RU2750517C1 - Handle for hand instruments and transosseous elements - Google Patents

Abstract

FIELD: medical technology.

SUBSTANCE: invention relates to medical technology, namely to devices used in traumatology and orthopedics. The handle for taps, awls, screwdrivers, Shants rods and knitting needles is a T-shaped holder for taps, awls, screwdrivers, Shants rods and knitting needles. The handle consists of parts of the Ilizarov apparatus, namely: bushings with a telescopic rod fixing unit, 32 mm brackets with a bolted shank, 55 mm brackets with a bolted shank, two 126 mm dies, an 82 mm die, bolts and nuts. The T-handle consists of two perpendicular 126mm dies, 82mm dies, 32mm brackets, bolts and nuts. It is possible to install and fix the tap, awl, screwdriver, Shantz rod and spoke by introducing a telescopic rod into the fixing unit of the sleeve and locking in a given position by pressing the end surface of the shank of the 32 mm bracket using a 55 mm bracket or bolt fixed in its hole by means of a nut when turned clockwise. When the 32-mm bracket is rotated using a 55-mm bracket or bolt fixed in its hole with a nut or a bolt in the telescopic rod fixing unit counterclockwise, it is possible to unlock and remove the above tap, awl, screwdriver, Shants' rod and spoke.

EFFECT: invention provides increased efficiency and reduction of treatment time for patients requiring osteosynthesis using hand instruments and transosseous elements.

1 cl, 3 dwg

Description

The device belongs to medical equipment, namely to instruments used in operative orthopedics and traumatology.

Relevance. In the treatment of fractures and pseudarthrosis, osteosynthesis is performed - an operation to achieve reduction and fixation of bone fragments. The failure of this operation and dissatisfaction with its results are a consequence of both the imperfection of the metal structures and the technique of osteosynthesis, which depends on the ergonomics of the instrumentation, the quality of the metal structures used and the atraumatic nature of the surgical intervention.

Analogs

In modern surgical traumatology and orthopedics, a wide range of implants for osteosynthesis and the instruments necessary for their application are used. As intraosseous implants for fixing fractures, screws, plates, pins, rods, nails and external fixation devices (AVF) are used. To reposition bone fragments during the operation, use AVF, distractors, repositioning forceps, hooks and joysticks - Shants screws with special removable handles.

Criticism of analogues

A common disadvantage of all the given analogs is the narrow focus and specificity of each of them with the need for a wide inventory of auxiliary tools.

Prototype

As a prototype device, we have chosen a control knob or a joystick for repositioning bone fragments (Ankin LN, Ankin NL Practical traumatology. European standards of diagnosis and treatment - M .: Kniga-plus, 2002. - 480 p; - P.58 - 74; - prototype device), used in closed intramedullary osteosynthesis of long bones, for example, the femur. The essence and application of this prototype device are as follows. The patient lies on the operating table on a healthy side with the injured limb bent at the knee joint at an angle of 100 degrees. Reposition of bone fragments is performed using devices of an orthopedic table, distractor, AVF or Shants' rods, which are inserted into the bone fragments and used as joysticks. When bone fragments are repositioned, the Shants 'rods should be placed as close to the fracture as possible: the Shants' rod is inserted into the proximal fragment monocortically, and into the distal fragment, bicortically. Then, with the help of two T-shaped handles, the bone fragments are repositioned under the control of an electro-optical converter (EOC). After reduction, closed intramedullary osteosynthesis with locking rods is performed, and the Shants rods are removed.

Criticism of the prototype

T-shaped handles for Shants rods used as joysticks have the following disadvantages:

- the problematic nature of the search and the complexity of manufacturing this device, which is not included in the range of traditionally used instruments in operative orthopedics and traumatology;

- the massiveness of the joystick with a relatively small T-shaped handle for the Shants rod, which causes low handling properties, insufficient efficiency and ergonomics of the prototype;

- too narrow focus and specialization of joysticks with limited technological capabilities and indications for their use;

- inexpediency of searching and purchasing joysticks with such limited technological capabilities and narrow indications for their use.

The purpose of the invention is to increase the efficiency of treatment of patients with skeletal fractures by optimizing open and closed intramedullary, extra-focal and extrafocal osteosynthesis.

The essence of the invention

The proposed device (Fig. 1, a, b), namely the handle for hand tools and transosseous elements (pos. 1), which is a T-shaped holder for taps, awls, hooks, screwdrivers, Shants rods and knitting needles, and differing in that that it consists of parts of the standard set of the Ilizarov apparatus, namely: the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3), 126-mm dies (pos. 4), 82-mm dies (pos. 5), 32 mm bolt-shank brackets (key 6), 55 mm bolt-shank brackets (key 7), bolts (key 8), and nuts (key 9). Installation and fixation of hand tools and transosseous elements (pos. 1), namely taps, awls, hooks, screwdrivers, Shants' rods and knitting needles, are carried out by inserting them into the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3) and blocking in a given position by the pressure of the end surface of the bolted shank of the 32-mm bracket (item 6) when it is turned clockwise, fixed in its hole with a nut (item 9) with a 55-mm bracket (item 7), or the end surface of the bolt ( pos. 8) when turned clockwise, while unlocking and removal of hand instruments and transosseous elements (pos. 1) is carried out by turning the bracket (pos. 6) or the bolt (pos. 8) in the fixing unit (pos. 2) of the sleeve telescopic rod (key 3) counterclockwise, and 126 mm dies (key 4), 82 mm die (key 5), 32 mm brackets (key 6), bolts (key 8), and nuts (pos. 9) T-shaped handles provide a comfortable manual grip and better handling properties of the device.

The choice of an arm (pos. 6) or a bolt (pos. 8) for locking in a given position and unlocking removable hand instruments and transosseous elements (pos. 1) in the fixation unit (pos. 2) of the telescopic rod is dictated by the fact that the rotation of the bracket (pos. 6) is carried out manually, and the bolts (pos. 8) - with a wrench. In the first case (Fig. 1, a), the rotation of the 32-mm bracket (item 6) with the 55-mm bracket (item 7) fixed in its hole by means of a nut (item 9) is performed by manual gripping and turning 55- mm bracket (pos. 7), installed so that the plane of its wide part is perpendicular to the plane of rotation, and used as a wing nut (a type of fastener designed for easy assembly and disassembly of bolted and screwed connections without the use of wrenches, and using only thumb and forefinger), with the only difference that the 55 mm bracket (key 7) is much more convenient to grip and turn in both directions than the rounded wing nut lugs. The advantage of the 55-mm bracket (item 7) over the wing nut is due, in addition to the convenience of its grip, the two-fold predominance of its length, and, consequently, the lever arm when turning in one direction or the other and, accordingly, a decrease in the required pressure on it, then there is laboriousness of screwing in and out. In the second case (Fig. 2, a), the rotation of the bolt (pos. 8) in the fixation unit (pos. 2) of the telescopic rod is performed using an open-end, ring (ring) or socket wrench of 10 mm.

The indication for the choice of the bracket (pos. 6) for blocking in a given position (Fig. 1, a) of removable hand instruments and transosseous elements (pos. 1) is the use of those that need to be frequently changed or reinstalled during use. For example, in bone osteosynthesis, when every time you have to change the tap for a screwdriver or a screwdriver of the same diameter (for a hexagon of a 4.5 mm screw) for a screwdriver of a different diameter (for a hexagon of a 3.5 mm screw), etc. Or, with manual insertion of the spoke, as it sinks into the bone, it is necessary to change the level of its attachment with reinstallation in the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3) - to prevent its bending, since the shorter its protruding from the knot fixation (pos. 2) the segment, the more resistant the spoke to deformation.

The indication for the choice of a bolt (pos. 8) for locking in a given position (Fig. 2, a) of removable hand instruments and transosseous elements (pos. 1), respectively, is their use in cases when during use they do not need frequent change or reinstallation. For example, when using the Schanz rod as a joystick during reposition of bone fragments during closed blocked intramedullary osteosynthesis.

The handle of the T-shaped handle (Fig. 1, a, b), consisting of two, located perpendicular to each other, 126 mm dies (item 4), 82 mm dies (item 5), 32 mm brackets ( pos. 6), bolts (pos. 8) and nuts (pos. 9), due to its bulk and mass, allows better control of the instrument and provides a tight grip with the surgeon's hand. This is especially important when working on dense tissues and large bones or bone fragments with an emerging regenerate, when significant physical efforts are required in combination with the ability to dose them without fatigue and a decrease in the surgeon's "muscle sense". The increased volume of the handle creates a comfortable rest in the palm and the grip of the surgeon's hand with pressure and pull of the instrument along its axis and when turning around it. Rotation around the axis of the instrument is facilitated not only by a convenient manual grip of its handle, but also by an increase in the lever arm of the handle by the presence of sufficient spacing between its ends, which exceeds the width of the surgeon's palm.

Application example of the device

As an example of the application of the proposed device, we present the following observation. Patient D., 53 years old, was admitted to the Republican Center of Orthopedics and Traumatology (RCTO) in Makhachkala on 06.04.2020 with a diagnosis of Closed fracture of both ankles of the left leg with rupture of the tibiofibular syndesmosis and external dislocation of the foot.

From the anamnesis: 1.5 hours before admission to the RCTO, she twisted her leg.

On 07.04.2020, the operation was performed: Osteosynthesis of the ankles of the left ankle joint with restoration of the tibiofibular syndesmosis. Under spinal anesthesia, a somewhat arcuate skin incision was made directly behind the external ankle, enveloping its apex anteriorly, 7-8 cm long. The area of an oblique fracture of the external ankle with displacement of fragments was exposed. The interponing tissues were removed and the fragments were repositioned with their fixation with a 3.5 mm screw, held in the sagittal plane and providing interfragmental compression. A simulated eight-hole plate with angular stability was placed on the lower third of the repositioned fibula, which was modeled along the outer contour of the lower third of the fibula. Extraosseous osteosynthesis was performed with six 3.5 mm screws that were locked in the plate and the tibiofibular syndesmosis was restored with a 4.5 mm screw inserted through both bones and the middle hole of the plate. Then, a somewhat arcuate skin incision was made, enveloping the inner ankle, 4-5 cm long. The fracture zone was exposed, reduction and osteosynthesis of the inner ankle was performed with a 4.5-mm screw and a fragment of the Kirschner wire (to ensure rotational stability). After X-ray control, which confirmed the satisfactory position of the fragments and verified a consistent osteosynthesis (Fig. 3, a, b), the wounds were sutured. A temporary (until wound healing) posterior plaster cast was applied from the middle third of the leg to the toes in the mid-physiological position of the foot.

During the operation, the handle for hand instruments and transosseous elements was applied as follows. A hex screwdriver for a 3.5 mm screw was installed in the handle for hand instruments and transosseous elements, consisting of parts of the standard set of the Ilizarov apparatus, namely: fixation unit for the telescopic rod sleeve, 126 mm dies, 82 mm dies, 32 mm bolt shank brackets, 55mm bolt shank bracket, bolts and nuts. The installation and fixation of hexagonal screwdrivers with a diameter of 3.5 mm and 4.5 mm was carried out by introducing them into the fixing unit of the telescopic rod sleeve and locking in a given position by the pressure of the end surface of the bolt shank of the 32-mm bracket when it is turned clockwise fixed in it. holes with a nut with a 55 mm bracket when it is turned clockwise, while unlocking and reinstallation with a change to another screwdriver - for a hexagon with a diameter of 4.5 mm - was carried out by turning the bracket in the fixation unit of the telescopic rod counterclockwise, and 126mm dies, 82mm die, 32mm brackets, T-handle bolts and nuts provided a comfortable manual grip and better handling properties.

The postoperative period was uneventful, the wound healed primarily, and the patient was discharged for outpatient follow-up care 4 days after the operation. The result of the treatment was assessed as good.

Features of the invention that differ from the prototype

The design features (distinguishing features from the prototype) of the device, namely the handles for hand instruments and transosseous elements, are as follows:

- the device is a T-shaped holder (Fig. 1, a, b and Fig. 2, a, b) for hand tools and transosseous elements (pos. 1), namely taps, awls, hooks, screwdrivers, Shants rods and knitting needles;

- the device consists of parts of the standard set of the Ilizarov apparatus, namely: the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3), 126-mm dies (pos. 4), 82-mm dies (pos. 5), 32 -mm bolted shank brackets (key 6), 55 mm bolted shank brackets (key 7), bolts (key 8) and nuts (key 9);

- clamping and fixing of hand tools and transosseous elements (pos. 1) is carried out by inserting them into the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3) and blocking the end surface of the bolted shank of the 32-mm bracket (pos. 6) when it is turned clockwise, fixed in its hole with a nut (item 9) with a 55 mm bracket (item 7), or by the end surface of the bolt (item 8) when it is turned clockwise;

- unblocking and removal of removable hand tools and transosseous elements (pos. 1) is carried out by turning the bracket (pos. 6) or the bolt (pos. 8) in the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3) counterclockwise ;

- the choice of an arm (pos. 6) or a bolt (pos. 8) for locking in a given position and unlocking removable hand instruments and transosseous elements (pos. 1) in the fixation unit (pos. 2) of the telescopic rod is dictated by the fact that the rotation of the bracket ( pos. 6) is carried out manually, and the bolts (pos. 8) - with a wrench;

- rotation of the 32-mm bracket (Fig. 1, a) (item 6) with a 55-mm bracket (item 7) fixed in its hole by means of a nut (item 9) is performed manually by gripping and turning the 55-mm arm ( pos. 7), installed so that the plane of its wide part is transverse to the plane of rotation, and used as a wing nut, with the only difference that the 55-mm bracket (pos. 7) is much more convenient for gripping and turning in both directions than the rounded protrusions of the wing-nut in the form of wings, but a twofold predominance of its length, and, consequently, of the lever arm when turning in one direction or the other, reduces the necessary pressure on it when screwing in and out;

- rotation of the bolt (pos. 8) (Fig. 2, a) in the fixation unit (pos. 2) of the telescopic rod is performed using an open-end, cap (ring) or socket wrench of 10 mm;

- an indication for the choice of a bracket (pos. 6) for locking in a given position (Fig. 1, a) of removable hand instruments and transosseous elements (pos. 1) is the use of those of them that, during use, require frequent change or reset of the level fixing them;

- an indication for the choice of a bolt (pos. 8) for locking in a given position (Fig. 2, a) removable hand tools and transosseous elements (pos. 1) is their use in cases where they do not need to be frequently changed during use or reinstallation;

- the handle of the T-shaped handle (Fig. 1, a, b), consists of two, located perpendicular to each other, 126 mm dies (item 4), 82 mm dies (item 5), 32 mm brackets (pos. 6), bolts (pos. 8) and nuts (pos. 9);

- clamping of hand instruments and transosseous elements in the device is possible at any level.

The technical result (advantages over the prototype) of the device, namely the handles for hand tools and transosseous elements, are as follows:

- economy, speed and simplicity of manufacturing the device with no need to search for materials for this, details for which are usually available in any orthopedic and trauma department of any medical institution;

- the device provides a simple, fast and reliable clamping and fixation of hand instruments and transosseous elements by inserting them into the fixation unit (pos. 2) of the sleeve of the telescopic rod (pos. 3) and blocking the end surface of the bolt shank of the 32-mm bracket (pos. . 6) or the end surface of the bolt (pos. 8) when turned clockwise;

- the device provides a simple, quick and convenient change of hand instruments and transosseous elements with their fastening at any level in the fixing unit of the telescopic rod sleeve by blocking and unlocking in the fixing unit (pos. 2) of the telescopic rod bush (pos. 3) by turning the bracket (pos. 6) or bolt (pos. 8) clockwise and counterclockwise;

- the possibility of choosing an arm (pos. 6) or a bolt (pos. 8) for locking in a given position and unblocking removable hand instruments and transosseous elements (pos. 1) in the fixation unit (pos. 2) of the telescopic rod;

- when manually locking and unlocking hand instruments and transosseous elements in the fixation unit (pos. 2) of the telescopic rod, turn the 32-mm bracket (pos. 6) with the 55-mm bracket ( pos. 7) is much more convenient for gripping and turning in both directions than the rounded projections of the wing nut in the form of wings, which is due to the twofold predominance of its length, and, consequently, of the lever arm and, accordingly, a decrease in the required pressure on it, that is, labor intensity screwing in and out;

- convenience and better handling properties of the handle of the T-shaped handle (Fig. 1, a, b and Fig. 2, a, b), which is due to its greater bulk and mass, and allows better control of the tool and provides a tight grip of it with a brush with the ability to dose efforts without fatigue and reduction of the surgeon's "muscular sense";

- the increased volume of the device handle creates a comfortable rest in the palm and the grip of the surgeon's hand with pressure and pull of the instrument along its axis and when turning around it;

- rotation around the axis of the instrument is facilitated not only by a convenient manual grip of its handle, but also by an increase in the lever arm of the handle by the presence of sufficient spacing between its ends, which exceeds the width of the surgeon's palm;

- ergonomics and expanding the technological capabilities of the instruments used, which contributes to a significant reduction in the labor intensity and duration of surgery, due to the better manipulation properties of the device;

- compact design, comfort and high efficiency of the device during the osteosynthesis operation, due to the quickness and ease of fastening instruments and transosseous elements in the handle and unlocking and removing them;

- the versatility of the device, due to the possibility of optimal use in different operations and on different segments of the musculoskeletal system with a combination of several functions and a wide range of acceptability and indications for use.

Thus, the proposed device makes it possible to increase the efficiency of the treatment of orthopedic and traumatological patients in need of surgical aid using a variety of instruments and transosseous elements.

Claims (1)

The handle for taps, awls, screwdrivers, Shants rods and knitting needles, which is a T-shaped holder for taps, awls, screwdrivers, Shants rods and knitting needles, characterized in that it consists of parts of the Ilizarov apparatus, namely: bushings with a telescopic fixation unit rods, 32 mm bolt shank brackets, 55 mm bolt shank brackets, two 126 mm dies, 82 mm ram, bolts and nuts, while the T-handle handle consists of two perpendicular to each other 126- millimeter dies, 82 mm dies, 32 mm brackets, bolts and nuts, it is possible to install and fix the tap, awl, screwdriver, Shants' rod and knitting needle by inserting a telescopic rod into the fixing unit of the sleeve and locking in a given position by pressing the end surface of the shank 32 -mm bracket by means of a 55 mm bracket fixed in its hole by means of a nut or and the bolt when they are turned clockwise, and when the 32-mm bracket is turned using a 55-mm bracket fixed in its hole with a nut or a bolt in the fixing unit of the telescopic rod counterclockwise, it is possible to unlock and remove the above tap, awl, screwdriver , Shantz rod and knitting needles.

Images