EP2244645A1 - Dispositif et procédé chirurgical pour réduire une fracture entre la tête épiphysaire et la diaphyse d'un os long, en particulier une fracture de l'humérus proximal - Google Patents

Dispositif et procédé chirurgical pour réduire une fracture entre la tête épiphysaire et la diaphyse d'un os long, en particulier une fracture de l'humérus proximal

Info

Publication number
EP2244645A1
EP2244645A1 EP09705411A EP09705411A EP2244645A1 EP 2244645 A1 EP2244645 A1 EP 2244645A1 EP 09705411 A EP09705411 A EP 09705411A EP 09705411 A EP09705411 A EP 09705411A EP 2244645 A1 EP2244645 A1 EP 2244645A1
Authority
EP
European Patent Office
Prior art keywords
plate
head
bone
jacking rod
fracture
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Withdrawn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
EP09705411A
Other languages
German (de)
English (en)
Inventor
Edwin Spencer
Emmanuel Lizee
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.)
Tornier SAS
Original Assignee
Tornier SAS
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 Tornier SAS filed Critical Tornier SAS
Publication of EP2244645A1 publication Critical patent/EP2244645A1/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Withdrawn legal-status Critical Current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
    • A61B17/80—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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • 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
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • 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
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread

Definitions

  • the present invention relates to a device and a method for reducing a fracture between the epiphyseal head and the diaphysis of a long bone.
  • a particularly advantageous, but not exclusive, application of the invention is the reduction of proximal humeral fractures, that is to say fractures between the upper epiphyseal head and the diaphysis of a human humerus.
  • proximal humeral fractures in shoulder surgery is aided with a stable construct that sustains early mobilization with high healing rates and low complication rates.
  • a plate bridging the fracture between the head and the diaphysis of the humerus aids in fixation, but the head must be reduced before fixation.
  • the object of the present invention is to provide a device and a method for reducing this type of fracture which limit the detachment of biological tissue surrounding the fracture whilst also improving the reduced position of the head.
  • the invention thus relates to a device for reducing a fracture between the epiphyseal head and the diaphysis of a long bone, as defined in claim 1.
  • the invention also relates to a surgical method for reducing a fracture between the epiphyseal head and the diaphysis of a long bone, as defined in claim 17.
  • the invention is based not on the idea of "forcing" the head in a single direction with the aim of pinning it against the diaphysis of the bone so as to reduce the fracture between said head and the diaphysis, but inversely of pushing the head in a direction tilted relative to the longitudinal direction of the bone whilst pulling the region of the head opposite the fracture in a substantially parallel but opposite direction.
  • the head is thus subjected to a resultant tilting movement which makes it possible to put the head back in place in a satisfactory manner and to thus reduce the fracture without using excessive force, in particular without disturbing the biological tissue in the vicinity of the reduced fracture by means of detachment.
  • the surgeon can thus control the jacking rod and the pulling means in order to correct especially the varus position of the humeral head by tilting it slightly outwardly, largely about a horizontal anteroposterior geometrical axis passing through said head.
  • the device and method according to the invention can be adapted to different sizes of fractured heads whilst also affording the surgeon a high level of precision with regard to the pushing forces exerted by the jacking rod and the pulling forces exerted by the pulling means so as to adjust the reduced position of the head as best as possible before firmly connecting the plate to the bone on either side of the reduced fracture, typically using conventional bone-anchoring means, such as screws.
  • a proximal humeral fracture fixed with the locking plate pushing the head from an inferior aspect to rotate the head to reduce the fracture allows for positioning the head out of varus or other malalignment, obviating the need for multiple pins to provisionally reduce the fracture, and minimizing the soft tissue stripping.
  • the humerus is reduced by pushing the head out of varus or other malalignment, thereby allowing fixation.
  • the point at which the rod exerts a pushing force on the head of the bone may vary depending both on the malalignment to be corrected and on the state of the bone matter forming said head.
  • the point of the head, at which the jacking rod exerts its pushing force is located at the fracture.
  • the corresponding device and method according to the invention are defines in dependent claims 5 and 19. Furthermore, if the face of the head facing the fracture has a sufficient level of resistance to this pushing force, the distal end of the rod maintains a pressing contact with said face when the head of the bone is tilted. The surgeon may optionally also temporarily reinforce this bone face of the head using suitable reinforcement elements put in place via the trajectory of the push rod. If the bone matter forming the inside of the head is too soft, guiding the rod leads to the distal end thereof continuing inside said head until said end abuts a portion which is sufficiently resistant to absorb the pushing force. The distal end of the rod may thus possibly continue until it abuts the inner side of the bone cortical of the epiphyseal head which, by nature, is hard enough to withstand the pushing force. The total length of the push rod used must therefore be anticipated accordingly.
  • the point of the head, at which the jacking rod exerts its pushing force is located at the end frontal aspect of the head, just close to the fracture.
  • the corresponding device and method according to the invention are defined in dependent claims 6 and 20.
  • a jacking device pushes an inferior aspect of the head.
  • sutures pull the superior aspect of the head.
  • locking screws fix the head to a locking plate and the jacking device is removed.
  • proximal humeral fracture reduction and fixation is commonly performed with fluoroscopic visualization to aid in positioning and locating the various appliances as required.
  • a radiolucent retractor allows access through soft tissue during reduction and fixation of the fracture, thereby allowing a scanner to "see" the humerus and the tools and appliances for reducing the fracture without being blocked by the retractor used to reduce the fracture.
  • FIG. 1 is a perspective view of a first embodiment of a device according to the invention, in the process of being arranged on the upper end portion of a human humerus;
  • - Figs. 2 to 4 are schematic front elevation views of the device shown in Fig. 1 , with cut-away regions showing three successive steps of use of the device respectively;
  • - Fig. 5 is a view similar to those shown in Figs. 3 and 4, showing on a larger scale a variant of the first embodiment of the device;
  • FIG. 6 is a side view of a second embodiment of a device according to the invention, at an initial stage of fixation
  • Fig. 7 is a plan view of one embodiment of a locking plate for the second embodiment
  • - Fig. 8 is a plan view of one embodiment of a jacking rod for the second embodiment
  • - Fig. 9 is a partial cross-sectional view of one embodiment of a collar and a corresponding threaded opening for the second embodiment
  • - Fig. 10 is a partial cross-sectional view of another embodiment of a corresponding threaded opening
  • FIG. 11 is a partial top view of still another embodiment of the threaded opening
  • - Fig. 12 is a side view of one embodiment of a radiolucent deltoid retractor; - Fig. 13 is a front view of the radiolucent retractor of Fig. 12;
  • FIG. 14 is a perspective view of another embodiment of a radiolucent retractor.
  • FIG. 15 is a block diagram of one embodiment of the steps for the method of reduction and fixation.
  • Various apparatuses and methods for the reduction and fixation of a fracture are disclosed. These apparatuses and methods are described with respect to treating a proximal humeral fracture, although they are suitable for treating other types of fractures. Treating a proximal humeral fracture during shoulder surgery includes reduction of the head out of varus or other malalignment and fixation of the diaphysis and head of the humerus.
  • Fig. 1 schematically shows the upper end portion of a humerus H, of which the epiphyseal head and the diaphysis are denoted by the references H1 and H2 respectively.
  • the description is based on the humerus H being oriented in its anatomical position for a patient standing up, so the terms “upper” and “top” for example refer to a direction directed upwardly in Figs. 2 to 5, whilst the terms “lower” and “bottom” refer to the opposite direction.
  • Figs. 2 and 4 also schematically show the scapula S connected to the humerus H as well as some soft parts M formed substantially of muscles and ligaments which surround and interconnect the humeral head H1 and the scapula S.
  • the humeral head H1 , the scapula S and the soft parts M thus form the shoulder of a patient, in which on its outer side, the scapula S delimits a substantially hemi-spherical glenoid face G, inside which a largely complementary face H1A delimited by the upper side of the head H1 is articulated, the relative articulated movements between said faces G and H1A normally being controlled by the soft parts M which are engaged accordingly.
  • a fracture F separates the humeral head H1 from the diaphysis H2. Owing to this fracture F and the ligaments and muscles surrounding the head H1 and the scapula S, the fracture F is naturally opened by a varus position of the head relative to its normal anatomical position, that is to say that said head is tilted slightly inwardly, thus drawing away from the diaphysis H 2 , in particular at the outer portion of the head, as can be seen clearly in Figs. 1 and 2, in which the extent of the opening of the fracture, in particular at the outer side of the shoulder, has been deliberately exaggerated.
  • a device 1 comprising a humeral osteosynthesis plate 10 which, in the embodiment shown in the figures, consists substantially of a main elongated body, shaped so as to extend lengthwise along the outer face of the humerus H, covering the fracture F.
  • Said plate 10 thus comprises along its length an epiphyseal portion 11 and a diaphyseal portion 12 which extend over the humeral head H1 and the humeral diaphysis H 2 respectively.
  • the plate portion 11 is completely penetrated by a hole 11 i which, when the plate 10 is arranged on the humerus H, opens onto the humeral head H1.
  • Said hole 1 I 1 is able to receive a bone-anchoring screw, as shown in Fig. 4 with a screw denoted by the reference numeral 20.
  • the cross-section of the passage of the hole 111 is greater than the transverse cross-section of the threaded rod of the screw 20 whilst the wall delimiting the opening of the hole 11 i on the side opposite the humerus H is constructed so as to cooperate, by means of complementary shaping, in particular by contact pressing and/or by screwing, with the head of the screw 20 when the rod thereof is screwed completely into the humeral head H1 , as in the configuration shown in Fig. 4.
  • the plate portion 11 is also completely penetrated by a plurality of holes 11 2 distributed along the periphery of the plate portion 11 , said holes 11 2 totaling two in the embodiment shown in the figures.
  • Each hole 11 2 receives, by means of threading, a resilient suture element in the form of a loop, as shown in Figs. 2 to 4 with a suture thread denoted by the reference numeral 21.
  • the cross-section of the passage of each hole 11 2 is smaller than that of the hole 1 I 1 and the walls delimiting the openings of each hole 11 2 are rounded so as to limit the risk of damaging the suture thread 21.
  • the plate portion 12 is completely penetrated by a hole
  • the hole 12 1 opens onto the humeral diaphysis H 2 in such a way that a bone-anchoring screw, similar to the aforementioned screw 20, may be screwed into the diaphysis through the hole 12 1 ; as shown in Figs. 2 to 4 with a screw denoted by the reference numeral 22.
  • the presence of said screw 22 in the hole 12 1 thus fixes the position of the plate 10 relative to the humerus H over the width of the hole 12i, that is to say in an anteroposterior direction, whilst the position of the plate in the longitudinal direction thereof can be adjusted within the limits of the length of the hole 12i, as long as the head of the screw 22 is not engaged with the wall delimiting the opening of the hole * ⁇ 2- ⁇ on the side opposite the humerus.
  • the plate portion 12 is also completely penetrated by holes 12 2 , totaling two in the embodiment shown, which are of a similar construction to the hole 11 i and which, when the plate 10 is arranged on the humerus H, open onto the diaphysis
  • Each of these holes 12 2 is thus able to receive a bone-anchoring screw, as shown in Fig. 4 with screws denoted by the reference numeral 23.
  • the plate portion 12 is completely penetrated by a threaded hole 12 3 which is centered on an axis X-X.
  • Said axis X-X is not perpendicular to the longitudinal direction of the plate 10 but is tilted towards the top of the side of the plate 10 which is to face the humerus H, forming with the longitudinal direction of the plate an angle denoted by ⁇ in Fig. 2, measuring approximately 45° in the embodiment sh own in the figures.
  • the reduction device 1 also comprises a rod 30, of which the working portion is provided with a thread 31 which complements the internal thread of the hole 12 3 .
  • the proximal end of the rod 30, that is to say its longitudinal end which, when in use, will be facing the surgeon and thus opposite the humerus
  • H is shaped as a manual guiding grip 32, in this case in the form of a knob for guiding the rod 30 in rotation about the central longitudinal axis thereof.
  • the distal end of the rod 30 is shaped into a rounded tip 33, as can be seen clearly in Figs. 2 to 4.
  • the device 1 is used as follows: Firstly, the surgeon cuts the biological tissue at the fracture F, preferably from a delto-pectoral approach. In a first step, the surgeon attempts to arrange the plate 10 along the humerus H in such a way that it covers the fracture F, whilst connecting the epiphyseal portion 11 of the plate to soft parts M.
  • the surgeon first passes, by means of the incision which he made previously, suture threads 21 through some soft parts M and threads these suture threads through the holes 11 2 so as to thus connect, by means of suturing, the plate 10 to said soft parts M.
  • the surgeon then inserts the plate 10 into the incision and slides it along the outer face of the humerus H until it is in the position shown in Fig. 2, in which said plate is held in a resilient manner by the loops formed by the suture threads 21.
  • the surgeon "parachutes" the plate 10 along the humerus using suture threads 21 , which makes it easier to fit the plate in place and improves the initial positioning of said plate without excessively enlarging the incision in the patient's shoulder.
  • the surgeon then takes hold of the rod 30 and inserts its proximal end into the threaded hole 12 3 .
  • the surgeon By guiding the rod 30 in rotation about its axis using its proximal grip 32, as indicated by the arrow 40 in Fig. 2, the surgeon progressively screws the thread 32 into the hole 12 3 , thus guiding in accordance with the axis X- X the rounded tip 33 of the rod through the humeral diaphysis H2.
  • this tip 33 passes fairly easily into the diaphysis H2 in the direction of the fracture F, depending on the sponginess of the bone matter to be penetrated.
  • the surgeon may form a tunnel which is largely centered on the axis X-X, for example by inserting a pin or drill fairly deeply into the diaphysis H2 from the outer face of said diaphysis.
  • the rod 30 is screwed into the threaded hole 12 3 until the rounded tip 33 of the rod reaches the fracture F. By screwing in the rod, this tip 33 thus abuts the lower face H1 B of the humeral head H1 , as shown in Fig. 2. Whilst still screwing in the screw 30, the rounded tip 33 firmly abuts the bone face H1 B and exerts a pushing force upwardly on the humeral head H1 in the direction of the axis X-X, as indicated by the arrow 41 in Fig. 3.
  • the entire head H1 is thus pushed in the same movement.
  • the rod 30 it is possible for the rod 30 to continue inside the head until its tip 33 abuts an inner portion which is sufficiently hard, in particular the inner side of the bone cortical of the head.
  • the inner portion of the head H1 thus tends to be lifted up whilst the outer portion is lowered owing to the head being tilted largely about a horizontal anteroposterior geometrical axis.
  • This tilting movement is partly controlled and monitored by the surgeon by adjusting the tension of the suture threads 21 , the soft parts M thus being engaged so as pull the outer portion of the head H1 downwardly in a direction substantially parallel to the axis X-X, as indicated by the arrow 42 in Fig. 3.
  • the articulation of the face H1A against the glenoid face G may help to guide this tilting movement.
  • the head of the screw 22 may, if necessary, outwardly hold the plate portion 12 in place, should said plate portion tend to move away from the outer face of the diaphysis H2 owing to resistance against the rod 30 being screwed in and contact pressing the head H1.
  • Tilting the entire humeral head H1 thus corrects the varus position of said head and also displaces it outwardly until it is in its normal anatomical position.
  • the fracture F is thus reduced by drawing the humeral head towards the diaphysis H2. Closing the fracture F in this manner may slightly modify the vertical position, either upwardly or downwardly, of the plate 10 along the diaphysis H2. This slight change to the altitude of the diaphyseal portion 12 of the plate is enabled by means of a corresponding relative translatory movement of the screw 22 in the oblong hole 12i, as shown in Fig. 3.
  • the surgeon fixes the position of the plate 10 along the humerus H on either side of the fracture F.
  • the screw 20 is inserted into the hole 11 1 so as to anchor the epiphyseal portion 11 of the plate relative to the humeral head H1 whilst, on the one hand, the screw 22 is screwed all the way into the oblong hole
  • the plate 10 is thus completely immobilized along the humerus H on both sides of the reduced fracture F, as shown in Fig. 4.
  • the rod 30 may then be removed from the plate 10 by means of unscrewing, as indicated by the arrow 43 in Fig. 4.
  • the threaded hole 12 3 as well as any other through-holes in the plate 10 which have not been used to receive bone-anchoring screws or the like, are advantageously sealed using a bone filling material.
  • the sutures 21 are advantageously tied firmly to the epiphyseal portion 11 of the plate, by cutting and removing any unnecessary excess threads, as shown in Fig. 4.
  • Fig. 5 shows a variant embodiment of the reduction device 1 which involves removing the threaded hole 12 3 which is delimited in the diaphyseal portion 12 of the plate and replacing it with a through-passage 12 4 which is larger in terms of the cross-section of its passage, whilst also providing the device 1 with an assembly which makes it possible to control the inclination of the push rod 30 relative to the plate 10.
  • a platelet 50 is thus arranged on the outer face of the diaphyseal portion 12 of the plate by means of removable screws 51 in such a way that a through-hole 52, delimited in the platelet 50, opens onto the passage 12 4 .
  • Said hole 52 can receive the rod 30 with a largely tubular olive 53 having a longitudinal axis Y-Y being interposed.
  • the main outer face 53A of the olive 53 is substantially spherical and centered on a point belonging to the axis Y-Y.
  • said spherical face 53A abuts, in a complementary manner, the main wall 52A delimiting the hole.
  • the olive 53 delimits a threaded through-hole 54 centered on the axis Y-Y.
  • the olive also delimits, over a portion of its periphery, a slit 55 which extends over the entire olive in the direction of the axis Y-Y and completely penetrates the tubular wall of the olive in such a way that said slit radially connects the outer face 53A of the olive and its inner hole 54.
  • the olive thus has a largely C-shaped cross-section owing to said slit 55.
  • the thread in the hole 54 is complementary to the thread 31 of the rod 30, it being noted that the inner diameter of said hole is slightly smaller than the outer diameter of the rod 30 when the olive 53 is in the resting state, that is to say when said olive is not subjected to any radial stress exerted so as to open out the edges of its slit 55.
  • the use of the variation of the reduction device 1 comprising the platelet 50 and the olive 53 is similar to that of the reduction device shown in Figs. 1 to 4, the difference being that, before the surgeon inserts and screws the rod 30 into the threaded hole 54, he has the option of adjusting the position of the axis Y-Y of said threaded hole relative to the platelet 50 and thus relative to the plate 10. Being able to adjust the position of said axis Y-Y allows the surgeon to modify the region of the lower face H1 B of the humeral head H1 , against which the rounded tip 33 of the rod 30 will press once the rod 30 has been screwed in.
  • the direction of application of the pushing force exerted on the humeral head H1 is thus adjusted, in particular so as to modify the intensity with which the head H1 is outwardly tilted and/or so as to exert said force on a healthier region of said head, for example a less fragile region.
  • Adjusting the position of the olive 53 in the hole 52 is made easier by a lateral screw 56 which is able to reversibly hold the olive in the position selected by the surgeon.
  • a lateral screw 56 which is able to reversibly hold the olive in the position selected by the surgeon.
  • Fig. 6 illustrates a side view of one embodiment of a jacking device 104 and a locking plate 102 at an initial stage of fixation.
  • the plate 102 is shown attached to the diaphysis 112 of a fractured humerus 110 with a screw 106.
  • a jacking device 104 attached to the locking plate 102 engages an inferior aspect of the head 108.
  • Suture material 114 is stitched in the teres minor, infraspinatus, supraspinatus, and/or subscapulars 116.
  • the jacking device 104 applies an inward directed force 122 to the most inferior aspect of the head 108.
  • the two forces 120, 122 impart a rotary motion 124 to the head 108 that moves the head 108 out of varus.
  • Varus is the inward angulation of the humerus 110.
  • the jacking device 104 is positioned to move the head 108 in alignment when the head 108 is malaligned other than being in varus, for example, when the head 108 is in valgus.
  • FIG. 7 illustrates a plan view of one embodiment of the plate 102.
  • the plate 102 provides fixation of the fracture.
  • the plate 102 includes an assortment of holes and openings 202, 204, 206.
  • the plate 102 has a contoured shape that allows the plate 102 to mate to the humerus 110. Further, the superior end of the plate 102 is wider than the inferior end. The wider superior end accommodates the head 108, which is typically wider than the shaft 112.
  • the margins around the superior end of the plate 102 includes several pairs of suture holes 206.
  • Each suture hole 206 is sized to receive suture material 114.
  • several of the pairs of suture holes 206 have a channel 210 between the two holes 206 of the pair.
  • the channel 206 receives the suture material 114 and its knot to avoid the suture material 114 from protruding above the distal surface of the plate 102.
  • One method of using the plate 102 uses the most superior suture holes 206 for the suture material 114 that is stitched to the supraspinatus muscle and uses the pairs of suture holes 206 on the upper sides of the plate 102 for the suture material 114 that is stitched to the infraspinatus, subscapulars, and/or teres minor.
  • the superior end of the plate 102 also includes locking holes 204 that receive locking screws 106.
  • the locking holes 204 are threaded openings at various locations and at various angles to accommodate fixing the head 108 to the plate
  • Locking screws 106 are inserted through the locking holes 204 and into the head 106 to fix the head 108 to the locking plate 102.
  • one or more of the locking holes 204 are configured to receive a jacking device 104.
  • the most inferior hole 202 at the superior end of the plate 102 is located adjacent the surgical neck.
  • the inferior hole 202 is the jacking device hole, that is, it is the hole that receives the jacking device 104.
  • the jacking device hole 202 has an angle that positions the jacking device 104 at an inferior aspect of the head 108.
  • the inferior end of the plate 102 includes a series of elongated holes 208 that are threaded.
  • the elongated holes 208 receive screws 106, either locking or nonlocking, that fix the shaft 112 to the plate 102.
  • the most superior of the elongated holes 208 is configured to allow an extended superior-inferior translation of the plate 102 when the first locking screw 106 is used to initially attach the plate 102 to the shaft 112.
  • FIG. 8 illustrates a plan view of one embodiment of the jacking device 104.
  • the jacking device 104 includes a jacking screwed rod 306 and a collar 302.
  • the jacking screw 306 moves longitudinally through the collar 302 when the jacking screw 306 is rotated, or screwed, about its longitudinal axis.
  • the jacking screw 306 is an elongated threaded member.
  • the proximal end of the jacking screw 306 includes a driver tip 310 that is configured to engage a driver.
  • the driver rotates the jacking screw 306.
  • the driver is a manual or a powered rotary device that allows the jacking screw 306 to be precisely located by screwing the jacking screw 306 relative to the collar 302.
  • the distal end of the jacking screw 306 includes a spherical end 308 for engaging an inferior aspect of the head 108.
  • the proximal end of the jacking screw 306 has other shapes for engaging the head 108, for example, a spiked or cupped end.
  • the spherical end 308 of the jacking screw 306 is sized to pass through the jacking screw hole 202 in the plate 102.
  • the distal end of the collar 302 includes a threaded fitting 304.
  • the illustrated embodiment shows a threaded fitting 304 that has a conical thread that engages corresponding threads in a jacking device hole 202.
  • the fitting 302 is configured to engage a hole 202, 204, 208 in the locking plate 102.
  • the threaded fitting 304 may not have threads that are conical.
  • the collar 302 has a configuration that allows the collar 302 to be screwed into the plate 102 securely and to be removed from the plate 102 after fixation.
  • the proximal end of the collar 302 has a slot for receiving a turning tool or the proximal end has a hexagonal shape for engaging a turning tool.
  • FIG. 6 illustrates the stage of shoulder surgery where reduction is complete with the head 108 out of varus and aligned with the shaft 112.
  • the fracture 118 has been reduced and the humerus is ready for fixation.
  • sutures are placed in the rotator cuff 116.
  • inverted mattress stitches of a non-absorbable braided suture material 117 are placed in the teres minor, infraspinatus, supraspinatus, and/or subscapulahs 116.
  • the ends of the suture material 114 are passed through suture holes 206 in the plate 102.
  • the plate 102 is then parachuted down onto the humerus 110.
  • the plate 102 is then provisionally secured to the shaft 112 of the humerus 110 by a screw 106 inserted through an elongated hole 208 that allows for superior and inferior translation of the plate 102.
  • a screw 106 inserted through an elongated hole 208 that allows for superior and inferior translation of the plate 102.
  • Using a non-locking screw 106 allows the shaft 112 to be drawn tight against the plate 102.
  • the most superior elongated hole 208 is configured to allow the greatest superior and inferior translation.
  • the other holes 208 are available for provisionally securing the shaft 112.
  • Pulling the suture material 117 away from the head 108 applies a force 120 away from the head.
  • Screwing the jacking screw 306 into the collar 302 moves the proximal end 308 of the screw 306 inward and applies a force 122 to the inferior end of the head 108.
  • the two forces 120, 122 apply a rotational force 124 to the head 108, thereby causing the head 108 to rotate in the direction of the force 124 and out of varus or other malalignment.
  • the fine threads of the jacking screw 306 allow the precise position and height of the head 108 to be dialed in to re-establish the anatomic neck/shaft angle.
  • the head 108 is positioned by being pushed from the inferior aspect and pulled from one or more of the suture material 114 attached to the superior aspect of the head 108.
  • the jacking device 104 rotates the head 108 in the coronal plane, that is, the axis of rotation of the head 108 is perpendicular to the coronal plane. Different sections of the suture material 114 are pulled with varying force to steer or guide the head 108 within the transverse plane.
  • locking screws 106 are placed in the head 106 through the locking holes 204. With the locking plate 102 securely fixed to the head 102, the jacking device 104 is removed from the plate 102. Additional locking screws 106 are then inserted through the elongated holes 208 and in the shaft 112.
  • FIG. 9 illustrates a partial cross-sectional view of one embodiment of a collar 302 and a corresponding threaded opening 202A.
  • the collar 302 includes a threaded fitting 304.
  • the threaded fitting 304 has conical threads that engage the corresponding threads in the jacking device hole 202A.
  • the jacking device hole 202 is formed in the locking plate 102 with an angle preset to direct the jacking screw 306 toward the inferior aspect of the head 108.
  • the jacking device hole 202A is a single threaded opening as illustrated, one of several threaded openings grouped together, or a multiple threaded opening, such as illustrated for the elongated holes 208 at the inferior end of the locking plate 102.
  • the additional options for the jacking device hole 202A allows for variations in the angle of the jacking screw 306.
  • FIG. 10 illustrates a partial cross-sectional view of one embodiment of a collar 302 and another embodiment of a corresponding threaded opening 202B.
  • the illustrated embodiment of the jacking device hole 202B includes a swivelling plug 502 in a plug opening 504.
  • the swivelling plug 502 is spherical with a circular cross-section that is slightly smaller in diameter than the circular cross-section of the plug opening 504. Accordingly, the swivelling plug 502 rotates within the plug opening 504, thereby allowing the angle of the jacking device hole 202B to be adjusted as needed.
  • the concave sidewalls of the plug opening 504 hold the swivelling plug 502 captive in the opening 504.
  • Axial pressure exerted by the jacking screw 306 when it engages the head 108 forces the outer surface of the swivelling plug 502 against the corresponding wall of the plug opening 504, and the fhctional engagement minimizes unintentional angular movement of the jacking screw 306.
  • FIG. 11 illustrates a partial top view of another embodiment of the threaded opening 202B' of FIG. 5.
  • the swivelling plug 502' has a spherical shape with the lateral sides flattened.
  • the plug opening 504' has a corresponding shape.
  • the flattened sides of the swivelling plug 502' prevent the swivelling plug 502' from rotating when the threaded fitting 304 of the collar 302 is screwed into the jacking device hole 202B'.
  • the flattened sides prevent the swivelling plug 502' from rotating when the jacking screw 306 is rotated.
  • FIG. 12 illustrates a side view of one embodiment of a radiolucent deltoid retractor 702A.
  • FIG. 13 illustrates a front view of the radiolucent retractor 702A of FIG. 7.
  • the deltoid retractor 702A includes a flat handle 704A attached to an extension 708A that terminates in a blade 706A.
  • the extension 708A has a neck 802 that transitions the wider flat handle 704A to the narrow blade 706A.
  • the retractor 702A includes a handle rib 710 that reinforces the connection of the handle 704A to the extension 708-A.
  • the retractor 702A also includes a blade rib 712 that reinforces the connection of the blade 706A to the extension 708A.
  • the reinforcement ribs 710, 712 provide structural strength for the radiolucent material to withstand the pulling and levering forces applied to the retractor 702A.
  • FIG. 14 illustrates a perspective view of another embodiment of a radiolucent retractor 702B.
  • the retractor 702B includes a rounded handle 704B attached to a curved extension 708B that terminates in a curved blade 706B.
  • the curved handle 704B and the transition to the curved extension 708B have a thickness that results in sufficient strength for the radiolucent material to withstand the pulling and levering forces applied to the retractor 702B.
  • the thickness and configuration of the curved blade 706B is such that the radiolucent material withstands the forces applied to the curved blade 706B.
  • retractors 702 are used. Fluoroscopy is used to allow the surgeon to visualize the procedure in real-time.
  • the illustrated retractors 702A, 702B are made of a radiolucent material that is transparent to the imaging rays of the fluoroscopic device. By being radiolucent, the retractor 702 does not block the surgeon's view of areas of interest.
  • the retractor 702 is made of two materials with the handle 704 being a first material and the blade 706 and a portion of the extension 708 being a second, radiolucent material. In this way only the portion of the retractor 702 that potentially would block the surgeon's view is made of a radiolucent material.
  • the first material is chosen for its strength, durability, grip, and/or characteristic other than being radiolucent.
  • FIG. 15 illustrates a block diagram of one embodiment of the steps for the method of reduction and fixation.
  • the illustrated method results in shorter surgery time for the patient and eliminates the need for provisionally reducing the fracture with multiple pins.
  • the illustrated method also minimizes soft tissue stripping, thereby improving healing rates.
  • the following steps are described with respect to the reduction and fixation of a proximal humeral fracture, the method is applicable to reducing and fixing other fractures.
  • the first step 1002 is to position the plate 10 or 102 adjacent the humerus H or 110 with the superior end of the plate proximate the head H1 or 108.
  • suture material 21 or 114 is stitched to the tissue adjacent the superior aspect of the head H1 or 108.
  • the suture material is then passed through the appropriate suture holes 112 or 206 in the plate 10 or 102.
  • the plate is then parachuted down onto the humerus.
  • inverted mattress stitches of a non-absorbable braided suture material, such as #2 Fiber- wire are placed in the supraspinatus, infraspinatus, subscapulars, and/or teres minor.
  • the next step 1004 is to provisionally secure the plate 10 or 102 to the diaphysis H2 or 112 of the humerus 110.
  • the non-locking screw 22 or 106 is inserted through the elongated hole or 208 that provides for superior and inferior translation of the plate 10 or 102.
  • the screw 22 or 106 is placed in the diaphysis H2 or 112 with the plate 10 or 102 at an appropriate height relative to the humerus H or 110.
  • the height or position of the plate relative to the humerus is changed by loosening the screw 22 or 106 and translating the plate along the humerus.
  • the next step 1006 is to position the head H1 or 108 out of varus or other malalignment and in alignment with the plate 10 or 102.
  • the positioning step 1006 includes attaching the jacking rod 30 or device 104 to the plate 10 or 102, positioning the jacking rod 30 or screw 306 such that the distal end 33 or 308 is angled up into the head H1 or 108, more specifically either the lower fracture face H1 B of the head H1 or an inferior aspect of the head 108, and adjusting the jacking rod 30 or screw 306 to apply a force 41 or 122 to the head.
  • Positioning the jacking rod or screw to contact the most inferior aspect of the head provides maximum leverage for rotating the head, although other positions are suitable for use. If there is no communication or hole for the jack rod or screw to pass through the cortex of the humerus H or 110, the cortex is perforated with a drill, such as one used for the locking screws 22 or 106.
  • the jacking rod 30 or device 104 is operated to advance the jacking thread 31 or screw 306.
  • the suture material 21 or 114 is pulled to guide or steer the head H1 or 108 into position adjacent the superior end of the plate 10 or 102.
  • the jacking rod 30 or screw 306 is rotated to dial in the appropriate head height to re-establish the anatomic neck/shaft angle.
  • the positioning step 1006 is performed under fluoroscopic guidance.
  • the radiolucent retractor 702 aids in positioning the head H1 or 108, along with pulling the suture material 22 or 114 and advancing the jacking rod 30 or screw 306.
  • the next step 1008 is to secure the plate 10 or 102 to the humerus H or 110. With the head H1 or 106 positioned, locking screws 20 or 106 are inserted through the locking holes 1 I 1 or 204 and into the head H1 or 108. The jacking rod 30 or device 104 is removed after the head is secured to the plate. The suture material 21 or 114 is tied. In the embodiment with the channels 210, the suture material 114 is tied and positioned in the appropriate channel 210.
  • the securing step 1008 also includes securing the diaphysis 112 to the locking plate 102 with locking screws 106.
  • Various developments and variations of the reduction devices and the associated surgical methods may also be envisaged. For example:
  • - resilient suture elements other than the threads 21 and the material 114 may be used to connect the epiphyseal portion of the plate 10 or 102 to some soft parts M and 116, as long as said suture elements can withstand the pulling force exerted thereupon by the surgeon so as to displace the humeral head from its incorrect position when reducing the fracture F;
  • the surgeon may, either alternatively or in addition, use suture systems comprising a bone anchor which is mechanically independent of the plate, that is to say an anchor which the surgeon engages in the bone matter of the humeral diaphysis H2 or 110 independently of fitting the plate in place; this type of anchor is generally screwed into or impacted in the bone matter; the surgeon then connects said bone anchor to some soft parts by means of suture elements, in particular threads, in such a way as to be able to pull on said suture elements and thus guide the humeral head, largely with the same movement, by tilting it and by using the suture elements described above; - another possibility, which may be used alternatively or in addition, for pulling the humeral head involves engaging an anchor of the type described above in the bone matter of said humeral head and in pulling a tie which is attached to said anchor so as to
  • the humeral head H1 cannot be pulled using suture elements or other suture or pulling elements as described above at the same time as being pushed by the rod 30 or the screw 36, but the pulling and pushing operations are carried out successively, or are even repeated several times one after the other, in particular depending on the surgeon's manipulative skill;
  • the illustrated method is suitable for being performed with a superior approach; for this superior approach, guides are used to place the screws percutaneously;
  • the plate 10 or 102 constitutes an isolated osteosynthesis element; the invention may be integrated with more elaborate osteosynthesis assemblies as well as with prosthetic assemblies which are simultaneously arranged so as to reduce a bone fracture of the same type as the fracture;
  • the rod 30 may optionally be provided, in its working part, with an outer collar similar to the collar 302, which the surgeon may grip with one hand, said collar being freely screwed about the thread 31 and thus displaced at leisure by the surgeon when the device 1 is being used; said sleeve makes it easier to grip and handle the rod 30, in particular when said rod is screwed in and unscrewed;
  • the reduction device 1 may be used on other long bones which are fractured between an epiphyseal head thereof and the diaphysis thereof; and/or - instead of guiding the jacking rod 30 or screw 306 relative to the plate 10 or 102 by means of screwing/unscrewing, other mechanical means which can be used by the surgeon may be used to exert a force for guiding said jacking rod so as push against a bone head, such as the humeral head.

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  • Orthopedic Medicine & Surgery (AREA)
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  • Heart & Thoracic Surgery (AREA)
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Abstract

L'invention concerne un dispositif améliorant la réduction d'une fracture entre la tête épiphysaire et la diaphyse d'un os long, limitant le détachement d'un tissu biologique à proximité, et comprenant ainsi : - une plaque allongée qui comprend, de part et d'autre de la fracture couverte par la plaque, une portion épiphysaire qui peut être fixée de manière rigide à la tête et une portion diaphysaire qui peut être fixée à la diaphyse à la fois de manière rigide et de façon à pouvoir être déplacée dans la direction longitudinale de la plaque, - une tige de levage destinée à pousser la tête, laquelle tige de levage pénètre la plaque et s'étend ainsi dans le sens de la longueur depuis la plaque jusqu'à atteindre une portion dure de la tête, de manière à pousser la tête vers une première voie, - un moyen de guidage mécanique pour guider de manière réversible la tige de levage par rapport à la plaque et dans la direction longitudinale de ladite tige, et - un moyen de traction pour tirer la tête, lequel moyen de traction tire la tête vers une voie opposée à la première voie, dans une direction en grande partie parallèle à la direction longitudinale de la tige de levage.
EP09705411A 2008-01-29 2009-01-29 Dispositif et procédé chirurgical pour réduire une fracture entre la tête épiphysaire et la diaphyse d'un os long, en particulier une fracture de l'humérus proximal Withdrawn EP2244645A1 (fr)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US2432708P 2008-01-29 2008-01-29
FR0852803A FR2930424A1 (fr) 2008-04-25 2008-04-25 Dispositif de reduction d'une fracture entre la tete epiphysaire et la diaphyse d'un os long, notamment d'une fracture humerale proximale.
US5247508P 2008-05-12 2008-05-12
US5228308P 2008-05-12 2008-05-12
PCT/EP2009/051030 WO2009095451A1 (fr) 2008-01-29 2009-01-29 Dispositif et procédé chirurgical pour réduire une fracture entre la tête épiphysaire et la diaphyse d'un os long, en particulier une fracture de l'humérus proximal

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EP2244645A1 true EP2244645A1 (fr) 2010-11-03

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EP09705411A Withdrawn EP2244645A1 (fr) 2008-01-29 2009-01-29 Dispositif et procédé chirurgical pour réduire une fracture entre la tête épiphysaire et la diaphyse d'un os long, en particulier une fracture de l'humérus proximal

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EP (1) EP2244645A1 (fr)
FR (1) FR2930424A1 (fr)
WO (1) WO2009095451A1 (fr)

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Publication number Priority date Publication date Assignee Title
US8545539B2 (en) 2008-05-12 2013-10-01 Edwin E. Spencer Proximal humeral fracture reduction and fixation device
US8979909B2 (en) * 2012-06-29 2015-03-17 Depuy Mitek, Llc Tissue repair suture plates and methods of use
PL3192451T3 (pl) 2014-09-13 2023-02-20 Yusuke Shimizu Hak medyczny
CN108113740A (zh) * 2018-01-09 2018-06-05 江苏荷普医疗科技股份有限公司 新型桡骨远端内侧接骨装置

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Publication number Priority date Publication date Assignee Title
FR2294685A1 (fr) * 1974-12-16 1976-07-16 Tornier Rene Perfectionnements aux dispositifs de prothese du femur
FR2483214A1 (fr) * 1980-05-30 1981-12-04 Tornier Sa Ets Dispositif perfectionne pour l'osteosynthese du col femoral

Non-Patent Citations (1)

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Title
See references of WO2009095451A1 *

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FR2930424A1 (fr) 2009-10-30

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