GB2126094A - Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist - Google Patents

Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist Download PDF

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Publication number
GB2126094A
GB2126094A GB08224523A GB8224523A GB2126094A GB 2126094 A GB2126094 A GB 2126094A GB 08224523 A GB08224523 A GB 08224523A GB 8224523 A GB8224523 A GB 8224523A GB 2126094 A GB2126094 A GB 2126094A
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United Kingdom
Prior art keywords
wrist
device
member
forearm
bones
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
GB08224523A
Inventor
Brian Norman Atkins
John Clegg
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Clegg John
Original Assignee
Clegg John
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Clegg John filed Critical Clegg John
Priority to GB08224523A priority Critical patent/GB2126094A/en
Publication of GB2126094A publication Critical patent/GB2126094A/en
Application status is Withdrawn legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64Devices extending alongside the bones to be positioned
    • A61B17/6425Devices extending alongside the bones to be positioned specially adapted to be fitted across a bone joint

Abstract

A device may be used either for holding the bones of the forearm adjacent the wrist after they have been set following fracture or for holding the bones of the forearm and the wrist during arthrodesis comprises a pair of elongate members. Each member comprises two longitudinally adjustable parts 21, 22 and two end clamps 27, 33 for a pair of Kirschner wires 29, 34. One end clamp 33 can move relatively to the part 21 without exerting any contracting force and the other end 27 is fixed to the part 22 and so is adjustable to effect positive extension and contraction. The part 21 may also carry a third Kirschner wire 36. The device is used for holding a set fracture by using the members with the wire 36 and only one or other of the wires 29 and 36 and for arthrodesis by fitting all three wires. <IMAGE>

Description

SPECIFICATION Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist The invention relates to a device for holding the bones of the wrist and forearm in positions to which they have been set after fracture or during arthrodesis of the wrist.

The invention is particularly concerned with such a device for use after fractures of the ulna or radius at the wrist joint or for use during arthrodesis of the wrist.

The fracture for which the device is especially intended to be used is a displaced fracture at the lower extremity or distal end of the radius that is the Colles or Smith type of fracture, which may occur in younger patients. In such a fracture there is a tendency for fore-shortening of the fore-arm to occur due to the pull of the muscles. The usual method of treatment is fixation in plaster of paris or where the fractured bone portions do not remain in the correct position, it may be necessary for the arm and wrist to be opened and internal fixation may be necessary to immobilise the bones.An object of the invention is to provide a device which will hold the fractured bone portions in the correct position and in distraction to counteract the pull of the forearm muscles without the need for open surgery and by which adjustment of the position of the bone portions can be effected from outside the arm.

According to the invention, the device comprises a pair of elongate members, each of adjustable length and each having individual adjustment means by which the length of the member can be adjusted, each member having adjacent the outer ends thereof clamping means for engagement with a pair of pins or wires which are to be passed transversely through the forearm and at least one bone or bone portion thereof to project from opposite sides of the forearm, each member being individually adjustable by said adjustment means to hold the pair of pins or wires in required relative positions and at a required spacing therebetween, as determined by the positions in which the bones or bone portions have been set or are to be held and the positions at which the pins or wires pass therethrough.

In one simple form of the device, primarily intended for fixing set bones of the forearm adjacent the wrist after fracture, each member may comprise a pair of relatively-adjustable parts and the adjusting means acts therebetween only to extend the member, thereby to enable the member to act as a strut, and is adjustable to permit the member to be contracted but without exerting any contracting force between the ends thereof, whereby the member cannot act as a tie.

In another simple form of the device, primarily intended for effecting arthrodesis of the wrist, each member may comprise a pair of relatively adjustable parts, the adjusting means acting therebetween positively both to extend and contract the member, whereby each member can act either as a strut or as a tie.

In yet another form of the device each member may comprise three parts, namely a centre part and two end parts providing the clamping means, one end part and the centre part being relatively adjustable and having first adjusting means acting therebetween only to effect extension between the centre part and said one end part and adjustable to permit said centre part and said one end part to be contracted but without exerting any contracting force between the centre portion and said one end part, and the other end part and the centre part being relatively adjustable and having second adjusting means acting therebetween to effect positive extension and contraction between said other end part and the centre part, the centre part of each member also having third clamping means thereon whereby a third pin or wire positioned between the other two pins or wires can be passed transversely through the bones of the forearm and secured at its ends to third clamping means.

By way of example two forms of the device and their use are now described with reference to the accompanying drawings in which:~ Figure 1 is a part elevation and part-sectional view of the first form of the device which is intended to be used for fixing bones of the forearm adjacent the wrist after they have been set following fracture; Figure 2 is a diagram showing how the device illustrated in Figure 1 is to be used for fixing fractured bone portions after a fracture of the lower extremity or distal end of the radius and ulna; Figure 3 is an elevation of the second form of the device which is intended primarily to be used during the arthrodesis of the wrist; Figure 4 is a sectional view of part of the device shown in Figure 3;; Figure 5 is a diagram showing how the device illustrated in Figures 3 and 4 is used during the arthrodesis of the wrist, and Figure 6 is a drawing of the skeleton of the hand and wrist prior to fitting the device as illustrated in Figure 5.

The first form of the device shown in Figure 1, comprises a pair of elongate members, each consisting of a tube 1 in which an externally screw-threaded rod 2 is freely slidable. Each rod 2 carries an adjusting nut 3 which engages the screw-thread on the rod 2 and abuts loosely against an end 4 of the respective tube 1. Each tube 1 has at the end remote from the rod 2 a solid end portion 5 having a transverse hole 6 therein for receiving a pin 7 and a clamping screw 8 for gripping the pin 7. Similarly each rod 2 has at the end remote from the tube 1 a transverse hole 9 for receiving a pin 10 and a clamping screw 1 1 for gripping the pin 10.

The device shown in Figure 1 is intended to be used for fixing the broken bone portions in transverse fractures of the lower extremity or distal end of the ulna or radius, or both, as shown in Figure 2. When these bone portions have been set by manipulation there is a tendency for the muscles to cause contraction or displacement of the bone portions thereby requiring re-setting or manipulation to avoid permanent disability of the wrist. The conventional method of fixing the bone portions in transverse fractures of the ulna or radius, that is in the Colles or Smith type of fracture, is immobilisation in plaster of paris of the wrist and adjacent part of the arm and where the bone portions do not remain in their correct positions to insert a plate to which the bone portions are permanently pinned. Open surgery of this kind is undesirable.By using the device provided by this invention open surgery is not required. Instead the pins 7 and 10 are inserted through the forearm, indicated at 12, under anaesthetic. Kirschner wires may be used as the pins 7 and 10. The device is fitted as follows. After manipulating the fracture to the correct position and manually holding the fracture to the correct length the first Kirschner wire 10 is passed through the distal portion 13, 14 of the ulna 1 5 and radius 16 respectively at an angle of approximately 200 to their shafts. Then the second Kirschner wire 7 is passed transversely through the shafts of the ulna and radius approximately parallel to the wire 10 at a distance of about 5 cms.One member consisting of the tube 1 and the rod 2 is then fitted on to the ends of the wires 7 and 10 at the side of the radius 16 and adjusted to length and the wires 7 and 10 are gripped by tightening the screws 1 1 and 8. The the other member is similarly fitted at the side of the ulna 1 5 and is made slightly shorter by adjustment of the nut 3 so that the wires 7 and 10 are not quite parallel as shown. The relative lengths of the two members are carefully adjusted so that the bone portions 13 and 14 are correctly located with respect to the shafts of the ulna 1 5 and radius 16. The muscles of the arm and wrist will tend to pull the two wires 7 and 10 towards each other but this is resisted by the two members acting as struts so that contraction of the arm is avoided.As the rods 2 are not fixed to the tubes 1 and the nuts 3 merely rest on the adjacent ends of the tubes 1, the two members cannot act as ties and therefore cannot effect any contraction of the bone portions. With this device the surgeon can make periodical inspection by radiology and if necessary effect adjustment of the bone portions by merely turning one or other or both of the nuts 3, thereby avoiding surgery as hitherto. For the comfort of the patient, plaster slabs may be applied to the arm after the fitting of the device, leaving the wrist joint free. The device is left in position for 5-6 weeks while the bone portions fuse together. The adjustable members 1 and 2 are then removed from the wires 7 and 10 and these are then removed from the arm under local anaesthetic.The device shown in Figures 1 and 2 and provided by this invention therefore enables a transverse fracture of the ulna or radius, or both, to be set and cured without open surgery of the arm and wrist and ensures that permanent displacement of the ulna and radius do not occur and also enables temporary displacement to be corrected without surgery.

The second form of the device shown in Figures 3 and 4 is intended primarily for use in the arthrodesis of the wrist as will be explained with reference to Figures 5 anu 6. The device shown in Figures 3 and 4 comprises a pair of elongate members each consisting of a tube 21 having an internal screwthread 23 which is engaged by a screw-threaded rod 22. Thus in this case the rod 22 is movable longitudinally within the tube 21 to effect elongation or contraction of the member.

The upper end of each rod 22, as shown in Figure 4, carries an end plate or flange 24 and an inverted cup-shaped wheel or nut 25 fixed thereto, for example by brazing or welding, by which the rod 22 is turned in the tube 21. The wheel or nut 25 contains the head 26 of a connector having a shank 27 through which there is a transverse hole 28 through which in use a pin 29 is passed.

The pin 29 is secured to the shank of the connector 26 by a clamping screw 30. The lower end, as shown, of each tube 21 contains a loosely fitting screw-threaded rod 31 having a nut 32 mounted thereon. The nut can be adjusted longitudinally of the rod 31 and abuts against the adjacent end face of the tube 21. The lower end, as shown, of the rod 31 has an end portion 33 having a transverse hole therein which in use, is passed a pin 34 which is clamped to the end portion 33 by a clamping screw 35 engaging a screw-threaded socket in the end face of the end portion 33. The lower parts of each member are therefore substantially the same as the corresponding items 1, 2, 3 and 8 of the member shown in Figure 1.The tube 21 of each member shown in Figure 3 also has a transverse hole intermediate in its length to receive a further pin 36 and a clamping screw 37 which is screwed into the tube 21 to grip the pin 36.

As aforesaid, the second form of the device is used for the arthrodesis of the wrist. Figure 6 shows the skeleton of the wrist before arthrodesis.

When arthrodesis is to be performed, the normally co-operating adjacent surfaces of the bones of the carpus 37 and the ulna 38 and radius 39 are cut away to provide abutting flat surfaces at 40 in Figure 5. A pair of Kirschner wires, these being the pins 34 and 36, are passed through arm 41 and the ulna 38 and radius 39 at substantially parallel positions near to the distal ends of the ulna and radius and are connected to the tubes 21 and the end portions 33 of the rods 31 by the clamping screws 37 and 35 respectively. The wires 34 and 36 are held from separation by the ulna and radius and are lightly located by adjustment of the nuts 32 whereby the tubes 21 and rods 31 together form a pair of struts but cannot act as ties as the rods 31 are freely slidable with respect to the tubes 21. Then the third pin 29, also a Kirschner wire, is passed through the carpus at a position which will allow accurate location of the flat surfaces 40. The rod 22 of each member is adjusted to approximately its mid-position in the respective tube 21 by turning the wheel 25 and then the Kirschner wire 29 is clamped at each end by the clamping screws 30. The surfaces 40 are then clamped together by pulling the wire 29 towards the wires 36 and 34 in the direction of arrows 42 by turning the wheels 25 in the appropriate directions. The rods 22 and the tubes 21 therefore together form ties clamping the carpus to the ulna and radius. The device and the wrist are then encased in plaster of paris.When radiological inspection has shown that the bones of the carpus and the ulna and radius have permanently fused together, the members are removed from the Kirschner wires and the latter are withdrawn under local anaesthetic.

Although for the arthrodesis of the wrist it is necessary to use all three pins or Kirschner wires 29, 36 and 34, there may be applications where one of the pins 36 or 34 need not be used. Also the second form of the device as shown in Figures 3 and 4 could be used to secure a fracture instead of using the first form of the device merely by omitting to use one of the pins or Kirschner wires 29 or 36. The members together with the other pins or Kirschner wires 29 or 36 and 34 are then equivalent to the members and Kirschner wires shown in Figure 1. The form of the device shown in Figure 3 can therefore be used both for securing a fracture and for effecting arthrodesis.

Claims (7)

1. A device for holding the bones of the wrist and forearm in positions to which they have been set after fracture or during arthrodesis of the wrist, the device comprising a pair of elongate members, each of adjustable length and each having individual adjustment means by which the length of the member can be adjusted, each member having adjacent the outer ends thereof clamping means for engagement with a pair of pins or wires which are to be passed transversely through the forarm and the ulna and the radius or portions thereof to project from opposite sides of the forearm and the ulna and the radius or portions adjustable by said adjustment means to hold the pair of pins or wires in required relative positions and at a required spacing therebetween, as determined by the positions in which the bones or bone portions have been set or are to be held and the positions at which the pins or wires pass therethrough.
2. A device according to Claim 1 and primarily intended for fixing set bones of the forearm adjacent the wrist after fracture, in which device, each member comprises a pair of relativeiyadjustable parts and the adjusting means acts therebetween only to extend the member, thereby to enable the member to act as a strut, and is adjustable to permit the member to be contracted but without exerting any contracting force between the ends thereof, whereby the member cannot act as a tie.
3. A device according to Claim 1 and primarily intended for effecting arthrodesis of the wrist, in which device each member comprises a pair of relatively adjustable parts, the adjusting means acting therebetween positively both to extend and contract the member, whereby each member can act either as a strut or as a tie.
4. A device according to Claim 1 in which each member comprises three parts, namely a centre part and two end parts providing the clamping means, one end part and the centre part being relatively adjustable and having first adjusting means acting therebetween only to effect extension between the centre part and said one end part and adjustable to permit said centre part and said one end part to be contracted but without exerting any contracting force between the centre portion and said one end part, and the other end part and the centre part being relatively adjustable and having second adjusting means acting therebetween to effect positive extension and contraction between said other end part and the centre part, the centre part of each member also having third clamping means thereon whereby a third pin or wire positioned between the other two pins or wires can be passed transversely through the ulna and the radius of the forearm and secured at its ends to third clamping means.
5. A device for holding the bones of the forearm adjacent the wrist after they have been set following fracture constructed and arranged substantially as described herein and shown in Figures 1 and 2 of the accompanying drawings.
6. A device for holding the bones of the wrist and forearm during the arthrodesis of wrist constructed and arranged substantially as described herein and shown in Figures 3-5 of the accompanying drawings.
7. A device which may be used either for holding the bones of the forearm adjacent the wrist after they have been set following fracture or for holding the bones of the forearm and the wrist during arthrodesis constructed in accordance with Figures 3 and 4 of the accompanying drawings.
GB08224523A 1982-08-26 1982-08-26 Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist Withdrawn GB2126094A (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
GB08224523A GB2126094A (en) 1982-08-26 1982-08-26 Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist

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Application Number Priority Date Filing Date Title
GB08224523A GB2126094A (en) 1982-08-26 1982-08-26 Device for holding the bones of the wrist and forearm after setting or during arthrodesis of the wrist

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GB2126094A true GB2126094A (en) 1984-03-21

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Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4968316A (en) * 1988-12-12 1990-11-06 Hergenroeder Patrick T Arthroscopic ankle joint distraction method
EP0566561A1 (en) * 1992-04-16 1993-10-20 POHL, Anthony Philip External bone fixation device
US6080155A (en) * 1988-06-13 2000-06-27 Michelson; Gary Karlin Method of inserting and preloading spinal implants
US6096038A (en) 1988-06-13 2000-08-01 Michelson; Gary Karlin Apparatus for inserting spinal implants
US6123705A (en) 1988-06-13 2000-09-26 Sdgi Holdings, Inc. Interbody spinal fusion implants
US6149650A (en) 1988-06-13 2000-11-21 Michelson; Gary Karlin Threaded spinal implant
US6210412B1 (en) 1988-06-13 2001-04-03 Gary Karlin Michelson Method for inserting frusto-conical interbody spinal fusion implants
US6224595B1 (en) 1995-02-17 2001-05-01 Sofamor Danek Holdings, Inc. Method for inserting a spinal implant
US6436098B1 (en) 1993-06-10 2002-08-20 Sofamor Danek Holdings, Inc. Method for inserting spinal implants and for securing a guard to the spine
US6758849B1 (en) 1995-02-17 2004-07-06 Sdgi Holdings, Inc. Interbody spinal fusion implants
US6770074B2 (en) 1988-06-13 2004-08-03 Gary Karlin Michelson Apparatus for use in inserting spinal implants
WO2008075097A1 (en) * 2006-12-20 2008-06-26 Medica Surgical Innovations Limited A joint fixator
US7691148B2 (en) 1995-06-07 2010-04-06 Warsaw Orthopedic, Inc. Frusto-conical spinal implant
US7828800B2 (en) 1995-06-07 2010-11-09 Warsaw Orthopedic, Inc. Threaded frusto-conical interbody spinal fusion implants
US8066705B2 (en) 1988-06-13 2011-11-29 Warsaw Orthopedic, Inc. Instrumentation for the endoscopic correction of spinal disease
CN104274238A (en) * 2014-10-21 2015-01-14 中国人民解放军第三军医大学第二附属医院 Fluoroscopic stereoscopic femoral neck localizing device

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB347495A (en) * 1930-05-09 1931-04-30 Earl Edward Youngren Improvements in and relating to surgical apparatus
GB421788A (en) * 1933-06-29 1934-12-31 Eloi Renevey Apparatus for the treatment of bone-fractures
GB567715A (en) * 1943-05-18 1945-02-28 Roger Anderson Fracture splints
GB1374511A (en) * 1971-03-16 1974-11-20 Riniker P Fixator for fractures of diaphyses
GB1481585A (en) * 1975-06-10 1977-08-03 Tsnii Travmatol I Ortoped Im N Apparatus for surgical treatment of fractured bones or of bone joints

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB347495A (en) * 1930-05-09 1931-04-30 Earl Edward Youngren Improvements in and relating to surgical apparatus
GB421788A (en) * 1933-06-29 1934-12-31 Eloi Renevey Apparatus for the treatment of bone-fractures
GB567715A (en) * 1943-05-18 1945-02-28 Roger Anderson Fracture splints
GB1374511A (en) * 1971-03-16 1974-11-20 Riniker P Fixator for fractures of diaphyses
GB1481585A (en) * 1975-06-10 1977-08-03 Tsnii Travmatol I Ortoped Im N Apparatus for surgical treatment of fractured bones or of bone joints

Cited By (31)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7722619B2 (en) 1988-06-13 2010-05-25 Warsaw Orthopedic, Inc. Method of maintaining distraction of a spinal disc space
US8758344B2 (en) 1988-06-13 2014-06-24 Warsaw Orthopedic, Inc. Spinal implant and instruments
US6080155A (en) * 1988-06-13 2000-06-27 Michelson; Gary Karlin Method of inserting and preloading spinal implants
US6096038A (en) 1988-06-13 2000-08-01 Michelson; Gary Karlin Apparatus for inserting spinal implants
US6123705A (en) 1988-06-13 2000-09-26 Sdgi Holdings, Inc. Interbody spinal fusion implants
US6149650A (en) 1988-06-13 2000-11-21 Michelson; Gary Karlin Threaded spinal implant
US6210412B1 (en) 1988-06-13 2001-04-03 Gary Karlin Michelson Method for inserting frusto-conical interbody spinal fusion implants
US8734447B1 (en) 1988-06-13 2014-05-27 Warsaw Orthopedic, Inc. Apparatus and method of inserting spinal implants
US6264656B1 (en) 1988-06-13 2001-07-24 Gary Karlin Michelson Threaded spinal implant
US8353909B2 (en) 1988-06-13 2013-01-15 Warsaw Orthopedic, Inc. Surgical instrument for distracting a spinal disc space
US8251997B2 (en) 1988-06-13 2012-08-28 Warsaw Orthopedic, Inc. Method for inserting an artificial implant between two adjacent vertebrae along a coronal plane
US6770074B2 (en) 1988-06-13 2004-08-03 Gary Karlin Michelson Apparatus for use in inserting spinal implants
US8066705B2 (en) 1988-06-13 2011-11-29 Warsaw Orthopedic, Inc. Instrumentation for the endoscopic correction of spinal disease
US7686805B2 (en) 1988-06-13 2010-03-30 Warsaw Orthopedic, Inc. Methods for distraction of a disc space
US7914530B2 (en) 1988-06-13 2011-03-29 Warsaw Orthopedic, Inc. Tissue dilator and method for performing a spinal procedure
US4968316A (en) * 1988-12-12 1990-11-06 Hergenroeder Patrick T Arthroscopic ankle joint distraction method
EP0566561A1 (en) * 1992-04-16 1993-10-20 POHL, Anthony Philip External bone fixation device
US7887565B2 (en) 1993-06-10 2011-02-15 Warsaw Orthopedic, Inc. Apparatus and method for sequential distraction
US6436098B1 (en) 1993-06-10 2002-08-20 Sofamor Danek Holdings, Inc. Method for inserting spinal implants and for securing a guard to the spine
US7993347B1 (en) 1993-06-10 2011-08-09 Warsaw Orthopedic, Inc. Guard for use in performing human interbody spinal surgery
US6224595B1 (en) 1995-02-17 2001-05-01 Sofamor Danek Holdings, Inc. Method for inserting a spinal implant
US6758849B1 (en) 1995-02-17 2004-07-06 Sdgi Holdings, Inc. Interbody spinal fusion implants
US7828800B2 (en) 1995-06-07 2010-11-09 Warsaw Orthopedic, Inc. Threaded frusto-conical interbody spinal fusion implants
US8226652B2 (en) 1995-06-07 2012-07-24 Warsaw Orthopedic, Inc. Threaded frusto-conical spinal implants
US8057475B2 (en) 1995-06-07 2011-11-15 Warsaw Orthopedic, Inc. Threaded interbody spinal fusion implant
US7942933B2 (en) 1995-06-07 2011-05-17 Warsaw Orthopedic, Inc. Frusto-conical spinal implant
US8409292B2 (en) 1995-06-07 2013-04-02 Warsaw Orthopedic, Inc. Spinal fusion implant
US8679118B2 (en) 1995-06-07 2014-03-25 Warsaw Orthopedic, Inc. Spinal implants
US7691148B2 (en) 1995-06-07 2010-04-06 Warsaw Orthopedic, Inc. Frusto-conical spinal implant
WO2008075097A1 (en) * 2006-12-20 2008-06-26 Medica Surgical Innovations Limited A joint fixator
CN104274238A (en) * 2014-10-21 2015-01-14 中国人民解放军第三军医大学第二附属医院 Fluoroscopic stereoscopic femoral neck localizing device

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