transverse bore 28 in the elongated body 12.
  • the purpose of the sleeve 62 is to keep the muscles away from the drill 66.
  • the drill 66 is then passed through the bush 62 and a hole is formed in the bone. If the tip of the drill 66 does not meet the assigned transverse bore 28 exactly, it is guided into the transverse bore 28 via the funnel-shaped opening 30. After drilling the hole in the bone, the drill 66 and then the sleeve 62 are removed.
  • the bone can be punched before drilling by means of a grain which is also guided through the bushing 62.
  • a thread can be cut into the bone and / or the ring web 32 using the bushing 64 and the thread cutter 68. This step is omitted if a self-tapping bone screw is used.
  • the bone screw is screwed into the hole predrilled in the bone, the screwdriver likewise being guided in an assigned hole 60 in the target device.
  • the locking nail 10 it is not necessary for 28 bone screws to be inserted into all transverse bores. However, it is recommended to fix the locking nail 10 at least at the distal and proximal end. Optionally, it can also be set at other positions, depending on the type of fracture.
  • the locking nail described above reduces the risk of circulatory disorders by a small cross section.
  • a drill or a bone screw can also be inserted into the transverse bore if it is not hit exactly. This is made possible by the funnel-shaped opening, which takes on a guiding function.
  • an "angular" arrangement of the screw with respect to the axis of the transverse bore is possible.
  • Locking nail elongated body, rounded end (distal), extended head end, driving-in end (proximal), contact surface, groove, central axis of the cross-hole, blind hole, cross-hole, funnel-shaped opening, ring bar, drive-in and knock-out pin, bolt body, support surface, screw, striking head, aiming device / drilling jig, screw pin, positioning sleeve, cross bar, guide hole, drill hole, thread drill, drill sleeve

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)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention a pour objet un clou de verrouillage pour le traitement de fractures osseuses, comprenant un corps de forme allongée (12), arrondi à son extrémité distale avant (14) et présentant une extrémité d'insertion proximale (18). Des trous transversaux (28), destinés à recevoir chacun une vis à os, sont ménagés le long du corps allongé. Le corps (12) est constitué par un matériau massif et présente, au moins sur un côté de chaque trou (28), une ouverture en forme d'entonnoir (30).
EP94931593A 1993-12-07 1994-11-09 Clou de verrouillage Withdrawn EP0732898A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE19934341677 DE4341677C1 (de) 1993-12-07 1993-12-07 Verriegelungsnagel
DE4341677 1993-12-07
PCT/EP1994/003694 WO1995015728A1 (fr) 1993-12-07 1994-11-09 Clou de verrouillage

Publications (1)

Publication Number Publication Date
EP0732898A1 true EP0732898A1 (fr) 1996-09-25

Family

ID=6504383

Family Applications (1)

Application Number Title Priority Date Filing Date
EP94931593A Withdrawn EP0732898A1 (fr) 1993-12-07 1994-11-09 Clou de verrouillage

Country Status (6)

Country Link
EP (1) EP0732898A1 (fr)
JP (1) JPH09506018A (fr)
DE (1) DE4341677C1 (fr)
FI (1) FI962320A (fr)
NO (1) NO962394L (fr)
WO (1) WO1995015728A1 (fr)

Families Citing this family (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19629011C2 (de) * 1996-07-18 2001-08-23 Dietmar Wolter Hilfsmittel für die Osteosynthese
CA2308778C (fr) 1997-10-20 2007-01-09 Synthes (U.S.A.) Dispositif d'osteosynthese
GB9823974D0 (en) 1998-11-02 1998-12-30 Grampian Healthcare National H Fracture treatment
DE20301902U1 (de) * 2003-02-07 2003-05-15 Stryker Trauma Gmbh Verriegelungsnagel, insbesondere für Frakturen der proximalen Femur
US20070173835A1 (en) * 2006-01-13 2007-07-26 Medoff Robert J Intramedullary implant for fracture fixation and method of using the same
DE102013005414A1 (de) 2013-03-28 2014-10-02 Dietmar Wolter Osteosynthesesystem für die multidirektionale, winkelstabile Versorgung von Frakturen von Röhrenknochen umfassend einen Marknagel und Knochenschrauben
DE102013005413A1 (de) 2013-03-28 2014-10-02 Dietmar Wolter Osteosynthesesystem für die multidirektionale, winkelstabile Versorgung von Frakturen von Röhrenknochen umfassend einen Marknagel und Knochenschrauben
US10987146B2 (en) * 2019-03-05 2021-04-27 Nextremity Solutions, Inc. Bone defect repair apparatus and method

Family Cites Families (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3464008D1 (en) * 1983-03-09 1987-07-09 Howmedica Int Inc Fixing nail
US4756307A (en) * 1987-02-09 1988-07-12 Zimmer, Inc. Nail device
CH683065A5 (de) * 1990-03-20 1994-01-14 Synthes Ag Tibia-Marknagel mit angepasstem Querschnitt.
DE9101035U1 (fr) * 1991-01-30 1991-04-18 Howmedica Gmbh, 2314 Schoenkirchen, De
US5248313A (en) * 1991-04-17 1993-09-28 Greene Bruce L Fibular intramedullary rod
DE4143362C2 (de) * 1991-07-19 1994-06-30 Pennig Dietmar Mark- und Verriegelungsnagel
DE9109883U1 (fr) * 1991-08-09 1991-09-26 Howmedica Gmbh, 2314 Schoenkirchen, De
DE9115200U1 (fr) * 1991-12-07 1992-02-13 Howmedica Gmbh, 2314 Schoenkirchen, De
EP0565216B1 (fr) * 1992-04-10 1999-01-13 aap Implantate AG Clou médullaire

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9515728A1 *

Also Published As

Publication number Publication date
JPH09506018A (ja) 1997-06-17
FI962320A (fi) 1996-06-05
NO962394L (no) 1996-08-07
FI962320A0 (fi) 1996-06-03
DE4341677C1 (de) 1995-07-13
WO1995015728A1 (fr) 1995-06-15
NO962394D0 (no) 1996-06-06

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