US2612159A - Trochanteric plate for bone surgery - Google Patents

Description

Sept. 30, 1952 J.IG. COLLISON 2,612,159

TROCHANTERIC PLATE FOR BONE SURGERY Filed March 1, 1949 ntot I Qtto cg Patented Sept. 30, 1952 craoonanrnaro PLATE Fen eons SURGERY John G. oouisen, Greensboro, N. o.; Marie B.

Collison administr'atrix of said John G. Collison, deceased Application March 1, 1949, Serial N0. 79,026

The invention relates to improvements in trochanteric plates for use in bone surgery, and one of the objects of the invention is to provide such a plate that will produce greatly improved results in the treatment of hip fractures, such as neck fractures or trochanter fractures, where nails or screws are used, and in femoral head prosthesis operations.

Another object of the invention is to provide a trochanteric plate so constructed that it will maintain the shaft which carries the artificial head, in femoral head prosthesis operations, perfectly rigid and in the exact position in which it was originally inserted, and likewise, in pin operations, in fractures of the neck or the trochancar, will maintain the nail or screw used perfectly rigid and in fixed position laterally, thereby preventing any overriding of the femur on the head, and permitting union of the fractured parts.

A further object of the invention is to provide a trochanteric plate which, in pin operations, using either nail or screw, the nail or screw and plate are freely movable, relatively, longitudinally of the nail or screw, in the event of absorption.

Another object of the invention is to provide a trochanterio plate adapted to use either in femoral head prosthesis operations or in pin operations, with either nail or screw, in cases involving fracture of the trochanter or the neck of the femur. I

Various other objects and advantages of the invention will be apparent to those skilled in the art of bone surgery, from the following detailed 11 Claims. (01. 128-92) description, taken in connection with the accompanying drawings, in which:

Figure 1 is an elevational view, with parts in section, of the trochanteric plate with surgical nail mounted in place on the femur;

Figure 2 is a similar view of the troohanteric plate with a surgical screw;

Figure 3 is a similar view but showing the trochanteric plate in combination with the parts used in a femoral head prosthesis operation; and

Figure 4 is a perspective view of the trochanteric plate.

Referring to the drawings in more detail, numeral I indicates the upper portion of a femur, including the femoral head 2, the femoral neck 3, and the greater trochanter 4. In Figures 1 and 2 a fracture of the femoral neck is indicated by a line 5. It should be mentioned here that the bone structure is illustrated merely diagrammatically, and no attempt has been made to give an anatomically correct illustration thereof, either interiorly or exteriorly, as that is obviously entirely unnecessary.

The preferred structure of the troohanteric plate will first be described, and then willfollow a description of its application in hip operations.

Referring particularly to Figure ernumeral 6 indicates the trochanteric plate generally. This plate has a shank portion 1 which is preferably curved in cross-section to conform generally to the shape of the bone, and is provided with the desired number of holes 8, four in the embodiment illustrated, to receive screws 9, for perma nently securing the plate in position. The screw holes are preferably countersunk, as shown.

Carried by the shank portion '3 is a tubular portion or member ID. The shank. portion and the tubular portion are preferably formed integral, as shown, but it will be apparent that the two parts may be formed separately and then be rigidly united by any desired means.

This tubular portion I0 is of substantial length and extends at an angle to the shank portion which is approximately the angle between the shaft and neck of the femur. In other words, the angle between the shaft and the neck of the femur differs somewhat in different persons, as much as 10 degrees, and the tubular portion of the trochanteric plate is arranged at an angle to the shank thereof which is the mean or average angle in femurs, about 135 degrees, so that the plate is applicable to all femurs.

Adjacent its outer end, the tubular member it may be provided interiorly with an annular shoulder II.

The trochanteric plate as a whole constitutes a strong and rigid device, which is preferably made of stainless steel, as are all other parts used in connection therewith, though the invention is not limited to the use of any particular material. When the plate is secured in position on the femur the tubular member extends a considerable distance into the bone and provides an exceedingly strong reenforcement for nails, screws, shafts, or other devices which may be used in cooperation therewith, as will appear more clearly in the description of the application of the plate.

The tubular member is shown as round and cylindrical, exteriorly and interiorly, and that is preferably the shape thereof, but of course it could be oval, rectangular, triangular, etc., in cross-section, either on the outside or the inside;

it being necessary only that it be of such a shape as to receive and support or reenforce nails, screws, shafts, etc., used in hip operations. Accordingly, the use of such words as tubular portion, section, or member, herein or in the claims, is not intended to define or limit the element to any specific shape either on the inside or the outside.

The use of the plate in connection with nails or screws, in the treatment of fractures, will now be described, reference being had to Figures 1 and 2.

Merely as an illustration, a femoral neckfracture is shown. Before applying the plate, a hole or cavity is formed in the neck of the femur of substantially the length and the cross-sectional size and shape of the tubular portion IU of the trochanteric plate. This hole or cavity extends toward the femoral head and of course is formed at the same angle that the tubular member l bears to the plate shank 7. In boring the hole, at exactly the same angle as that of the tubular member a drill jig is temporarily attached to the shaft of the femur, but a description thereof is unnecessary as it forms no part of the present invention.

Thetubular member is. now. inserted in the openingand the plate is. permanently secured to the-femur shaft, as by. means of the screws 9.

These screws may extend through .theproximal and distal cortex, as shown, or. only through the proximal cortex.

With thetrochantericv plate now secured in place, an appropriate nail, such. as a flanged surgical nail I2, Figure l, is inserted in the tubular section [0 of the trochanteric plate, and

. then itis driven in, as by a mallet, until the nail nail is properly positioned. And when the nail is in position the tubular. member, which extends a considerable distance into the bone, provides an exceedingly strong reenforcement for the nail,

and will rigidly maintain the nail laterally fixed l in exactly the position in which it is inserted, and thereby hold the proximal and distal fragments in proper alignment and prevent overriding of the femur on the head, and thus permit union ofthe fractured parts.

It will also be noted by reference to Figure 1 that the nail and the tubular section of the plate are freely movable, relatively, longitudinally of the nail, which is obviously of very considerable importance in the event absorption occurs, for it permits the femoral shaft carryingthe tubular member ID to move upwardly along thenail to bring the fractured parts closer together while at the same time maintainingthem aligned.

In Figure 2 a surgical screw [3 is shown in place of the surgical nail l2. When surgical screws are used instead of nails, in pinning operations, the tubular member of the plate functions in the same manner as above described in connection with the use of surgical nails. That is, the tubular. member will properly guide the screw into position, and by reason of its reenforcing function it will maintain the screw rigidly in laterally fixed position and prevent any overriding of the femur on the head, and as also previously described in connection with the use of surgical nails, the tubular member and the screw are freely movable relatively, longitudinally of the screw.

Figure 3 illustrates the parts in a femoral head prosthesis operation. In this operation the acetabulum is cleared of. the. femoral head and an artifical head is substituted. The operation becomes necessary or advisable where, from the result of a fracture or otherwise the head absorbs,

or in some cases the operation may be performed at the time of the fracture. The operation also becomes necessary or advisable as the result of ankylosis caused by certain types of arthritis. The present invention produces highly desirable results in those operations requiring the use of an artificial femoral head.

Numeral [4 refers to an artifical femoral head. In shape it is preferably a segment of a sphere, and may be made of stainless steel or of other desirable material. Numeral l5 refers to a stainless steel shaft or rod. The central portion of thisshaftis of substantially the same diameter as the-external: diameter of the tubular member ID. The'inner end of the shaft has a slightly reduced portion [6 forming a shoulder IT. The

' artificial'head I 4 is centrally bored so that the head will fit neatly on the reduced portion it, with the plane surface of the spherical segment abutting the shoulder H. The outer end of the shaft also has a reduced portion, indicated by numeral i8,'to form a shoulder I9. This reduced portion inakesa neat fit in the tubular member [0, with the shoulder 19 abutting the inner end of the tubular member. It will be understood, of course, that the natural, upward pull of the muscles will hold the artificial head and shoulder H. in abutting relation, and will also hold in abutting relation the shoulder 19 and the end of the tubular member I 0.

' In applying the parts in this femoral head prosthesis operation, the femoral head is first removed from acetabulum. Then the previously mentioned drill jig is. temporarily attached to the shaft of the femur anda hole is bored all the way through the femoral neck. Then the trochanteric plate is permanently attached to the femoral shaft in the manner hereinbefore described, with the tubular portion H] of the plate extending into the hole in the bone. Then the reduced portion i8 of the shaft is inserted in the tubular portion ll] of the trochanteric plate, with the shoulder 19 resting on the end of the tubular member, and the artificial head I4 is then placed on the reduced portion I-B of theshaft, resting against the shoulder I1. The parts are now in position ready to reduce the ball into the acetabulum.

It will be apparent that in femoral head prosthesis operations the trochanteric plate of the present invention performs a highly desirable "function, in that the.tubular member ID extending a considerable distance into the bone and embracing the shaft which carries the artificial head, maintains the shaft in a rigid and laterally fixedv position, which may well mean the difference between success and failure in this operation. It. will also be noted that while as previously described in pinning operations relative movement is permitted between the tubular member. and the nail or screw, 1ongitudinally of thenail or screw, no such relative longitudinal movement is permitted between the tubular member and the shaft in the femoral head prosthesis operation, for the artificial head abutsthe shoulder l1, and the shoulder I9 abuts the. .end of. the .tubuar member.

. .Thereshould be no rotary movement of the shaft inthe tubular member ID, and the friction created. by the .sidewise pressure of the shaft in the-tubular member prevents such rotary movement. However, insome cases it may be desirable to clamp these parts together, and accordingly the reduced end portion of the shaft may terminate short of the outer end of the tubular member, and the end of the shaft may be centrally threaded to receive a screw 20, the head of which screw'rests upon a washer 2|. Thus by turning the screw the shoulder IQ of the shaft will be firmly clamped against the end of the tubular member ID.

From the foregoing description it will be apparent that the trochanteric plate disclosed herein provides a marked advance in hip operations, particularly in pinning operations and in femoral head prosthesis operations.

Having fully described the invention, what I claim is: I

1. In bone surgery, a trochanteric plate, said trochanteric plate comprising a shank portion and a surgical implement supporting portion,

said portions being rigidly connected, said shank portion adapted to be secured to the shaft of the femur, said implement supporting portion having substantial length and adapted to extend into the bone, and said implement supporting portion having a passage therethrough to receive a bone surgery implement.

2. In bone surgery, a trochanteric plate, said trochanteric plate comprising a shank portion and a surgical implement supporting portion, said portions being rigidly connected, said shank portion adapted to be secured to the shaft of the femur, said implement supporting portion having substantial length and arranged at an obtuse angle to the shank portion and adapted to extend into the bone and said implement supporting portion having a passage therethrough to receive a bone-surgery implement.

3. In bone surgery, a trochanteric plate, said trochanteric plate comprising a shank portion and a tubular portion, said portions being rigidly connected, said shank portion adapted to be secured to the bone, said tubular portion having substantial length and adapted to extend into the bone, and the hollow of said tubular portion receiving a bone surgery implement.

4. In bone surgery, a trochanteric plate, said trochanteric plate comprising a shank portion and a tubuar portion, said portions being rigidly connected, the two portions permanently arranged at approximately the angle that the neck of the femur bears to the shaft of the femur, and the tubular portion having substantial length and the hollow of the tubular portion receiving and reenforcing a bone surgery implement.

5. In bone surgery, a trochanteric plate, said trochanteric plate comprising a rigid shank portion and a rigidly connected tubular portion, said portions permanently, arranged at approximately the angle between the neck and shaft of the femur, and said tubular portion having substantial length and the hollow of the tubular portion receiving and reenforcing a surgical nail.

6. In bone surgery, a trochanteric plate, said trochanteric plate comprising a rigid shank portion and a rigidly connected tubular portion, said portions permanently arranged at approximately the angle between the neck and shaft of the femur, and said tubular portion having substantial length and the hollow of the tubular portion receiving and reenforcing a surgical screw.

'7. In bone surgery, a trochanteric plate, said trochanteric plate comprising a rigid shank portion and a rigidly connected tubular portion, said portions permanently arranged at substantially the angle between the neck and shaft of the femur, and said tubular portion having substantial length and the hollow of the tubular portion in the hollow of said tubular portion and extending into the head of the femur, said nail and tubular portion being freely movable, relatively,

longitudinally of the nail.

9. In bone surgery, a trochantericplate, said trochanteric plate comprising a rigid shankportion and .a rigidly connected tubular portion, said shank portion adapted to be secured to the femur shaft, said tubular portion having substantial length and arranged at an angleto the shank portion approximating the angle between the neck and shaft of the femur and extending into the bone, a surgical screw mounted with a neat fit inthe hollow of said tubular portion and extending into the head of the femur, said screw and tubular portion being freely movable, relatively, longitudinally of the screw.

10. In bone surgery, a trochanteric plate, said trochanteric plate comprising a rigid shank portion and a rigidly connected tubular portion, said shank portion adapted to be secured to the femur shaft, said tubular portion arranged at an angle to the shank portion approximating the angle between the neck and shaft of the femur and extending into the bone, a shaft mounted in said tubular portion and extending through the neck of the femur, and an artificial femur head mount ed on the inner end of said shaft. v 1 1'. A fracture nail support device comprising a tubular portion adapted to enter the head of a femur and a plate portion adapted to extend along the femur shaft adjacent the head, said portions being rigidly interconnected and the plate portion extending laterally from one end of the tubular portion such that the axis of the tubular portion forms an obtuse angle with the plane of the plate portion, said tubular portion having an inner diameter adapted to accommoe date a' fracture nail.

1 JOHN G. COLLISON.

REFERENCES CITED The following references are of record in the file of thispatent:

UNITED STATES PATENTS Number Name Date 2,243,717 Moreira May 27, 1941 2,397,545, Hardinge Apr. 2, 1946 2,441,765 Hopkins May 18, 1948 2,500,370 McKibben Mar. 14, 1950 OTHER REFERENCES Piedmont Hospital Bulletin for 1937, page 24.

La Presse Medicale for May 3, 1947, page 302 copies of both publications in Div. 55.

Journal of Bone and Joint Surgery-1941, page 807.

The Journal of Bone and Joint Surgery for July 1950, advertising page 34'; (Copy of the above publication in Div. 55.)

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