FR2669214A1 - Adjustable total wrist prosthesis - Google Patents

Adjustable total wrist prosthesis Download PDF

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Publication number
FR2669214A1
FR2669214A1 FR9014545A FR9014545A FR2669214A1 FR 2669214 A1 FR2669214 A1 FR 2669214A1 FR 9014545 A FR9014545 A FR 9014545A FR 9014545 A FR9014545 A FR 9014545A FR 2669214 A1 FR2669214 A1 FR 2669214A1
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FR
France
Prior art keywords
rod
guide
wrist prosthesis
prosthesis according
total
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.)
Granted
Application number
FR9014545A
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French (fr)
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FR2669214B1 (en
Inventor
Loda Antonio Guillermo
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Individual
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Individual
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Publication date
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Priority to FR9014545A priority Critical patent/FR2669214A1/en
Publication of FR2669214A1 publication Critical patent/FR2669214A1/en
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Publication of FR2669214B1 publication Critical patent/FR2669214B1/fr
Granted legal-status Critical Current

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Classifications

    • 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
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364—Rotation about the common longitudinal axis
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • 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
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
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    • 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
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    • 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
    • A61F2002/30574—Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30774—Apertures or holes, e.g. of circular cross section internally-threaded
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30886—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts externally-threaded
    • 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
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    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891—Plurality of protrusions
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    • A—HUMAN NECESSITIES
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    • 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
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    • A61F2/30—Joints
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    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891—Plurality of protrusions
    • A61F2002/30894—Plurality of protrusions inclined obliquely with respect to each other
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30907—Nets or sleeves applied to surface of prostheses or in cement
    • A61F2002/30919—Sleeves
    • 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
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    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • A61F2002/4264—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists for radio-carpal joints
    • A—HUMAN NECESSITIES
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    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4631—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

Landscapes

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

Abstract

This prosthesis comprises a first rod (1) which is nailed into the radius (2) and finishes in a shoulder (3), which shoulder supports an articulation element (4) which is off-centre with respect to the rod (1) and which supports a guide (7) whose distance with respect to the shoulder (3) is adjustable and which supports, by way of a ball joint, a block (9) which supports one or more rods (10) which are nailed into the metacarpal bones (11, 12).

Description

La présente invention se rapporte à une nouvelle prothèse totale de poignet, du type de celle qui s'implante en prothèse permanente par une opération chirurgicale effectuée dans le carpe, c'est-à-dire entre l'avant-bras et la main, par une ostéotomie partielle des carpiens. The present invention relates to a new total wrist prosthesis, of the type which is implanted as a permanent prosthesis by a surgical operation performed in the carpus, that is to say between the forearm and the hand, by a partial carpal osteotomy.

On connait déjà une prothèse totale de poignet, divulguée par le brevet des E.U.A. n0 4 063 3L4, du 20
Décembre 1977, délivré au nom de la demanderesse de la présente, qui est constituée par une prothèse totale de poignet qui comprend une tige adaptée pour être enclouée et cimentée dans un alésage axial pratiqué dans le canal médullaire du radius, ladite tige présentant à une de ses extrémités une embase plane qui est solidaire d'une saillie tubulaire, ladite saillie tubulaire présentant une cavité ouverte, dont l'axe est décentré par rapport à l'axe de ladite tige, et à l'intérieur de laquelle est inséré un élément en matière plastique dans lequel est à son tour insérée une rotule ; sur cette rotule fait saillie, dans le sens inverse de ladite tige, une deuxième tige qui peut être enclouée dans le troisième métacarpien, et ladite deuxième tige est munie d'un élément présentant la forme d'une double saillie transversale d'aspect triangulaire.We already know a total wrist prosthesis, disclosed by US Patent No. 4,063 3L4, dated 20
December 1977, issued in the name of the plaintiff hereof, which is constituted by a total wrist prosthesis which comprises a rod adapted to be embedded and cemented in an axial bore made in the medullary canal of the radius, said rod having at one of its ends a flat base which is integral with a tubular projection, said tubular projection having an open cavity, the axis of which is offset relative to the axis of said rod, and inside which is inserted a plastic material in which a ball joint is inserted; on this patella protrudes, in the opposite direction from said rod, a second rod which can be inserted into the third metacarpal, and said second rod is provided with an element having the form of a double transverse projection of triangular appearance.

Bien que ce type de prothèse totale de poignet ait représenté un grand progrès en son temps, le temps et les treize années d'expérience ont montré qu'elle est affectée de certains inconvénients. L'un d'eux, et peut être le plus important, consiste en ce qu'au fil des années, il se produit chez le patient un changement ou une modification des forces musculo-tendineuses (qui interagissent entre les différents os et les différents points d'insertion musculaire), ce qui a pour résultat une déstabilisation de la main et du poignet et donne lieu à des positions de la main qui sont différentes de celles qu'on attend normalement.Un autre inconvénient auquel on s'est heurté consiste en ce que la prothèse protégée par le brevet des E.U.A. précité ne permet pas de faire varier sa longueur pour corriger la hauteur du carpe qui est affectée par une maladie ou une lésion. Although this type of total wrist prosthesis has represented great progress in its time, time and thirteen years of experience have shown that it is affected by certain disadvantages. One of them, and perhaps the most important, is that over the years there is a change or modification in the musculo-tendon forces (which interact between the different bones and the different muscle insertion points), which results in destabilization of the hand and wrist and gives rise to hand positions that are different from those normally expected. Another disadvantage that has been encountered is in that the prosthesis protected by the patent of the USA above does not allow its length to be varied to correct the height of the carp which is affected by a disease or an injury.

L'objectif de la présente invention est donc de remédier aux inconvénients précités d'une façon simple et efficace. La présente invention a donc pour objet une nouvelle prothèse totale de poignet réglable, du type qui comprend une première tige fixée au radius par un procédé adéquat, et au moins une deuxième tige fixée à l'un des métacarpiens, ladite première tige et ladite au moins une deuxième tige étant liées entre elles par une articulation, ladite prothèse totale de poignet étant caractérisée en ce que ladite articulation est constituée par :un guide monté sur un moyen de support et de réglage axial, excentré par rapport à l'axe de ladite première tige, qui est associé à une embase disposée à l'extrémité de ladite première tige ; et un patin monté mobile dans ledit guide, ledit patin portant ladite au moins une deuxième tige fixée sur sa partie distale. The objective of the present invention is therefore to remedy the aforementioned drawbacks in a simple and effective manner. The present invention therefore relates to a new total adjustable wrist prosthesis, of the type which comprises a first rod fixed to the radius by an adequate method, and at least a second rod fixed to one of the metacarpals, said first rod and said to at least one second rod being linked together by an articulation, said total wrist prosthesis being characterized in that said articulation consists of: a guide mounted on a support and axial adjustment means, eccentric relative to the axis of said first rod, which is associated with a base disposed at the end of said first rod; and a shoe mounted movably in said guide, said shoe carrying said at least one second rod fixed on its distal part.

Ledit moyen de support peut être de préférence constitué par un axe associé à des moyens de réglage de la hauteur dudit guide par rapport à ladite embase. Said support means may preferably be constituted by an axis associated with means for adjusting the height of said guide relative to said base.

On a constaté que les problèmes qu'on observe sur les patients auxquels on a appliqué les prothèses totales de poignet qui ont été divulguées et revendiquées dans le brevet des E.U.A. n0 4 063 314 sont dus à deux causes principales qui, combinées entre elles, donnent un résultat amplifié. L'une de ces causes consiste en ce que la rotule utilisée dans la prothèse du brevet cité permet des mouvements pratiquement illimités dans toutes les directions et dans tous les sens. It has been found that the problems observed in patients to whom total wrist prostheses have been applied which have been disclosed and claimed in the U.S. patent. No. 4,063,314 are due to two main causes which, when combined, give an amplified result. One of these causes is that the ball joint used in the prosthesis of the cited patent allows practically unlimited movements in all directions and in all directions.

La deuxième cause consiste en ce que ladite rotule est située au centre réel de rotation anatomique du poignet, c'est-à-dire sur la tête du radius.  The second cause is that said patella is located at the real center of anatomical rotation of the wrist, that is to say on the head of the radius.

Ceci a pour effet que, lorsque les forces de traction des moteurs tendineux du poignet varient avec le temps, les moments des forces par rapport au centre de rotation changent également, ce qui, associé au mouvement illimité de la rotule, a pour effet que la main peut prendre une position différente de la position qu'on attendait normalement. This has the effect that, when the tensile forces of the wrist tendon motors vary over time, the moments of the forces relative to the center of rotation also change, which, associated with the unlimited movement of the patella, has the effect that the hand can take a different position than the one normally expected.

On a donc découvert que, pour assurer une stabilité correcte et permanente de la main, il faut que le centre de rotation de la prothèse soit reporté plus loin dans la direction distale, et placé dans l'articulation carpo-métacarpienne. It has therefore been discovered that, in order to ensure correct and permanent stability of the hand, the center of rotation of the prosthesis must be transferred further in the distal direction, and placed in the carpo-metacarpal joint.

De cette façon, on obtient que le moment de force des moteurs du poignet, par rapport à ce nouveau centre de rotation, reste toujours constant.. In this way, we obtain that the moment of force of the wrist motors, relative to this new center of rotation, always remains constant.

Ce chnagement de position du centre de rotation de la prothèse, apporte comme avantage principal la stabilité du poignet et, comme avantage additionnel, l'élimination des saillies triangulaires prévues dans le brevet précité, qui ne sont plus nécessaires maintenant. This position change of the center of rotation of the prosthesis, brings as main advantage the stability of the wrist and, as an additional advantage, the elimination of the triangular projections provided in the aforementioned patent, which are no longer necessary now.

Un autre avantage obtenu avec la nouvelle prothèse consiste en ce que le guide est associé à la base de la tige fixée dans le radius, avec possibilité de se déplacer axialement et de tourner de façon réglable. Ce mouvement axial permet de protéger les tiges vis-à-vis des forces d'extension de la main lorsque cette dernière supporte un poids, en constituant un amortisseur ou une articulation de cardan de la prothèse. Le mouvement de rotation dudit guide sur un axe décentré par rapport à l'axe de la première tige reproduit la rotation physiologique qui représente le mouvement normal de flexion-rotation de toute articulation. Another advantage obtained with the new prosthesis consists in that the guide is associated with the base of the rod fixed in the radius, with the possibility of moving axially and of turning in an adjustable manner. This axial movement makes it possible to protect the rods from the extension forces of the hand when the latter supports a weight, by constituting a shock absorber or a cardan joint of the prosthesis. The rotational movement of said guide on an axis off-center with respect to the axis of the first rod reproduces the physiological rotation which represents the normal movement of flexion-rotation of any joint.

En outre, on a avantageusement remplacé la rotule utilisée dans les prothèses antérieures par un guide et un patin, ce patin étant monté dans le guide avec possibilité de glissement relatif d'une amplitude qu'on peut limiter à volonté. In addition, the ball joint used in the previous prostheses has advantageously been replaced by a guide and a pad, this pad being mounted in the guide with the possibility of relative sliding of an amplitude which can be limited at will.

D'autres caractéristiques et avantages de llin- vention seront mieux compris à la lecture de la description qui va suivre, de deux exemples de réalisation et en se référant aux dessins annexés sur lesquels
la figure 1 comprend une vue éclatée d'une pre mière forme de réalisation de la prothèse totale objet de L'invention, et deux vues en coupe A-A et B-B de ladite prothèse
la figure 2 est une vue schématique de la prothèse totale de la figure l, implantée dans le squelette d'une main et d'une partie de#l'avant-bras
la figure 3 est une vue éclatée d'une deuxième forme de réalisation préférée de la prothèse objet de l'invention ; et
la figure 4 montre une vue schématique de la prothèse totale de la figure 3, implantée dans le squelette d'une main et d'une partie de l'avant-bras.Other characteristics and advantages of the invention will be better understood on reading the description which follows, of two exemplary embodiments and with reference to the appended drawings in which
Figure 1 includes an exploded view of a first embodiment of the total prosthesis object of the invention, and two sectional views AA and BB of said prosthesis
Figure 2 is a schematic view of the total prosthesis of Figure l, implanted in the skeleton of a hand and part of the forearm
Figure 3 is an exploded view of a second preferred embodiment of the prosthesis object of the invention; and
Figure 4 shows a schematic view of the total prosthesis of Figure 3, implanted in the skeleton of one hand and part of the forearm.

On observe sur les figures 1 et 2 une première tige 1 qui a été placée par cimentage ou équivalent dans le radius 2. Ladite première tige 1 présente à son extrémité libre une embase 3 qui porte, solidairement fixé sur elle, un corps cylindrique 4 qui présente un trou traversant et fileté 5. Dans ce trou 5 est disposé un axe 6 fileté de façon correspondante et qui porte un guide 7 monté sur son extrémité avec possibilité de rotation. Le guide 7 présente des bords 8 servant à positionner un patin 9. Lesdits bords 8 présentent des butées, non représentées, qui limitent le mouvement du patin 9. FIGS. 1 and 2 show a first rod 1 which has been placed by cementing or the like in radius 2. Said first rod 1 has at its free end a base 3 which carries, fixedly attached to it, a cylindrical body 4 which has a through and threaded hole 5. In this hole 5 is disposed a pin 6 correspondingly threaded and which carries a guide 7 mounted on its end with possibility of rotation. The guide 7 has edges 8 used to position a shoe 9. Said edges 8 have stops, not shown, which limit the movement of the shoe 9.

Ledit patin 9 porte deux deuxièmes tiges 10 fixées sur lui, qui sont cimentées dans le troisième métacarpien ll et dans le quatrième métacarpien 12. Dans ce cas, on a utilisé deux deuxièmes tiges mais il est évident qu'on peut utiliser entre une et quatre tiges, selon le besoin. Said pad 9 carries two second rods 10 fixed on it, which are cemented in the third metacarpal ll and in the fourth metacarpal 12. In this case, two second rods were used but it is obvious that one can use between one and four rods, as required.

On observe qu'avec l'axe fileté 6 dans son ex trémité proximale, il est possible de régler la hauteur du carpe, ce qui rend la prothèse totale de poignet selon l'invention est avantageuse comparativement aux prothèses déjà connues. D'un autre côté, le montage de la prothèse peut s'effectuer par alésage axial du radius et cimentage de la prothèse, ou en prévoyant une prothèse munie d'une chemise en titane, ce qui évite le cimenta- ge. It is observed that with the threaded axis 6 in its proximal end, it is possible to adjust the height of the carpus, which makes the total wrist prosthesis according to the invention is advantageous compared to the prostheses already known. On the other hand, the mounting of the prosthesis can be carried out by axial bore of the radius and cementing of the prosthesis, or by providing a prosthesis provided with a titanium jacket, which avoids cementing.

La forme particulière du guide 7 et du patin 9 qui lui est associé donne à la prothèse un mode d'articulation possédant une possibilité de flexion, d'extension et de coulissement radio-cubital. The particular shape of the guide 7 and the pad 9 which is associated with it gives the prosthesis a mode of articulation having a possibility of flexion, extension and radio-ulnar sliding.

Pour obtenir un fonctionnement correct, il faut que le guide 7 et le patin 9 soient construits de préférence en métal, avec interposition de polyéthylène à haut poids moléculaire pour favoriser le glissement. To obtain correct operation, it is necessary that the guide 7 and the shoe 9 are preferably constructed of metal, with interposition of high molecular weight polyethylene to promote sliding.

Sur les figures 3 et 4, on peut voir la première tige 1, placée dans le canal médullaire du radius 2. In Figures 3 and 4, we can see the first rod 1, placed in the medullary canal of radius 2.

Ladite première tige 1 présente à son extrémité libre une embase 3 qui porte une saillie cylindrique 6' fixée solidairement sur cette embase, et excentrée par rapport à l'axe de la première tige 1, cette saillie étant filetée dans sa partie 13 proche de la base 3, et sa surface latérale restante 14 étant lisse. Sur ladite partie filetée 13, se visse une pièce filetée 4' qui présente un trou fileté 5'.Said first rod 1 has at its free end a base 3 which carries a cylindrical projection 6 'fixedly attached to this base, and eccentric with respect to the axis of the first rod 1, this projection being threaded in its part 13 close to the base 3, and its remaining lateral surface 14 being smooth. On said threaded part 13, a threaded piece 4 'is screwed which has a threaded hole 5'.

Un guide 7 est monté sur une extrémité d'un corps tubulaire 15 qui présente son autre extrémité ouverte et dont l'intérieur est revêtu d'une fourrure cylindrique 17 en polyéthylène à haut poids moléculaire, le diamètre intérieur de ladite fourrure cylindrique 17 coïncidant avec le diamètre extérieur de ladite saillie cylindrique 6'. A guide 7 is mounted on one end of a tubular body 15 which has its other open end and the interior of which is coated with a cylindrical fur 17 made of high molecular weight polyethylene, the internal diameter of said cylindrical fur 17 coinciding with the outside diameter of said cylindrical projection 6 '.

Dans sa position d'implantation dans le patient, ladite saillie cylindrique 6' est emmanchée dans le corps tubulaire 15 de manière que Ledit guide 7 puis se se déplacer en rotation et en coulissement axial par rapport à l'embase 3. In its implantation position in the patient, said cylindrical projection 6 'is fitted into the tubular body 15 so that said guide 7 then moves in rotation and in axial sliding relative to the base 3.

La pièce filetée 4' joue le rôle de butée contre l'extrémité libre du corps tubulaire 15, ce qui permet de régler l'écartement minimum entre l'embase 3 et le guide 7. The threaded piece 4 'acts as a stop against the free end of the tubular body 15, which makes it possible to adjust the minimum spacing between the base 3 and the guide 7.

Il est évident que le pas du filetage de la piè- ce filetée 4' et de la saillie cylindrique 6' peut être millimétrique ou micrométrique. Le patin 9 présente une rainure 9' dans laquelle on peut introduire des protubérances pratiquées sur les bords 8 du guide 7, ce qui limite le déplacement latéral du patin 9 par rapport au guide 7. It is obvious that the pitch of the thread of the threaded part 4 'and of the cylindrical projection 6' can be millimeter or micrometer. The shoe 9 has a groove 9 ′ into which protuberances formed on the edges 8 of the guide 7 can be introduced, which limits the lateral movement of the shoe 9 relative to the guide 7.

Le patin 9 porte, associées à sa partie distale, deux deuxièmes tiges 8 destinées à se fixer dans les troisième et quatrième métacarpiens. Avec cette forme de réalisation préférée, on confère à la prothèse une liberté de mouvement par glissement latéral et de flexion-extension grâce à la combinaison guide 7-patin 9, et de rotation axiale et d'extension et de compression par la combinaison saillie cylindrique 6'-corps tubulaire 15. The pad 9 carries, associated with its distal part, two second rods 8 intended to be fixed in the third and fourth metacarpals. With this preferred embodiment, the prosthesis is given freedom of movement by lateral sliding and of flexion-extension by means of the guide 7-pad 9 combination, and of axial rotation and of extension and compression by the cylindrical projection combination. 6'-tubular body 15.

La combinaison des mouvements donnée a pour résultat le mouvement de circumduction. The combination of movements given results in the circumduction movement.

Ce mouvement de circumduction peut avoir un angle d'amplitude limité aux besoins du patient, ce qu'on obtient en modifiant la longueur de la rainure 9' du patin 9 et en introduisant des butées, non représentées, qui limitent l'angle de rotation du corps tubulaire 15, c'est-à-dire du guide 7. This circumduction movement can have an amplitude angle limited to the needs of the patient, which is obtained by modifying the length of the groove 9 ′ of the pad 9 and by introducing stops, not shown, which limit the angle of rotation. of the tubular body 15, that is to say of the guide 7.

Dans cette forme de réalisation préférée, on utilise un patin 9 en métal qui glisse contre une surface en polyéthylène à haut poids moléculaire 16 disposé sur le guide 7. In this preferred embodiment, a metal shoe 9 is used which slides against a high molecular weight polyethylene surface 16 disposed on the guide 7.

Bien entendu, diverses modifications et variantes pourront être apportées par l'homme de l'art aux dispositifs qui viennent d'être décrits uniquement à titre d'exemples non limitatifs sans sortir du cadre de l'invention.  Of course, various modifications and variants may be made by those skilled in the art to the devices which have just been described only by way of nonlimiting examples without departing from the scope of the invention.

Claims (9)

REVENDIC#TIONSCLAIM # TIONS 1. Prothèse totale de poignet réglable, du type qui comprend une première tige fixée au radius par un procédé adéquat et au moins une deuxième tige fixée à des métacarpiens, ladite première tige et ladite au moins deuxième tige étant liées entre elles par une articulation, caractérisée en ce que ladite articulation est constituée par : un guide (7) et un patin (9), ledit guide (7) étant monté sur un moyen de support et de réglage axial (4, 5, 6 ; 4', 5', 6', 13, 14, 15, 17), qui est excentré par rapport à l'axe de ladite première tige (I), ledit moyen de support et de réglage étant associé à une embase (3) disposée à l'extrémité libre de ladite première tige, et ledit patin (9) étant monté mobile dans ledit guide (7) et portant ladite au moins une deuxième tige (10) fixée sur sa partie distale. 1. Total adjustable wrist prosthesis, of the type which comprises a first rod fixed to the radius by an adequate method and at least a second rod fixed to the metacarpals, said first rod and said at least second rod being linked together by a joint, characterized in that said articulation consists of: a guide (7) and a shoe (9), said guide (7) being mounted on a support and axial adjustment means (4, 5, 6; 4 ', 5' , 6 ', 13, 14, 15, 17), which is eccentric relative to the axis of said first rod (I), said support and adjustment means being associated with a base (3) disposed at the end free from said first rod, and said shoe (9) being movably mounted in said guide (7) and carrying said at least one second rod (10) fixed on its distal part. 2. Prothèse totale de poignet selon la revendication 1, caractérisée en ce que ledit moyen de support comprend un axe filet (6) qui se visse dans un filetage (5) pratiqué dans un corps cylindrique (4) fixé à ladite embase. 2. Total wrist prosthesis according to claim 1, characterized in that said support means comprises a thread axis (6) which is screwed into a thread (5) formed in a cylindrical body (4) fixed to said base. 3. Prothèse totale de poignet selon la revendication 2, caractérisée en ce que ledit filetage (5) est de pas millimétrique. 3. Total wrist prosthesis according to claim 2, characterized in that said thread (5) is of millimeter pitch. 4. Prothèse totale de poignet selon la revendication 1, caractérisée en ce que l'un des deux éléments constitués par ledit guide (7) et ledit patin (9) est en polyéthylène à haut poids moléculaire tandis que l'autre élément est métallique. 4. Total wrist prosthesis according to claim 1, characterized in that one of the two elements constituted by said guide (7) and said pad (9) is made of high molecular weight polyethylene while the other element is metallic. 5. Prothèse totale de poignet selon la revendication 1, caractérisée en ce que ledit moyen de support comprend une saillie cylindrique (6') partiellement filetée (en 13), qui est fixée à ladite base (3) et sur laquelle sont montés une pièce filetée (4') qui se visse sur la portion filetée (13), et un corps tubulaire creux (15) qui est réuni solidairement à la partie proximale dudit guide (7). 5. Total wrist prosthesis according to claim 1, characterized in that said support means comprises a cylindrical projection (6 ') partially threaded (at 13), which is fixed to said base (3) and on which a part is mounted threaded (4 ') which screws onto the threaded portion (13), and a hollow tubular body (15) which is joined integrally to the proximal part of said guide (7). 6. Prothèse totale de poignet selon la revendication 5, caractérisée en ce que ledit corps tubulaire (15) présente sa cavité revêtue d'une fourrure de polyéthylène à haut poids moléculaire (17). 6. Total wrist prosthesis according to claim 5, characterized in that said tubular body (15) has its cavity coated with a high molecular weight polyethylene fur (17). 7. Prothèse totale de poignet selon la revendication 6, caractérisée en ce que le diamètre intérieur de ladite fourrure de polyéthylène (17) coïncide avec le diamètre extérieur de ladite saillie cylindrique (6'). 7. Total wrist prosthesis according to claim 6, characterized in that the inside diameter of said polyethylene fur (17) coincides with the outside diameter of said cylindrical projection (6 '). 8. Prothèse totale de poignet selon la revendication 5, caractérisée en ce que ladite saillie cylindrique (6') et ledit corps tubulaire (15) sont munis de moyens de butée (4') servant à limiter l'angle de rotation relative de ces éléments. 8. Total wrist prosthesis according to claim 5, characterized in that said cylindrical projection (6 ') and said tubular body (15) are provided with abutment means (4') serving to limit the relative angle of rotation of these elements. 9. Prothèse totale de poignet selon la revendication 5, caractérisée en ce que ledit patin (9) présente une rainure (9') dans laquelle se logent des protubérances dudit guide (7) servant à limiter le mouvement dudit patin.  9. Total wrist prosthesis according to claim 5, characterized in that said pad (9) has a groove (9 ') in which are housed protuberances of said guide (7) serving to limit the movement of said pad.
FR9014545A 1990-11-21 1990-11-21 Adjustable total wrist prosthesis Granted FR2669214A1 (en)

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EP1159939A1 (en) * 2000-05-30 2001-12-05 Biomet Merck France Total wrist prosthesis
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FR2833480A1 (en) * 2001-12-13 2003-06-20 Fixano Wrist articulation prosthesis comprises three elements, a main element forming convex articulation side supported against large bone and bone support rods, radial element and intermediate sliding element
US6673114B2 (en) 2000-05-03 2004-01-06 Smith & Nephew, Inc. Multi modular trialing system and instrumentation
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AU2012253444B2 (en) 2011-05-12 2016-02-18 Howmedica Osteonics Corp. Wrist implant for carpal hemiarthroplasty

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US4063314A (en) * 1975-07-15 1977-12-20 Antonio Guillermo Loda Total wrist joint prosthesis
US4259752A (en) * 1980-01-04 1981-04-07 Julio Taleisnik Endoprosthetic wrist joint
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Cited By (12)

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DE9316763U1 (en) * 1993-11-03 1994-01-20 Howmedica Gmbh Endoprosthesis for the proximal wrist
US6673114B2 (en) 2000-05-03 2004-01-06 Smith & Nephew, Inc. Multi modular trialing system and instrumentation
EP1159939A1 (en) * 2000-05-30 2001-12-05 Biomet Merck France Total wrist prosthesis
FR2809612A1 (en) * 2000-05-30 2001-12-07 Biomet Merck France TOTAL WRIST PROSTHESIS
WO2002069853A1 (en) 2001-03-02 2002-09-12 Guerard Jean-Louis Wrist prosthesis
US7563287B2 (en) 2001-03-02 2009-07-21 Guerard Jean-Louis Wrist prosthesis
US6953479B2 (en) 2001-07-16 2005-10-11 Smith & Nephew, Inc. Orthopedic implant extension
FR2833480A1 (en) * 2001-12-13 2003-06-20 Fixano Wrist articulation prosthesis comprises three elements, a main element forming convex articulation side supported against large bone and bone support rods, radial element and intermediate sliding element
US7625408B2 (en) 2003-07-22 2009-12-01 Avanta Orthopaedics, Llc Prosthetic wrist implant
US7628819B2 (en) 2003-07-22 2009-12-08 Avanta Orthopaedics, Llc Prosthetic wrist implant
US8758445B2 (en) 2003-07-22 2014-06-24 Avanta Orthopaedics, Llc Prosthetic wrist implant
US9233004B2 (en) 2003-07-22 2016-01-12 Howmedica Osteonics Corp. Prosthetic wrist implant

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