MXPA00009014A - Controlled reduction apparatus for the congenital luxation of the hip treatment - Google Patents

Abstract

The present invention describes an apparatus to reduce the congenital luxation of the hip by means of controlled traction characterized for comprising:a trans-femoral element (A) composed of a trans-osseous element that runs through the injured femur, into which the controlled traction is directed to the injured extremity by means of a direct traction to the femur. A reducer member having the function of carrying out the longitudinal traction, rotation, adduction, abduction, extension and controlled flexion of said extremity. The employment of the apparatus of this invention results in the reduction in a controlled way of the congenital luxation of the hip, normalizing the size and shape of the osseous elements and therefore their functionality.

Description

CONTROLLED REDUCTION APPARATUS FOR THE TREATMENT OF CONGENITAL HIP LUXATION.

BACKGROUND OF THE INVENTION.

The congenital dislocation of the hip consists of the displacement of the hip joint from its normal position that takes place at the birth of the baby or soon after. The cause is unknown, however it is known that the hereditary factor is important since family incidence is frequent.

This occurs in both men and women is estimated in a female - male 9: 1. It is estimated a frequency of 1.55 x 1000 typical persistent. The congenital dislocation of the hip is predominant in Mediterranean countries, where the family incidence reaches up to 30% of newborns, in Italy there are clinics dedicated exclusively to the care of patients with this pathology.

Congenital hip dislocation develops before the tenth week in the hip primordium. The alterations include: Laxity of the capsule, elongation of the round ligament, alterations of the acetabulum and the femoral head, anteversion of 60 ° against the normal 12 degrees, presence of the pulvinar, alterations of the limbus, muscular alterations of the hip, anteversion from 80 to 90 °, and limitation of 90 ° abduction.

Congenital hip dislocation is classified as • Teratologies: probably genetic deformities, • Typical: Postnatal - has some contact between the femoral head and the acetabulum, and • dislocation without serious damage to the anatomical structures.

The clinical picture includes the presence of: • Asymmetry of the gluteal folds of the thigh and popliteal.

Positive tests of Barlow and Ortolani. External rotation of limb dislocated from 15 to 20 °. 90 ° abduction. Femoral shortening in relation to the level of the knees. Galeazzí sign: level difference in the knees with hips at right angles. Delayed march and alteration of the march. However, there are several additional signs for clinical determination.

The radiological data demonstrate the existence of: Hilgenreiner lines or "Y" lines. Ombredanne vertical line or Perkins line. acetabular index 27.5 ° in the newborn, index greater than 30 ° (it is found in hip luxadas). CE angle of Wiberg: procedure for ages 3 to 4 years - normal 35 °.

The treatment for congenital hip dislocation varies according to the age of the patient, typical treatments include: From birth to 2 months of age of the patient: Abduction cushion, • From 2 to 18 months of age of the patient: Cutaneous traction. Adductor thyotomy type Russel (weights) 15 days. Closed reduction. Gypsum device 90 ° flexion and 60 ° abduction for 6 months. Radiographic studies. Arthrography Evaluation of surgical reduction.

• One and a half years at 3 years of age of the patient: percutaneous or open adductor myotomy.

Skeletal traction approximately 15 days. Closed or surgical reduction (Salter) (anteversion of the femur - osteotomies).

Plaster 8 weeks.

• From 4 to 7 years of age of the patient: Myotomy. Traction. Surgery 1st Salter 2nd correction of femoral anteversion 8-10 weeks later. • 8 years or more: Femoral osteotomy, Arthroplasty.

The treatment of congenital dislocation of the hip involves traction of the dislocated limb to cause a femoral descent, separation of the leg from the vertical axis (abduction) and internal rotation of the dislocated limb to introduce the femoral head into the acetabular cavity -if exists-, with which the coxofemoral joint is restored.

With existing methods that are based on skin traction, there is no such thing as yet, or the possibility of reducing Congenital Hip Dislocation when the patient is 3 years old is highly unlikely.

Some examples of apparatuses used in the prior art are illustrated in the United States Patent USP4574790 of Wellershaus, USP4913136 of Chong, where orthopedic devices of the type known as harness are described for treating hip dislocation, in these devices are It aims to perform the femoral descent by applying a traction to the extremities directly on the patient's skin. In a very simple development, in United States Patent USP4383526 to Robins a tablet is described wherein a traction is applied to the extremities of the patient by means of a tourniquet.

Figures 7 and 8 illustrate other apparatuses of the prior art, these consist of the Wingfield traction frame and the Bryant traction apparatus. The Bryant traction device, as shown in Figure 8, consists of applying a traction on the limb that is dislocated, for this purpose a weight and a pulley (not polished) are applied, the weights exert a pulling force that is transmitted to a strap and to a pedicel thigh bandage, that is to say that it covers the thigh and foot, while the torso of the patient is held in a fixed position by pelvic thigh support means. Said apparatus has the following disadvantages: a) The traction is applied in soft tissues, the aforementioned because the bandage transmits the load of the weights towards the skin mainly and to the soft tissues; causing that the weight applied to carry out the traction of the extremity injures said tissues. In fact, the use of the Bryant traction device results in even skin necrosis, so the application of this device is only performed in hospitals and under medical supervision, with the risks indicated. b) The traction of the extremities is performed without control, the aforementioned as a result of the traction is performed by the weights, and to increase the traction the weight of these is increased, in addition said weights must be estimated according to the tolerance of the skin and soft tissues under the traction exerted by said weights, which in no case is constant, since it depends on the nature of each individual, age, type of dislocation, etc. c) The results are not satisfactory, they do not manage to reduce the dislocation in 100% of the cases and it is highly unlikely when the patient is older than three years.

For its part, the Wingfield frame, Figure 7, aims to reduce the dislocation of the hip by means of the same mechanics as Bryant's apparatus, using traction with weights, except that the position of the patient is in dorsal decubitus and not in flexion. 90 ° of the hip.

With the apparatus and method of the present invention, there is a method for performing the controlled reduction of the dislocated extremity avoiding soft tissue injuries that occur with the use of traction weights of the prior art apparatuses, being the apparatus of the present invention capable of performing longitudinal traction, internal and external rotation, abduction, flexion and controlled extension of the dislocated extremity, in order to thereby heal the congenital dislocation of the hip.

A second objective is to make it possible to descend the dislocated femoral head in children older than 3 years with controlled mechanical traction.

Still a third objective is to bring the femoral head close to the three axes of rotation: flexion, abduction and internal rotation.

DESCRIPTION OF THE INVENTION. With the present invention it is intended to solve a high percentage of cases of children with Congenital Hip Dislocation that exist throughout the world. [There are endemic areas of very high percentages, which according to orthopedic texts statistics reach up to 30% in families of several countries in Europe, 2% as a global 20 statistics.

The failure of the apparatuses of the prior art has been determined because they did not consider in their design the contraction carried out by the pelvic muscles, which are very powerful muscles and which, despite the dislocation, exert contraction 25 on the limb. luxado avoiding the reduction. The success that the apparatuses of the prior art can have decreases as the age of the patient advances due to the resistance of said soft tissues. With the method and apparatus of the present invention, said problem is greatly overcome.

Based on the surprising results of the structural changes obtained with this procedure and controlled traction device, a systematic study can be made to see the response of the method in children with this ¡S--. < * -, - - - - - - - - - - - - - - - - - - The above in order to refine the method and help the corrective surgery to be much better projection and surgical facility if necessary.

The invention has proven to achieve an exact control of femoral traction tending not to damage or devitalize the soft tissues. With this device a new method of daily controlled femoral descent is obtained, and success has been obtained by performing a decrease of 1 millimeter per day. The method of the present invention results in ease of handling for the reduction of congenital hip dislocation, shorter hospitalization time, expenses significantly reduced, positive results.

The invention consists in providing controlled trans femoral traction, which had not been described in the past.

The term reduction of the dislocation of the hip refers to the action of healing or curing the congenital dislocation of the hip.

DESCRIPTION OF THE FIGURES.

Figure 1 shows the Apparatus for the Controlled Reduction of Congenital Hip Dislocation "in accordance with the present invention, Figures 2, 3, 4, 5 and 6 show the different components of the Apparatus of the present invention. illustrate prior art apparatuses.

Figure 2 shows in front and side view, the traction-compression means (B), and the means of flexion-extension and abduction-adduction (C) of the reduction device (1). Figure 3 shows front, side and top view of the rotation means (D) of the Reduction device (1).

Figure 4 shows the arc (55) of the clamping means (E) of the Reduction apparatus (1). Figures 5 and 6 show the moving point means (F) of the Reduction apparatus (1). Figure 7 shows a WINGFIELD FRAME, prior art apparatus. Figure 8 shows a BRYANT TRACTION apparatus of the prior art.

In relation to these figures, the elements with the following numbers have been identified: Controlled Reduction Apparatus (1), Transfemoral Medium (A), Traction controlled means - controlled longitudinal compression (B), Abduction means - adduction and flexion - controlled extension (C), Controlled rotation means (D), Point Media Fixed (E), Moving Point Media (F).

DETAILED DESCRIPTION OF THE INVENTION.

In accordance with the figures, the congenitally dislocated hip reduction apparatus (1) of the present invention comprises a transfemoral means (A), consisting of a transverse bone element (11) passing through the dislocated femur. , towards which the controlled traction of the dislocated extremity is directed by means of a direct traction to the femur.

Said trans-femoral element (11) preferably comprises a transverse femoral supracondylar nail of the type known as Steinman's nail selected from the size and thickness according to the age of the patient and the physician's judgment. By virtue of such a trans-femoral element, the traction is not performed on soft tissues, so its use automatically eliminates necrosis and damage to the soft tissues, in addition, it allows traction to be applied to cause the femoral descent much higher than the force of opposition due to the pelvic muscles, gluteus etc., with which the femoral descent is insured.

Preferably, the trans-femoral means (A) further comprises a bandage (12), preferably a plastic bandage, which surrounds the thigh of the patient, in the portion where the trans-femoral element (11) has been placed. The plastic bandage is applied on the transfemoral element (11) and fixing means (43) (figure 3). So that upon solidification of said bandage, the transfemoral element (11) and the fixing means (43) will remain firmly attached to the bandage (12). The fixing means (43) are attached to the rotation means (D), in this way the trans-femoral element (11), the bandage (12), the fixing means (43), the means of rotation (D) and the dislocated femur form a unitary rigid piece, with such an arrangement, any movement is directly transmitted to the dislocated femur.

The bandage (12) transmits a minimum amount of tension to the soft tissues surrounding it, but it allows to join said trans-femoral element (11) with the reducing means (B), (C), (D), (E) ) and (F). Alternatively, a canvas and plaster may be used in place of the bandage (12).

The reduction and reduction of the dislocation is achieved by means of the reducing device (1) which has the function of performing longitudinal traction-compression, internal and external rotation, abduction, adduction, flexion and controlled extension of the dislocated extry . The reducing device (1) comprises: transfemoral medium (A), controlled longitudinal traction-compression means (B), abduction means - 25 adduction and flexion - controlled extension (C), controlled rotation means (D), means of Fixed point (E) and moving point means (F).

The controlled compression-traction means (B) illustrated in Figure 2, are intended to exert a force on the longitudinal axis of the dislocated member on the transfemoral means (A), depending on the direction of the applied force a movement of traction or compression. With the movement of traction, the transfemoral means moves away from the thorax of the user, in particular of the coxofemoral cavity, In the compression movement, the transfemoral means (A) approaches said cavity. In Figure 2 the tension-compression means (B) of a preferred embodiment of the present invention is illustrated, this consists of a mechanical means of traction-compression (20). The compression-traction means of the preferred embodiment of the invention is at one of its ends secured to a stable point or fixed point, and the other end is secured to the transfemoral element (A) which forms a free point within the system. The mechanical tension-compression means (20) comprises: a tubular member (21) with its threaded outer surface, at least a portion of said hollow tubular member, being provided in the hollow portion with a groove or cut (22) extending from about the center of the member (21) to the end. Inside the said tubular member (21) an extension or extension member (23) is inserted. This assembly allows the mechanical tension-compression means (20) to acquire a variable length. The extension (23) consists of a bar or threaded tube of an external diameter smaller than the internal diameter of the tubular member (21), said extension (23) at one end comprises a transverse tooth (24), said transverse tooth moves in the inside the slot (22) and is maintained in a particular position by means of the traction control elements. In the embodiment illustrated in Figure 2, the traction control means comprises a pair of nuts (25) located on each side of the tooth (22) that allow to control the traction applied to the extry of the patient by means of establishing a fixed position of the extension (23). When it is desired to apply a traction, the first nut (25) is rotated to define a new position of the tooth (24), and then the second nut (25) is rotated to ensure the new position of the tooth (24). The change of position of the tooth (24) means in a traction to the dislocated femur, because the tooth moves within the groove (22), the movement of the tooth (124) is restricted by the nuts (25), of so that the position that reaches the tooth will be fixed and consequently the traction generated will remain stable, in this way a traction or compression controlled by the doctor is achieved. In the method of the present invention, a displacement of approximately one millimeter should preferably be generated each day.

The compressive tensioning means (20) can acquire a dimension such that the end (23) can be introduced into the holes (62) of the moving means (60), in case nuts (27) will be required to secure the end (23) to the mobile medium (60). Such an arrangement gives the system greater stability.

As will be apparent to one skilled in the art, the mechanical controlled compression traction means (20) illustrated in Figure 2 can be replaced by any other means of traction known in the art, for example, pneumatic, hydraulic pistons or other means of mechanical displacement, its replacement is considered included within the scope of the present invention.

The means of abduction-flexion-extension (C) of the reducing device (1) aims to allow movements of flexion and extension of the dislocated member, that is, the possibility of raising or lowering the dislocated femur with respect to the base (50). ), as well as adduction or adduction, which consists in separating or approaching the dislocated member of the longitudinal central axis of the body.

The means of abduction-flexion-extension (C) of the reducing device (1) comprises in the preferred embodiment of the invention a combination (30) of a ball joint (31) and nut (32), and is placed between the tubular segments (21) and (28).

The ball joint (31) comprises two covers (33 and 34) with radial indentations (35), so that one cover is superimposed on the other and because the indentations are coupled, thereby preventing both covers (33) and (34) turn on the same axis as a screw (36). The screw (36) has a crank (37) that allows its manipulation, by tightening the screw (36) it is achieved that the caps (33) and (34) of the ball joint are narrowed, which ensures that the caps are not will slide The direction in which the movement is generated translates into flexion or extension, or abduction or adduction. In order for a flexion or extension to occur, the label must be oriented perpendicular to the surface of the stretcher (50), in a position as illustrated in the left figure of Figure 2, while to generate abduction or adduction, the The tag should be arranged in a position parallel to the surface of the stretcher (50), as illustrated in the right figure of Figure 2.

The ball (31) operates in combination with the nut (32), the nut (32) tightens and releases the ball (31), thereby allowing the ball to rotate and assume a position parallel or perpendicular in relation to the base (fifty). Of course, such a combination can also allow the label to adopt a position that allows a mixed movement of flexion or extension, with abduction or adduction. The nut 21 is placed on the threaded segment (28), but can be placed on the segment (21), its function is only to tighten the ball joint (31) to prevent it from turning on its transverse axis.

Each ballot provides flexion or extension, and / or abduction or controlled adduction by loosening, turning each cap and tightening the crank screw (36) and the nut (32) in the position determined by the doctor during the treatment.

As will be evident to a person skilled in the art, the position of the ball joint (31) and the nut (32) can change, either in the order in which they are arranged or the position within the reducing device (1) in any case the change of disposition does not change the effect of flexion, extension, adduction and abduction. Also, other mechanisms and arrangements can be used to replace said ball joints, for example using spherical ball joints, such changes are considered to be included within the spirit of the invention.

The means of rotation (D) of the controlled reduction device of the congenital hip dislocation (1) are intended to allow rotation of the dislocated extremity on its own axis, and depending on the direction of movement can be internal rotation or external rotation .

The rotation means (D) of the present invention are illustrated in figure 3. This comprises a rotation plate (40) having a semicircular shape, with fixing means (43) for joining the plastic bandage (12), said fixing means (43) join the rotation means (40) with the bandage (12) that contains the transfemoral element (11). The semicircular rotation plate (40) has a channel (41) defining a semicircular section, where the extension (23) of the tension-compression means (20) is inserted, the connection between the end (23) of the tension-compression means (20) and the rotation plate is made by means of the nuts 5. (26) as illustrated in figure 3. As the extension (23) moves in the semicircular channel (41), a movement of rotation of the extremity on its own axis is defined. According to the method of the invention, in order to cause a rotation movement, the nuts (26) must be loosened, the dislocated extremity rotated towards the position determined by the doctor and then the nuts (26) will be tightened with what is said. get a stable position.

The rotation plate (40) for its part is attached to the fixing means (43) by means of nuts and screws (44) which are inserted in the holes (432) and (42) of the means (43) and the plate (40) respectively. The fastening means (43) are illustrated in Figure 3 and comprise a post (431) having perforations (432) in order to place the rotation plate (40) at different heights, said post being placed on a base (433), the base (433) is joined to the bandage (12), so that when the bandage solidifies, the fixing means 20 protrude from the bandage but form a rigid connection therewith. The bases (433) can assume a curved shape that best suits the contour of the dislocated leg.

The rotation plate (40) has been described as rotation means (D), but such means 25 can be replaced by another which offers similar operation. The present invention is not considered limited by the use of the rotation plate (20) as a rotation element (D).

The reducing device (1) is attached to the transfemoral element, for its In order to function properly, it requires a fixed point from which it can exert longitudinal traction, rotation, adduction, abduction and flexion and extension, this fixed point can be established in any position with the condition that it also - l --------- Í _------ ¡_--- FÉ_- establish the patient's coccyx as fixed point, so that when the compression traction element (20) is actuated, only the move the dislocated extremity. The components of the fixed point means (E) are illustrated in Figures 1 and 4.

In a preferred embodiment of the invention, the fixed point means (E) of the controlled reduction apparatus of the congenital hip dislocation (1), illustrated in FIG. 1, comprises pelvic support means (51) and a fixed point arc (55).

In accordance with Figure 1, the pelvic thorax vest (51) is firmly attached to a base (50) by means of the latches (52) such as screws, rivets, staples, tie-downs or any means known in the art that allows Fasten the vest (51) to the stretcher (50). The vest (51) comprises fastening means (511) to the chest of the patient, in figure 1 said means (511) is illustrated as a pair of braces and buckles that allow the fastening and adjustment of the vest (51) to the Patient's rib cage. In this way it is ensured that the patient's body maintains a substantially fixed position.

The base (50) comprises a substantially flat and rigid structure, said base (50) includes fastening means (54) for said base to be transportable. Said fastening means can be of any type or material as long as it allows carrying out the fastening function for transfer, such as handles. The base can optionally incorporate a window (53) for cleaning, taking into account that patients are in most cases babies, through it diaper changes or garments that can be soiled with body exudates can be made.

The fixing means (E) further comprise a fixed point arc (55) for reduction, said arc consists of elements forming a structure firmly attached to the base (50) and provide a fixed point for the reduction operation. In figure 4 a front and top view of said arch is illustrated.

The patient's body is placed below the arch (55). The arch (55) comprises a crossbar (551) joined at its ends with respective posts (552) that have a base (553), the connection between the crossbar and the posts is achieved by means of connection (554) such as screw and nuts, the posts comprise perforations (555) to allow the placement of the crossbar (551) at different heights, both the crossbar (551) and the posts (552) can comprise perforations (555) throughout its length or only in sections thereof, in the manner illustrated in the post to the right in Figure 4.

As illustrated in Figures 1 and 4, the segment (28) of the compression traction means (20) is inserted in any hole (555) of the cross member (551) and secured by means of the nuts (29); for its part the arc (55) is attached to the base (50) by joining means (556) such as screws and nuts, thereby ensuring a firm position for the compression traction means (B) of the apparatus of the present invention.

The arch (55) allows versatility to the apparatus of the invention, since the same apparatus can be used to treat both the right and left limbs.

As will be apparent to a person skilled in the art, the arc (55) can be replaced by any means that satisfies the need to establish a fixed point, for example, the fixed point can be established directly on the vest, or the fixing means can be arranged in a position close to the feet of the patient, such variations are considered to fall within the scope of the present invention.

Optionally, the apparatus of the present invention further comprises movable point means (F) in order to provide greater stability during traction and femoral descent. Said means are illustrated in figures 5 and 6.

The moving point means (F) illustrated in Figures 5 and 6 comprises a support for sliding foot (60). The slidable means (60) comprises a post (61) and a base (63), the post (61) includes perforations (62) in which a foot carrier (64) is placed, said carrier comprises a support (641) wherein the heel of the patient's foot as well as straps (642) can be placed to hold the foot to the wearer, the straps may contain buckles or any means to be secured to the patient's foot. The means (40) is slidable by virtue of arms (65) that move within two grooved guides (66) disposed on each side of the base (63). With said means (40) it is provided that the traction and compression movements that generate a displacement in the dislocated extremity, are not limited by the position of the foot support, but that the foot support (40) can adjust to the movement of the foot. tip caused by the pulling means (B).

In the movements of abduction, adduction, flexion and extension, additional means may be provided for the foot support (60) to assume such positions.

Method.

The controlled traction device of congenital hip dislocation (1) performs longitudinal traction, rotation, abduction, adduction, flexion and extension, in order to place the femoral head in the coxofemoral cavity. The method begins with the placement of a transfemoral nail (11) in the patient's dislocated femur, then is surrounded with the plastic bandage (12), preferably made of circular fiberglass, in the lower limb dislocated from thigh to leg and it also places the fixing means (43). It is preferred that the ends of the nail (11) protrude from the bandage (12).

The transfemoral medium can be placed in any portion of the dislocated femur, however it is preferred to place it near the end closest to the knee.

The thorax of the patient is attached to the pelvic thorax vest (51) that is secured to the stretcher (50). Subsequently, the extension (28) is secured by means of the nuts (29) in the arch (55), while the end (23) is secured to the rotation plate (40), which in turn is secured to the fixing means (43) with the joining means (44) such as screws and nuts.

The rotation plate (40) is fixed by means of the screw (44) to the posts (431) of the fastening means (43) that has already been said, they are attached to the bandage (12).

According to the method of the present invention, the position of the pin (30) must coincide with the position of the dislocated coxofemoral cavity of the patient, so that its operation is optimal. But it can take any position.

Once the traction device is placed, the possibilities of: - Longitudinal traction to reduce the femoral ascent, - Possibility of flexion, - Possibility of abduction, - Possibility of internal rotation of the dislocated hip.

The possibility of performing the longitudinal traction to correct the femoral ascent is achieved by actuating the traction-compression control means (20), illustrated as the nuts (25) so that the extension (23) obliges the ascending limb Femoral to descend to the level of the coxofemoral joint or that determined by the doctor.

This decrease is done slowly, decreases of 1 mm daily show excellent results.

The possibility of flexion, extension, adduction and abduction of the limb is achieved by loosening the cranks (37) and nut (32), rotating the caps (33) and (34) to the desired position and tightening the caps again by half of the crank (37), and finally tighten the nut (32).

Internal rotation of the dislocated segment is possible by loosening the nuts (26) and allowing the extension (23) to move within the channel (41) exhibiting a curved path.

Preferably the adduction-abduction, flexion-extension and rotation are performed when the femoral descent has occurred, the adduction, abduction, flexion, extension and rotation are intended to bring the femoral head to the acetabulum. Sometimes it is necessary to perform surgery to remove tissues that prevent the approach between the acetabulum and the femoral head.

Finally, when the femur and the coccyx are close together in the hip joint, a positive chemoraxis process takes place, consisting of the growth of the femoral head inside the acetabular cavity, which does not occur while the hip is dislocated. When this happens starts the containment of the hip, reduced or placed in its proper position.

The preferred embodiment illustrated in Figure 1, comprising a base (50) consisting of a stretcher has the additional advantage of allowing the patient to carry out the treatment at home. It has already been said that with the apparatuses of the prior art, the treatment is carried out compulsorily in the facilities of a hospital in view of the serious risk of injury of the soft tissues; in the method of the present invention in view of the fact that the risk of injury has been eliminated, the patient, who in most cases is a child under two years of age, can be moved to his home on the stretcher (50) and brought to medical consultation during the period of time in which the femoral descent is carried out for radiological and clinical control of its evolution. The foregoing is a great advantage over the prior art therapeutic devices and methods.

Results The method exhibits the following results: From the use of the controlled reduction apparatus of congenital dislocation of the hip (1) of the present invention it is observed that the reduction of the congenital hip dislocation develops in a controlled manner, the size and shape of the bone elements are normalized of the dislocated hip and therefore its functionality. It is a method that can descend a hip theoretically at any age since it is a mechanical traction device with unlimited force possibility.

As additional benefits are observed: with the above it is possible to solve the problem of hip reduction and a large projection of support that tends to achieve maximum functionality according to the case and the age of the patient. can avoid bone or soft tissue correction surgeries, according to the case and criteria of the orthopedist. The current problem of millions of children with this congenital aberration in the world will be solved with this method. ......-._... _.- .. _.- »--.....

Claims (9)

KBW? .D / C.4C / 0? .ES.

1. A controlled reduction device for congenital hip dislocation (1) characterized in that it comprises: 5 - A trans-femoral means (A), consisting of a transverse element that passes through the dislocated femur, towards which controlled traction is directed to the dislocated extremity by means of a direct traction to the femur. • A reducing member that has the function of carrying out longitudinal traction, rotation, adduction, abduction, flexion and controlled extension of 10 said extremity.

2. The congenital hip dislocation controlled reduction apparatus (1) according to claim 1, wherein the reducing member comprises: • Longitudinal compression traction means (B), 15 • Adduction means flexion and extension abduction (C), • Means of rotation (D). • Fixed point media (E).

3. The controlled reduction apparatus of claim 2, further comprising 20 - Moving point means (F)

4. The congenital hip dislocation controlled reduction apparatus (1) according to claim 2, wherein the longitudinal traction means (B) comprises: - a tubular segment (21) with its external threaded surface, at least one portion of said hollow tubular member, a slot or cut (22) extending from about the center of the member (21) to the end being disposed in the hollow portion. Inside said tubular member (21) is inserted an extension member (23), • an extension member (23) consisting of a threaded rod or tube of smaller diameter than the internal diameter of the tubular member (21), said extension member at its end comprises a transverse tooth (24), said transverse tooth moves inside the groove (22) and is maintained in a particular position by means of the traction control elements, nuts (25), said nuts being held on each side of said tooth. • Traction control means, nuts (24), which allow to control the traction applied to the end of the patient by means of establishing a fixed position to the extension (23). This assembly allows the reducing means (B) to acquire a variable length.

5. The congenital hip dislocation controlled reduction apparatus (1) according to claim 2, wherein the abduction-adduction and flexion-extension means (C) comprise: • a combination of ball joint (31) and nut (32) , wherein the nut (32) is on a threaded segment (28) and is intended to prevent radial movement of the ball, and the ball joint comprises two caps (33) and (34) with radial indentations (35), state the lids joined by a screw (36) having a crank (37) and

6. The congenital hip dislocation controlled reduction apparatus (1) according to claim 2, wherein the rotation means (D) comprise a rotation plate (40) characterized in that: • it has a semicircular shape, with means for joining to the fixing means (43) that is attached to the bandage (12). • it also has a channel (41) defining a semicircular section, where the end (23) of the member (20) of said reducing means (B) is inserted. As the end (23) moves in the semicircular channel, a movement of rotation of the extremity on its own axis is defined.

7. The congenital hip dislocation controlled reduction apparatus (1) according to claim 1, wherein the fixed point means (E) comprise: • Pelvic thoracic support means (51) which is firmly secured to a base ( 50), and • A fixed point arc (55)

8. The congenital hip dislocation controlled reduction apparatus (1) according to claim 6, wherein said reducing means optionally comprises: • a moving point means (F)

9. The congenital hip dislocation controlled reduction apparatus (1) according to claim 8, wherein said moving point means (F) comprises a foot sliding support (60). É_-Ü_k-M _-- 1_- | "* - ..- tt -,? -, A ....