EP1983911A1 - Dispositif de fixation de fractures et montage d'implantation pour celui-ci - Google Patents

Dispositif de fixation de fractures et montage d'implantation pour celui-ci

Info

Publication number
EP1983911A1
EP1983911A1 EP06733966A EP06733966A EP1983911A1 EP 1983911 A1 EP1983911 A1 EP 1983911A1 EP 06733966 A EP06733966 A EP 06733966A EP 06733966 A EP06733966 A EP 06733966A EP 1983911 A1 EP1983911 A1 EP 1983911A1
Authority
EP
European Patent Office
Prior art keywords
fixation device
fixed angle
holes
fracture fixation
jig
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Withdrawn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
EP06733966A
Other languages
German (de)
English (en)
Other versions
EP1983911A4 (fr
Inventor
Jorge L. Orbay
Javier E. Castaneda
Edward Mebarak
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.)
DePuy Products Inc
Original Assignee
DePuy Products Inc
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 DePuy Products Inc filed Critical DePuy Products Inc
Publication of EP1983911A1 publication Critical patent/EP1983911A1/fr
Publication of EP1983911A4 publication Critical patent/EP1983911A4/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Withdrawn legal-status Critical Current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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • 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
    • A61B17/80—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

Definitions

  • This invention relates broadly to surgical devices. More particularly, this invention relates to surgical devices and tools for implanting fracture fixation devices.
  • Severe long bone fractures are often treated with plating.
  • plating a relatively large incision is made at the location of the fracture, musculature and tendons are displaced from the bone to expose the bone surface, and a bone plate is fixedly attached to one or more pieces of the fractured bone in a manner which, ideally, supports and stabilizes the fracture for healing. Due to the relatively invasive nature of the procedure required to implant the plate, plating is generally reserved for fractures which cannot be treated with a less invasive method of immobilization.
  • a Colles' fracture which results from compressive forces being placed on the distal radius bone, and which causes backward displacement of the distal fragment and radial deviation of the hand at the wrist, is treated with a dorsal plate when there is a significant degree of displacement.
  • a less-displaced Colles' fracture is commonly under-treated due to the hesitancy of physicians to prescribe operative and invasive treatment. If not properly treated, such a fracture results in permanent wrist deformity. It is therefore important to align the fracture and fixate the bones relative to each other so that proper healing may occur.
  • relatively minimally invasive fixation devices have become available for treatment of wrist fractures. For example, U.S. Pat. No.
  • a fracture fixation device a supra-metaphyseal plate portion and an intramedullary nail portion which is horizontally and vertically offset relative to the plate portion by a neck portion.
  • the plate portion includes longitudinally displaced fixed angle holes, each of which is adapted to orient a peg (or locking screw, collectively referred to as 'peg') in a different angular orientation such that pegs therethrough generally corresponds to the articular surface of the subchondral bone.
  • the nail portion includes threaded screw holes oriented normal to an endosteal surface, and a smaller K- wire alignment hole parallel to the screw holes.
  • An implantation jig for the fixation device has a first portion with a concave surface seatable on the plate portion of the fixation device, and a relatively elevated second portion in alignment over the screw holes of the intramedullary nail portion of the fixation device.
  • the first portion includes openings in alignment with the fixed angle holes.
  • a cannulated locking drill guide locks the jig relative to the implant and is used to guide a drill in alignment with one of the fixed angle holes.
  • the back of the first portion of the jig is curved upward to facilitate maneuvering the nail portion of the fixation device within the intrafocal space and to allow the first portion to rest on the diaphyseal-side of the fracture during the implantation process.
  • the first portion of the jig includes two K- wire guide holes which extend on either side of the front end of plate portion when the jig is coupled to the plate portion.
  • the K-wire guide holes are designed to closely hold an appropriately sized K-wire and direct it at a fixed angle parallel to the endmost screw hole of the plate portion.
  • Two such guide holes are provided, as the endmost holes for left and right fixation devices (for left and right hands) each have opposite respective angles, and the jig may be used with each of the left and right devices.
  • the K-wire guide hole located on the side of the operative limb (left or right hand) is used.
  • the respective K-wire guide hole defines an axis which is substantially parallel to and closely spaced to the axis of the endmost screw hole, thus anticipating the path of a peg through the endmost screw hole.
  • a K-wire is drilled into bone through the appropriate K-wire guide hole and its placement within the bone is viewed under fluoroscopy to ensure its placement, and the subsequent placement of the peg through the endmost screw hole, relative to the articular surface of the subchondral bone is appropriate.
  • the second portion of the jig includes longitudinally displaced holes or slots for drill guides.
  • the second portion also includes a K- wire guide hole configured to direct a K- wire at a fixed angle into the K- wire alignment hole of the nail portion of the fixation device. Similar to above, prior to drilling any holes into the diaphysis for the screws for the nail portion, a K- wire is drilled through the K- wire guide hole in the second portion and its placement can be viewed under fluoroscopy to ensure its placement relative to the diaphysis is appropriate.
  • Fig. 1 is a side elevation of a fixation device according to the invention
  • Fig. 2 is a plan view of a fixation device according to the invention.
  • Fig. 3 is a bottom view of the plate-portion end of the fixation device of the invention.
  • Fig. 4 is a plate-portion end view of the fixation device of the invention.
  • Fig. 5 is a perspective view of an implantation jig according to the invention coupled to the fixation device of the invention.
  • a fracture fixation device 10 includes a supra-metaphyseal plate portion 12 and an intramedullary nail portion 14 which is horizontally and vertically offset relative to the plate portion by a neck portion 16.
  • the plate portion 12 has a narrow profile and is slightly rounded about its upper surface 20.
  • the plate portion 12 includes four longitudinally displaced fixed angle holes 22, 24, 26, 28, each preferably threaded, and each of which is adapted to lock a fastener, such as a smooth or threaded shaft peg 30, in a different orientation from the others (i.e., the axes are oblique relative to each other).
  • the pegs 30 are laterally displaced defining an imaginary surface (generally transverse to the longitudinal axis A of the plate portion) which generally corresponds to (i.e., extends parallel to) the articular surface of the subchondral bone.
  • the plate portion 12 includes a dimple 32 for referencing an implantation jig, as described below.
  • the nail portion 14 includes three threaded screw holes 34, 36, 38 oriented normal to a preferably flattened endosteal surface 40, and a smaller K-wire alignment hole 42 parallel to the screw holes and sized to closely receive a K-wire at a fixed angle.
  • the tail end 44 of the nail portion 14 is provided with a portion 46 having downward and then upward curve which facilitates maneuvering the tail end of the nail portion through the intrafocal space and into the medullary canal.
  • an implantation jig 100 for the fixation device has a first portion 102 seatable on the plate portion 12 of the fixation device, and a relatively elevated second portion 104 in alignment over the screw holes 34, 36, 38 of the intramedullary nail portion 14 of the fixation device 10.
  • the first portion 102 includes a lower nub (not shown) which seats in the dimple 32 (Fig. 2) on the plate portion 12 of the fixation device.
  • the first portion includes access openings 106 (at the front), 110 (at the left side, and at right the side, not shown), 108 (at the rear) in axial alignment with the fixed angle screw holes 22, 24, 26, 28.
  • Such openings are preferably initially positioned over drill guide tips (not shown) which are inserted in all of the fixed angle holes of the plate portion but the hole beneath access opening 110.
  • the drill guide tips which functions as miniature drill guides, are described in detail in co-owned U.S. Serial No. 11/011,917, filed December 14, 2004, which is hereby incorporated by reference herein in its entirety.
  • a cannulated locking drill guide 116 having a threaded end 118 is provided through opening 110 and thread into hole 26 in the plate portion 12, such that a portion of the guide 116 applies a force against said jig 100.
  • the locking drill guide 116 in conjunction with the engagement of the nub within the dimple 32 immobilizes the jig 100 relative to the fixation device 10 so that the two are fixed relative to each other.
  • the back 120 of the first portion 102 of the jig 100 is curved upward to facilitate maneuvering the nail portion 14 of the fixation device within the intrafocal space and to allow the first portion to rest on the diaphyseal-side of the fracture (e.g., the proximal cortex of the distal radius) during the implantation process.
  • the diaphyseal-side of the fracture e.g., the proximal cortex of the distal radius
  • the first portion 102 of the jig 100 includes two K-wire guide holes 122, 124 which extend on either side of the front of the plate portion when the jig 100 is fixed relative to the fixation deice 10 to guide a K-wire offset relative to the plate portion.
  • the K-wire guide holes 122, 124 are designed to closely hold an appropriately sized K-wire 126 and direct it at a fixed angle parallel to the endmost screw hole 22 (e.g., distalmost where the fixation device is used at the distal radius).
  • the endmost holes for left and right fixation devices each have opposite respective angles, and the same jig may be used with each of the left and right devices.
  • the K-wire guide hole located opposite the side on which the locking drill guide is positioned is used. That is, as shown in Fig. 5, with the locking drill guide on the left side of the plate, the right side K-wire guide hole 122 is used.
  • the respective K-wire guide hole 122 defines an axis which is laterally offset, substantially parallel to, and closely spaced to the axis of the endmost screw hole 22 (preferably within approximately 5 mm), thus anticipating the path of a peg through the endmost screw hole 22.
  • a K-wire 126 is drilled into bone through the appropriate K-wire guide hole 122 and its placement within the bone is viewed under fluoroscopy to ensure its placement relative to the articular surface of the subchondral bone is appropriate. If correct, the screw holes can be drilled with assurance that the screws will not enter the articular space. If not correctly located as indicated by K-wire fluoroscopic visualization, the plate can be repositioned, the K- wire re-drilled and re-examined until placement is correct.
  • the second portion 104 of the jig includes longitudinally displaced holes or slots 130, 132, 134, as described in detail in U.S. Pat. No. 6,926,720, to longitudinally align drill guides with the screw holes 34, 36, 38 of the intramedullary portion 14 of the fixation device 10.
  • the second portion 104 also includes a K-wire guide hole 136 configured to direct a K-wire 138 at a fixed angle into the K-wire alignment hole 142 of the nail portion of the fixation device.
  • a K-wire is drilled through the K-wire guide hole in the second portion and its placement can be viewed under fluoroscopy to ensure its placement relative to the diaphysis is appropriate. If correct, the screw holes can be drilled with assurance that the screws will be properly aligned relative to the axis of the diaphysis. If not correctly aligned as indicated by fluoroscopic visualization, the nail portion can be repositioned, the K-wire re-drilled and re-examined until placement is correct.
  • the jig is usable in combination with drill guides, bits and gauges as described in previously incorporated U.S. Patent No. 6,926,720.

Abstract

L’invention concerne un dispositif de fixation de fractures comprenant une partie de plaque et une partie de clou intra-médullaire décalée par rapport à la partie de plaque par une partie de col. La partie de plaque comprend des trous pour tenons décalés longitudinalement qui orientent des tenons le long d'une surface imaginaire parallèle à l'os sous-chondral d'une surface articulaire. La surface supérieure de la partie de plaque comprend un cran destiné à indexer un montage. La partie de clou comprend des trous taraudés pour vis orientés normalement à une surface endostéale et un trou plus petit pour l'alignement de fils de Kirschner, parallèle aux trous pour vis. Le montage est doté d'une première partie qui s'indexe sur le cran et une deuxième partie alignée par-dessus les trous de vis de la partie de clou. L'arrière de la première partie du montage est courbé vers le haut pour faciliter la manipulation du montage. Les première et deuxième parties du montage comprennent des trous de guidage pour fils de Kirschner qui dirigent des fils de Kirschner par rapport à des trous dans le dispositif.
EP06733966A 2006-01-27 2006-01-27 Dispositif de fixation de fractures et montage d'implantation pour celui-ci Withdrawn EP1983911A4 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2006/002919 WO2007086854A1 (fr) 2006-01-27 2006-01-27 Dispositif de fixation de fractures et montage d'implantation pour celui-ci

Publications (2)

Publication Number Publication Date
EP1983911A1 true EP1983911A1 (fr) 2008-10-29
EP1983911A4 EP1983911A4 (fr) 2013-02-20

Family

ID=38309521

Family Applications (1)

Application Number Title Priority Date Filing Date
EP06733966A Withdrawn EP1983911A4 (fr) 2006-01-27 2006-01-27 Dispositif de fixation de fractures et montage d'implantation pour celui-ci

Country Status (7)

Country Link
EP (1) EP1983911A4 (fr)
JP (1) JP2009524473A (fr)
AU (1) AU2006336444A1 (fr)
CA (1) CA2640225A1 (fr)
IL (1) IL193043A (fr)
NO (1) NO20083686L (fr)
WO (1) WO2007086854A1 (fr)

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110106086A1 (en) * 2008-04-03 2011-05-05 Austofix Group Limited Tool jig for bone implant assembly
DE102009001707A1 (de) * 2009-03-20 2010-09-23 Mondeal Medical Systems Gmbh Dorsale Nagelplatte
GB2473874A (en) * 2009-09-29 2011-03-30 Peter Giannoudis Surgical plate and nail implant
US11051864B2 (en) * 2012-08-30 2021-07-06 DePuy Synthes Products, Inc. Intramedullary fixation assembly
CN110037784A (zh) * 2019-05-31 2019-07-23 山东威高医疗科技有限公司 一种基于电磁导航技术的用于辅助骨折复位的固定支架

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020143337A1 (en) * 2000-02-01 2002-10-03 Hand Innovations, Inc. Fixation device for metaphyseal long bone fractures
WO2003101320A1 (fr) * 2002-05-30 2003-12-11 Hand Innovations, Llc Dispositif intramedullaire de fixation de fractures d'os longs methaphysaires
US20040193165A1 (en) * 2003-03-27 2004-09-30 Hand Innovations, Inc. Anatomical distal radius fracture fixation plate and methods of using the same
WO2006081483A1 (fr) * 2005-01-28 2006-08-03 Depuy Products, Inc. Systeme clou-plaque

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB9016205D0 (en) * 1990-07-24 1990-09-05 Chadwick Christopher J Interlocking intramedullary nails
US5374271A (en) * 1993-02-24 1994-12-20 Hwang; Chi-Yuan Double nail guiding system for targeting of distal screw holes of interlocking nails
JP3752128B2 (ja) * 2000-04-06 2006-03-08 株式会社ホムズ技研 髄内釘の位置決め装置
KR100485896B1 (ko) * 2002-01-17 2005-04-29 조우신 골수강내 금속정의 나사삽입장치 및 이를 이용한 나사삽입방법
US6926720B2 (en) 2003-10-15 2005-08-09 Hand Innovations, Llc Jig assembly for implantation of a fracture fixation device
JP2005334139A (ja) * 2004-05-25 2005-12-08 Mizuho Co Ltd 動物の骨折治療方法

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020143337A1 (en) * 2000-02-01 2002-10-03 Hand Innovations, Inc. Fixation device for metaphyseal long bone fractures
WO2003101320A1 (fr) * 2002-05-30 2003-12-11 Hand Innovations, Llc Dispositif intramedullaire de fixation de fractures d'os longs methaphysaires
US20040193165A1 (en) * 2003-03-27 2004-09-30 Hand Innovations, Inc. Anatomical distal radius fracture fixation plate and methods of using the same
WO2006081483A1 (fr) * 2005-01-28 2006-08-03 Depuy Products, Inc. Systeme clou-plaque

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of WO2007086854A1 *

Also Published As

Publication number Publication date
WO2007086854A1 (fr) 2007-08-02
AU2006336444A1 (en) 2007-08-02
NO20083686L (no) 2008-08-27
JP2009524473A (ja) 2009-07-02
IL193043A0 (en) 2009-02-11
CA2640225A1 (fr) 2007-08-02
EP1983911A4 (fr) 2013-02-20
IL193043A (en) 2013-01-31

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