Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/683—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/74—Devices for the head or neck or trochanter of the femur
  • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
  • A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/74—Devices for the head or neck or trochanter of the femur
  • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
  • A61B17/746—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • 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
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8685—Pins or screws or threaded wires; nuts therefor comprising multiple separate parts

Definitions

• the present invention relates to a device for maintaining and compressing fragments of a fractured bone.
• US Patent 4,612,920 discloses a plate comprising at its distal end an oblong bore for blocking the rotation of a cervico-cephalic screw having at its distal end a spongy type thread and at its proximal end a cylindrical body comprising two plates.
• the compression of the fracture site and the blockage in one direction are effected by means of a compression screw screwed into the cervico-cephalic screw and resting in a bore made in the proximal end of the barrel of the plate.
• US Patent 5,484,439 discloses a screw-plate using the same type of screws housed in the barrel of the plate. Devices of this type "vis-plate" are still used today.
• the application WO 2008/128663 A2 describes a reduction and compression device adapted to fracture of the femoral neck also comprising a plate screwed into the femur bone, and supporting two or three compression screws parallel to the axis of the neck of the femur. femur.
• a ring or nut is placed on the head of the compression screw to lock it in the cell of the plate and prevent any axial movement under the weight of the body.
• An example of an intramedullary nail associated with a compression screw for the reduction of a femoral head fracture is described in patent EP 1 443 865 B1.
• US 2013/0041414 A1 discloses a telescopic screw being screwed into a bone nail which is inserted into the femur.
• the telescopic screw has a locking ring that can be deformed to fix the position of the screw in the nail. Similar systems are described in DE 197 23 339 A1 and EP 1 415 605 A1. A bone nail that can receive a compression screw in a desired position is described in WO 2012/099944 A1.
• the difficulty of determining the correct length of screw is therefore real and causes complications; it is naturally aggravated in the case of multi-fragmentary or unstable fractures, the reduction of which is difficult.
• the dimensions of the fractured bone can then vary during the setting of the screw-plate while the choice of the screw has already been made.
• the operator can attempt to correct these variations by impaction of the plate or manual compression of the cephalic screw, but in any case, the inexperienced operator will not know precisely what will ultimately be the impaction race exact cephalic screw.
• a vis-plate type device comprising, as is most often the case, a cephalic screw with two plates
• the practitioner must orient perfectly at the end of the screwing the two dishes of the body of the cervico-cephalic screw in relation to the axis of the femur and slide on it the plate in order to fix it correctly on the femur; this action complicates the surgical technique and increases the risk of affecting the quality of the reduction of the fracture site performed beforehand, and the anchoring of the screw in the bone.
• the manufacturer of these devices must provide the practitioner with numerous cervico-cephalic screws whose length can vary from 50 mm to 145 mm and the incrementation of 5 mm in 5 mm, which implies significant production and inventory management costs for the manufacturer and for the hospital.
• the present invention relates to an osteosynthesis device for maintaining and compressing two parts of a fractured bone, simplifying the operative technique, allowing a variable final positioning in the screw plate, to neutralize the measurement approximations. resulting from the operating constraints, eliminating the risk of disunity or jamming, guaranteeing the obtaining of a constant value pre-defined by the manufacturer of the impaction stroke of the cephalic screw whatever its position in the plate and significantly reducing the range of cervico-cephalic screws required without decreasing the operating possibilities.
• the device according to the present invention which can be used in particular for fractures of the ends of the femur, is of the type essentially comprising a) a cervico-cephalic screw provided with a distal thread, preferably sliding on the body of the screw that can be screwed into the bone, b) a support constituted by a plate of a shape adapted to its fixation on the bone or by a centromedullary nail that can be inserted into the medullary canal, and c) a means of locking the screw on the support , and it is distinguished in that the locking means of the cervico-cephalic screw is movable on the support along the axis of the screw and in that the final positioning of the screw is variable.
• the locking means is preferably constituted by a clamping screw acting on an elastically deformable ring that can be frictionally locked against the wall of the support holding the cervico-cephalic screw.
• the ring has a conical shape, the wall of which has at least one slot, cooperating with the proximal end of the cervico-cephalic screw, and comprises fixing means on the clamping screw.
• the ring is constituted by an elastically deformable bead formed in the proximal portion of the cervico-cephalic screw body.
• the cervico-cephalic screw comprises two distinct elements secured by fastening means, namely a threaded screw head constituting the distal portion, and a screw body whose proximal portion receives the locking means in the support.
• the screw head comprises sliding means on the screw body, while blocking the rotation that is to say without possibility of rotation so that the body and the screw head are secured in rotation but not in translation.
• the screw body has at its distal portion elastic deformation means, which can snap into the screw head.
• This elastically deformable means can be deformed under a determined force of value releasing the translation of the screw head when a force applied axially on the screw head exceeds this predetermined value.
• the translation of the screw head relative to the screw body is limited by at least two stops.
• the screw body comprises at its distal end a slotted head snapping into the screw head, a cylindrical distal portion having two flats cooperating with the inner proximal portion of the screw head, a central cylindrical portion. with a diameter greater than the diameter of the distal cylindrical portion sliding in the internal bore of the support plate, a conically shaped proximal portion cooperating with the internal conical portion of the split ring, having an internal thread cooperating with that of the screw. clamping and two flats cooperating with the laying instrument.
• the proximal end of the screw body consists of a Morse taper of a taper preferably between 1% and 20%.
• the head of cervico-cephalic screw is constituted at its outer distal end of a spongy type thread; at its inner distal end of a groove and a bore cooperating with the slotted allowance of the screw body; at its outer proximal end of a cylindrical portion of smaller diameter than the piercing of the plate; at its internal proximal portion of a cylindrical with two flats cooperating with the distal portion of the screw body.
• the length of the inner cylindrical portion which can slide on the screw body is preferably greater than about 2.5 times the value of its diameter to avoid any risk of jamming by buttresses.
• the split ring axially slotted to allow plastic and elastic deformation, has at its inner distal end a bore conical which cooperates with that of the proximal end of the screw body and at its proximal end a shoulder snapping on the clamping screw ensuring the locking of the device once the establishment carried out.
• the clamping screw is composed at its distal end of an external thread cooperating with that of the distal end of the screw body and at its proximal end a securing means with the ring.
• the external diameters of the external proximal portion of the screw head, the central portion of the screw body, the split ring and the head of the clamping screw are smaller than the internal diameter of the barrel. of the plate holding the cervico-cephalic screw.
• the shoulder of the slotted head distal of the screw body and the shoulder formed by the difference in diameter between the distal portion and the central portion of the screw body limit the translation of the screw head to a value of between 10 and 16 mm and preferably about 13 mm.
• the constituent elements of the device of the invention that is to say the cervico-cephalic screw, the conical ring, the clamping screw and the plate, or the centro-medullary nail if appropriate, are made of materials commonly used in osteosynthesis devices, preferably stainless steel or titanium.
• the advantages of the present invention will become more apparent with the following explanation of pose.
• the practitioner following the usual techniques, prepares the bone cavity by piercing and tapping, then chooses the cervico-cephalic screw adapted according to the measured length. He introduces this cervico-cephalic screw into the plate and then screws this assembly into the bone by means of a standard screw-type screwing instrument, with the help of a guide pin on which the cervico screw is threaded. cephalic. The screwing being done, after removal of the pin if necessary, the practitioner orients the plate relative to the femur, the impact with an impactor-type instrument and fixed by means of cortical screws.
• the screw head Under the effect of the natural impaction by the weight of the body, the screw head will be able to slide up to 13 mm with respect to the plate without protruding from the locking screw.
• a cervico-cephalic screw can be locked in a plate in any depth of screwing into the bone, for example from 80 to 110 mm for a 42 mm plate gun length. This simplifies the surgical procedure, accepts inaccuracies and reduces the number of cervico-cephalic screws to two for a range covering the lengths of 65 to 110 instead of the ten cervico-cephalic screws usually proposed with conventional devices.
• Ablation of the device is simple since by unscrewing the clamping screw it causes and detaches the split ring from the inside of the plate allowing disassembly of the cervico-cephalic screw by means of a T-key.
• Figure 1 sectional view of the device mounted in a plate, all being implanted in a femur.
• Figures 2 to 5 views defining the cervico-cephalic screw head.
• Figures 6 to 7 views defining the split ring.
• Figures 8 to 10 views defining the cervico-cephalic screw body.
• Figures 11 to 12 views defining the clamping screw.
• Figures 13 to 14 sectional views of the device mounted in a plate indicating the maximum and minimum positions of the same screw.
• Figure 15 perspective view of a variant of the body of cervico-cephalic screws.
• Figure 16 plan view of the device mounted in a plate, all being implanted in a centromedullary nail.
• Figures 17 to 18 views defining the split ring.
• Figure 19 perspective view of a variant of the split ring.
• Figure 20 perspective view of a variant of the clamping screw.
• Figure 21 Sectional views of a variant of the device mounted in a plate.
• Figure 22 perspective view of a variant of the body of cervico-cephalic screws.
• Figure 23 perspective view of a variant of the clamping screw.
• Figure 24 perspective view of a detail of Figure 21.
• the cervico-cephalic screw shown in Figure 1 is composed of the screw head (1) mounted on the screw body (2), and it is mounted in a plate (3) fixed on the femur by means of cortical screws. (4).
• the screw head (1) shown in Figures 2 to 5, comprises at its outer distal end a spongy type thread (8) for anchoring in the bone.
• the inner distal end consists of a bore (11) in which the slotted head (18) of the screw body slides and a groove (12) in which the head (18) of the screw body can 'engage.
• the proximal portion consists of a bore (41) having two flats (10) cooperating with the cylindrical portion (19) and the two flats (24) of the screw body. Its diameter (7) is smaller than the bore (42) of the plate (3).
• the drilling (9) allows its guidance on spindle during installation.
• the split ring (5) shown in Figures 6 and 7, has a conical bore (16) cooperating with the cone (21) of the screw body (2). It has a groove (14) splitting it axially and a shoulder (15) fitting into the groove (26) of the clamping screw (6). Its outer diameter (13) is smaller than the bore (42) of the plate (3).
• the screw body (2) shown in Figures 8 to 10, has at its distal end a split head (18).
• the split head (18) of the screw body after having tightened to enter the proximal portion (10 + 41) deploys in the groove (12). ) of the screw head (1) holding it in this position during the installation by the practitioner.
• the split head (18) will tighten and slide the screw head (1).
• the force from which the screw head (1) can slide is determined by the difference between the diameters of the split head (18) and the bore (11) as well as the thickness (45) of the flexible portion of the split head (18).
• the screw body (2) has a cylindrical part (19) and two flats (24) which cooperate with the diameter (41) and the two flats (10) of the screw head (1) so as to allow the sliding by blocking the rotation.
• the cylindrical guide (17) slides in the bore (42) of the plate (3).
• the proximal end comprises a cone (21) on which two flats (23) are made symmetrically opposite allowing the rotational drive during screwing into the bone by means of an instrument.
• the internal thread (20) ensures the tightening of the clamping screw (6).
• the bore (44) allows its guidance on spindle during installation.
• the shoulders (46) and (22) limit the sliding of the screw head (1) to 13mm.
• the clamping screw (6) shown in Figures 11 and 12, has a thread (27) cooperating with the thread (20) of the screw body (2).
• the groove (26) allows the snap ring (5).
• the head (25) has a smaller diameter than the bore (42) of the plate (3) and a drive means (28) of hexagonal type.
• Figures 13 and 14 show the extreme positions of the same cervico-cephalic screw mounted in the barrel (43) of a plate (3) while guaranteeing the natural impaction stroke of 13 mm without protruding the clamping screw (6).
• FIG. 15 shows a variant of the screw body where the split head has been replaced by a groove (29) shaped to receive the split ring (33), the principle of releasing the sliding of the head from screw (1) to a fixed value remaining unchanged.
• FIG. 16 The sectional view of Figure 16 shows the device mounted in a tube (31) which is blocked by a screw (32) screwed into a centromedullary nail (30) of a commercially available type.
• the functionality of the device remains unchanged and the dimensions can be adapted to this configuration.
• several devices could be inserted into the intramedullary nail depending on the dimensions.
• the split ring (33), shown in Figures 17 and 18, has a slot (36) and a bore (35) whose diameter is greater than the diameter of the groove (29) so that it can be tighten. Its diameter (34) cooperates with the diameter of the groove (12).
• the thickness (37) is smaller than the width of the groove (29) and the chamfer (38) facilitates its deformation during the sliding of the screw head (1).
• FIG. 19 shows a variant (39) of the split ring (5) having at least two partial grooves (40) staggered on the periphery facilitating its deformation.
• FIG. 20 shows a variant (45) of the clamping screw (6) having a cylindrical portion (46) which fits into the bore (44) of the screw body (2) so as to block the deformation of the head (18).
• This configuration is useful for avoiding natural impaction by body weight in young subjects.
• FIG. 21 shows a variant (47) of the cervico-cephalic screw which is monobloc.
• This cervico-cephalic screw is locked by means of the split ring (5) snapped onto the clamping screw (6) in a tube (48) mounted in the plate (3).
• This tube (48) slides in translation in the plate (3) and is locked in rotation by means of the lug (50) integral with the plate (3) cooperating with the flat (49) of the tube (48). The sliding distance is limited by the length of the flat (49).
• the tube (48) holding the cervico-cephalic screw (47) is in the most protruding end position relative to the plate (3).
• the perspective view of Figure 22 shows a variant (51) of the screw body where the proximal portion (52) is slotted with grooves (53) to make it deformable.
• the conical portion (54) cooperates with the cone (56) of the clamping screw (55).
• the proximal portion (52) increases in external diameter due to the penetration of the cone (56) until it the inner wall (42) of the plate (3).
• the screw body is then locked in rotation and in translation.
• the perspective view of Figure 23 shows a variant (51) of the clamping screw having a conical portion (56) which cooperates with the conical portion (54) of the screw body.
• FIG. 24 shows the tube (48) of the device of Figure 21, including a flat (49) in sliding contact with the lug (50), preventing rotation in the holder.
• a stop (57/58) is provided to limit the sliding of the tube (48), the lug (50) being slidable against the flat (49) between the two stops.

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• 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)
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• Surgical Instruments (AREA)

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• 2013
  • 2013-05-28 FR FR1354841A patent/FR3006164A1/fr active Pending
• 2014
  • 2014-05-22 US US14/894,747 patent/US20160128731A1/en not_active Abandoned
  • 2014-05-22 EP EP14731708.5A patent/EP3003183A1/de not_active Withdrawn
  • 2014-05-22 WO PCT/FR2014/051206 patent/WO2014191663A1/fr not_active Ceased

Non-Patent Citations (1)

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