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
  • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
  • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
• • 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
  • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
  • A61B17/809—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs

Definitions

• the invention relates to an implant for fixing parts of a human shoulder blade.
• the shoulder joint is a joint enabling a movement of the am relative to the body. More in particular, the shoulder oint is a ball joint, with the substantially spherical extremity of the humerus resting in a bowl-shaped space defined by the shoulder blade (scapula) .
• Tftat bowl-shaped space is, viewed relative to the body, substantially open outwards and downwards, and has on its inside a wall defined by the glenoid, while an upper wall is defined by the tip of the shoulder blade (acromion) .
• this bone piece is interrupted by an artificial sectioning of the bone, a so-called osteotomy, or by a fracture, the healing process is rendered more difficult in that it is not properly possible, if at all, to fix the broken parts relative to each other in a stable manner.
• a problem involved is that the deltoid (musculus deltoides) extends over the shoulder joint, which muscle should be passed during the fixing of the acromion for fitting an implant.
• an implant according to the invention has the features as described in claim 1.
• Fig. l is a schematic perspective view of a right shoulder of a human, in rear view;
• Fig. 2 is a more schematic section of some parts of the shoulder oint;
• Fig. 3 is a schematic top plan view of the right shoulder;
• Fig. A is a top plan view of an embodiment of an implant according to the invention;
• Fig. 4B is a bottom view of this embodiment
• Fig. 4C is a side elevation of this embodiment
• Fig. 4D is a front view of this embodiment.
• Fig. 5 is a section, co ⁇ parable with Fig. 2, to illustrate th ⁇ » action of the i ⁇ plant according to the invention.
• Fig. 1 schematically shows a right shoulder joint, generally designated by reference numeral l, of a human, in rear view.
• the shoulder joint l can be interpreted as a ball joint, with the substantially spherical extremity 2 of the humerus 3 resting in a bowl-shaped space 5 defined by the shoulder blade (scapula) 4.
• the bony part of this bowl-shaped space 5 is on its inside defined by the glenoid 6 and at its upper side by the tip (acromion) 7 of the shoulder blade .
• the acromion 7 can be considered a roof-shaped extremity of a bone ridge 8 which is an integral part of the shoulder blade 4.
• acromion body 11 is the portion of the acromion 7 which is still an integral part of the shoulder blade 4; the acro ⁇ iion fracture part 12 is the broken-of , extreme portion of the acromion 7.
• Fig. 3 schematically shows the (broken) acromion i from the top.
• Fig. 3 illustrates that the bone ridge a of the shoulder blade , viewed from the acromion 7, is directed obliquely backwards, and that the collarbone (clavicle) 9 is directed obliquely forwards but not connected, or at least not by bone, to the shoulder blade 4.
• the deltoid (musculus deltoides) 20 attached to the collarbone 9 overlies the acromion fracture part 12.
• This deltoid 20 disturbs the position of the acromion fracture part 12 relative to the acromion body 11 in that on the extremity of the acromion fracture part 12 remote from the fracture 10, a downwardly directed force is exerted, which force is in Fig. 2 designated by Fl. Consequently, the healing of the fracture 10. i.e. adhesion of the acro ⁇ rion fracture part 12 to the acromion body 11 through bone growth, is rendered difficult not only because the acromion fracture part 12 can move relative to the acromion body 11, but also because the acromion fracture part 12 assumes a wrong, downwardly hinged position relative to the acromion body 11.
• the implant according to the invention promotes the healing process, on the one hand in that the acromion fracture part 12 is fixed relative to the acromion body 11, and on the other in that the above-mentioned forces are taken up.
• the inplant 40 is manufactured from a material that is strong and biocompatible.
• the material used can for instance be stainless steel, but preferably titanium is used, because in that case, it is still possible to produce an image, by means of X- adiation, of the set acromion 7, the glenoid and the humerus.
• the i ⁇ plant 40 has a substantially L-shaped cross section, and comprises a bone plate 41 and a base plate 42 substantially perpendicular thereto.
• the intersecting line between the plane defined by the bone plate 41 and the plane defined by the base plate 42 is designated by 43.
• the thickness of the bone plate 41 and the base plate 42 is relatively small, and is preferably about 1 mm.
• the two plates 41 and 42 are manufactured from a flat strip, by bending that strip over the line 43.
• the two plates 41 and 42 are preferably manufactured from a solid block, by cutting away portions of the material, because in that case, the resulting implant 40 is stronger.
• the implant 40 is intended to be fitted on the acromion 7, with the bone plate 41 on top of the acromion 7 while the base plate 42 is downwardly directed and rests against the extremity of the acromion 7, as sketched in Fig. 5.
• the base plate 42 measured along the intersecting line 43, has a length 42 based on the corresponding dimension of the acromion 7.
• a suitable length ⁇ is about 26 mm.
• the width B 4 of the base plate 42, measured perpendicularly to the plane of the bone plate 41. is about 7-10 mm.
• a suitable width is about a.5 mm.
• a central portion of the base plate 42 has been removed over a length of about 14 mm.
• the base plate 42 comprises two base portions 44 and 45 substantially perpendicular to the bone plate 41, each having a length L u and 4S respectively (measured in the direction of the above- mentioned intersecting line 43) of about 6 mm.
• a hole 46, 47 for passing a screw 61 (see Fig. 5) therethrough.
• each base portion 44, 45 remote from the bone plate 41 Located at the end of each base portion 44, 45 remote from the bone plate 41 is a substantially triangular hook portion 48, 49, which is substantially perpendicular to the base plate 42 and hence directed substantially parallel to the bone plate 41.
• the bone plate 41 comprises a bone plate base portion 51 and a bone plate fixation portion 52.
• the bone plate base portion 51 adjoins the intersecting line 43, and has a length 51, measured along the intersecting line 43, which length corresponds to the length I ⁇ a of the base place 42.
• the bone plate base portion 51 can extend as an uninterrupted whole along the intersecting line 43 or, as shown in the top plan view of Fig. 4A, be provided with a central recess 53 having for instance a semicircular or semi-elliptic contour, which recess 53 is a continuation of the removed central portion of the base plate 42.
• the bone plate fixation portion 52 has an elongated shape with a center line 54. This center line 54 intersects the intersecting line 43 at an intersection S about halfway the bone plate base portion 51.
• Provided in the elongated bone plate fixation portion 52 is at least one hole 55 for passing a screw 62 (Fig. 5) therethrough. In the exemplary embodiment shown, three of such holes 55, 55*, and 55" are present.
• the center line 54 of the elongated bone plate fixation portion 52 makes an angle a with the intersecting line 43, which angle ⁇ is adapted to the direction of the bone ridge 8.
• this angle ⁇ is in the range of 40°-80°.
• a suitable value for this angle o is about 60°.
• a suitable width B 5 for the bone plate fixation portion 52, measured perpendicularly to the center line 54, is about 8 mm.
• a suitable length L 52 for the bone plate fixation portion 52, measured along the center line 54 from the end to the intersection 5, is about 50 cm.
• the bone plate 41 has a shape which, in top plan view (see Fig. 4A) substantially corresponds to the shape of a hockey stick or to the shape of the Greek letter ⁇ .
• an implant for a left shoulder is of mirror-symmetrical design in respect of the implant shown for the right shoulder.
• the fitting of the implant 40 is effected through surgery, as will be appreciated.
• the i ⁇ plant 40 is slid over the acromion 7 from aside, with the hook portions 48, 49 being stuck under the extremity of the acromion fracture part 12, while the bone plate 41 comes to lie on the acromion body 11 and the bone ridge 8.
• Horizontal screws 61 axe provided through the holes 46, 47 in the base portions 44, 45 of the base plate 42, which horizontal screws 61 preferably extend into the acromion body 11.
• vertical screws 62 are provided through the holes 55, 55P 55" in the bone plate fixation portion 52, which vertical screws 62 extend into the acromion body 11 and/or the bone ridge 8.
• at least one of those holes (55 M ) is slightly elongated (with the long axis of the ellipse being substantially perpendicular to the base plate) , to be able to take up some play during fitting.
• the horizontal screws 61 the acromion fracture part 12 is at first positioned in the right place relative to the acromion body 11. However, these screws 61 alone would not be able to withstand the above-mentioned force Fl.
• the deltoid muscle extends over the extremity of the acromion fracture part 12, and that deltoid muscle actually sits in the way during the fitting of the fixation means.
• cannular screws i.e. screws having a channel extending therethrough, along the body axis thereof, are preferably used, which screws can be fitted by means of a guide wire. This technique is known per se.
• the implant according to the invention provides maximum stability while involving a minimum of f stening material and a minimum of "operation damage" (to the deltoid muscle) .
• the bone plate fixation portion 52 has a bent center line 54.
• the implant is slightly bent so that its shape is more properly adapted to the shape of the bone parts of the patient in question. This adaptation can be performed by the surgeon himself directly before the fitting of the implant.
• the number of base portions is larger than two, or that the number of screw holes (55) differs from three.

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)
• Prostheses (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (3)

Publications (1)

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• 1995
  • 1995-11-15 NL NL1001661A patent/NL1001661C2/nl not_active IP Right Cessation
• 1996
  • 1996-11-14 WO PCT/NL1996/000448 patent/WO1997018770A1/en not_active Application Discontinuation
  • 1996-11-14 AU AU75083/96A patent/AU708718B2/en not_active Ceased
  • 1996-11-14 EP EP96937579A patent/EP0871406A1/de not_active Withdrawn
  • 1996-11-14 CA CA 2235730 patent/CA2235730A1/en not_active Abandoned

Non-Patent Citations (1)

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