Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—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
  • A61B17/16—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
  • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays

Definitions

• the present invention relates to a locking system for intramedullary nails and, more precisely, to a distal locking system for intramedullary nails for operations on long bones, such as tibia, femora, ulna, radius, and the like.
• the system according to the present invention assists the surgeon and the surgical assistant in the use of intramedullary nails for the treatment of long bone fractures, such as femora, tibia and humerus.
• distal fastening screws are used, where 'distal' means screws positioned in antithetical position with respect to the surgical access site.
• optical fibre calibration alignment device is of fundamental importance in order to limit all the pathologies which derive from the use of radiological apparatuses and which may effect both patients and personnel, including surgeons and paramedics responsible for surgical instruments and/or assistance in the operating theatre.
• the exposure time represents a biological hazard higher than that of the system according to the present invention, which instead implies the positioning of an optical fibre or arthroscopic optics of maximum 4 mm in diameter and positioning it in lateral- medial direction in the femoral or humeral nails.
• the positioning of the optical fibre is provided in medium-lateral direction for tibia nails.
• Figure 1 is a perspective, frontal view and side view of the positioning and locking system according to the present invention
• Figure 2 is a perspective, frontal view and a view from another side of the locking system according to the present invention
• figure 3 is a plan view from the top of the locking system according to the present invention
• figure 4 is a detailed view of the locking system according to the present invention and according to figure 1.
• the system of the present invention includes a first support 1 consisting of an instrumental pedestal for the external alignment of an intramedullary nail 2.
• a handle 3 which constitutes the supporting template for the later positioning of the intramedullary nail 2 in the patient.
• Handle 3 presents a guiding arm 4 adapted to slidingly support a telescopic distance adjustment body 5.
• Telescopic adjuster 5 includes a pair of guides 51 adapted to slide on guiding arm 4.
• a locking screw 6 is provided to lock the longitudinal running of said telescopic adjuster 5 on guiding arm 4.
• a locking device 7 of adjuster body 5 consisting of a screw 70 fitted on band 71 is provided.
• Band 71 is tightened by the rotation of screw 70 thus locking the position of the adjustment body 5 on guiding arm 4.
• a support device 8 for spatial angular orientation is arranged on the end of the telescopic adjuster body.
• Device 8 essentially consists of a double ball joint with screw for locking the respective rotations, so that by acting on the latter it is possible to lock/release the position of the device with respect to adjustment body 5.
• a radial position adjustment device 9 On the distal end of supporting device 8 is fitted a radial position adjustment device 9 provided with a supporting seat block for an optical fibre device 10 (or alternatively for arthroscopic optics, or endoscopic optics of any kind).
• adjustment device 9 fits a micrometric screw system 90 by means of which the displacement of optical fibre assembly 10 may be micrometrically adjusted with respect to the absolute horizontal and vertical direction (i.e. with respect to pedestal 1 ).
• alignment guiding templates 11 of intramedullary nail 2 the length and diameter of templates 11 being chosen according to use.
• templates 11 may be threaded or not threaded.
• liners and trocars may be provided for the sake of introduction of said optical assembly 10 and said templates, as well as supplementary guide masks. It must be specified here that respective guiding templates 12 of nail 2 are removably fitted on guiding arm 4 for the intrinsically known purpose similarly as described in relation to templates 11.
• the patient is firstly positioned as already known from conventional techniques for intramedullary nail application in relation to the treated bone segment. Surgical access is then performed in the conventional manner. A medullar channel is then prepared by boring or the like and, as contemplated by the conventional techniques in use, with the respective determination of the length of intramedullary nail 2 to be inserted, by means of the conventional techniques in use.
• Nail 2 of predetermined length is then fixed to handle 3 and respective guide arm 4 of the device according to the present invention by means of connection screw (not shown in the drawings) and the system is positioned on support 1 for external alignment.
• telescopic distance adjuster 5 and spatial angular orientation support 8 are inserted on guiding arm 4. Then, after determining the position of the system, the latter is fixed in the determined position by means of the block of the telescopic distance regulator 5 and of the spatial angular orientation support 8. Then the system is disconnected from its external alignment support 1 and telescopic distance regulator 5 along with spatial angular orientation support 8 are released from the system, leaving the previously obtained alignment conditions unchanged while guiding arm 4 remains connected to intramedullary nail 2 by means of connection screw (not shown in the figure). In this condition, nail 2 is inserted inside the medullary channel.
• threaded templates 12 are positioned after being perforated with drills in the proximal part of the treated bone segment, and by means of respective guiding arm 4. System stability is increased in this way. Telescopic distance regulator 5 and spatial angular orientation support 8 are then re-inserted and the latter are locked to the same previously determined reference point.
• Surgical access in the patient is made in this condition and on the bone distal part by micro-incision. Then, in the access made is inserted a liner and a hole is made by drilling in the cortical until either nail 2 or the middle of the medullar channel is reached. After perforating, the hole must be cleaned up using a cleaning brush of the alignment hole.
• optical fibre 10 (or arthroscopic optics) is inserted through a liner to reach the most reachable part of the nail.
• the insertion of optical fibre 10 in the hole and its connection to a monitor allows to identify the possible displacement endured by nail 2 during its insertion in the medullary channel.
• optics 10 are extracted from the hole and radial correction is possibly performed by means of aforesaid spatial angular orientation support 8 in the measure determined by the observer on a monitor.
• the hole of nail 2 is of a known diameter (e.g. 5 mm) and the view on the monitor identifies a position on the limit of the hole or at a peripheral part of the same, a correction of 2.5 mm will be required (i.e. the size of the radius) to return perfectly in axis with the hole itself. Then a second hole is made after performing the correction.
• threaded template 11 may be inserted to completely stabilise the system and start positioning the locking screws of nail 2 through the other holes of the spatial angular orientation support.
• supplementary guides may be connected to find the orientation of the holes with different directions (not shown in the drawings).

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Dentistry (AREA)
• Animal Behavior & Ethology (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Oral & Maxillofacial Surgery (AREA)
• General Health & Medical Sciences (AREA)
• Pathology (AREA)
• Radiology & Medical Imaging (AREA)
• Surgical Instruments (AREA)

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• 2006
  • 2006-10-31 EP EP06809151A patent/EP2086427A1/de not_active Withdrawn
  • 2006-10-31 WO PCT/IB2006/003058 patent/WO2008053264A1/en active Application Filing

Non-Patent Citations (1)

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