US3263A - photo-litho - Google Patents

Description

muren srA'rn-s PATENT Enron'.

eno. o.` JARvrs, or PORTLAND,"CONNECTICUT,

APPARATUS" FOR REDUCINGDISLOCATIONS.

Specioationof-Letters -Patent No. 8,263, dated September 14, 1843.

To all 'whom/t may concern.'

Be jit known that I, Geenen O. JAnv'Is, of Portland, in the county of Middlesex and State of AGonnecticuhhave invented a new and useful imachine or instrument for the purpose of producinglthe extension7 counterextensionyand transverse or lateral motion necessary to reduce fractures and `dislocations of bones and of maintaining a just coadaption ofthe lfractured ends of'bones during the process of reunion; andthat-the followingisaffull and exact description of thesame as invented or improvedby me.

l denominate the said machine the adjuster.

u Theldrawings annexed to the subjoined specification are referred to therein and form a 1 part thereof.

II. Theiirst part of the machine may be called the case. @Its 4form is shown inthe drawing at B. tmay be composed of any solid and vstrong material, such as wood,

b`rass,`iron,` &c., but brass issuppo-sedto be the best. It may be cast (if of brass) about one eighth of an 4inch thick and twelve inches long, the edges beingturned at right angles with the plate about one fourth of 'an inch, asshown atf/, ,`leaving the case `about one and one fourthof an inch wide.

except at o-ne end wherea pinionwheel is to be fitted `and is `marked D, inthe drawing. `The wholeinoluding the cap shown at Erewliich is to be made fast to the case B,` by screws `at the screw-holes marked m; m, m, &c. in thecap, and a, n, n, &c. in the case`-s1ioi`ild`be about halfV an inchthic-k, it being hollow within. This hollow ist to be divided `longitudinally by a partition marked 71 cast lengthwise on. lthe plate.

Thus the edge 4of the case 7u; the partition marked "It, the case B, and the cap Efo'rm the four sides of thefway for the rack C, to1 be hereafter described. The other edge of the case 7c, the partition It, the oase B,`

and the cap E,` form the way for the screw f, of the fork A, to be* hereafter described. On one end of" thecase terminating the way for the screw j', is to be cast a nut markedg, a" screw Vhole to 1be made through it to receive the screw f,` of the fork A. At

the other end of `the case and nearly in a line `with the sameway isto be placed a pinion wheel'marked D7 about one and one' fourth of an inch in diameter and one. fourth ofan nich thick with cogsto matclnand so placed inthe case as to fit accurately the i cogs of the rack` C, when passing in its Lway. The shaft inarletlG, ofsaid pinion wheel, and `which also serves as the shaft ofthe Iratch-wheel marked `Ris tobear on'the cap E and the case B. On the outside of the i cap JE and directly over the pinion-'wheel and `fastened Aon the Vsaine .shaft 1G yis :the ratch-wheel F about one and one fourth of an inch in diameter and three sixteenths of aninch thick. A catch or dogmarked H u is to be-fittedto the ratches of the wheel "F and fastened to the cap E by apin with a' spring `marked g, operating to keep `the `catch applied tothe ratches. The-extremity ofthe shaft G terminates over the ratchlwheel by ahub ornut to be received into a corresponding hole inthe `end ofthe lever I. LThis r lever maybe 'abouteight inches long and ofaV convenientsize witha` square hole in one end adapted to said hub G to be applied or removed atlthe pleasure of the operator.

Il. The second part of the machine may bedenfon'iinated the fork and is marked A in the drawing. :It-may be made of any firm metal, but steel is supposed tobe the best. 'Its arms markedv c, c, consist of a thin plate of such metal about three fourths of an inch wide and long enough to extend a littlemore than half around the upper part from` the inside oftliethigh, and at the same time eachlarm the onel forwardand the other backward rising by a gradual curve "until the ends ofthe arms reach 'an imaginary transverse line crossing the upper part of the os ilium: said arms H to `sta-nd at such a distance from each other as to sit loosely atall times to the part `a1: plied,`am:l the endsof the arms terminating in a square notch marked* C, C. A small fiat button marked b5 b, is firmly attached on the outside 'near the top of each of said arms. At the 'center between the two ends is to be firmly attached the shank or screw fr at one endand standing` in nearly opposite directions to the arms a, a. It may be about ten inches long and threeeighths of an 4inch in diameter, fitted to be received intothe screw hole marked g, in the end of the case B.l and intended toeXtend `or contract the length of the machine or instrument at pleasure, and to allow a free rotary motion to the case. From the top of the shank attached to the arms a small pin projects marked d, about one fourth of an inch long, on which may be placed at pleasure the curve K at a corresponding pin-hole at c in said curve now to be described.

III. The third part of the machine may be denominated the curve shown at K in the drawing. It may be made of any solid metal, but iron is supposed to be the best. It is to be in shape a curve round-ed at its middle, and flattened at the ends to about one inch broad with a square notch in -each end as at c, c. lts curve and length may be about as a segment two inches in diamater of a circle which is nine inches in diameter. Two small fiat buttons marked l), are placed one near each end on and attached to its convex surface. A pin-hole marked e, is made in the center between the two ends to admit the pin marked el, projecting from the top of the screw j', of the fork A.

1V. The fourth part of the machine may be denominated the rack and is shown at C, in the drawing. It may be of any strong metal but steel is the best. lt may be about half an inch wide and one-fourth of an inch thick and thirteen inches long to the angle marked 0, in the drawing. On one edge are to be cut cogs to match accurately into the cogs of the pinion-wheel D. From the angle (which should be a right angle) to the other end marked p, may be about four and a half inches, and it should stand in an opposite direction to the hub of the shaft G when the rack C is in its way. This part of the rack marked y), may be denominated the foot of the rack, and forms the point of exi tension for the machine.

V. The fifth part of the machine may be denominated the transvecture, and consists of three separate parts shown at P, Q, and R, in the drawing. They may be of any solid metal, but iron is supposed to be the best. It consists first of a lever marked P about fourteen inches long of suitable strength and of convenient size and shape for the parts attached. A pin marked il, is attached by a hinge-joint marked fu, to the end of the lever P. Said pin may be about one and a half inch long, and one-' fourth of an inch in diameter terminating` in a screw, which is intended to fasten into a screw-hole in the center of the femoral plate marked w. The said plate is shown at R, and may be about six inches long and one and a half inch wide and one-eighth of an inch thick, curved to fit the inside of the thigh. About two and a half inches from the hinge-joint on the lever P is to be attached by another joint the fulcrum marked Q. Said fulcrum is to be so fitted to the -case B that it may slip on or off at pleasure, and when on, that it may hold the trans vecture firmly to the case B. The transvecture is intended to produce lateral or transverse motion at the option of the operator, by applying his own hand or that of an assistant to the lever P.

Vl. The sixth part of the machine may bedenon'iinated the tibia-fork, and is shown at T in the drawing. It may be of the same material as the fork. Tt should have a short screw one and a half inch long or thereabouts, and be fastened at right angles with the arms, which should consist of a steel plate about half an inch wide and oneeighth of an inch thick in form of a half circle, the arms extending beyond the diameter of such circle about two inches in parallel lines and standing about six inches apart. The screw should be of the same size as screw f, and is intended to be inserted into the screw-hole g, instead of the screw The tibia fork is intended to be used instead of the fork in all fractures and dislocations occurring below the knee-joint, and when used it forms the point of counterextension of the instrument.

Vll'. The seventh part of the machine may be denominated the brachi-fork and is shown on Plate Il, at U. It may be made of the same material as the fork. ltshould consist of a screw about one and a half inch long of the same size as the screw f, of the fork A, terminating in a stem about three and a half inches long, and of any convenient size and shape; the extremity of the stem however to stand divergent from the time of the screw about one and a half inch. From the top or extremity of the stem and at a right angle with it, a curve is to commence and should form a little less than half of a circle, whose diameter is about four inches. This part also may be of any convenient size or shape, but round is the bestshape. The brachi-fork is intended to be used instead of the fork or tibia-fork in most cases of fracture or disloiation occurring below the condyles of the os humeri. For such purposes it is to be inserted by its screw into the screw-hole g, of the case B, and when thus used it forms the counter-extending point of the instrument. lVhen in use the case lies on the front of the forearm, the curve of the brachi-fork passing around on the back of the arm and close to the condyles at the elbow-joint.

VIH. The eighth part of the machine may be denominated t-he straps or rollsl of which there should be two, o-ne for the fork A, and the other for the curve K. They may consist of leather, cloth, or any other strong and pliable material covered with some soft fabric such as velvet or canton fiannel. They should be made hollow, and stuffed with some elastic substance (curled unter rest/ng on, the florsum 0j' the "c'Z'flll/m.

Let the several parts `ofthe instrument be hair being supposed to be best) leavingthe ends ofroll' L `free for some distance for a number of small button-holes to be made therein `lor the purpose of fastening to the buttons l), Z); the said rolls being shown at L and M in the drawing. The roll at L for y the fork should be long enough to hang loosely down between the arms a, a., Vpassing overthe notches c, C, andfastening to the buttons l), b. The roll M for the lcurve K to stretch across the ends in the square notch and fasten by lbutton holes to the buttons b, by The foregoing rolls, when both are used` formthe counter-extending `point of the instrument, when the parts, to which theyseparately `belong are also used.

IX. The ninth partl of the machine may be denominated Tthe belts, of which there should be two, shown at N `and O in the drawing. The oneatN should be fitted to clasp firmly the thigh close to and above the condyles of `the os` femoris, or the arm close to and above the os humeri. It may be found substantially described in 'Sir Charles Bells Institutes of Surgery, article DsZocatz'on, 'Philadelphia edition, 184:0, page 114.4. The other belt represented at O may be made on the same principle, and should be made to `fit the ankle above and close to the `malleolus processes or the fore-,arm at the wrist.` TheloopS, which are shown at e, &c., may be `of iron, cloth, or any strong material fastened firmly to the belts as represented in the drawing. Said loops are to be fastened to the foot 79, of the rack C, `by strong cords passing through the loops and over the foot 7), and made fast thereto. The cords are shown at N passed through the loops e, e. l I

X. The tenth part of the machine 1s simply a strap of leather or cloth with a loop at pleasure-a buckle made fastat the midb'epassed around'the other arm of thefork and made fast inthe buckle. The strap in use passes overthe-dorsum ilii and confines the arms of the fork outward. It is shown at S in the drawing. i

The following is the mode of using the above described machine or instrument. is believed that al description ot' its use in two dislocations, one of the hip-joint, the

other of the elbow-joint, and intwo frac-` tures, one of the thigh-bone, the other of the leg-bones` will be a sufficient explantion for all `who are acquainted with the science or practice of surgery.

`l. ,Daal/ocation of the' fhig/1.4607176 upward and outward; the zecullof the bone and trockcombined as represented in Plate II. `Let the belt N bebuckled around so as to clasp the thigh firmly above and close to the conlhis hands to the lever I, and elongate the limb by `moving the` lever until with the other hand he feels the round head of the femur descend to a transverse line with the acetabulum..` Now let the assistants, the one havinghold of the lever P and the other of l the limb simultaneously operate, the one by backward, reaching nearly as high as the top of the os ilium. Fasten the strap S to the arms, crossing the dorsum of the os iliumrso as to confine the arms outward. Fasten the loops by the cords alreadypassed through them to the foot of the rack. Now let a common handkerchief or any thing convenient for that end be passed around the limb and instrument close to the knee, and made fast, to confine the instrument to the limb. Vliet the leg be bent at rightan! gles with the thigh, and the thigh placed in a line with the body. Let an assistant, with one hand, take hold of the limb to be operated on, `at the foot and, `with Vthe `other hand, take hold of the knee. Another assistant having hold of the lever of thetransvecture, let the `operator now apply one of the lever casting t-he limb outward from the body` the other by thro-wing the foot inward l and the knee outward, rotating thethigho-n its ownaXis. q of the bone directly over the acetabulum, 1 into which he restores the head of the bone (if need be) by gently pressing with the handon the trochanter major, whileexteni sion in the limb is gradually relaxed.

at one end to slip on tothe arm ofthe fork I The operator finds the Ahead 2. To reduce and treat n Ute Zimt 7903i- Vtion an oblige/c fracture 0f zt/72e thigh-bone dlef-with holes in the other end that 1t may (0s terminal-Let the transvecture be removed from the case, and place the curve K on the pin (Z. Apply and fast-en the instrument as before. except that the handkerchief, &c. be dispensed with.' Now, place the limb with the instrument atiixed on the double inclined plane with the necessary bandages upon it. `Let the operator extend the limb by thelever as before until a just coaptation of theends of the bones may be readily effected by him. Apply the proper splints, bandages, &c., agreeably to approvedA works on`surgery, continuing such eXtension with theadjuster as shall preserveto the limb its due length and relieve it from y l straight pos/tion of the Zim?) is to` Zie prc-` y served: 'It is only necesary to elongatethe instrumentby `running out Vthe screw of the fork and the back from their ways suficiently to adapt its length to the length of the whole limb; the point of extension being made fast by cords to the belt buckled around the ankle and from below the sole of the foot while the counter-extending point is applied as before to the angle between the perinacum and thigh. rIwo long splints, one long enough to reach from the periuaeum to the sole of the foot, the other from the top of the os ilium to the sole of the foot, and each about two and a half inches wide and about one third of an inch thick, are to be folded in a cloth of cotton or iannel so as to form a easement or bo-x for the limb to be laid in. The adjuster is to be applied and made fast after the limb is laid in the above easement or box. Now, let the operator extend the limb as before to effect. coaptation. Let the adjuster, splints, and limb be now tied firmly together by passing two tapes, one abo-ve and the other below the knee for such purpose.

4. To redt/,ee cmd treat m obligue fracture of Z'ze Zeg where strong muscular com/raet/eas (lf/"e 'regu/reci to be overcome t0 avoid eeft/ier draag/er to the pat/ent 01' deformity of the limo-Fasten by the buckle and straps attached the belt N immediately below the knee and around the leg. Fasten in like manner the belt O to the ankle as before. Let the fork A be removed from the case, and the tibia fork screw be inserted in its stead. Slip the arms of the tibia fork through the loops of the belt N. Fasten by strong cords the loops of the belt (l to the foot of the back below the sole of the foot. Now. place the limb on the double inclined plane as before, the proper bandages being previously laid on t-he plane. Now, let the operator lengthen the limb to its due extent by throwing the rack out., the lever I operating on the shaft of the pinion wheel, and that again on the rack as before. Let vthe surgeon adjust the fractured bones, dress with splints, bandages, ttc., as directed by approved works on surgery, maintaining such extension ot' the limb by the adjuster as shall be necessary to relieve undue muscular contraction, and preserve due length to the limb.

5. To reduce c dislocation, of the elbowfjoiaff, fiche/re 'ie corone/d process 0f the 'HZ/1m Zz'es a the poster/01" fossa of the 7mmera's for Hte reception. of the elec/Hman, prot-ess of' z/ze alaaf-Let the tibia fork be removed from the case. and the brachi-fork be inserted in its stead; the rack being so far run into its way as that the instrument shall be at least as long as the foreearm and hand combined. Let the belt N be buckled around the arm close to the condyles of the humerus with the loops on the back of the arm close to and imi'nediately above the olecranon process of the ulna. Let the belt O be buckled around the wrist, the loops lying one on the front the other on` the back of the wrist with strong cords in them. Now let the curve of the brachi-fork be passed through the loops of the Vbelt N on the back of the arm. The case now lying on the front of the fore-arm, let the foot of the rack be closely fastened by the cords in the loops of the belt O to the wrist. Now, let the operator in the same manner as before so far throw the rack out by a gradual and steady motion as that the coronoid process of the ulna may ride over and lie in front of the pulley-like'surface of the humerus, as the operator performs the necessary flexion of the fore-arm to bring the process into its place.

For the principles that should govern in the reduction of dislocations and fractures and the practice that should obtain in relation to position, splints, bandage, &c., reference is of course made to approved works on the principles and practice of surgery.

The invention herein before described is believed to differ from all others heretofore known or used in the application of three specific principles to the purposes above mentioned, and the invention is claimed to consist in the application of these principles, to wit: First, the application of the lever to produce extension, counter-extension, and lateral or transverse motion in reducing dislocations and fractures of bones; secondly, the application of the ratch-wheel andv dog or catch to maintain such extension and counter-extension; thirdly, such an application of the screw and rack combined as that the instrument may be readily accommodated to any length or position of limb, and adapted to reduce any form of fracture or dislocation of any of the (so called) long bones and many others; indeed all, where the principle of extension and counter-extension apply in their reduction; and, fourthly, if is also claimed that the combination of various parts of the above described maehine to produce the foregoing effect has been hitherto unknown in the art of surgery.

The lever may be applied to produce extension and counter-extension in several different ways; one only beside the one herein described will be named, to wit: by the lever operating on a. shaft, on which coils a strap as of leather, cloth, or any strong and flexible material; the strap being attached to the end of a rod fitted to slide in a way, and which is thrown out of its way asfthe strap is coiled on its shaft; but, ofthe various methods the rack and pinion wheel herein described is supposed to be the best.

The ratch wheel and catch may also be variously applied. In addition to the mode herein described, the one just referred to, in which the lever may also be used, may be equally adapted to the ratoli Wheel and in before described and for the object set 1c catch; but the one herein described is supforth. posed to be the best. Dated at Middletown, Conn. July 15th Vhat I claim as iny inyentionand desire A. D. 1843. to secure by Letters Patent isy The application of the lever to the purposes above specified and the combination In presence ofof the lever With the ratcb-wbeel and catch, LANGDON C. HUBBARD, and the screw and rack, in the manner heren JONATHAN BARNES.

eno. o. Jiinvis.

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