JP2022008254A - System and method for bone fixation - Google Patents

Abstract

To provide a system for fixing a bone with a cord.SOLUTION: A system for fixing a bone includes a buckle having a plurality of lock bars and a hook 50. A cord 40 may connect the hook with an opposite end of the buckle and may connect around a bone 20. The buckle may include lock bars on the opposite end of the buckle to receive the cord and allow frictional resistance to loosening of the cord around the bone to facilitate reduction of a fracture 14.SELECTED DRAWING: Figure 8

Description

Cross-reference of related applications

This application is based on US Provisional Patent Application No. 63 / 043,841 filed on June 25, 2020 and US Provisional Patent Application No. 63 / 115,460 filed on November 18, 2020 (agent). It claims priority based on reference number 3768.098P2) and US provisional patent application No. 63 / 185,761 filed on May 7, 2020 (agent reference number 3768.098P3). The provisional patent applications No. 63 / 043,841, No. 63 / 115,460, and No. 63 / 185,761 are all incorporated herein by reference in their entirety.

This application is a US provisional patent application No. 62 / 856,676 (agent reference number 3768.085P) filed on June 24, 2019 and a US provisional patent application filed on September 24, 2019. US Pat. Related applications, US Patent Application Nos. 16 / 910,328, US Provisional Patent Applications 62 / 856,676, and 62 / 905,017, which are incorporated by reference in their entirety into this application.

The present application relates generally to devices, devices, and methods for bone fixation, and more specifically to devices for skeletal fracture fixation and instrumentation-related fastening to facilitate fracture reduction. , Devices, and methods.

Fractures of the femur may occur spontaneously or iatrogenic during total hip arthroplasty. Depending on the fracture pattern, fastening alone, fastening with one or more plates, fastening with struts, fastening with extended hip stems, or a combination of plates, struts, and / or extended hip stems. The fastening technique used can be used for bone fixation. However, the problem with fastening is that the bone junction can be poor without the use of additional support devices. The use of additional supports may or may not be desirable, especially when total hip arthroplasty. In femoral fractures, high loads on the fastening wires can result in erosion and poor fixation of adjacent bones due to wire movement.

Fracture reduction of long bones often requires rearrangement of the spiral fracture and multiple bone fragments. Bone forceps are often hinged devices (eg, pliers) with special tips or protrusions for gripping (eg, engaging and holding) bone. Closing such forceps exerts a force on the bone fragments, pushing them closer together. The limitation of conventional forceps is to apply force linearly or almost linearly. Such forceps can also be large and take up space when multiple forceps are used, as is often the case, limiting access to the fracture site for installing hardware (eg plates or screws). In some cases. In addition, some fractures cannot be fully reduced by the single-sided force exerted by forceps. In addition, the forceps must be removed after fixation, which can result in loss of reduction and misalignment at a later date.

In another example, rigid fastening wires have been used to provide circumferential force to reduce the fracture. The use of such wires has several drawbacks, such as the wires being so stiff that they can be extremely difficult to handle. Moreover, it is almost impossible to modify the wire to fit in another position unless the wire is initially placed in the best condition. In addition, conventional methods of tensioning rigid fastening wires require the ends to be twisted into a tight spiral. This requires special large tools, and the resulting stranded wire can be extremely stiff and often cannot be flattened anyway. If the stranded wire is left in place, the wire can irritate the soft tissue. This method is rarely used as a result of the reduced use of rigid temporary wire fixation due to these constraints.

There is a need for devices that improve bone connection while minimizing bone erosion and immobilization due to wire movement.

The present invention will be more fully understood from the detailed description described below in this specification and from the accompanying drawings of preferred embodiments of the invention, the detailed description and drawings of the present invention. Should not be construed as limiting, but merely for explanation and understanding.

FIG. 3 is a perspective view showing a system for bone fixation with a buckle and a cord according to the present invention.

FIG. 6 is a cross-sectional view showing a portion of the buckle of FIG. 1 provided with a locking bar.

A side sectional view showing the buckle of FIG. 1 provided with a locking bar and showing the cord of FIG. 1 passing around the locking bar.

A side view showing the end of the cord of FIG. 1 with a loop for attaching to the buckle.

The side view which shows the passer which accepts the cord of FIG. 1 in an internal cavity.

A side view of the passer of FIG.

FIG. 5 is a side view showing the system of FIG. 5, wherein the cord is attached to the base end of the buckle and the loop of the cord is configured to be attached to the buckle.

A side view showing the system of FIG. 7 with buckles and loops attached to each other.

A side view showing the system of FIG. 8 further equipped with a tensioner.

FIG. 9 is a side view showing the system of FIG. 9 in which the base end of the cord is received through the passage of the tensioner.

FIG. 10 is a side view showing the system of FIG. 10 with the tensioner positioned so as to connect to the buckle.

FIG. 11 is a side view of the system of FIG. 11 showing the direction of rotation of the tensioner handle for pulling the cord so as to tighten the cord against the buckle and bone.

FIG. 11 is a side view of the system of FIG. 11 showing that the cord is disconnected.

The perspective view which shows the tensioner of FIG.

FIG. 3 is a perspective view showing another buckle useful as an alternative to the buckle of FIG.

Top view of the buckle of FIG.

FIG. 3 is a perspective view showing a plate having a plurality of buckles according to the present invention.

Top view of the plate of FIG.

FIG. 3 is a perspective view showing a washer having a plurality of locking bars according to the present invention.

The present invention will be discussed in detail below with reference to various exemplary embodiments according to the invention with reference to the accompanying drawings. In the following detailed description, a number of specific details are provided for a complete understanding of the present invention. However, it will be apparent to those skilled in the art that the present invention may be practiced without those specific details. In other examples, well-known structures are not shown in detail to avoid unnecessarily obscuring the invention. Accordingly, all implementations described below are exemplary implementations provided to allow one of ordinary skill in the art to make or use embodiments of the present disclosure, and the present disclosure as defined by the claims. It is not intended to limit the scope of.

The following description refers to the systems, methods and devices used to fix the femur. However, those skilled in the art will recognize that other bone immobilizations are also suitable for use with the systems, methods and devices described above. Similarly, the various drawings, steps, procedures, and workflows are shown merely as examples, indicating that the described systems, methods, or appliances play their respective roles or produce results in different time frames or sequences. It does not limit it at all. The teachings of the present invention are applicable to fixation with respect to any bone.

Moreover, it is not intended to be bound by any explicit or implied theory set forth in the technical field, background, outline, or detailed description below. Also, the specific devices and methods exemplified in the accompanying drawings and described in the following specification are merely exemplary embodiments of the concept of the invention as defined in the appended claims. Should also be understood. Accordingly, the specific dimensions and other physical properties of the embodiments disclosed herein should not be considered limiting unless the claims expressly provide otherwise.

The system 10 for fixing or reducing the bone 20 can include a strap, a belt or a connector or buckle 30 connected to a cord 40 extending around the bone 20, as shown in FIG.

The buckle 30 may include a plurality of locking bars 70 and a connecting end or hook 50, as shown in cross section in FIGS. The locking bar may have a teardrop shape in cross section as shown in the drawing, or may have a circular cross section. The hook 50 may be at the tip of the buckle 30 and has an opening 55 through which the cord (eg, cord 40) passes through the opening and the receiving cavity 60 is bounded by the inner surface of the hook 50. It may be possible to enter inside. The cord 40 may have a loop 42 such that the loop 42 may be connectable to the distal end portion when the opening 44 of the loop 42 receives the distal end side portion 32 of the buckle 30 therein. When connected to the buckle 30, the tip 46 of the cord 40 can be received in the cavity 60. The cord 40 can also be connected to the buckle 30 by other means than loops, such as knots, fit rings, splice connections other than ice-price, hitch connections or embedded internal stoppers.

The buckle 30 may be made of, for example, stainless steel, surgical grade plastic, titanium, PEEK, or cobalt chrome. In addition, the cord 40 can be made of a material that can be left in the body during the bone healing period, such as ultra high molecular weight polyethylene (UHMWPE). The cord 40 may be, for example, a 50 cm tape having a width of 3.5 mm and a thickness of 0.6 mm. Further, the cord 40 may be flexible (eg, suture tape) and is made from stranded or braided stranded wire of a metal or metal alloy fine wire such as cobalt chrome, stainless steel, titanium and titanium alloys. You may.

The base end portion 48 of the cord 40 can be connected to the base end portion 31 of the buckle 30. For example, the cord 40 may be connected to the locking bar 70 as shown in FIGS. After extending around the bone 20 as shown in FIG. 1, the cord 40 extends distally towards the hook 50 under the locking bar 70 and extends upward away from the bone 20 and then upwards. Of the locking bars 70, the course may be reversed around the bar 72 on the distal end side and turned toward the proximal end side so as to be away from the hook 50. The cord 40 extends away from the hook 50 from the bar 72 on the distal end side toward the proximal end side and then downward toward the bone 20, and then extends toward the distal end side, and the cord 40 extends toward the proximal end side of the locking bar 70. It may be designed to orbit around the bar 74 of. From the bottom side 75 of the bar 74 on the proximal end side, the cord 40 can extend upward and toward the distal end side toward the upper side 73 of the bar 72 on the distal end side. The cord 40 extends upward again and / or brings the upper 73 into contact with the first cord portion 80 of the cord 40, and at the same time the second cord portion 82 is opposite to the upper 73 of the first cord portion 80. Can touch the side. The cord 40 may extend downward from the upper side 73 toward the hook 50 toward the tip side and then toward the bone 20 while in contact with the bar 72. The first cord portion 80 and the second cord portion can come into contact with each other as the cord 40 extends from the bar 72 toward the proximal end side away from the hook 50. The base end 48 of the cord 40 can be located on the distal end extension 49 extending away from the locking bar 70 around the bone 20 and extending towards the hook 20. It is possible for the user to pull the proximal end 48 in the direction opposite to the hook 50 and pull the cord 40 so as to pass and pass between the locking bars 70 as described above. By passing the cord 40 through the bar 70 and in contact with the bar 70, frictional resistance is generated against the cord 40 coming off the bar 70, and the cord 40 is tightened so that such an arrangement state is the fractured portion of the bone 20. May be kept to hold for a period of time, or the cord 40 may remain in place to allow reduction of the fracture.

As described, the system 10 is available for fixing or reducing the bone 20, and such fixing or reduction methods are described below.

The cord 40 can be passed around the bone 20 and under the tissue and muscle 11 using the passer 100 as shown in FIGS. 5-7. The passer 100 has a curved extension portion 102 having a cavity 104 along the inner peripheral side surface for receiving the cord 40 prior to treatment, and the passer holding the cord 40 in the cavity 104. The procedure of manipulating the 100 to pass it around the bone 20 and under the tissue and muscle 11 is performed, and the tip portion 46 can be passed to the opposite side of the bone 20 with respect to the handle portion 101 of the passer 100. May be. The passer 100 can be removed from the bone 20 while leaving the cord 40 around the bone 20 so that the tip 46 and the proximal 48 can be located on the same side of the bone 20.

As schematically shown in FIGS. 7-9, the loop 42 of the cord 40 can be connected to the hook 50 and received by the cavity 55. The cord 40 is threaded around the locking bar 70 and connected to the locking bar 70, as described above, shown in FIGS. 1 to 3, and schematically shown in FIGS. 7-9. be able to. The user can tighten the cord 40 around the bone 20 to reduce the fractured portion 14 of the bone 10 by pulling the proximal end 48 while holding the buckle 30.

In one example, the buckle 30 can include a pair of slots 35 located on both axial or longitudinal sides of the buckle 30 relative to the bone 20 as shown in FIG. The slot 35 can be configured to accept the arm 210 of the tensioner 200 shown in FIG. 14 and schematically shown in FIGS. 9-13 (eg, shapes and dimensions are made). .. After the cord 40 is threaded around the bone 20 and connected to the buckle 30, the base 48 of the cord 40 is placed in the tensioner 200 so that the cord 40 can be pulled or pulled by the tensioner 200. Can be passed through the receiving passage 230. The arm 210 can be received in slot 35 to connect the tensioner 200 to the buckle 30.

The handle 240 of the tensioner 200 can be rotated by the user so that the tensioner 200 pulls the cord 40 away from the bone 20 and towards the proximal end 250 of the tensioner 200, as shown in FIG. The force exerted on the cord 40 by pulling by the tensioner 200 is, as described above, pulling the cord 40 around the locking bar 70 of the buckle 30 and tightening the cord 40 around the bone 20, for example, the cord 40. The friction provided by passing around the locking bar 70 may hold the cord 40 at a particular tightness to allow reduction of the fractured portion 14.

The tensioner 200 can include a rod 260 that is connected to the handle 240 and has a passage 230 to provide the pull of the cord 40 as described.

After the cord 40 has been tightened to the desired degree around the bone 20, for example when the fracture 14 is placed in the desired placement as determined by the user or surgeon, the cord 40 is cut and the proximal end 48 Can be located at or adjacent to the proximal end 31 of the buckle 30, for example, as shown in FIG. All sutures around the fracture can be completed with the buckle 30 and cord 40 remaining.

As mentioned above, the buckle 30 and the cord 40 are used for temporary fixation of the bone (eg, the fractured portion 14 of the bone 10), and at the end of the period (eg after the bone has healed) the buckle and the cord are It may be removed or the buckle 30 and cord 40 may remain in the body after bone healing. In one example, a bone plate may be placed over the tape (eg, cord 40) to allow such a plate to be attached to the appropriate portion of bone (eg, bone 10), cord 20 and buckle 30. Is in place to reduce the fractured part (eg, fractured part 14). The cord 40 may be cut and removed if the plate is sufficient to hold the bone and the cord 40 is also not needed. Such plates can also be applied to the bone other than on the cord to hold the bone, for example, to reduce the fracture. Such plates or other surgical hardware may be in the presence or absence of the buckle and cord (eg buckle 30 and cord 40) hardware to stabilize the bone (eg, fracture 14) during bone hardening. Regardless, it may remain in the body.

In one example, a large number of examples of buckles and cords (eg buckle 30 and cord 40) are used to secure a fracture (eg, fracture 14) or otherwise bone (eg bone 10) along the bone. It can be used to hold together in various locations in the longitudinal direction. In this way, the fractured portion can be reduced by the portion by gradually gathering the fragments of the bone (for example, the bone 10). Such fracture reduction can be a kinetic task and can be adjusted and reversed together by manipulating a series of buckles and cords (eg, numerous examples of buckles 30 and cord 40). Due to the often complex geometry of the mating surfaces that can be compromised, it may be necessary to divert the force.

In another example not shown, a holding member (not shown) may be used in place of the tensioner 200, the holding member comprising an arm configured like the arm 210 described above for the tensioner 200. However, it is a holding member that does not have a mechanism for attracting the cord 40. Alternatively, the holding member may include a holding portion that extends away from the arm, allowing the user to hold the holding member holding the buckle 30 on the arm. While holding the holding member to hold the buckle, the user can, for example, pull the proximal end 48 of the cord 40 to secure the cord 40 around the bone 20 to reduce the fractured portion 14. ..

In another example shown in FIGS. 15-16, the buckle 300 may be utilized in place of the buckle 30 described above, with the buckle 300 on the two outer sides configured to be attached to the loop 42 of the cord 40. A hook 310 having a prong 320 that projects toward it can be provided. The locking bar 350 can be used to connect the locking bar 70 to the cord 40 as described above.

In the example shown in FIGS. 17-18, the plate 120 receives a buckle 130 having a locking bar 170 and a screw so that the plate 120 can be fastened to the bone (eg, bone 10). It can be provided with a plurality of openings 140 for passing through. The cord (eg, cord 40) can be attached to the first buckle 131 and the second buckle 132 of the buckle 130 as described above for the cord 40 attached to the buckle 30. In an example not shown, the second buckle 132 may be replaced with a hook similar to the hook 50 described above, with the cord (eg, cord 40) relative to the locking bar 171 of the buckle 131 and the hook. The locking bar 70, hook 50 and cord 40 can be attached as described. Numerous examples of such buckles can exist along the length of the plate (eg, plate 120). Each embodiment of the cord attached to the opposing buckle (eg, first buckle 131 and second buckle 132) (eg, cord 40) has a specific treatment for reducing the fractured portion (eg, fractured portion 14). It is possible to apply tension to the same degree or to varying degrees around the bone (eg, bone 10) to achieve the goal. Inserting a screw into the opening 140 after one or more such cords have been attached to one or more of the buckles 130 along the plate 120 to fix and reduce the fracture of the bone (eg bone 10). Can be done.

In the example shown in FIG. 19, the washer 400 may include a locking bar 470 and an opening 440 for receiving and threading a screw to fasten the washer 400 to a bone (eg, bone 10). can. The washer 400 can also be installed in a desired location on a bone (eg bone 10) where no other hardware is installed, or the washer 400 is installed on a plate and the opening 440. May be aligned with the holes in the plate so that the screws can pass through the openings 440 and the openings in the plate to connect the washers 400 to such plates. The cord (eg, cord 40) is, for example, a locking bar 470 and a locking of another washer, buckle or plate to hold together parts of the bone (eg bone 10) to reduce the fracture. Can be attached to a bar or hook. In another example, the locking bar may be integrated with other fracture fixing hardware such as washers, plates, toothed washers, bone anchors. The buckle in this case may be capable of fixing both ends of the cord (eg, cord 40), or the cord may be two separate parts of the hardware (eg, first buckle 131, second). It may be fixed between the buckle 132 and the washer 400).

Although the present invention has been described with respect to at least one embodiment, the present invention can be further modified within the scope and ideas of the present disclosure. Accordingly, the present application is intended to cover any variant, use, or adaptation of the invention that uses the general principles of the invention. Further, the present application is intended to cover developments from the present disclosure that fall into the known or normal practice in the field to which the invention belongs and within the scope of the appended claims. ..

Claims (20)

Fracture fixation system
It comprises a connector having a proximal end for connecting to a first end of a cord configured to extend around the bone to secure the fractured portion of the bone, said proximal end being fractured. It comprises a plurality of locking bars forming a slot boundary for engaging the cord so as to tighten the cord to secure the portion, and the connector is of the cord extending around the bone. A system having an end-to-end connection end on the opposite side of the connector to the base end for attachment to a second end. The system of claim 1, wherein the connecting end comprises a hook or loop. The first aspect of the present invention, wherein the connector further comprises slots on both sides of the connector longitudinally and aligned longitudinally with respect to the connector, the slots being configured to engage an arm of a tensioner. System. 3. The third aspect of the invention, further comprising a tensioner engaged in the slot to hold the connector to allow the user to tension the cord to secure the fracture. system. The fourth aspect of claim 4, wherein the tensioner comprises a handle connected to a rod having a passage for receiving the cord, and the rotation of the handle applies tension to the cord to fix the fractured portion. system. The system according to claim 1, wherein the first locking bar among the plurality of locking bars has a teardrop shape in cross section. A bone plate further comprising a plate having a plurality of openings for receiving a screw for connecting the plate to the bone, and the connector comprising a first portion of the bone plate, said base. The system according to claim 1, wherein the end portion and the tip portion are located on the side and both sides of the bone plate so that the cords are aligned substantially perpendicular to the longitudinal dimension of the bone plate. The bone plate comprises a second connector having a second proximal end that connects to the first end of the second cord, the second proximal end engaging the second cord. The second connector comprises a plurality of locking bars forming a boundary of the slot for the second tip side for attachment to the second end of the second cord extending around the bone. The system of claim 7, wherein the system has a connecting end. The system of claim 1, wherein the cord is sewn and tightened around a locking bar so that the cord is held at a particular tightness that allows fixation of the fracture. It ’s a way to fix the bone,
The step of aligning the opposing parts of the fractured bone to the correct placement of the bone,
The step of attaching the first end of the cord to the end for connecting to the end of the connector,
A step of attaching a second end of the cord to the base by advancing the cord through multiple slots bounded by multiple locking bars at the base of the connector.
A method that includes a step of applying force to pull the cord around the locking bar so that the cord is held in a specific tension to secure the bone. 10. The method of claim 10, wherein the step of attaching the first end comprises attaching the first end to a hook or loop at the tip. Claimed, further comprising engaging the tensioner arm with a slot of the connector to hold the connector, the slot being located on both sides of the connector longitudinally and aligned longitudinally with respect to the connector. 10. The method according to 10. 12. The step of claim 12, further comprising accepting the cord in the passage of the tensioner rod and the user rotating the handle connected to the rod to tension the cord to secure the fracture. Method. The method according to claim 10, wherein the first locking bar among the plurality of locking bars has a teardrop shape in cross section. 15. the method of. The connector comprises a first portion of the bone plate, with proximal and distal ends located on the sides and sides of the bone plate so that the cords are aligned approximately perpendicular to the longitudinal dimension of the bone plate. 10. The method of claim 10, further comprising connecting the bone plate to the bone via a plurality of bone connection openings. Fracture fixation system
A connector comprising a connector having a tip-side opening for receiving a screw that allows the connector to be connected to the bone.
The connector has a proximal end for connecting to a first end of a cord configured to extend around the bone to secure the fractured portion of the bone, the proximal end being the fractured portion. The system is equipped with multiple locking bars that form the boundaries of the slots for engaging the cord to tighten the cord to secure. 17. The system of claim 17, wherein the first locking bar of the plurality of locking bars has a teardrop shape in cross section. 17. The system of claim 17, wherein the cord is sewn and tightened around a locking bar so that the cord is held at a particular tightness that allows fixation of the fracture. .. The connector is a first connector and a second tip for accepting a second screw that is a second connector and allows a second connection of the second connector to the bone. Further comprising a second connector having a side opening, said connector is a second end of the cord configured to extend around the bone to secure the fractured portion of the bone. 17. The system of claim 17, which has a second proximal end for connecting to.

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