HRP20020279A2 - Guide for angular plate for trochanter and condylar fractures - Google Patents

Abstract

The 95-degree angle plate guide is used when installing the tiles in trochanteric pertrochanteric fractures of the knee, and consists of a guide head (9), a guide body (10) on which the guide body contains 4 projections (7), for inserting the guide into the bone , and the guide arms (6). Depending on the stage of the surgery, two drill bit extensions (2) or a drill bit (3) are placed on the guide head (9), both of which are fixed to the guide head by 2 pins (5) and 2 screws (4). At the top of the guides, there is a 2.1 mm diameter wire hole (8) through which a 2 mm thick guide wire is inserted into the bone, by which we determine the direction and position of the trepanation hole, and by which the bone guide is fixed. Bone angles The strength of the bone drilled and the angles of the puncher (chisel) determined according to the anatomical characteristics of the bone and cannot be altered. After drilling a hole through the drilling holes (11) and later blasting through the hole for the puncher (chisel) (12), the wedge and the plate are inserted into the same place that we prepared with the guide and its extensions and the error in determining the angle of 95 degrees or position tiles are not possible if the guide wire is correctly inserted through the guide. The guide is simple, does not require any special education, the need for absolute precision after placement and placement of the guide wire, reduction of the rtg. radiation to both patients and surgery staff.

Description

The technical field to which the invention belongs

According to the international classification of patents (IPC), the subject of the invention can be most closely treated with class A 61 B 17/18 with the title Instruments or equipment for bone fracture operations.

Technical problem

The technical problem solved by this invention consists in the following: how to determine the angle of bone trepanation at an angle of 95 degrees without moving the fragments after repositioning the fragments and temporary fixation, how to determine the crease angle, how to position the bone blade with the exact direction of trepanation which corresponds to the angle of the tile, how to determine the length of the leg of the tile.

State of the art

The corner plate is one of the older forms of osteosynthesis for fractures of the upper leg in the hip area for pertrochanteric and subtrochanteric fractures and condylar fractures, and which is still often used.

Classic bone trepanation is performed in two acts, i.e. first, trepanation is performed with a drill with a diameter of 4.5 mm, which is a standard part of the operating set, and after the crease is made using a protractor that is attached to the bone from the outside, trepanation with a blade is performed in the same place. This procedure is difficult since it is difficult to guess the angle in two directions that are anatomically determined for the bone, i.e. an angle of 95 degrees in the direction of the floor plan and the axial angle of the bone, which is usually around 15 degrees.

The existing methods of determining the trepanation angle consist of a metal protractor, which is used to determine the crease angle and the placement of the bone trepanation chisel. There is the most common way of introducing a 95-degree plate using a metal protractor that is placed against the bone and then under X-ray. with the amplifier, he determines the direction of drilling the bone with three creases on the outside of the bone in two directions to determine the angle of 95 degrees in the ap. X-ray projection and 12-15 degrees in the axillary projection. The current existing protractor does not allow accurate determination of the angle of wrinkling, and it is difficult for an inexperienced surgeon to hit the same place at the same angle in two projections, determine the direction of wrinkling first with the drill and then introduce the blade in the same place, after which the plate is placed.

Changes were tried with the guide on the protractor, which also rests on the bone from the outside, but also in the later trepanation there is always a deviation and an error in the placed plate.

Until now, known blade guidance systems never enable the same trepanation procedure in the same direction without additional corrections under the X-ray intensifier, nor does it enable precision.

Presentation of the essence of the invention

The invention enables a practical application, a durable and simple device that can be used for a long time, without additional special maintenance, and is used simply by touching it to the bone and fixing the position with a single wire (Kirschner wire) in the place where we want to place the definitive osteosynthetic agent later, i.e. an angle plate made of 95 degrees.

The construction solution of the guide simplifies and facilitates the placement of the angular plate in the case of fractures in the trochanteric and condylar region of the upper leg, the operative procedure is simplified in the speed and simplicity of introducing the blade to the bone and the creation of a channel in which the definitive angular plate is placed, and the amount of x-rays is reduced. of radiation for the transplant team and for the transplant patient.

With this invention, the guide is simply fixed to the bone with only one wire (Kirschner wire), which is placed under x-ray. with the intensifier and the firm pressure of the guide on the bone, the location of the subsequent perforation of the outer part of the bone for the wedge plate is precisely determined. By changing the guide of the drill to the guide of the punch (chisel) on the head of the guide, the exact location and angle for the corner plate is determined. By using the guide, there is no need for additional control examinations using x-rays. reinforcing because the guide wire in the guide prevents the movement of the guide and accurately determines the given direction of the tile wedge.

Experts can see the simplicity and precision of placing the guide on the bone and later the accuracy of drilling and cutting with a chisel for wedge plates on the bone. With the help of the guide, there is no possibility of secondary displacement after fixing the guide using a single wire with a diameter of 2 mm (Kirschner wire), thus providing a place to determine the direction of the tile. There is no need for additional radiation using x-rays. reinforcing, when drilling the bone with a drill or additional radiation with a chisel in order to determine the angle of placement of the tile. The operator and the entire team is exposed to only one x-ray. radiation during diascopic placement of guide wires.

Furthermore, the guide at its end, which adheres to the bone, has 4 sharp spikes that are firmly pressed into the bone and prevent secondary movements of the guide later. By moving the drill bit through the drill bit guide, it gives us the accuracy of creating the later perforation point of the punch (chisel) through the guide, and it also provides a place at a certain angle for the 95 degree wedge plate.

The instrumentation used when using the guide is the standard instrumentation that is used for the angle plate and it is not necessary to add any angle instruments. After use, the guide is simply washed and stored for the next use.

Brief description of the drawing

The subject invention is shown in the attached drawings where:

Figure 1.1 shows a plan view of the guide body for a 95-degree angle tile.

Figure 1.2. shows a blueprint of a guide body for a 95 degree angle tile.

Figure 2 shows the ground plan of the drill guide.

Figure 3 shows the ground plan of the punch guide.

Method of application of the invention

Figure 1.1 shows the floor plan of the body of the guide (1), which is made of medical steel and electroplated.

The guide consists of the head of the guide (9), the body of the guide (10), on the upper side of which there is a soldered handle (6) for which the guide is grasped. The handle of the guide is hard soldered (13) to the body of the guide. On the underside of the body of the guide there are 4 soldered sharp spikes (7) which are pressed into the bone when using the guide. The head of the guide is bent at an angle of 30 degrees (14) in relation to the body of the guide. An angle of 30 degrees was determined based on the anatomical curvature of the femur in the trochanteric and condylar parts.

The guide is 20 mm wide.

When using the guide, two attachments for the head of the guide (9) are used, namely the drill guide (Figure 2} and the guide of the punch (chisel) (Figure 3). At the top of the guide of the drill and the guide of the punch (chisel) there is an identical hole for the guide wire ( 8) with a diameter of 2.1 mm, with which the guide wire with a diameter of 2 mm (Kirschner wire) is fixed to the bone.

When drilling the bone during transplantation, the drill guide is first placed on the guide head (9) (Figure 1.2). The drill guide is fixed to the head of the guide using 2 pins (5) and two screws with an internal diameter of 3.2 mm (4).

After fixing the drill guide to the guide head, the body of the guide is pressed into the bone.

The body of the bone guide is fixed by drilling through the hole for the guide wire (8) of the drill guide (Figure 2). Drilling, i.e. trepanation of the bone, is performed one centimeter less than the length of the introduced guide wire, and from the outside using a 4.5 mm drill bit. which is also a standard drill in the set for drilling the cortical (outer) part of the bone. After drilling, the guide wire is inserted through the hole for the guide wire (8). The guide is fixed with the same wire so that there is no secondary displacement of the guide on the bone.

Bone drilling is also done through 3 holes (11) on the drill guide (2).

In the two shafts, the exact angle and place of placement of the future plate is determined in accordance with the rules for placement of angle plates for trochanteric fractures.

The guidewire is the only fixed part of the entire guidewire during surgery and it does not change after insertion.

Additional control X-ray. inspection checks the position of the guide wire. The guide wire must be on the upper edge of the upper leg neck.

This is followed by removing the entire guide from the bone and from the guide wire, changing the drill guide (Figure 2) for the punch guide (Figure 3) by unscrewing the two diagonally placed screws (4) and two pins (5) on the drill guide, which were used to fix the head guides. After that, the punch guide (chisel) is placed on the head of the guide body (Figure 3), which is fixed to the head of the guide body using two diagonally positioned screws (4) and two pins (5). The drill guide and the punch guide (chisel) are fixed and removed from the head of the guide in the same way, using two diagonally placed screws (4) and two pins (5).

Then, through the hole for the guide wire (8) on the guide on which it is fissed with the guide of the perforator (chisel) (Figure 3), the guide wire that is in the bone is placed, and the 4 soldered sharp spikes (7) on the body of the guide are again pressed into the bone using a handle of the guide, which is then held by the person assisting the operative procedure. Then a channel is made with a punch (chisel) through the places created by drilling with a punch (chisel) for inserting the corner tile under the guide at a certain angle of 95 degrees. The hole for the punch (chisel) (12) is equal in diameter to the arm of the tile. A standard punch (chisel) from the set is taken and bone trepanation is performed. After trepanation of the bone, the guide wire as well as the guide wire are removed from the bone. The further procedure of transplantation is completely identical to the rest of the operative procedure of placement of the corner plate and fixation with screws.

In the described way of application, the guide for the angle plate enables accurate setting of the bone drilling angle, reduces the radiation of the patient and staff during the surgical procedure, and speeds up the operation itself as a whole.

The callsigns for the images are:

1 guide body

2 drill guides

3 punch guides

4 screw on the punch and drill guide

5 pin on the punch and drill guide

6 handles on the guide body

7 spike on the guide body

8 hole for guide wire

9 guide head

10 guide body

11 holes for drilling

12 punch hole (chisel)

13 place of hard solder

14 angle of 30 degrees between the head of the guide and the body of the guide.

Claims (4)

1. A guide for an angle plate for trochanteric and condylar fractures of the femur bone, indicated by the fact that it consists of a guide head (9) and a guide body (10), the guide body (10) is fixed to the base with 4 spikes (7), and two accessories are added to the head of the guide (9), namely the drill guide and the punch guide, depending on the stage of use. 2. Guide for an angle plate according to claim 1, indicated by the fact that trepanation is performed through the drill guide and a guide wire is introduced through the opening for the guide wire (8) with which wire the position of the punch guide is determined and that guide wire remains fixed during the entire use . 3. Angle plate guide according to claim 1 and 2, characterized in that the drill guide is replaced by a punch guide that is positioned using a guide wire, and the punch guide is fixed to the head of the guide with two pins (5) and two screws (4). 4. Guide for an angle plate according to claim 3, indicated by the fact that a channel is made through the guide of the punch with a punch at an angle of 95 degrees, which angle is determined by the shape of the guide of the punch, and an angle plate is introduced into the channel.