FR2927529A1 - Joint e.g. inter-phalangeal joint, prosthesis, for patient, has blade forming central part projecting in transverse direction, where central part is directed from side of treated joint whose flexion movement is realized on central part - Google Patents

Joint e.g. inter-phalangeal joint, prosthesis, for patient, has blade forming central part projecting in transverse direction, where central part is directed from side of treated joint whose flexion movement is realized on central part Download PDF

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Publication number
FR2927529A1
FR2927529A1 FR0800808A FR0800808A FR2927529A1 FR 2927529 A1 FR2927529 A1 FR 2927529A1 FR 0800808 A FR0800808 A FR 0800808A FR 0800808 A FR0800808 A FR 0800808A FR 2927529 A1 FR2927529 A1 FR 2927529A1
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FR
France
Prior art keywords
joint
prosthesis
characterized
central part
bone
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
FR0800808A
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French (fr)
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FR2927529B1 (en
Inventor
Witte Gerard De
Original Assignee
Pfaifer Patrick
Witte Gerard De
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Filing date
Publication date
Application filed by Pfaifer Patrick, Witte Gerard De filed Critical Pfaifer Patrick
Priority to FR0800808A priority Critical patent/FR2927529B1/en
Publication of FR2927529A1 publication Critical patent/FR2927529A1/en
Application granted granted Critical
Publication of FR2927529B1 publication Critical patent/FR2927529B1/en
Application status is Expired - Fee Related legal-status Critical
Anticipated expiration legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
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    • A61F2/4241Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
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    • A61F2/00Filters 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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    • A61F2/00Filters 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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    • A61F2/00Filters 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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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30565Special structural features of bone or joint prostheses not otherwise provided for having spring elements
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    • A61F2230/0028Shapes in the form of latin or greek characters
    • A61F2230/0045Omega-shaped
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028Shapes in the form of latin or greek characters
    • A61F2230/0054V-shaped
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00035Other metals or alloys
    • A61F2310/00071Nickel or Ni-based alloys

Abstract

The prosthesis (1) has a central portion (3) with an elastic blade (5) whose thickness is oriented in direction parallel to a plane of articular mobility of a bone with respect to other, where the prosthesis is made of a metallic material e.g. NITINOL(RTM: nickel and titanium alloy). The blade forms a central part (5d) projecting in a transverse direction, where the central part is directed after implantation from a side of a treated joint whose flexion movement is realized on the central part. A medullary rod (2) has a medullary part from a side opposite to the central portion.

Description

1 La présente invention concerne une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne. 1 The present invention relates to a joint prosthesis for inter-phalangeal or phalango-metacarpal or phalangométatarsienne joint. Pour traiter une affection au niveau d'une articulation inter-phalangienne, une technique connue consiste à immobiliser l'articulation en position d'alignement des phalanges au moyen d'une broche. To treat a condition at an inter-phalangeal joint, a known technique is to hold the joint in alignment position phalanges by means of a pin. Une telle arthrodèse a pour inconvénient majeur d'être invalidante, le patient ne pouvant plus saisir un objet de dimensions réduites tel qu'une aiguille posée sur une surface. Such fusion has the major disadvantage of disabling, the patient no longer able to grip an object of reduced dimensions such as a needle resting on a surface. Une autre technique consiste à implanter aux extrémités des deux os concernés des inserts de resurfaçage en matériau métallique. Another technique consists of implanting the ends of two bones involved resurfacing inserts made of metallic material. Cette technique n'est pas satisfaisante, compte tenu de l'absence de contrôle, ou du contrôle réduit, des mouvements de l'articulation en extension et dans la direction médio-latérale, et compte tenu de la diffusion de particules métalliques dans l'organisme du patient que génère le contact des implants métal sur métal. This technique is not satisfactory, given the lack of control, or the reduced control of joint movements in extension and in the medio-lateral direction, and taking into account the distribution of metal particles in the the patient's body that generates the contact of metal on metal implants.

Une autre technique encore consiste à implanter une prothèse articulaire en matériau souple et élastique, notamment en silicone, comprenant deux tiges médullaires et une partie centrale élargie, les deux tiges médullaires étant destinées à être insérées dans les canaux médullaires des deux os concernés, et la partie centrale étant destinée à occuper l'espace articulaire. Yet another technique involves implanting a joint prosthesis of flexible and elastic material, in particular silicone, comprising two spinal rods and a widened central part, the two spinal rods being intended to be inserted into the medullary canals of the two bone concerned, and central portion being intended to occupy the joint space.

La déformabilité de cette partie centrale permet le mouvement des deux tiges médullaires l'une par rapport à l'autre et donc le mouvement des deux os concernés l'un par rapport à l'autre. The deformability of the central portion permits movement of the two spinal rods relative to the other and thus the movement of the two bones concerned relative to the other. Une telle prothèse a également pour inconvénient important de ne pas permettre un bon contrôle du mouvement des phalanges dans le sens de l'extension et dans la direction médio-latérale. Such a prosthesis also has the major drawback of not allowing a good control of the movement of the phalanges in the direction of extension and in the medial-lateral direction. De plus, les tiges médullaires ont une certaine possibilité de jeu axial par rapport aux os, qui est génératrice de frottements répétés et donc de diffusion dans l'organisme du patient de particules de silicone. In addition, spinal rods have a limited possibility of axial play relative to the bone, which generates repeated friction and thus diffusion into the patient's organism of silicone particles. Cette diffusion conduit à l'affection connue sous le nom de "siliconite". This diffusion leads to the condition known as the "siliconite".

La présente invention vise à remédier à l'ensemble des inconvénients précités des prothèses selon la technique antérieure. The present invention aims to remedy all the aforementioned disadvantages of prior art prostheses. Son objectif principal est donc de fournir une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne, permettant un mouvement contrôlé et limité d'un os par rapport 2 à l'autre, particulièrement dans le sens du mouvement d'extension de l'articulation et dans la direction médio-latérale. Its main objective is to provide a joint prosthesis for interphalangeal joint or phalango-metacarpal or phalangométatarsienne, allowing controlled and limited movement of a bone 2 in relation to each other, particularly in the direction of movement of extension of the joint and in the medio-lateral direction. Un autre objectif de l'invention est de fournir une prothèse n'ayant pas d'effets néfastes sur l'organisme du patient, en particulier ne générant pas de 5 diffusion de particules du matériau constituant la prothèse. Another object of the invention is to provide a prosthesis having no adverse effects on the patient's organism, in particular do not generate scattering particles 5 of the material forming the prosthesis. Un objectif supplémentaire de l'invention est de fournir une prothèse restant relativement facile à fabriquer. A further object of the invention to provide a prosthesis remaining relatively easy to manufacture. La prothèse concernée comprend, de manière connue en soi, deux parties latérales d'ancrage osseux et une partie centrale déformable destinée 10 à occuper l'espace articulaire. The relevant prosthesis comprises, in known manner, two side portions of bone anchor and a deformable central portion 10 intended to occupy the joint space. Selon l'invention, - ladite partie centrale déformable comprend au moins une lame en matériau élastique, dont l'épaisseur est orientée dans une direction parallèle au plan de la mobilité articulaire d'un os par rapport à l'autre, et 15 - ladite lame forme une partie médiane saillante dans le sens transversal, dirigée, après implantation, du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation. According to the invention, - said deformable central portion comprises at least a resilient material blade, whose thickness is oriented in a direction parallel to the plane of the articular mobility of a bone relative to each other, and 15 - said blade forms a projecting middle portion in the transverse direction, directed after implantation, the side of the treated joint on which performs the bending movement of the joint. Par le terme "épaisseur" ci-dessus, il faut entendre la dimension de la lame selon une direction perpendiculaire au plan de la mobilité articulaire d'un 20 os par rapport à l'autre. By the term "thickness" above is meant the dimension of the blade in a direction perpendicular to the plane of the articular mobility of a bone 20 with respect to each other. Cette structure en au moins une lame élastique à partie médiane saillante sur le côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire du côté palmaire dans le cas du traitement d'une articulation inter-phalangienne ou phalango- métacarpienne 25 ou phalango-métatarsienne, permet d'obtenir une capacité appropriée de déformation de la partie centrale de la prothèse dans le sens de la flexion, c'est-à-dire dans le sens du pivotement d'un os (phalange) dans la direction palmaire par rapport à l'autre os (phalange ou métacarpe ou métatarse) tout en ayant une capacité appropriée de rappel élastique en position neutre. This structure of at least one elastic blade projecting middle portion on the side of the treated joint on which performs the bending movement of the joint, that is to say of the palmar side in the case of treating a interphalangeal joint or phalango- metacarpal 25 or phalango-metatarsal, provides adequate capacity of deformation of the central portion of the prosthesis in the direction of bending, that is to say in the direction of pivoting of a bone (phalanx) in palmar direction with respect to the other bone (phalanx or metacarpal or metatarsal) while having an appropriate capacity for elastic return in the neutral position. La 30 déformation en flexion de cette partie centrale de la prothèse est réalisée par le tendon fléchisseur, qui subsiste après implantation, et le retour en position neutre d'alignement des deux os concernés est réalisé par le rappel élastique de ladite lame, en suppléance du tendon extenseur, généralement sacrifié lors de l'implantation de la prothèse ou en mauvais état chez de nombreux 35 patients. 30 the bending deformation of the central portion of the prosthesis is achieved by the flexor tendon, which remains after implantation, and the return to the neutral position of alignment of the two bones concerned is achieved by the resilient return of said blade, replacement of the extensor tendon, usually sacrificed during the implantation of the prosthesis or in poor condition in many patients 35. 3 La prothèse selon l'invention reproduit ainsi le mouvement de flexion-extension d'une articulation inter-phalangienne ou phalango-métacarpienne ou phalango-métatarsienne dans les meilleures conditions. 3 The prosthesis according to the invention and the reproduced motion flexion-extension of an inter-phalangeal joint or phalango-metacarpal or phalango-metatarsal in the best conditions. La structure en lame et la disposition précitée de cette lame par rapport au plan de mobilité d'un os par rapport à l'autre fait que la largeur de la lame est orientée perpendiculairement à ce plan, conférant à la prothèse une rigidité importante dans la direction transversale à ce plan, c'est-à-dire dans la direction médio-latérale de l'articulation traitée. The blade structure and the above provision of the blade relative to the mobility plan of a bone relative to each other that the width of the blade is oriented perpendicularly to this plane, giving the prosthesis a high rigidity in the direction transverse to that plane, that is to say in the medio-lateral direction of the treated joint. Cette rigidité assure un parfait contrôle du mouvement de l'articulation dans cette direction. This rigidity ensures perfect control of joint movement in this direction. Il en est de même du contrôle du mouvement d'un os en rotation longitudinale par rapport à l'autre os. It is the same movement control of a longitudinal rotating bone with respect to the other bone. Ladite lame pourrait présenter une forme en "U" ou en "V". Said blade may have a shape of a "U" or "V". De préférence, toutefois, cette lame présente une forme ondulée, c'est-à-dire comprend deux portions arrondies latérales reliées chacune à l'une des parties d'ancrage et une portion arrondie centrale formant ladite partie médiane saillante. Preferably, however, this blade has a corrugated shape, that is to say comprises two lateral rounded portions each connected to one of the anchor portions and a central rounded portion forming said projecting middle portion. Cette structure ondulée s'avère reproduire le mouvement naturel de l'articulation dans les meilleures conditions. This corrugated structure proves to reproduce the natural movement of the joint in the best conditions. En particulier, les déformations conjointes des parties arrondies latérales et centrale permettent d'obtenir une amplitude de flexion importante, et une force de rappel élastique appropriée. In particular, the joint deformation of the side and central rounded portions allow to obtain a large flexural amplitude, and an appropriate elastic restoring force. Avantageusement, chaque portion arrondie latérale s'étend sur un arc de l'ordre de 90 à 100 degrés et se raccorde à une portion rectiligne elle-même raccordée, par son autre extrémité, à ladite portion arrondie centrale. Advantageously, each lateral rounded portion extends over an arc of the order of 90 to 100 degrees and is connected to a straight portion itself connected, by its other end to said central rounded portion. Cette portion arrondie centrale s'étend de préférence sur un arc de l'ordre de 180 degrés. This central rounded portion preferably extends over an arc of about 180 degrees. De préférence, lesdites portions rectilignes divergent dans la direction dudit côté de l'articulation sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire. Preferably, said straight portions diverge in the direction of said side of the joint on which performs the bending movement of the joint, that is to say generally the palmar side. En cas de mouvement d'extension extrême de l'articulation, les zones de ces portions rectilignes raccordées auxdites portions arrondies latérales sont susceptibles de venir au contact l'une avec l'autre, limitant ainsi la déformation de la partie centrale de la prothèse dans le sens de cette extension. In the event of extreme movement of extension of the joint, the areas of these rectilinear portions connected to said side rounded portions are likely to come into contact with each other, thereby limiting the deformation of the central portion of the prosthesis in the direction of this extension. L'angle formé par lesdites portions rectilignes peut notamment être de l'ordre de 30 degrés. The angle formed by said straight portions can in particular be of the order of 30 degrees. 4 De préférence, lesdites parties d'ancrage sont constituées par des tiges médullaires destinées à être engagées étroitement dans le canal médullaire des os traités. 4 Preferably, said anchor portions are formed by spinal rods to be engaged tightly in the medullary canal of the treated bone. Ces tiges médullaires, de par leur forme et leur rigidité, présentent de 5 faibles risques de jeu par rapport aux os, limitant ainsi le risque de frottements générateurs de particules métalliques. These spinal rods, by their shape and stiffness, 5 present low risk of play relative to the bone, thus limiting the risk of generating friction metal particles. Avantageusement, au moins une de ces tiges médullaires comprend un aspect de surface ou un revêtement propre à assurer son immobilisation par rapport à l'os dans lequel elle est implantée, par croissance des cellules 10 osseuses le long de cette tige médullaire. Advantageously, at least one of these medullary rods comprises a surface finish or coated so as to ensure its immobilisation with respect to the bone in which it is implanted, by growth of bone cells 10 along the spinal rod. Notamment, cette tige médullaire peut présenter une surface rugueuse, obtenue par exemple par grenaillage de la surface brute de cette tige, ou un revêtement poreux, notamment un revêtement ostéo-inducteur. In particular, the spinal rod may have a rough surface, obtained for example by shot peening the gross area of ​​the rod, or a porous coating including an osteoinductive coating. Ladite partie centrale de la prothèse présente avantageusement une 15 largeur supérieure à celle des parties d'ancrage. Said central portion of the prosthesis 15 preferably has a width greater than that of the anchor portions. Par ce terme "largeur", il faut entendre la dimension de la lame selon une direction perpendiculaire au plan de la mobilité articulaire d'un os par rapport à l'autre. By the term "width" means the dimension of the blade in a direction perpendicular to the plane of the articular mobility of a bone relative to each other. Cette largeur supérieure augmente la rigidité de la prothèse dans la 20 direction médio-latérale. This larger width increases the rigidity of the prosthesis 20 in the mediolateral direction. Avantageusement, au moins une partie d'ancrage présente un rebord ou une collerette destiné à prendre appui contre l'os dans lequel cette partie d'ancrage est destinée à être implantée. Advantageously, at least one anchoring part has a flange or a collar intended to bear against the bone in which the anchoring portion is intended to be implanted. Ce rebord ou cette collerette augmente la surface d'appui de la partie 25 d'ancrage contre l'os et réduit les forces exercées sur les zones d'ancrage osseux de cette partie d'ancrage. This flange or collar that increases the bearing surface portion 25 of the anchor against the bone and reduces the forces exerted on the bone anchor zones of the anchoring portion. La venue en butée de ce rebord ou de cette collerette contre l'os détermine en outre une position précise de la partie d'ancrage par rapport à l'os, et donc un positionnement précis de la prothèse par rapport à l'os. The abutment of this edge or of the collar against the bone further determines a precise position of the anchoring portion with respect to the bone, and thus accurate positioning of the prosthesis relative to the bone. 30 De préférence, la prothèse est réalisée en un matériau métallique, notamment en l'alliage de nickel et de titane connu sous la dénomination "NITINOL". 30 Preferably, the prosthesis is made of a metallic material, in particular nickel and titanium alloy known under the name "NITINOL." L'invention sera bien comprise, et d'autres caractéristiques et avantages de celle-ci apparaîtront, en référence au dessin schématique annexé, représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de la prothèse qu'elle concerne. The invention will be better understood, and other characteristics and advantages thereof will appear, in reference to the accompanying drawings, showing by way of example, a preferred embodiment of the prosthesis to which it relates. La figure 1 en est une vue en perspective ; Figure 1 is a perspective view; ia figure 2 en est une vue de côté ; ia Figure 2 is a side view; 5 la figure 3 en est une vue de dessus ; 5 Figure 3 is a top view; la figure 4 en est une vue similaire à la figure 2, après implantation dans deux phalanges ; Figure 4 is a view similar to Figure 2, after implantation in two phalanges; et la figure 5 en est une vue similaire à la figure 2, selon une variante de réalisation. and Figure 5 is a view similar to Figure 2, according to one embodiment.

Les figures 1 à 4 représentent une prothèse d'articulation 1 pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatartienne, qui comprend deux tiges médullaires 2 d'ancrage osseux et une partie centrale déformable 3 destinée à occuper l'espace articulaire. Figures 1 to 4 show a joint prosthesis for one interphalangeal joint or phalango-metacarpal or phalangométatartienne which comprises two rods 2 medullary bone anchor and a deformable central portion 3 intended to occupy the joint space. Cette prothèse 1 est constituée en une seule pièce de matériau métallique élastiquement déformable, notamment en l'alliage de nickel et de titane connu sous la dénomination "NITINOL". The prosthesis 1 is made of a single piece of elastically deformable metallic material, in particular the alloy of nickel and titanium known under the name "NITINOL." Les tiges médullaires 2 présentent, du côté opposé à la partie centrale 3, des parties médullaires 2a et, du côté de cette partie centrale 3, un rebord d'appui 2b. Spinal rods 2 have, on the side opposite to the central portion 3, portions medullary 2a and the side of this central part 3, a support flange 2b.

Chaque partie 2a a une section transversale substantiellement carrée et est légèrement effilée en direction de son extrémité opposée à la partie centrale 3, cette forme permettant à chaque tige 2 de pouvoir être engagée étroitement dans le canal médullaire de l'un des os de l'articulation traitée, avec calage en pivotement selon l'axe longitudinal de l'os. Each part 2a has a substantially square cross section and is slightly tapered towards its end opposite the central portion 3, this form enabling each rod 2 can be closely engaged in the medullary canal of a bone of treated joint with pivoting wedge along the longitudinal axis of the bone. Chaque partie 2a présente par ailleurs un aspect de surface rugueux, obtenu par exemple par grenaillage de sa surface, cet aspect de surface rugueux permettant d'assurer l'immobilisation de la tige 2 par rapport à l'os dans lequel elle est implantée par croissance des cellules osseuses le long de la partie 2a. Each part 2 also presents a rough surface appearance, obtained for example by blasting its surface, the rough surface appearance to ensure the immobilization of the rod 2 relative to the bone in which it is implanted by growth bone cells along the portion 2a. Chaque rebord 2b fait saillie de la tige 2 sur trois côtés de celle-ci, c'est- à-dire latéralement de part et d'autre de la tige 2, et en direction du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire s'agissant d'une articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne. Each edge 2b protrudes from the rod 2 on three sides thereof, that is to say, laterally from either side of the rod 2, and towards the joint side processed on which is realized the flexing movement of the hinge, that is to say generally the palmar side in the case of an inter-phalangeal or phalango-metacarpal or phalangométatarsienne joint.

6 La partie centrale 3 est constituée par une lame 5 présentant .une forme ondulée. 6 The central portion 3 is constituted by a plate 5 having .a corrugated shape. La lame 5 a une largeur orientée perpendiculairement au plan dans lequel se réalise la mobilité articulaire d'un os par rapport à l'autre et une épaisseur orientée parallèlement à ce plan, ladite largeur étant nettement supérieure à ladite épaisseur, d'un rapport compris entre environ 10 à 1 ou 15 à 1 ainsi que cela apparaît par comparaison des figures 2 et 3. Elle comprend deux portions arrondies latérales 5a reliées chacune à l'une des tiges 2, une portion arrondie centrale 5b et deux portions rectilignes 5c reliant chaque portion latérale 5a à la portion centrale 5b. The blade 5 has a width oriented perpendicular to the plane in which the joint mobility is realized of a bone relative to each other and a thickness oriented parallel to this plane, said width being substantially greater than said thickness, a ratio between about 10-1 or 15-1 as is apparent by comparison of figures 2 and 3. It comprises two lateral rounded portions 5a each connected to one of the rods 2, a central rounded portion 5b and 5c two rectilinear portions connecting each side portion 5a to the central portion 5b. Chaque portion latérale 5a s'étend sur un arc de l'ordre de 90 à 100 degrés ; Each side portion 5a extends over an arc of the order of 90 to 100 degrees; la portion centrale 5b s'étend sur un arc de l'ordre de 180 degrés ; the central portion 5b extends over an arc of about 180 degrees; les portions rectilignes 5c divergent l'une de l'autre dans la direction du côté de l'articulation sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire, formant entre elles un angle de 30 degrés. the rectilinear portions 5c diverge from each other in the direction of the side of the joint on which performs the bending movement of the joint, that is to say generally the palmar side, forming between them an angle 30 degrees. Comme cela est particulièrement visible sur les figures 2 et 4, lesdites portions rectilignes 5c et la portion arrondie centrale 5b forment une partie médiane 5d de la lame 5 faisant saille dans le sens transversal de la prothèse 1, c'est-à-dire perpendiculairement à la direction longitudinale de cette prothèse. As is particularly visible in Figures 2 and 4, said rectilinear portions 5c and the central rounded portion 5b form a middle portion 5d of the blade 5 by projecting in the transverse direction of the prosthesis 1, that is to say perpendicularly to the longitudinal direction of the prosthesis. Cette partie médiane 5d est dirigée, après implantation, du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire (cf. figure 4). This middle portion 5d is directed after implantation, the side of the treated joint on which performs the bending movement of the joint, that is to say generally the palmar side (cf. Figure 4). La lame 5, de par sa structure, permet d'obtenir une capacité appropriée de déformation de la partie centrale 3 de la prothèse 1 dans le sens de la flexion, c'est-à-dire dans le sens du pivotement d'un os (phalange) dans la direction palmaire par rapport à l'autre os (phalange ou métacarpe ou métatarse) tout en ayant une capacité appropriée de rappel élastique en position neutre. The blade 5, by its structure, allows to obtain an appropriate capacity for deformation of the central portion 3 of the prosthesis 1 in the direction of bending, that is to say in the direction of pivoting of a bone (phalanx) in palmar direction with respect to the other bone (phalanx or metacarpal or metatarsal) while having an appropriate capacity for elastic return in the neutral position. La déformation en flexion de cette partie centrale 3 est réalisée par le tendon fléchisseur de l'articulation, qui subsiste après implantation, et le retour en position neutre d'alignement des deux os concernés est réalisé par le rappel élastique de la lame 5, en suppléance du tendon extenseur, généralement sacrifié lors de l'implantation de la prothèse 1 ou en mauvais état chez de nombreux patients. The bending deformation of the central portion 3 is performed by the flexor tendon of the joint, that remains after implantation, and the return to the neutral position of alignment of the two bones concerned is achieved by the resilient return of the blade 5, in replacement of the extensor tendon, usually sacrificed during the implantation of the prosthesis 1 or in poor condition in many patients. La partie médiane saillante 5d de la lame 5 permet, par les déformations conjointes des parties arrondies 5a 7 et 5b d'obtenir une amplitude de flexion importante ainsi qu'une force de rappel élastique appropriée. The protruding middle portion 5d of the blade 5 allows, by the joint deformation of rounded portions 5a and 5b 7 to obtain a large flexural amplitude and an appropriate elastic restoring force. En cas de mouvement d'extension extrême de l'articulation, les zones des portions rectilignes 5c raccordées auxdites portions arrondies latérales 5a 5 sont susceptibles de venir au contact l'une avec l'autre, limitant ainsi la déformation de la partie centrale 3 de la prothèse dans ce sens. In the event of extreme movement of extension of the joint, the zones of rectilinear portions 5c connected to said side rounded portions 5a 5 may come into contact with each other, thereby limiting deformation of the central portion 3 of the prosthesis in this direction. La lame 5 a par ailleurs sa largeur orientée perpendiculairement audit plan dans lequel se réalise le mouvement de flexion, conférant à la prothèse une rigidité importante dans la direction transversale à ce plan, c'est-à-dire 10 dans la direction médio-latérale de l'articulation traitée. The blade 5 has also its width oriented perpendicular to said plane in which performs the bending movement, giving the prosthesis a high rigidity in the transverse direction to said plane, that is to say 10 in the mediolateral direction of the treated joint. Cette rigidité assure un parfait contrôle du mouvement de l'articulation dans cette direction. This rigidity ensures perfect control of joint movement in this direction. Il en est de même du contrôle du mouvement d'un os en rotation longitudinale par rapport à l'autre os. It is the same movement control of a longitudinal rotating bone with respect to the other bone. La prothèse 1 reproduit ainsi le mouvement de flexion-extension d'une 15 articulation inter-phalangienne ou phalango-métacarpienne ou phalango- métatarsienne dans les meilleures conditions. The prosthesis 1 thus reproduces the flexion-extension movement of an interphalangeal joint 15 or phalango-metacarpal or metatarsal phalango- in the best conditions. À titre purement indicatif, les dimensions suivantes peuvent être données pour la prothèse 1 selon invention : - longueur totale de la prothèse : 24 mm ; As a guide only, the following dimensions may be given to the prosthesis 1 according to the invention: - total length of the prosthesis: 24 mm; 20 - largeur des parties 2a des tiges médullaires 2 au niveau des rebords 2b : 2 à 2,5 mm ; 20 - width portions 2a spinal rods 2 at the edges 2b: 2 to 2.5 mm; - rayon de génération des portions arrondies 5a et 5b, au niveau des faces concaves de ces portions : 0,625 mm ; - generating radius rounded portions 5a and 5b at the concave faces of these portions: 0.625 mm; - largeur de la lame 5 : 3,5 mm ; - width of the blade 5: 3.5 mm; 25 - épaisseur de la lame 5 : 0,25 mm ; 25 - thickness of the blade 5: 0.25 mm; - dimension, dans le sens transversal de la prothèse 1, de ladite partie médiane saillante 5d, depuis les faces convexes des portions arrondies 5a jusqu'à la face convexe de la portion arrondie 5b : 5 mm. - dimension in the transverse direction of the prosthesis 1, said projecting middle portion 5d, since the convex faces of rounded portions 5a to the convex side of the rounded portion 5b: 5 mm. La figure 5 montre une variante de réalisation possible de la prothèse 1, 30 dans laquelle la lame 5 présente une épaisseur moindre, de l'ordre de 0,125 mm et dans laquelle l'une des tiges médullaires 2 s'étend selon une direction longitudinale non sensiblement parallèle à celle de l'autre tige médullaire 2, l'angle formé par les deux directions longitudinales de ces deux tiges médullaires étant de l'ordre de deux 170 degrés. Figure 5 shows a possible embodiment of the prosthesis 1, 30 in which the blade 5 has a smaller thickness, of the order of 0.125 mm and wherein one of the two spinal rods extends in a longitudinal direction not substantially parallel to that of the other spinal rod 2, the angle formed by the two longitudinal directions of the two spinal rods being of the order of two 170 degrees.

8 Comme cela apparaît de ce qui précède, l'invention fournit une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalango-métatarsienne présentant de nombreux avantages par rapport aux prothèses homologues de la technique antérieure, en particulier ceux de : - permettre un mouvement contrôlé et limité d'un os par rapport à l'autre, particulièrement dans le sens du mouvement d'extension de l'articulation et dans la direction médio-latérale, - de ne pas générer de diffusion de particules du matériau constituant la prothèse, et - de rester relativement facile à fabriquer. 8 As appears from the above, the invention provides a joint prosthesis for interphalangeal joint or phalango-metacarpal or metatarsal-phalango with many advantages over the prior art prostheses counterparts, particularly those of: - allow controlled and limited movement of a bone relative to each other, particularly in the direction of movement of extension of the joint and in the medio-lateral direction - not generate scattering particles of the material constituting the prosthesis, and - to remain relatively easy to manufacture. L'invention a été décrite ci-dessus en référence à une forme de réalisation donnée à titre de pur d'exemple. The invention has been described above with reference to an embodiment given purely as an example. Il va de soi qu'elle n'est pas limitée à cette forme de réalisation mais qu'elle s'étend à toutes les formes de réalisations couvertes par les revendications ci-annexées. Obviously it is not limited to this embodiment but that it extends to all embodiments covered by the appended claims. Ainsi, ladite partie centrale déformable 3 de la prothèse pourrait présenter une forme en "U" ou en "V" en lieu et place d'une forme ondulée. Whereby said deformable 3 of the prosthesis central portion could have a shape of a "U" or "V" in lieu of a corrugated shape.

Claims (3)

REVENDICATIONS
1 û Prothèse d'articulation (1) pour articulation inter-phalangienne ou phalango-métacarpienne ou phalango-métatartienne, comprenant deux parties latérales (2) d'ancrage osseux et une partie centrale déformable (3) 5 destinée à occuper l'espace articulaire, caractérisée en ce que : - ladite partie centrale déformable (3) comprend au moins une lame (5) en matériau élastique, dont l'épaisseur est orientée dans une direction parallèle au plan de la mobilité articulaire d'un os par rapport à l'autre, et - ladite lame (5) forme une partie médiane (5d) saillante dans le sens 10 transversal, dirigée, après implantation, du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation. 1 û joint prosthesis (1) for inter-phalangeal joint or phalango-metacarpal or phalango-métatartienne comprising two side parts (2) bone anchor and a deformable central portion (3) 5 intended to occupy the joint space characterized in that: - said deformable central portion (3) comprises at least one blade (5) of resilient material whose thickness is oriented in a direction parallel to the plane of the joint mobility of a bone with respect to the other, and - said blade (5) form a central portion (5d) projecting in the transverse direction 10, directed after implantation, the side of the treated joint on which performs the bending movement of the joint.
2 û Prothèse (1) selon la revendication 1, caractérisée en ce que ladite lame (5) présente une forme ondulée, c'est-à-dire comprend deux portions arrondies latérales (5a) reliées chacune à l'une des parties d'ancrage (2) et 15 une portion arrondie centrale (5b) formant ladite partie médiane saillante (5d). 2 û prosthesis (1) according to Claim 1, characterized in that said blade (5) has a corrugated shape, that is to say comprises two lateral rounded portions (5a) each connected to one of the parts of anchor (2) and 15 a central rounded portion (5b) forming said protruding central portion (5d).
3 û Prothèse (1) selon la revendication 2, caractérisée en ce que chaque portion arrondie latérale (5a) s'étend sur un arc de l'ordre de 90 à 100 degrés et se raccorde à une portion rectiligne (5c) elle-même raccordée, par son autre extrémité, à ladite portion arrondie centrale (5b). 3 û prosthesis (1) according to claim 2, characterized in that each lateral rounded portion (5a) extends over an arc of the order of 90 to 100 degrees and is connected to a straight portion (5c) itself connected by its other end to said central rounded portion (5b). 20 4 û Prothèse (1) selon la revendication 2 ou la revendication 3, caractérisée en ce que ladite portion arrondie centrale (5b) s'étend sur un arc de l'ordre de 180 degrés. 20 4 U prosthesis (1) according to claim 2 or claim 3, characterized in that said central curved portion (5b) extends over an arc of about 180 degrees. û Prothèse (1) selon la revendication 3 ou la revendication 4, caractérisée en ce que lesdites portions rectilignes (5c) divergent dans la 25 direction dudit côté de l'articulation sur lequel se réalise le mouvement de flexion de cette articulation. û prosthesis (1) according to claim 3 or claim 4, characterized in that said rectilinear portions (5c) diverge in the direction of said side 25 of the joint on which performs the bending movement of the joint. 6 û Prothèse (1) selon la revendication 5, caractérisée en ce que l'angle formé par lesdites portions rectilignes (5c) est de l'ordre de 30 degrés. 6 û prosthesis (1) according to claim 5, characterized in that the angle formed by said straight portions (5c) is of the order of 30 degrees. 7 û Prothèse (1) selon l'une des revendications 1 à 6, caractérisée en ce 30 que lesdites parties d'ancrage sont constituées par des tiges médullaires (2) destinées à être engagées étroitement dans le canal médullaire des os traités. 7 û prosthesis (1) according to one of claims 1 to 6, characterized in 30 that said anchor portions are formed by spinal rods (2) intended to be engaged tightly in the medullary canal of the treated bone. 8 û Prothèse (1) selon la revendication 7, caractérisée en ce qu'au moins une de ces tiges médullaires (2) comprend un aspect de surface ou un revêtement propre à assurer son immobilisation par rapport à l'os dans lequelelle est implantée par croissance des cellules osseuses le long de cette tige médullaire (2). 8 û prosthesis (1) according to claim 7, characterized in that at least one of said spinal rods (2) comprises a surface finish or coated so as to ensure its immobilisation with respect to the bone in lequelelle is implanted bone cell growth along the medullar pin (2). 9 ù Prothèse (1) selon l'une des revendications 1 à 8, caractérisée en ce que sa partie centrale (3) présente une largeur supérieure à celle des parties d'ancrage (2). 9 ù prosthesis (1) according to one of claims 1 to 8, characterized in that its central portion (3) has a width greater than that of the anchoring portions (2). ù Prothèse (1) selon l'une des revendications 1 à 9, caractérisée en ce qu'au moins une partie d'ancrage (2) présente un rebord (2b) ou une collerette destiné à prendre appui contre l'os dans lequel cette partie d'ancrage (2) est destinée à être implantée. ù prosthesis (1) according to one of claims 1 to 9, characterized in that at least one anchoring portion (2) has a flange (2b) or a collar intended to bear against the bone in which this anchoring portion (2) is intended to be implanted. 10 11 ù Prothèse (1) selon l'une des revendications 1 à 10, caractérisée en ce qu'elle est réalisée en un matériau métallique, notamment en l'alliage de nickel et de titane connu sous la dénomination "NITINOL". 10 11 ù prosthesis (1) according to one of claims 1 to 10, characterized in that it is made of a metallic material, in particular nickel and titanium alloy known under the name "NITINOL."
FR0800808A 2008-02-14 2008-02-14 A joint prosthesis for interphalangeal joint or phalango-metacarpal or phalango-metatarsal Expired - Fee Related FR2927529B1 (en)

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US9724140B2 (en) 2010-06-02 2017-08-08 Wright Medical Technology, Inc. Tapered, cylindrical cruciform hammer toe implant and method
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US9808296B2 (en) 2014-09-18 2017-11-07 Wright Medical Technology, Inc. Hammertoe implant and instrument
US10080597B2 (en) 2014-12-19 2018-09-25 Wright Medical Technology, Inc. Intramedullary anchor for interphalangeal arthrodesis

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