EP3694428A2 - Medical arthrodesis implant - Google Patents

Medical arthrodesis implant

Info

Publication number
EP3694428A2
EP3694428A2 EP18857446.1A EP18857446A EP3694428A2 EP 3694428 A2 EP3694428 A2 EP 3694428A2 EP 18857446 A EP18857446 A EP 18857446A EP 3694428 A2 EP3694428 A2 EP 3694428A2
Authority
EP
European Patent Office
Prior art keywords
longitudinal axis
medical implant
connecting bridge
bone
distance
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.)
Pending
Application number
EP18857446.1A
Other languages
German (de)
French (fr)
Inventor
Christophe Averous
Patrice Determe
Christophe Cermolacce
Patrice Diebold
Stéphane GUILLO
Thierry Heckel
Hubert Rocher
Renaud FRIOUX
Christophe Roy
Danilo CAMPANI
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.)
Adsm
Original Assignee
Adsm
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 Adsm filed Critical Adsm
Publication of EP3694428A2 publication Critical patent/EP3694428A2/en
Pending 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
    • A61B17/7291—Intramedullary pins, nails or other devices for small bones, e.g. in the foot, ankle, hand or wrist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4225—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30594—Special structural features of bone or joint prostheses not otherwise provided for slotted, e.g. radial or meridian slot ending in a polar aperture, non-polar slots, horizontal or arcuate slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30622—Implant for fusing a joint or bone material

Definitions

  • the present invention relates to a medical implant for connecting in-between a first bone and a second adjacent bone of a joint.
  • the invention relates to a medical implant for connecting and fixing between them two adjacent phalanges said proximal and distal of the foot or hand.
  • Certain pathologies such as toes in claws or Hallux Valgus or metatarsalgia, induce in the foot a deformation of the toes: in particular, it happens that two adjacent phalanges of a toe do not maintain their natural alignment and form between them a angle deforming the toe steadily.
  • Such deformation can take place in a vertical plane, and the patient then suffers from metatarsalgia: the toe adopts a configuration "in claw" in which it is folded on itself permanently.
  • the deformity can alternatively take place in a horizontal plane: the patient then suffers from Hallux Valgus: the toe, in particular the big toe, forms a prominence on the outside of the foot.
  • this technique involves surgically blocking the joint formed by the two phalanges having lost their natural alignment, by realigning them on top of each other and by welding them in one by bone fusion, the two phalanges being held together to each other during the time required for bone fusion by means of an implant.
  • the implant used in this type of correction therefore has two parts, a part intended to be introduced into a first phalanx, for example a proximal phalanx, and a second part intended to be introduced into a second phalanx, for example the adjacent distal phalanx.
  • the two phalanges are thus joined to one another.
  • the implant must allow the fusion of the two bones, or phalanges, so contiguous.
  • WO201 1/1 10784 discloses an implant comprising a first portion to be inserted into the proximal phalanx and a second portion to be inserted into the distal phalanx.
  • surgeons usually practice after implantation, a cut of the bone of the part of the phalanx creating walking. In general, the surgeon cuts the upper part of the distal phalanx bone. This resection is traumatic for the patient.
  • the implant according to the present invention allows the fusion of a proximal phalanx and a distal phalanx, for the foot or hand, not generating this step or shift after implantation.
  • the present invention provides an implant having a specific structure for fusing a proximal phalanx and a distal phalanx for the hand or for the foot, avoiding the creation of a shift of the upper outer portions between the two phalanges.
  • the two phalanges are perfectly aligned, and the surgeon does not need to resect the upper part of the distal phalanx bone.
  • the implant according to the invention thus simplifies the operating procedure for joining two phalanges.
  • the implant according to the invention makes it possible to perform a much less traumatic operation for the patient. Thanks to the implant according to the invention, the risks of complications subsequent to the operation are also greatly reduced.
  • the implant according to the invention thus makes it possible to restore to the organ treated its natural anatomy, in particular the natural angle between the phalanges thus wound together.
  • the medical implant according to the present invention is intended to allow bone fusion between a first bone (P1) and a second bone (P2), said implant comprising a first portion of generally elongate shape, carried by a longitudinal axis A, intended to be introduced into the first bone (P1) and comprising first fixing means and a second portion of also elongate shape having another longitudinal axis B, intended to be introduced into the second bone (P2) and comprising second fixing means, said first and second parts being interconnected by a connecting bridge, said connecting bridge being centered around the orthonormal axes X, Y, Z of said implant ensuring at least an axial offset of the second part with respect to the first part so that the longitudinal axis B of said second portion is firstly positioned in at least one direction which is inclined at an angle (a) with respect to the axis longitudinal axis A of the first part and secondly offset by at least one distance along at least one of the axes XX ', YY' and ZZ 'of the connecting bridge in order
  • the profile of the connecting bridge may allow different axial offsets combined or not to position the second part relative to the first part in different geometric planes combinable or not.
  • the medical implant according to the present invention comprises a longitudinal axis B of the second part which is shifted by a distance (D S i) along the axis YY '.
  • the medical implant according to the present invention comprises a longitudinal axis B of the second part which is shifted by a distance (D S 2) along the axis ZZ '.
  • the medical implant according to the present invention comprises a first portion which is of elongate shape and comprises at least three tabs each extending respectively along the longitudinal axis A and comprising a distal end and a proximal end.
  • the medical implant according to the present invention comprises a first part whose legs are regularly arranged around the longitudinal axis A making it possible to produce between said tabs and in the body of the first part an opening bore or cannula carried by the longitudinal axis. A and crossing the connecting bridge to ensure the passage of a guide pin.
  • the medical implant according to the present invention comprises a first part, each lug of which comprises, on its outer periphery, fastening means consisting of hooked catches defining an external serrated profile over the entire length of the first part, said hooked catches having each an edge directed towards the connecting bridge.
  • the medical implant according to the present invention comprises a second portion which is of elongate shape and comprises at least three tabs each extending respectively along the longitudinal axis B and comprising a distal end and a proximal end.
  • the medical implant according to the present invention has a longitudinal axis A of the first portion which intersects the longitudinal axis B of the second portion at a point of intersection 1-3 between the distal and proximal ends of said first portion.
  • the medical implant according to the present invention has a point of intersection l 3 located at a distance L 3 from the proximal end and at a distance L 3 from the distal end of the first part.
  • the medical implant according to the present invention comprises orthonormal axes X, Y, Z of the connecting bridge which intersects at a point of intersection l 2 .
  • the medical implant according to the present invention comprises a point of intersection l 2 which is at a distance L 2 from the proximal face of the second part.
  • the medical implant according to the present invention comprises a connecting bridge whose vertical axis D intersects the longitudinal axis B of the second part at a point of intersection situated at a distance Dsi from the point of intersection l 2 .
  • the medical implant according to the present invention comprises a connecting bridge whose longitudinal axis XX 'coincides with the longitudinal axis A of the first part.
  • the medical implant according to the present invention comprises a connecting bridge whose longitudinal axis XX 'is inclined with respect to the longitudinal axis A of the first part.
  • the medical implant according to the present invention comprises a connecting bridge which is delimited by two opposite faces which merge respectively with the distal end of the first part and the proximal end of the second part.
  • the medical implant according to the present invention comprises a distance (D S i) which is less than or equal to 20 millimeters.
  • the medical implant according to the present invention comprises a distance (D S2 ) which is less than or equal to 10 millimeters.
  • Figure 1 is a perspective view illustrating the medical implant according to the present invention.
  • Figure 2 is a front view showing the medical implant according to the present invention.
  • Figure 3 is a sectional view showing the medical implant according to the present invention.
  • FIGS. 1 to 3 show a medical implant 1 according to the invention allowing the realization of an arthrodesis in order to connect and fix between them two adjacent phalanxes called proximal P1 and distal P2.
  • the medical implant according to the invention 1 is preferably monobloc. It can be produced for example by injection molding or by machining.
  • the medical implant 1 may be made of a biocompatible material, metallic or not.
  • this material may be chosen from polyetherketones (PEEK or PEKK), titanium, stainless steel, polylactic acids, and mixtures thereof.
  • the implant 1 comprises a first part 20 and a second part 30 intended to be respectively introduced into the medullary canal of the proximal phalanx P1 and the distal phalanx P2, said first and second parts 20, 30 being interconnected by a bridge. connection 40 centered around the orthonormal axes X, Y, Z of said implant 1.
  • the first portion 20 is of elongated shape comprising a distal end 20a and a proximal end 20b.
  • the first portion 20 has a longitudinal axis A intended to be aligned, in other words coincidental, when it is introduced with the longitudinal axis of the medullary canal of the proximal phalanx P1.
  • the first part 20 consists of at least three lugs 21, 22, 23 extending respectively along the longitudinal axis A and from the distal end 20a or the connecting bridge 40.
  • the lugs 21, 22, 23 give the first part 20 a generally cylindrical star shape.
  • the three lugs 21, 22, 23 extend parallel to each other.
  • the tabs 21, 22, 23 may extend along respective axes slightly diverging from the longitudinal axis A.
  • the tabs 21, 22, 23 are regularly arranged around the longitudinal axis A making it possible to produce between said tabs and in the body of the first part 20 an opening bore or cannula 25 carried by the longitudinal axis A and passing through the bridge. link 40 to ensure the passage of a guide pin to be able to handle and guide the implant 1 more easily during its introduction.
  • each lug 21, 22, 23 has, on its outer periphery, notches for hooking 24 which determines an outer profile serrated along the entire length of the first part 20.
  • Hooked notches 24 are first fastening means for ensuring the maintenance of the first portion 20 of the implant 1 in the proximal phalanx P1 in which the latter is intended to be introduced.
  • the hooked notches 24 each have an edge 24a directed towards the connecting bridge 40 for improving the fixation and retention of the first portion 20 within the medullary canal of the proximal phalanx P1.
  • the second portion 30 is elongate in shape including a distal end 30a and a proximal end 30b.
  • the second portion 30 is intended to be inserted into the medullary canal of the distal phalanx P2 adjacent to said proximal phalanx P1.
  • the second part has a longitudinal axis B intended to be aligned, in other words merged, with the longitudinal axis of the medullary canal of the distal phalanx P2.
  • the second part 30 consists of at least three tabs 31, 32, 33 each extending along the longitudinal axis B and from the distal end 30a or the connecting bridge 40.
  • the tabs 31, 32, 33 give the second portion 30 a generally slightly conical star shape.
  • the three tabs 31, 32, 33 extend parallel to each other and in alignment with the tabs 21, 22, 23 of the first part 20.
  • the tabs 31, 32, 33 may extend along respective axes deviating slightly from the longitudinal axis B.
  • each tab 31, 32, 33 has on its outer periphery hooked notches 34 defining an external serrated profile along the entire length of the second part 30.
  • Hooked notches 34 constitute second attachment means intended to maintain the second portion 30 of implant 1 in the distal phalanx P2 in which the latter is intended to be introduced.
  • the hooked notches 34 each have an edge 34a directed towards the connecting bridge 40 for improving the fixation and retention of the second portion 30 within the medullary canal of the distal phalanx P2.
  • the connecting bridge 40 has a profile centered around the orthonormal axes X, Y, Z which allows the latter to provide at least an axial offset of the second portion 30 relative to the first portion 20 of the implant 1.
  • the axes do not intersect in the central part. Therefore, to meet the anatomical needs, the implant adopts a bayonet shape.
  • the profile of the connecting bridge 40 may allow different axial shifts combined or not to position the second portion 30 relative to the first portion 20 in different geometric planes combinable or not.
  • the offset is made relative to the center of the joint.
  • Such an embodiment of the implant 1 makes it possible to shift the distal phalanx relative to the proximal phalanx towards the inside or the outside of the foot or the hand and thus to carry out adduction or abduction, respectively.
  • Such an embodiment is particularly advantageous in the case of a Hallux Valgus treatment.
  • the connecting bridge 40 is delimited by two opposite faces 40, 41 which may come as a function of its geometric profile to merge respectively with the distal end 20a of the first portion 20 and proximal end 30b of the second portion 30.
  • the profile of the connecting bridge 40 makes it possible to position the longitudinal axis B of said second portion 30 in a first direction which is inclined at an angle ⁇ relative to the longitudinal axis A. of the first part 20.
  • the angle a may vary from about 0 to 25 °, for example from 10 to 20 °, is preferably about 10 °. It is possible to vary the angle a in particular to adjust the implant of the invention to the anatomy of the part of the human body to be treated, for example the foot or the hand.
  • the profile of the connecting bridge 40 makes it possible to position the longitudinal axis B of said second portion 30 in a second direction which is offset by a distance Dsi with respect to the longitudinal axis XX 'of said connecting bridge 40.
  • the distance Dsi is provided along the axis ⁇ '. It is also possible according to the profile of the connecting bridge 40 to position the longitudinal axis B of said second portion 30 in a third or fourth direction which is shifted by a distance Ds 2 along the longitudinal axis ZZ 'of said bridge link 40.
  • the implant 1 may have a connecting bridge 40 ensuring according to its profile a positioning of the axis B:
  • the distances D S i, and D S 2 are strictly greater than 0 and less than or equal to 20 millimeters for D S i, and less than or equal to 10 millimeters for Ds 2 .
  • the longitudinal axis A of the first portion 20 intersects the longitudinal axis B of the second portion 30 at a point of intersection l 3 located between the distal 20a and proximal ends 20b of said first portion 20.
  • This point of intersection l 3 is positioned at a distance L 3 from the proximal end 20b and at a distance L 3 from the distal end 20a of the first portion 20.
  • the intersection point l 3 is spaced from the distal end 20a of the first portion 20 in the proximal direction to be located in a region corresponding to the proximal half of the first portion 20.
  • the orthonormal axes X, Y, Z of the connecting bridge 40 intersect at a point of intersection l 2 which is at a distance L 2 from the proximal face 30a of the second portion 30.
  • the vertical axis YY 'of the connecting bridge 40 intersects the longitudinal axis B of the second portion 30 at a point of intersection at a distance Dsi of the intersection point l 2 .
  • the longitudinal axis ZZ 'of the connecting bridge 40 intersects the longitudinal axis B of the second part 30 at a point of intersection l 4 at a distance Ds 2 from the point of intersection l 2
  • the longitudinal axis XX 'of the connecting bridge 40 of the implant 1 may coincide with the longitudinal axis A of the first part 20 or inclined with respect to the longitudinal axis A of the first part 20.
  • the implant 1 according to the invention ensures, once implanted, an internal shift of the phalanx distal to the proximal phalanx.
  • the distal phalanx once welded to the proximal phalanx, has a longitudinal axis slightly offset downwards, ie towards the caudal direction.
  • the entire distal phalanx is offset towards the caudal direction with respect to an implantation performed with an implant of the prior art for which the axes A and B are not separated by the distance D S i and / or D S 2 such as defined above.
  • the outer portions of the proximal phalanx and the distal phalanx are perfectly aligned, and the surgeon does not need to cut the upper part of the distal phalanx bone. to realign the upper parts of the phalanges.
  • the implant according to the invention since the upper part of the distal phalanx bone does not protrude beyond the upper line of the proximal phalanx and this bone does not create a step between the proximal phalanx and the distal phalanx. It is thus possible, thanks to the implant according to the invention, to weld the two phalanxes P1 and P2 in one and to block the articulation between these two phalanges and to treat pathologies such as toes in claws, metatarsalgia or the Hallux Valgus.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Surgery (AREA)
  • Neurology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)

Abstract

The medical implant (1) according to the present invention comprises a first, generally elongate portion (20) extending along the longitudinal axis A, intended to be inserted into the first bone (P1) and comprising first attachment means (24), and a second, also elongate, portion (30) following another longitudinal axis B, intended to be inserted into the second bone (P2) and comprising second attachment means (34), wherein said first and second portions (20, 30) are connected together via a connecting bridge (40) which is centered about the orthonormal axes X, Y, Z of said implant (1), providing for at least one axial offset of the second portion (30) with respect to the first portion (20) such that the longitudinal axis B of the second portion (30) is positioned in at least one direction forming an angle (α) relative to the longitudinal axis A of the first portion (20), and is offset by at least a certain distance along at least one of the axes XX', YY' and ZZ' of the connecting bridge (40) in order to avoid any offset between the outer upper portions of the first bone (P1) and the second bone (P2).

Description

Implant médical pour arthrodèse  Medical implant for arthrodesis
La présente invention est relative à un implant médical destiné à relier entre-deux un premier os et un deuxième os adjacent d'une articulation. Selon un exemple de réalisation non limitatif l'invention porte sur un implant médical permettant de relier et de fixer entre elles deux phalanges adjacentes dites proximale et distale du pied ou de la main. Certaines pathologies, comme les orteils en griffe ou les Hallux Valgus ou les métatarsalgies, induisent au niveau du pied une déformation des orteils : en particulier, il arrive que deux phalanges adjacentes d'un orteil ne conservent pas leur alignement naturel et forment entre elles un angle déformant l'orteil de façon constante. Une telle déformation peut avoir lieu dans un plan vertical, et le patient souffre alors de métatarsalgie : l'orteil adopte une configuration « en griffe » dans laquelle il est replié sur lui-même en permanence. La déformation peut alternativement avoir lieu dans un plan horizontal : le patient souffre alors d'Hallux Valgus : l'orteil, en particulier le gros orteil, forme une proéminence à l'extérieur du pied. Ces pathologies provoquent des douleurs de l'avant-pied, des cors, des gênes fonctionnelles : le patient a du mal à marcher correctement : il peut également avoir des difficultés pour se chausser. The present invention relates to a medical implant for connecting in-between a first bone and a second adjacent bone of a joint. According to a nonlimiting exemplary embodiment, the invention relates to a medical implant for connecting and fixing between them two adjacent phalanges said proximal and distal of the foot or hand. Certain pathologies, such as toes in claws or Hallux Valgus or metatarsalgia, induce in the foot a deformation of the toes: in particular, it happens that two adjacent phalanges of a toe do not maintain their natural alignment and form between them a angle deforming the toe steadily. Such deformation can take place in a vertical plane, and the patient then suffers from metatarsalgia: the toe adopts a configuration "in claw" in which it is folded on itself permanently. The deformity can alternatively take place in a horizontal plane: the patient then suffers from Hallux Valgus: the toe, in particular the big toe, forms a prominence on the outside of the foot. These pathologies cause forefoot pain, corns, functional discomfort: the patient has difficulty in walking properly: he may also have difficulties to put on his shoes.
Pour corriger ces pathologies, il est d'usage de pratiquer une arthrodèse interphalangienne : cette technique consiste à bloquer par voie chirurgicale l'articulation formée par les deux phalanges ayant perdu leur alignement naturel, en les réalignant l'une sur l'autre et en les soudant en une seule par fusion osseuse, les deux phalanges étant maintenues accolées l'une à l'autre durant le temps nécessaire à la fusion osseuse au moyen d'un implant. To correct these pathologies, it is customary to perform an interphalangeal arthrodesis: this technique involves surgically blocking the joint formed by the two phalanges having lost their natural alignment, by realigning them on top of each other and by welding them in one by bone fusion, the two phalanges being held together to each other during the time required for bone fusion by means of an implant.
L'implant utilisé dans ce type de correction présente donc deux parties, une partie destinée à être introduite dans une première phalange, par exemple une phalange proximale, et une deuxième partie destinée à être introduite dans une deuxième phalange, par exemple la phalange distale adjacente à la première phalange : les deux phalanges sont ainsi accolées l'une à l'autre. L'implant doit permettre la fusion des deux os, ou phalanges, ainsi accolés. The implant used in this type of correction therefore has two parts, a part intended to be introduced into a first phalanx, for example a proximal phalanx, and a second part intended to be introduced into a second phalanx, for example the adjacent distal phalanx. at the first phalanx: the two phalanges are thus joined to one another. The implant must allow the fusion of the two bones, or phalanges, so contiguous.
Des implants destinés à réaliser des arthrodèses interphalangiennes ont déjà été décrits. Ainsi, le document WO201 1/1 10784 décrit un implant comprenant une première partie destinée à être insérée dans la phalange proximale et une deuxième partie destinée à être insérée dans la phalange distale. Implants for performing interphalangeal arthrodesis have already been described. Thus, WO201 1/1 10784 discloses an implant comprising a first portion to be inserted into the proximal phalanx and a second portion to be inserted into the distal phalanx.
On connaît également d'après le brevet européen EP 2544633 appartenant au demandeur un implant médical comprenant une première partie de forme globalement allongée, portée par un axe longitudinal, destinée à être introduite dans le premier os et comprenant des premiers moyens de fixation et une deuxième partie, de forme également allongée présentant un autre axe longitudinal, destinée à être introduite dans le deuxième os et comprenant des deuxièmes moyens de fixation, lesdits première et deuxième parties étant reliées entre elles par un noyau central présentant un profil en forme d'étoile à au moins trois branches. It is also known from European Patent EP 2544633 belonging to the applicant a medical implant comprising a first portion of generally elongate shape, carried by a longitudinal axis, intended to be introduced into the first bone and comprising first fixing means and a second part, of form also elongate having another longitudinal axis, intended to be introduced into the second bone and comprising second fixing means, said first and second parts being interconnected by a central core having a star-shaped profile with at least three branches.
Toutefois, les implants existants n'assurent pas toujours un alignement adéquat des parties extérieures des phalanges, créant par exemple une marche entre la phalange proximale et la phalange distale. Ce phénomène est particulièrement dommageable dans le cas d'une arthrodèse des os du pied, dans la mesure où une telle marche cause un conflit avec la chaussure. Le patient peut ressentir une douleur ou des difficultés à se chausser. However, existing implants do not always provide adequate alignment of the outer portions of the phalanges, for example creating a step between the proximal phalanx and the distal phalanx. This phenomenon is particularly harmful in the case of an arthrodesis of the foot bones, insofar as such a step causes a conflict with the shoe. The patient may feel pain or difficulty fitting.
Pour éviter ces désagréments, les chirurgiens pratiquent généralement après l'implantation, une coupe de l'os de la partie de la phalange créant la marche. En général, le chirurgien coupe la partie supérieure de l'os de la phalange distale. Cette résection est traumatique pour le patient. To avoid these inconveniences, surgeons usually practice after implantation, a cut of the bone of the part of the phalanx creating walking. In general, the surgeon cuts the upper part of the distal phalanx bone. This resection is traumatic for the patient.
Ainsi, l'implant suivant la présente invention permet la fusion d'une phalange proximale et d'une phalange distale, pour le pied ou pour la main, ne générant pas cette marche ou décalage après implantation. Thus, the implant according to the present invention allows the fusion of a proximal phalanx and a distal phalanx, for the foot or hand, not generating this step or shift after implantation.
La présente invention propose un implant présentant une structure spécifique permettant de fusionner une phalange proximale et une phalange distale pour la main ou pour le pied, en évitant la création d'un décalage des parties extérieures supérieures entre les deux phalanges. Ainsi, après implantation de l'implant selon l'invention, les deux phalanges sont parfaitement alignées, et le chirurgien n'a pas besoin de procéder à une résection de la partie supérieure de l'os de la phalange distale. The present invention provides an implant having a specific structure for fusing a proximal phalanx and a distal phalanx for the hand or for the foot, avoiding the creation of a shift of the upper outer portions between the two phalanges. Thus, after implantation of the implant according to the invention, the two phalanges are perfectly aligned, and the surgeon does not need to resect the upper part of the distal phalanx bone.
L'implant selon l'invention permet ainsi de simplifier la procédure opératoire pour ressouder deux phalanges. De plus, l'implant selon l'invention permet de réaliser une opération beaucoup moins traumatisante pour le patient. Grâce à l'implant selon l'invention, les risques de complications subséquents à l'opération sont également grandement réduits. L'implant selon l'invention permet ainsi de restituer à l'organe traité son anatomie naturelle, en particulier l'angle naturel entre les phalanges ainsi ressoudées. The implant according to the invention thus simplifies the operating procedure for joining two phalanges. In addition, the implant according to the invention makes it possible to perform a much less traumatic operation for the patient. Thanks to the implant according to the invention, the risks of complications subsequent to the operation are also greatly reduced. The implant according to the invention thus makes it possible to restore to the organ treated its natural anatomy, in particular the natural angle between the phalanges thus wound together.
L'implant médical suivant la présente invention est destiné à permettre la fusion osseuse entre un premier os (P1 ) et un deuxième os (P2), ledit implant comprenant une première partie de forme globalement allongée, portée par un axe longitudinal A, destinée à être introduite dans le premier os (P1 ) et comprenant des premiers moyens de fixation et une seconde partie de forme également allongée présentant un autre axe longitudinal B, destinée à être introduite dans le deuxième os (P2) et comprenant des deuxièmes moyens de fixation, lesdits premières et deuxièmes parties étant reliées entre elles par un pont de liaison, ledit pont de liaison étant centré autour des axes orthonormés X, Y, Z dudit implant assurant au moins un décalage axial de la deuxième partie par rapport à la première partie afin que l'axe longitudinal B de ladite deuxième partie soit d'une part positionnée dans au moins une direction qui est inclinée d'un angle (a) par rapport à l'axe longitudinal A de la première partie et d'autre part décalé d'au moins une distance le long de l'un au moins des axes XX', YY' et ZZ' du pont de liaison afin d'éviter la création d'un décalage des parties extérieures supérieures entre le premier os (P1 ) et le deuxième os (P2). The medical implant according to the present invention is intended to allow bone fusion between a first bone (P1) and a second bone (P2), said implant comprising a first portion of generally elongate shape, carried by a longitudinal axis A, intended to be introduced into the first bone (P1) and comprising first fixing means and a second portion of also elongate shape having another longitudinal axis B, intended to be introduced into the second bone (P2) and comprising second fixing means, said first and second parts being interconnected by a connecting bridge, said connecting bridge being centered around the orthonormal axes X, Y, Z of said implant ensuring at least an axial offset of the second part with respect to the first part so that the longitudinal axis B of said second portion is firstly positioned in at least one direction which is inclined at an angle (a) with respect to the axis longitudinal axis A of the first part and secondly offset by at least one distance along at least one of the axes XX ', YY' and ZZ 'of the connecting bridge in order to avoid the creation of an offset upper outer portions between the first bone (P1) and the second bone (P2).
En effet, le profil du pont de liaison peut permettre différents décalages axiaux combinés ou non afin de positionner la seconde partie par rapport à la première partie dans des plans géométriques différents combinables ou non. Indeed, the profile of the connecting bridge may allow different axial offsets combined or not to position the second part relative to the first part in different geometric planes combinable or not.
La combinaison du décalage angulaire et du décalage linéaire par rapport au centre de l'articulation solutionne au mieux le problème technique par le fait que le chirurgien n'a plus à donner un coup de lame de scie pour égaliser les hauteurs de P1 et P2 une fois l'implant en place.  The combination of the angular offset and the linear offset from the center of the joint best solves the technical problem by the fact that the surgeon no longer has to give a saw blade stroke to equalize the heights of P1 and P2 a the implant in place.
L'implant médical suivant la présente invention comprend un axe longitudinal B de la deuxième partie qui est décalé d'une distance (DSi) le long de l'axe YY'. The medical implant according to the present invention comprises a longitudinal axis B of the second part which is shifted by a distance (D S i) along the axis YY '.
L'implant médical suivant la présente invention comprend un axe longitudinal B de la deuxième partie qui est décalé d'une distance (DS2) le long de l'axe ZZ'. The medical implant according to the present invention comprises a longitudinal axis B of the second part which is shifted by a distance (D S 2) along the axis ZZ '.
L'implant médical suivant la présente invention comprend une première partie qui est de forme allongée et constituée d'au moins trois pattes s'étendant chacune respectivement selon l'axe longitudinal A et comprenant une extrémité distale et une extrémité proximale. The medical implant according to the present invention comprises a first portion which is of elongate shape and comprises at least three tabs each extending respectively along the longitudinal axis A and comprising a distal end and a proximal end.
L'implant médical suivant la présente invention comprend une première partie dont les pattes sont régulièrement disposées autour de l'axe longitudinal A permettant de réaliser entre lesdites pattes et dans le corps de la première partie un alésage débouchant ou canule porté par l'axe longitudinal A et traversant le pont de liaison afin d'assurer le passage d'une broche de guidage. The medical implant according to the present invention comprises a first part whose legs are regularly arranged around the longitudinal axis A making it possible to produce between said tabs and in the body of the first part an opening bore or cannula carried by the longitudinal axis. A and crossing the connecting bridge to ensure the passage of a guide pin.
L'implant médical suivant la présente invention comprend une première partie dont chaque patte comporte sur sa périphérie externe des moyens de fixation constitués de crans d'accroché déterminant un profil externe dentelé sur toute la longueur de la première partie, lesdits crans d'accroché présentant chacun une arête dirigée vers le pont de liaison. L'implant médical suivant la présente invention comprend une seconde partie qui est de forme allongée et constituée d'au moins trois pattes s'étendant chacune respectivement selon l'axe longitudinal B et comprenant une extrémité distale et une extrémité proximale. The medical implant according to the present invention comprises a first part, each lug of which comprises, on its outer periphery, fastening means consisting of hooked catches defining an external serrated profile over the entire length of the first part, said hooked catches having each an edge directed towards the connecting bridge. The medical implant according to the present invention comprises a second portion which is of elongate shape and comprises at least three tabs each extending respectively along the longitudinal axis B and comprising a distal end and a proximal end.
L'implant médical suivant la présente invention comporte un axe longitudinal A de la première partie qui coupe l'axe longitudinal B de la seconde partie en un point d'intersection l3 situé entre les extrémités distales et proximales de ladite première partie. The medical implant according to the present invention has a longitudinal axis A of the first portion which intersects the longitudinal axis B of the second portion at a point of intersection 1-3 between the distal and proximal ends of said first portion.
L'implant médical suivant la présente invention comporte un point d'intersection l3 se trouvant positionné à une distance L3 de l'extrémité proximale et à une distance L3 de l'extrémité distale de la première partie. L'implant médical suivant la présente invention comprend des axes orthonormés X, Y, Z du pont de liaison qui se coupe en un point d'intersection l2. The medical implant according to the present invention has a point of intersection l 3 located at a distance L 3 from the proximal end and at a distance L 3 from the distal end of the first part. The medical implant according to the present invention comprises orthonormal axes X, Y, Z of the connecting bridge which intersects at a point of intersection l 2 .
L'implant médical suivant la présente invention comporte un point d'intersection l2 qui se trouve à une distance L2 de la face proximale de la seconde partie. The medical implant according to the present invention comprises a point of intersection l 2 which is at a distance L 2 from the proximal face of the second part.
L'implant médical suivant la présente invention comporte un pont de liaison dont l'axe vertical D coupe l'axe longitudinal B de la seconde partie en un point d'intersection se trouvant à une distance Dsi du point d'intersection l2. The medical implant according to the present invention comprises a connecting bridge whose vertical axis D intersects the longitudinal axis B of the second part at a point of intersection situated at a distance Dsi from the point of intersection l 2 .
L'implant médical suivant la présente invention comporte un pont de liaison dont l'axe longitudinal XX' est confondu avec l'axe longitudinal A de la première partie. The medical implant according to the present invention comprises a connecting bridge whose longitudinal axis XX 'coincides with the longitudinal axis A of the first part.
L'implant médical suivant la présente invention comporte un pont de liaison dont l'axe longitudinal XX' est incliné par rapport à l'axe longitudinal A de la première partie. The medical implant according to the present invention comprises a connecting bridge whose longitudinal axis XX 'is inclined with respect to the longitudinal axis A of the first part.
L'implant médical suivant la présente invention comporte un pont de liaison qui est délimité par deux faces opposées qui viennent se confondre respectivement avec l'extrémité distale de la première partie et l'extrémité proximale de la seconde partie. The medical implant according to the present invention comprises a connecting bridge which is delimited by two opposite faces which merge respectively with the distal end of the first part and the proximal end of the second part.
L'implant médical suivant la présente invention comprend une distance (DSi) qui est inférieure ou égale à 20 millimètres. The medical implant according to the present invention comprises a distance (D S i) which is less than or equal to 20 millimeters.
L'implant médical suivant la présente invention comprend une distance (DS2) qui est inférieure ou égale à 10 millimètres. The medical implant according to the present invention comprises a distance (D S2 ) which is less than or equal to 10 millimeters.
La description qui va suivre en regard des dessins annexés et donnés à titre d'exemples non limitatifs permettra de mieux comprendre l'invention, les caractéristiques qu'elle présente, et les avantages qu'elle est susceptible de procurer : The following description with reference to the accompanying drawings and given by way of non-limiting example will better understand the invention, the features it has, and the benefits it is likely to provide:
Figure 1 est une vue en perspective illustrant l'implant médical suivant la présente invention. Figure 1 is a perspective view illustrating the medical implant according to the present invention.
Figure 2 est une vue de face montrant l'implant médical suivant la présente invention. Figure 2 is a front view showing the medical implant according to the present invention.
Figure 3 est une vue en coupe représentant l'implant médical suivant la présente invention. Figure 3 is a sectional view showing the medical implant according to the present invention.
On a montré en figure 1 à 3 un implant médical 1 selon l'invention permettant la réalisation d'une arthrodèse afin de relier et de fixer entres elles deux phalanges adjacentes dites proximale P1 et distale P2. FIGS. 1 to 3 show a medical implant 1 according to the invention allowing the realization of an arthrodesis in order to connect and fix between them two adjacent phalanxes called proximal P1 and distal P2.
L'implant médical suivant l'invention 1 est de préférence monobloc. Il peut être réalisé par exemple par injection moulage ou encore par usinage. L'implant médical 1 peut être réalisé dans un matériau biocompatible, métallique ou non. Par exemple, ce matériau peut être choisi parmi les polyéthercétones (PEEK ou PEKK), le titane, l'acier inoxydable, les acides polylactiques, et leurs mélanges. L'implant 1 comprend une première partie 20 et une seconde partie 30 destinées à être respectivement introduite dans le canal médullaire de la phalange proximale P1 et de la phalange distale P2, lesdites première et seconde parties 20, 30 étant relié entre elles par un pont de liaison 40 centré autour des axes orthonormés X, Y, Z dudit implant 1 . The medical implant according to the invention 1 is preferably monobloc. It can be produced for example by injection molding or by machining. The medical implant 1 may be made of a biocompatible material, metallic or not. For example, this material may be chosen from polyetherketones (PEEK or PEKK), titanium, stainless steel, polylactic acids, and mixtures thereof. The implant 1 comprises a first part 20 and a second part 30 intended to be respectively introduced into the medullary canal of the proximal phalanx P1 and the distal phalanx P2, said first and second parts 20, 30 being interconnected by a bridge. connection 40 centered around the orthonormal axes X, Y, Z of said implant 1.
La première partie 20 est de forme allongée comprenant une extrémité distale 20a et une extrémité proximale 20b. La première partie 20 présente un axe longitudinal A destiné à être aligné, autrement dit confondu, lors de son introduction avec l'axe longitudinal du canal médullaire de la phalange proximale P1 . The first portion 20 is of elongated shape comprising a distal end 20a and a proximal end 20b. The first portion 20 has a longitudinal axis A intended to be aligned, in other words coincidental, when it is introduced with the longitudinal axis of the medullary canal of the proximal phalanx P1.
La première partie 20 est constitué d'au moins trois pattes 21 , 22, 23 s'étendant chacune respectivement selon l'axe longitudinal A et à partir de l'extrémité distale 20a ou du pont de liaison 40. Les pattes 21 , 22, 23 confèrent à la première partie 20 une forme générale cylindrique en étoile. The first part 20 consists of at least three lugs 21, 22, 23 extending respectively along the longitudinal axis A and from the distal end 20a or the connecting bridge 40. The lugs 21, 22, 23 give the first part 20 a generally cylindrical star shape.
Sur l'exemple représenté, les trois pattes 21 , 22, 23 s'étendent parallèlement les unes aux autres. Dans une forme de réalisation non représentée, les pattes 21 , 22, 23 peuvent s'étendre selon des axes respectifs s'écartant légèrement de l'axe longitudinal A. In the example shown, the three lugs 21, 22, 23 extend parallel to each other. In an embodiment not shown, the tabs 21, 22, 23 may extend along respective axes slightly diverging from the longitudinal axis A.
Les pattes 21 , 22, 23 sont régulièrement disposées autour de l'axe longitudinal A permettant de réaliser entre lesdites pattes et dans le corps de la première partie 20 un alésage débouchant ou canule 25 porté par l'axe longitudinal A et traversant le pont de liaison 40 afin d'assurer le passage d'une broche de guidage pour pouvoir manipuler et guider plus aisément l'implant 1 lors de son introduction. The tabs 21, 22, 23 are regularly arranged around the longitudinal axis A making it possible to produce between said tabs and in the body of the first part 20 an opening bore or cannula 25 carried by the longitudinal axis A and passing through the bridge. link 40 to ensure the passage of a guide pin to be able to handle and guide the implant 1 more easily during its introduction.
L'alésage débouchant ou canule 25 peut permettre également d'injecter un activateur d'ostéo-intégration dans l'implant 1. Selon l'invention, chaque patte 21 , 22, 23 comporte sur sa périphérie externe des crans d'accroché 24 déterminant un profil externe dentelé sur toute la longueur de la première partie 20. The opening bore or cannula 25 may also make it possible to inject an osseointegration activator into the implant 1. According to the invention, each lug 21, 22, 23 has, on its outer periphery, notches for hooking 24 which determines an outer profile serrated along the entire length of the first part 20.
Les crans d'accroché 24 constituent des premiers moyens de fixation destinés à assurer le maintien de la première partie 20 de l'implant 1 dans la phalange proximale P1 dans laquelle cette dernière est destinée à être introduite. Hooked notches 24 are first fastening means for ensuring the maintenance of the first portion 20 of the implant 1 in the proximal phalanx P1 in which the latter is intended to be introduced.
Les crans d'accroché 24 présentent chacun une arête 24a dirigée vers le pont de liaison 40 permettant d'améliorer la fixation et la retenue de la première partie 20 à l'intérieur du canal médullaire de la phalange proximale P1. The hooked notches 24 each have an edge 24a directed towards the connecting bridge 40 for improving the fixation and retention of the first portion 20 within the medullary canal of the proximal phalanx P1.
La deuxième partie 30 est de forme allongée comprenant une extrémité distale 30a et une extrémité proximale 30b. La seconde partie 30 est destinée à être insérée dans le canal médullaire de la phalange distale P2 adjacente à ladite phalange proximale P1 . The second portion 30 is elongate in shape including a distal end 30a and a proximal end 30b. The second portion 30 is intended to be inserted into the medullary canal of the distal phalanx P2 adjacent to said proximal phalanx P1.
La deuxième partie présente un axe longitudinal B destiné à être aligné, autrement dit confondu, avec l'axe longitudinal du canal médullaire de la phalange distale P2. La seconde partie 30 est constitué d'au moins trois pattes 31 , 32, 33 s'étendant chacune respectivement selon l'axe longitudinal B et à partir de l'extrémité distale 30a ou du pont de liaison 40. The second part has a longitudinal axis B intended to be aligned, in other words merged, with the longitudinal axis of the medullary canal of the distal phalanx P2. The second part 30 consists of at least three tabs 31, 32, 33 each extending along the longitudinal axis B and from the distal end 30a or the connecting bridge 40.
Les pattes 31 , 32, 33 confèrent à la seconde partie 30 une forme générale légèrement conique en étoile. Sur l'exemple représenté, les trois pattes 31 , 32, 33 s'étendent parallèlement les unes aux autres et dans l'alignement des pattes 21 , 22, 23 de la première partie 20. Dans une forme de réalisation non représentée, les pattes 31 , 32, 33 peuvent s'étendre selon des axes respectifs s'écartant légèrement de l'axe longitudinal B. The tabs 31, 32, 33 give the second portion 30 a generally slightly conical star shape. In the example shown, the three tabs 31, 32, 33 extend parallel to each other and in alignment with the tabs 21, 22, 23 of the first part 20. In an embodiment not shown, the tabs 31, 32, 33 may extend along respective axes deviating slightly from the longitudinal axis B.
Selon l'invention, chaque patte 31 , 32, 33 comporte sur sa périphérie externe des crans d'accroché 34 déterminant un profil externe dentelé sur toute la longueur de la seconde partie 30. According to the invention, each tab 31, 32, 33 has on its outer periphery hooked notches 34 defining an external serrated profile along the entire length of the second part 30.
Les crans d'accroché 34 constituent des seconds moyens de fixation destinés à assurer le maintien de la seconde partie 30 de l'implant 1 dans la phalange distale P2 dans laquelle cette dernière est destinée à être introduite. Les crans d'accroché 34 présentent chacun une arête 34a dirigée vers le pont de liaison 40 permettant d'améliorer la fixation et la retenue de la seconde partie 30 à l'intérieur du canal médullaire de la phalange distale P2. Hooked notches 34 constitute second attachment means intended to maintain the second portion 30 of implant 1 in the distal phalanx P2 in which the latter is intended to be introduced. The hooked notches 34 each have an edge 34a directed towards the connecting bridge 40 for improving the fixation and retention of the second portion 30 within the medullary canal of the distal phalanx P2.
On note que la direction des crans d'accroché 24 et 34 de chaque première et seconde partie 20, 30 dirigée respectivement vers le pont de liaison 40 permet lors de l'introduction de l'implant 1 de faciliter le rapprochement des phalanges proximale P1 et distale P2 en vue de la fusion de ces dernières. Note that the direction of hooked notches 24 and 34 of each first and second part 20, directed respectively towards the connecting bridge 40 allows during the introduction of the implant 1 to facilitate the approximation of the proximal phalanges P1 and distal P2 for the purpose of merging them.
Le pont de liaison 40 présente un profil centré autour des axes orthonormés X, Y, Z qui permet à ce dernier d'assurer au moins un décalage axial de la seconde partie 30 par rapport à la première partie 20 de l'implant 1 . Les axes ne se coupent pas dans la partie centrale. De ce fait, pour répondre aux besoins anatomiques, l'implant adopte une forme en baïonnette. The connecting bridge 40 has a profile centered around the orthonormal axes X, Y, Z which allows the latter to provide at least an axial offset of the second portion 30 relative to the first portion 20 of the implant 1. The axes do not intersect in the central part. Therefore, to meet the anatomical needs, the implant adopts a bayonet shape.
Le profil du pont de liaison 40 peut permettre différents décalages axiaux combinés ou non afin de positionner la seconde partie 30 par rapport à la première partie 20 dans des plans géométriques différents combinables ou non. Le décalage est réalisé par rapport au centre de l'articulation. The profile of the connecting bridge 40 may allow different axial shifts combined or not to position the second portion 30 relative to the first portion 20 in different geometric planes combinable or not. The offset is made relative to the center of the joint.
Une telle forme de réalisation de l'implant 1 permet de décaler la phalange distale par rapport à la phalange proximale vers l'intérieur ou l'extérieur du pied ou de la main et ainsi de réaliser respectivement une adduction ou une abduction. Une telle forme de réalisation est en particulier avantageuse dans le cas d'un traitement d'un Hallux Valgus. Such an embodiment of the implant 1 makes it possible to shift the distal phalanx relative to the proximal phalanx towards the inside or the outside of the foot or the hand and thus to carry out adduction or abduction, respectively. Such an embodiment is particularly advantageous in the case of a Hallux Valgus treatment.
Le pont de liaison 40 est délimité par deux faces opposées 40, 41 qui peuvent venir en fonction de son profil géométrique se confondre respectivement avec l'extrémité distale 20a de la première partie 20 et extrémité proximale 30b de la seconde partie 30. Dans l'exemple de réalisation de la présente invention le profil du pont de liaison 40 permet de positionner l'axe longitudinal B de ladite seconde partie 30 dans une première direction qui est inclinée d'un angle a par rapport à l'axe longitudinal A de la première partie 20. The connecting bridge 40 is delimited by two opposite faces 40, 41 which may come as a function of its geometric profile to merge respectively with the distal end 20a of the first portion 20 and proximal end 30b of the second portion 30. In the embodiment of the present invention, the profile of the connecting bridge 40 makes it possible to position the longitudinal axis B of said second portion 30 in a first direction which is inclined at an angle α relative to the longitudinal axis A. of the first part 20.
L'angle a peut varier d'environ 0 à 25°, par exemple de 10 à 20°, est de préférence d'environ 10°. Il est possible de faire varier l'angle a en particulier pour ajuster l'implant de l'invention à l'anatomie de la partie du corps humain à traiter, par exemple le pied ou la main. The angle a may vary from about 0 to 25 °, for example from 10 to 20 °, is preferably about 10 °. It is possible to vary the angle a in particular to adjust the implant of the invention to the anatomy of the part of the human body to be treated, for example the foot or the hand.
Egalement le profil du pont de liaison 40 permet de positionner l'axe longitudinal B de ladite seconde partie 30 dans une seconde direction qui est décalée d'une distance Dsi par rapport à l'axe longitudinal XX' dudit pont de liaison 40. Also the profile of the connecting bridge 40 makes it possible to position the longitudinal axis B of said second portion 30 in a second direction which is offset by a distance Dsi with respect to the longitudinal axis XX 'of said connecting bridge 40.
Dans notre exemple la distance Dsi est prévue le long de l'axe ΥΥ'. Il est également possible en fonction du profil du pont de liaison 40 de positionner l'axe longitudinal B de ladite seconde partie 30 dans une troisième ou quatrième direction qui est décalée d'une distance Ds2 long de l'axe longitudinal ZZ' dudit pont de liaison 40. In our example the distance Dsi is provided along the axis ΥΥ '. It is also possible according to the profile of the connecting bridge 40 to position the longitudinal axis B of said second portion 30 in a third or fourth direction which is shifted by a distance Ds 2 along the longitudinal axis ZZ 'of said bridge link 40.
En fonction des cas pathologiques l'implant 1 peut présenter un pont de liaison 40 assurant selon son profil un positionnement de l'axe B : Depending on the pathological cases the implant 1 may have a connecting bridge 40 ensuring according to its profile a positioning of the axis B:
• Soit incliné de l'angle a par rapport à l'axe longitudinal A et décalé selon la direction Dsi le long de l'axe YY ' ;  • Either inclined at the angle a with respect to the longitudinal axis A and shifted in the direction Dsi along the axis YY ';
· Soit incliné de l'angle a par rapport à l'axe longitudinal A et décalé selon la direction Ds2 le long de l'axe ZZ' ; · Either inclined by the angle α with respect to the longitudinal axis A and shifted in the direction Ds 2 along the axis ZZ ';
• Soit incliné de l'angle a par rapport à l'axe longitudinal A et décalé selon la combinaison des directions Dsi et/ou Ds2. Selon l'invention, les distance DSi, et DS2, sont strictement supérieure à 0 et inférieure ou égale à 20 millimètres pour DSi, et inférieure ou égale à 10 millimètres pour Ds2. • Either inclined by the angle a with respect to the longitudinal axis A and shifted according to the combination of the directions Dsi and / or Ds 2 . According to the invention, the distances D S i, and D S 2, are strictly greater than 0 and less than or equal to 20 millimeters for D S i, and less than or equal to 10 millimeters for Ds 2 .
On note que cette combinaison de décalage axiaux de l'axe longitudinal B de ladite seconde partie 30 permet d'éviter la création d'un décalage des parties extérieures et supérieures entre le premier os P2 et le deuxième os P1 lorsque l'implant 1 est introduit dans les canaux médullaire de ces derniers. Note that this combination of axial shifts of the longitudinal axis B of said second portion 30 avoids the creation of a shift of the outer and upper portions between the first bone P2 and the second bone P1 when the implant 1 is introduced into the medullary channels of these.
Selon notre exemple de réalisation, l'axe longitudinal A de la première partie 20 coupe l'axe longitudinal B de la seconde partie 30 en un point d'intersection l3 situé entre les extrémités distale 20a et proximale 20b de ladite première partie 20. According to our exemplary embodiment, the longitudinal axis A of the first portion 20 intersects the longitudinal axis B of the second portion 30 at a point of intersection l 3 located between the distal 20a and proximal ends 20b of said first portion 20.
Ce point d'intersection l3 se trouve positionné à une distance L3 de l'extrémité proximale 20b et à une distance L3 de l'extrémité distale 20a de la première partie 20. Le point d'intersection l3 est espacé de l'extrémité distale 20a de la première partie 20 dans la direction proximale pour être situé dans une région correspondant à la moitié proximale de la première partie 20. De telles formes de réalisation permettent de réaliser un décalage optimal de la phalange distale P2 dans la direction caudale par rapport à la phalange proximale P1 après implantation. This point of intersection l 3 is positioned at a distance L 3 from the proximal end 20b and at a distance L 3 from the distal end 20a of the first portion 20. The intersection point l 3 is spaced from the distal end 20a of the first portion 20 in the proximal direction to be located in a region corresponding to the proximal half of the first portion 20. Such embodiments make it possible to realize an optimal offset of the distal phalanx P2 in the caudal direction relative to the proximal phalanx P1 after implantation.
Egalement, les axes orthonormés X, Y, Z du pont de liaison 40 se coupent en un point d'intersection l2 qui se trouve à une distance L2 de la face proximale 30a de la seconde partie 30. D'autre part l'axe vertical YY' du pont de liaison 40 coupe l'axe longitudinal B de la seconde partie 30 en un point d'intersection se trouvant à une distance Dsi du point d'intersection l2. Egalement l'axe longitudinal ZZ' du pont de liaison 40 coupe l'axe longitudinal B de la seconde partie 30 en un point d'intersection l4 se trouvant à une distance Ds2 du point d'intersection l2 Also, the orthonormal axes X, Y, Z of the connecting bridge 40 intersect at a point of intersection l 2 which is at a distance L 2 from the proximal face 30a of the second portion 30. On the other hand, the vertical axis YY 'of the connecting bridge 40 intersects the longitudinal axis B of the second portion 30 at a point of intersection at a distance Dsi of the intersection point l 2 . Also the longitudinal axis ZZ 'of the connecting bridge 40 intersects the longitudinal axis B of the second part 30 at a point of intersection l 4 at a distance Ds 2 from the point of intersection l 2
Dans des exemples de variantes non représentées, l'axe longitudinal XX' du pont de liaison 40 de l'implant 1 peut être confondu avec l'axe longitudinal A de la première partie 20 ou incliné par rapport à l'axe longitudinal A de la première partie 20. In examples of variants not shown, the longitudinal axis XX 'of the connecting bridge 40 of the implant 1 may coincide with the longitudinal axis A of the first part 20 or inclined with respect to the longitudinal axis A of the first part 20.
Grâce à sa structure spécifique, l'implant 1 selon l'invention assure, une fois implanté, un décalage interne de la phalange distale par rapport à la phalange proximale. En particulier, grâce à l'implant selon l'invention, la phalange distale, une fois ressoudée à la phalange proximale, présente un axe longitudinal légèrement décalé vers le bas, autrement dit vers la direction caudale. Due to its specific structure, the implant 1 according to the invention ensures, once implanted, an internal shift of the phalanx distal to the proximal phalanx. In particular, thanks to the implant according to the invention, the distal phalanx, once welded to the proximal phalanx, has a longitudinal axis slightly offset downwards, ie towards the caudal direction.
Ainsi, toute la phalange distale se trouve décalée vers la direction caudale par rapport à une implantation réalisée avec un implant de l'art antérieur pour lequel les axes A et B ne sont pas séparés par la distance DSi et/ou DS2 telle que définie ci-dessus. Thus, the entire distal phalanx is offset towards the caudal direction with respect to an implantation performed with an implant of the prior art for which the axes A and B are not separated by the distance D S i and / or D S 2 such as defined above.
Après l'implantation de l'implant selon l'invention, les parties extérieures de la phalange proximale et de la phalange distale sont parfaitement alignées, et le chirurgien n'a pas besoin de couper la partie supérieure de l'os de la phalange distale afin de réaligner les parties supérieures des phalanges. After implantation of the implant according to the invention, the outer portions of the proximal phalanx and the distal phalanx are perfectly aligned, and the surgeon does not need to cut the upper part of the distal phalanx bone. to realign the upper parts of the phalanges.
En effet, grâce à l'implant selon l'invention, la partie supérieure de l'os de la phalange distale ne dépasse pas au-delà de la ligne supérieure de la phalange proximale et cet os ne crée pas de marche entre la phalange proximale et la phalange distale. II est ainsi possible, grâce à l'implant selon l'invention, de souder les deux phalanges P1 et P2 en une seule et de bloquer l'articulation entre ces deux phalanges et de traiter des pathologies telles que les orteils en griffes, les métatarsalgies ou encore les Hallux Valgus. Indeed, thanks to the implant according to the invention, the upper part of the distal phalanx bone does not protrude beyond the upper line of the proximal phalanx and this bone does not create a step between the proximal phalanx and the distal phalanx. It is thus possible, thanks to the implant according to the invention, to weld the two phalanxes P1 and P2 in one and to block the articulation between these two phalanges and to treat pathologies such as toes in claws, metatarsalgia or the Hallux Valgus.

Claims

REVENDICATIONS
Implant médical (1 ) destiné à permettre la fusion osseuse entre un premier os (P1 ) et un deuxième os (P2), ledit implant comprenant une première partie (20) de forme globalement allongée, s'étendant le long de l'axe longitudinal A, destinée à être introduite dans le premier os (P1 ) et comprenant des premiers moyens de fixation (24) et une seconde partie (30) de forme également allongée présentant un autre axe longitudinal B, destinée à être introduite dans le deuxième os (P2) et comprenant des deuxièmes moyens de fixation (34), lesdites première et deuxième parties (20, 30) étant reliées entre elles par un pont de liaison (40), caractérisé en ce que ledit pont de liaison (40) est centré autour des axes orthonormés X, Y, Z dudit implant (1 ) assurant au moins un décalage axial de la deuxième partie (30) par rapport à la première partie (20) afin que l'axe longitudinal B de ladite deuxième partie (30) soit d'une part positionnée dans au moins une direction qui est inclinée d'un angle (a) par rapport à l'axe longitudinal A de la première partie (20) et d'autre part décalé d'au moins une distance le long de l'un au moins des axes XX', YY' et ZZ' du pont de liaison (40) afin d'éviter la création d'un décalage des parties extérieures supérieures entre le premier os (P2) et le deuxième os (P1 ). A medical implant (1) for enabling bone fusion between a first bone (P1) and a second bone (P2), said implant comprising a first portion (20) of generally elongated shape extending along the longitudinal axis A, intended to be introduced into the first bone (P1) and comprising first fixing means (24) and a second portion (30) of also elongate shape having another longitudinal axis B, intended to be introduced into the second bone ( P2) and comprising second fixing means (34), said first and second parts (20, 30) being interconnected by a connecting bridge (40), characterized in that said connecting bridge (40) is centered around orthonormal axes X, Y, Z of said implant (1) providing at least one axial offset of the second portion (30) relative to the first portion (20) so that the longitudinal axis B of said second portion (30) is on the one hand positioned in at least one direct ion which is inclined at an angle (a) with respect to the longitudinal axis A of the first part (20) and secondly offset by at least one distance along at least one of the axes XX ' , YY 'and ZZ' of the connecting bridge (40) to avoid creating an offset of the upper outer portions between the first bone (P2) and the second bone (P1).
Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe longitudinal B de ladite deuxième partie (30) est décalé d'une distance (DSi) le long de l'axe YY'. Medical implant (1) according to claim 1, characterized in that the longitudinal axis B of said second portion (30) is offset by a distance (D S i) along the axis YY '.
Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe longitudinal B de ladite deuxième partie (30) est décalé d'une distance (DS2) le long de l'axe ZZ'. Medical implant (1) according to claim 1, characterized in that the longitudinal axis B of said second portion (30) is offset by a distance (D S 2) along the axis ZZ '.
Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que la première partie (20) est de forme allongée et constituée d'au moins trois pattes (21 , 22, 23) s'étendant chacune respectivement selon l'axe longitudinal A et comprenant une extrémité distale (20a) et une extrémité proximale (20b). Medical implant (1) according to claim 1, characterized in that the first part (20) is of elongate shape and consists of at least three tabs (21, 22, 23) each extending along the longitudinal axis A respectively. and comprising a distal end (20a) and a proximal end (20b).
Implant médical (1 ) suivant la revendication 4, caractérisé en ce que les pattes (21 , 22, 23) sont régulièrement disposées autour de l'axe longitudinal A permettant de réaliser entre lesdites pattes et dans le corps de la première partie (20) un alésage débouchant ou canule (25) porté par l'axe longitudinal A et traversant le pont de liaison (40) afin d'assurer le passage d'une broche de guidage. Medical implant (1) according to claim 4, characterized in that the tabs (21, 22, 23) are regularly arranged around the longitudinal axis A making it possible to produce between said tabs and in the body of the first part (20). an opening bore or cannula (25) carried by the longitudinal axis A and passing through the connecting bridge (40) to ensure the passage of a guide pin.
Implant médical (1 ) suivant la revendication 4, caractérisé en ce que chaque patte (21 , 22, 23) comporte sur sa périphérie externe des moyens de fixation constitués de crans d'accroché (24) déterminant un profil externe dentelé sur toute la longueur de la première partie (20), lesdits crans d'accroché (24) présentant chacun une arête (24a) dirigée vers le pont de liaison (40). Medical implant (1) according to claim 4, characterized in that each lug (21, 22, 23) comprises on its outer periphery fixing means consisting of hooked notches (24) determining an external serrated profile over the entire length of the first part (20), said hooked notches (24) each having an edge (24a) directed towards the connecting bridge (40).
7. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que la seconde partie (30) est de forme allongée et constituée d'au moins trois pattes (31 , 32, 33) s'étendant chacune respectivement selon l'axe longitudinal B et comprenant une l'extrémité distale (30a) et une extrémité proximale (30b). 7. Medical implant (1) according to claim 1, characterized in that the second portion (30) is of elongate shape and consists of at least three tabs (31, 32, 33) each extending along the axis respectively. longitudinal B and comprising a distal end (30a) and a proximal end (30b).
8. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe longitudinal A de la première partie (20) coupe l'axe longitudinal B de la seconde partie (30) en un point d'intersection l3 situé entre les extrémités distale (20a) et proximale (20b) de ladite première partie (20). 8. Medical implant (1) according to claim 1, characterized in that the longitudinal axis A of the first portion (20) intersects the longitudinal axis B of the second portion (30) at a point of intersection l 3 located between the distal (20a) and proximal (20b) ends of said first portion (20).
9. Implant médical (1 ) suivant la revendication 4, caractérisé en ce que le point d'intersection l3 se trouve positionné à une distance L3 de l'extrémité proximale (20b) et à une distance L3 de l'extrémité distale (20a) de la première partie (20). 10. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que les axes orthonormés X, Y, Z du pont de liaison (40) se coupe en un point d'intersection l2. 9. Medical implant (1) according to claim 4, characterized in that the point of intersection l 3 is positioned at a distance L 3 from the proximal end (20b) and at a distance L 3 from the distal end (20a) of the first part (20). 10. Medical implant (1) according to claim 1, characterized in that the orthonormal axes X, Y, Z of the connecting bridge (40) intersects at a point of intersection l 2 .
1 1 . Implant médical (1 ) suivant la revendication 5, caractérisé en ce que le point d'intersection l2 se trouve à une distance L2 de la face proximale (30a) de la seconde partie (30). 1 1. Medical implant (1) according to claim 5, characterized in that the point of intersection l 2 is at a distance L 2 from the proximal face (30a) of the second part (30).
12. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe vertical D du pont de liaison (40) coupe l'axe longitudinal B de la seconde partie (30) en un point d'intersection se trouvant à une distance Dsi du point d'intersection l2. 12. Medical implant (1) according to claim 1, characterized in that the vertical axis D of the connecting bridge (40) intersects the longitudinal axis B of the second portion (30) at a point of intersection at a distance Dsi from the point of intersection l 2 .
13. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe longitudinal XX' du pont de liaison (40) peut être confondu avec l'axe longitudinal A de la première partie (20). 14. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que l'axe longitudinal XX' du pont de liaison (40) est incliné par rapport à l'axe longitudinal A de la première partie (20). 13. Medical implant (1) according to claim 1, characterized in that the longitudinal axis XX 'of the connecting bridge (40) may be coincident with the longitudinal axis A of the first portion (20). 14. Medical implant (1) according to claim 1, characterized in that the longitudinal axis XX 'of the connecting bridge (40) is inclined relative to the longitudinal axis A of the first portion (20).
15. Implant médical (1 ) suivant la revendication 1 , caractérisé en ce que le pont de liaison (40) est délimité par deux faces opposées (40, 41 ) qui viennent se confondre respectivement avec l'extrémité distale (20a) de la première partie (20) et extrémité proximale (30b) de la seconde partie (30). 15. Medical implant (1) according to claim 1, characterized in that the connecting bridge (40) is delimited by two opposite faces (40, 41) which merge respectively with the distal end (20a) of the first portion (20) and proximal end (30b) of the second portion (30).
16. Implant médical (1 ) suivant la revendication 2, caractérisé en ce que la distance (DSi ) est inférieure ou égale à 20 millimètres. 16. Medical implant (1) according to claim 2, characterized in that the distance (D S i) is less than or equal to 20 millimeters.
17. Implant médical (1 ) suivant la revendication 3, caractérisé en ce que la distance (DS2) est inférieure ou égale à 10 millimètres. 17. Medical implant (1) according to claim 3, characterized in that the distance (D S2 ) is less than or equal to 10 millimeters.
EP18857446.1A 2017-10-09 2018-10-05 Medical arthrodesis implant Pending EP3694428A2 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR1759426A FR3072015B1 (en) 2017-10-09 2017-10-09 MEDICAL IMPLANT FOR ARTHRODESIS
US201762570156P 2017-10-10 2017-10-10
PCT/FR2018/052462 WO2019073149A2 (en) 2017-10-09 2018-10-05 Medical arthrodesis implant

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EP3694428A2 true EP3694428A2 (en) 2020-08-19

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EP (1) EP3694428A2 (en)
FR (1) FR3072015B1 (en)
WO (1) WO2019073149A2 (en)

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WO2021231329A1 (en) 2020-05-11 2021-11-18 Gensano Llc Cannulated bone implant

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FR2957244B1 (en) * 2010-03-09 2012-04-13 Synchro Medical ARTHRODESE IMPLANT
US8608785B2 (en) * 2010-06-02 2013-12-17 Wright Medical Technology, Inc. Hammer toe implant with expansion portion for retrograde approach
US9724138B2 (en) * 2011-09-22 2017-08-08 Arthrex, Inc. Intermedullary devices for generating and applying compression within a body
US20160045324A1 (en) * 2014-08-12 2016-02-18 Neutin Orthopedics, LLC Titanium plasma coated medical grade thermoplastic or polymer proximal and distal interphalangeal toe implant
FR3024835B1 (en) * 2014-08-18 2021-07-30 In2Bones ARTHRODESIS IMPLANT AND GRIPPING INSTRUMENT OF SUCH AN IMPLANT
DE102015107056B4 (en) * 2015-05-06 2021-04-01 Syntellix Ag Arthrodesis implant

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US20200390563A1 (en) 2020-12-17
FR3072015A1 (en) 2019-04-12
WO2019073149A3 (en) 2019-07-25
WO2019073149A2 (en) 2019-04-18
FR3072015B1 (en) 2022-05-20

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