US3900025A - Apparatus for distracting or compressing longitudinal bone segments - Google Patents

Apparatus for distracting or compressing longitudinal bone segments Download PDF

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Publication number
US3900025A
US3900025A US463463A US46346374A US3900025A US 3900025 A US3900025 A US 3900025A US 463463 A US463463 A US 463463A US 46346374 A US46346374 A US 46346374A US 3900025 A US3900025 A US 3900025A
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United States
Prior art keywords
movement
support member
support members
bone
bore
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Expired - Lifetime
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US463463A
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English (en)
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Jr Walter P Barnes
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Individual
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Priority to US463463A priority Critical patent/US3900025A/en
Priority to CA221,773A priority patent/CA1046371A/en
Priority to GB13366/75A priority patent/GB1499566A/en
Priority to DE2515430A priority patent/DE2515430C2/de
Priority to JP50045105A priority patent/JPS5757136B2/ja
Priority to FR7511613A priority patent/FR2268507B1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones

Definitions

  • ABSTRACT An orthopedic apparatus for selectively distracting or compressing contiguous longitudinal bone segments comprising a first and second support member each of which can be placed longitudinally coextensively adjacent respective bone segments.
  • a first longitudinal bore extends within the first support member for receiving and threadably engaging one portion of a threaded driving rod
  • a second longitudinal bore, axially aligned with the first longitudinal bore extends within the second support member for receiving and threadably engaging another portion of the threaded driving rod.
  • the apparatus can be inserted into the limb according to standard orthopedic surgical procedures and then mounted adjacent the bone segments after which the support members are periodically adjusted to stimulate the growth of new bone matter between the distracted bone segments.
  • a method for distracting longitudinal bone segments by insertably mounting an adjustable distracting apparatus adjacent longitudinal bone segments and periodically adjusting the apparatus to stimulate a build up of new bone growth between the bone segments.
  • FIG/O APPARATUS FOR DISTRACTING OR COMPRESSING LONGITUDINAL BONE SEGMENTS BACKGROUND OF THE INVENTION This invention relates to an orthopedic apparatus for distracting or compressing contiguous longitudinal bone segments whereby the apparatus is releasably mounted immediately adjacent the bone segments within the limb.
  • U.S. patents U.S. Pat. Nos.
  • the prior art devices cause many surgical and post operative problems because of their inherent structural deficiencies. None of the prior art devices presently in use or previously mentioned adequately hold the distracted bone segments in rigid axial alignment, because the rigidity of the connection between the support apparatus is dependent upon the rigidity of the bone fixation pins. Thus, not only is angulation and rotation of the bone segments difficult to control when these prior art devices are used, but there is also an increased chance of infection in the open wounds surrounding the pins and pressure necrosis of the skin adjacent the pins. The use of a cast has the disadvantages of causing the patient general discomfort and delaying the time within which the distracted limb may be therapeutically exercised to alleviate muscular tightening, muscle atrophy, and joint stiffness.
  • an apparatus for a size for implantation within a limb in direct contact with a bone for selectively positioning, i.e., distracting or compressing contiguous longitudinal bone segments, comprising a first elongated support member and a second elongated support member, each having means for placement longitudinally coextensively adjacent a respective bone segment.
  • the first and second support members are operatively connected together for adjusting the longitudinal displacement between each support member and for preventing rotational movement of the first and second support members during the longitudinal movement thereof and each have means for releasable attachment immediately adjacent their respective 'bone segments.
  • the apparatus is surgically placed within the limb and mounted immediately adjacent the bone segments.
  • the support members may then be periodically adjusted to distract or compress the bone segments.
  • the invention not only prevents angulation and rotation of the bone segments, but also eliminates the need for a post operative cast, since the bone segments are rigidly held in place by the support members in an axially aligned position. Therefore, there is no chance of infection due to pin tract wounds in the limb, and rehabilitation of the limb may be commenced soon after the operation.
  • the apparatus is lightweight and simple in design, and may be constructed to accommodate almost any bone size.
  • FIG. 1 is a perspective view of the preferred apparatus embodiment of the invention in a closed position and mounted on illustrated bone segments within a limb;
  • FIG. 2 is a top view of the apparatus of FIG. 1 shown in the partially opened position with new bone growth formed between the bone segments;
  • FIG. 3 is an end sectional view along line 3-3 of FIG. 1 with the limb shown in phantom lines;
  • FIG. 4 is a front sectional view along line 44 of FIG. 2;
  • FIG. 5 is a perspective view of a second apparatus embodiment of the invention in an opened position
  • FIG. 6 is an end sectional view along line 6-6 of FIG. 5;
  • FIG. 7 is a rear sectional view along line 77 of FIG.
  • FIG. 8 is a front view of a third apparatus embodiment of the invention in a closed position
  • FIG. 9 is an end sectional view along line 9-9 of FIG. 8;
  • FIG. 10 is a top view of the apparatus of FIG. 8;
  • FIG. 11 is a perspective view of the apparatus of FIG. 8 in an open position
  • FIG. 12 is a front sectional view along line l2l2 of FIG. 11 showing the pawl mechanism in a closing position;
  • FIG. 13 is a front sectional view along line 12-12 of FIG. 11 showing the pawl mechanism in an opening position
  • FIG. 14 is an exploded perspective view of the pawl mechanism.
  • FIGS. l4 the preferred apparatus embodiment of the invention is shown generally at 5 and is releasably mounted to bone 4 within a limb (see FIG. 3), comprising a first or proximal longitudinal bone segment 18, and a second or distal longitudinal bone segment 22.
  • a limb see FIG. 3
  • the invention is adaptable to be used on any relatively long bone and for either distraction or compression, as desired.
  • the apparatus includes a pair of elongated support members 6 and 8.
  • Each support member comprises a rectangular block of stainless steel that has a concave rear surface 52 which permits each support member to lie immediately adjacent to each respective bone segment.
  • Screws or pin members 14 may be used to releasably mount the apparatus to femur bone 4 through a plurality of screw holes or apertures 15 in support members 6 and 8.
  • the size of the screws may vary according to the size of the apparatus'and bone, screws having a diameter of 0.164 inches and a suitable length are recommended so that the apparatus is firmly secured to each of the femur bone segments.
  • Other means for mounting the support members may be utilized, as long as each support member is securely mounted to the bone segments.
  • Support members 6 and 8 are rigidly adjustably connected together by driving rod 10 and guiding rod 12.
  • Driving rod 10 not only imparts longitudinal movement to the support members but also maintains substantial longitudinal alignment of the first and second support members.
  • Driving rod 10 comprises threaded and axially aligned sections 40 and 43, which are engageable with similarly oppositely threaded bores 44 and 46, extending within support members 6 and 8.
  • Bore 44 has an internal left-handed thread corresponding to section 40 of rod
  • bore 46 has an internal right-handed thread corresponding to section 42 of rod 10. This feature permits second support member 8 to move or impart bone segment 22 a longitudinal distance in the direction of arrow 1 in response to the rotational movement of driving rod 10.
  • Smooth guiding rod 12 is mounted or fixed within bore 48 in support member 6, and the opposite portion of guiding rod 12 is slidably engageable or mounted within bore 50 in support member 8.
  • Guiding rod 12 gives the apparatus rigidity as it is adjustably opened or closed by preventing rotational movement of the first and second support members during the longitudinal movement thereof and maintains each support member in constant axial alignment, thereby eliminating angulation and rotation of the bone segments.
  • Fluid drainage holes 56 are interspaced along the top of each support member.
  • Small threaded pin or screw 9 is'threadably screwed into bore 11, in socket head 26, of rod 10 and is then screwed into bone segment 18 after the apparatus is adjusted to insure that the distracted distance remains constant.
  • the apparatus In use as a distraction device, the apparatus is inserted into the limb adjacent the bone segments and distraction is accomplished in periodic adjustments to position the bone segments as desired, thereby enabling the formation of new bone growth 54 between the bone segments.
  • the method of distracting the bone segments is hereinafter described in more detail.
  • FIGS. -7 show a second apparatus embodiment of the present invention, comprising first and second elongated support members 60 and 62 that are rigidly adjustably connected by means of threaded driving rod 58 and smooth guiding rod 82.
  • Guiding rod 82 is connected to support members 60 and 62 in the same manner as shown in the previously described preferred apparatus embodiment and prevents rotational movement of the support members during the longitudinal movement of second support member 62.
  • An internally threaded bore 64 extends within support member 62 for engagement with one end portion of driving rod 58; and smooth bore 66, axially aligned with threaded bore 64, extends within support member 60 for receiving another end portion of rod 58.
  • End 71 of driving rod 58 is mounted to beveled gear 72 for engagement with beveled gear 74 which is rotatably mounted in, bushing 76 within support member 60 oppositely .(see FIGS. 6 and 7).
  • gear 74 is rotated gear 72 connected to each other and are operatively connected to each other by means of a rack and pinion mechanism.
  • the interconnection of second portions 96 and 98 inherently prevents support members 91 and 93 from rotating during the longitudinal movement thereof/The rack and pinion mechanism comprises a driving gear pinion 108 having a wrench receiving aperture ll].
  • Arms 96 and 98 have slots 107 and 109 for first and second gear racks 103 and 105, respectively.
  • pinion 108 is locked within arms 96 and 98 and is simultaneously operatively engageable with gear racks 103 and 105.
  • Support member 94 will longitudinally move or impart in the direction of arrow 117 (see FIG. 11) when pinion 108 is rotated in the direction of arrow 115.
  • FIGS. 12-14 A pawl and gear rack mechanism is shown in FIGS. 12-14 which restricts the longitudinal displacement of the support members in a first set of opposed directions while preventing longitudinal movement in a second set of opposed directions opposite the first set.
  • the pawl mechanism comprises a pawl 118 having a flange 120 and a shank 122. The shank is inserted into spring 124.
  • Cylindrical housing 126 contains slots 128 and 129 for receiving flange 120, and is threaded at 127 for insertion into bottom surface 1 13 of housing 112.
  • Gear rack 119 is machined out of the bottom surface of arm 98 (see FIGS. 12 and 13).
  • pawl 118 is held in a biased position against rack 119 when housing 126 is screwed into position within housing 1 12.
  • FIGS. 12-14 A pawl and gear rack mechanism is shown in FIGS. 12-14 which restricts the longitudinal displacement of the support members in a first set of opposed directions while preventing longitudinal movement in a second set of opposed directions
  • 12 and 13 respectively show the adaptability of the pawl mechanism to be mounted in housing 126 in a first position in which the biased engagement of pawl 118 against rack l 19 permits converging longitudinal movement of the support members while preventing diverging longitudinal movement therof, and in a second position in which the biased engagement of pawl 118 against rack 119 prevents converging longitudinal movement while permitting diverging longitudinal movement thereof.
  • FIG. 12 flange 120 is inserted into slot 129 so that the support members may simultaneously converge towards pinion 108.
  • FIG. 13 shows flange 120 inserted and, in slot 128 thus permitting the support members to simultaneously diverge away from pinion 108.
  • a follower apparatus 28 as shown in use with the third apparatus embodiment in FIG. 10 and l 1, that may be used to increase the rigidity of the coupled bone segments.
  • Follower plate 28 is attached to the medial side of the bone by using longer screws 95. If the follower is used, onlay graft 24 may be placed on the top of the bone, as shown in FIGS. 8, l0, and 11.
  • all of the apparatus embodiments may be used to reduce fractures by simply closing the support members until the fractured segments of bone are joined by compression.
  • the method of using the invention for distraction comprises the steps of attaching the proximal or first support member 6 to proximal bone segment 18.
  • Onlay graft 24 is not mounted to the bone until after the bone is broken and both support members are in place.
  • Bone 4 is then cut in a step-cut fashion or may be drilled in a transverse direction, and then fractured. Care is taken while fracturing the bone to prevent the tearing of the periosteum.
  • the periosteum is split longitudinally and incised circumferentially at the distal end of the incision to form a split sleeve of periosteum; thus, periostial growth of new bone is not endangered.
  • the distal or second support member 8 is clamped to the distal bone segment after the bone is broken, and the none segments are then manually axially aligned to correct angulation and rotation of the bone segments which occurs after the bone is broken. Once the bone segments are aligned, the second support member is mounted to distal bone segment 22 in the same manner as the first support member was mounted to proximal bone segment 18.
  • an onlay graft 24 is taken from the fibula and/or ileum during the operation and is loosely affixed to bone segment 4 by using longer screw 20 (see FIG. 3).
  • the onlay graft is mounted on the medial side of bone 4 bridging gap 3 between bone segments 18 and 22 after the apparatus is adjusted.
  • the onlay graft will become incorporated into new bone growth 54 as the bone ends are completely joined by callus.
  • Screw 20 may be placed in any of the pin receiving apertures 15, but is preferably placed in the second opening of support member 6.
  • onlay graft 24 is affixed to the bone, the apparatus is adjustably opened by rotating rod end 26 with a screwdriver or the like, until the apparatus and bone segments are distracted approximately three/fourths inch to 1 inch.
  • Onlay graft 24 will slide along the medial side of the bone as shown in FIG. 2.
  • the wound in the limb is then closed according to standard surgical techniques. After a week to ten days, a small incision is made in the limb over the rod end and rod 10 is rotated again, thereby opening the apparatus another one/- fourth inch to one/eight inch. This procedure may be repeated about every 10 days over a period of 3 to 6 weeks until a maximum distraction of approximately 2 inch to 2 /2 inch is effectuated.
  • This periodic adjustment is to insure that the gradual build up of callus or new bone growth 54 will be maintained between the bone segments.
  • the newly formed callus is broken up and new callus growth is stimulated.
  • the patient may be placed in traction because a cast need not be used.
  • the traction relieves the pressure that the lengthened bone exerts against the knee and hip socket.
  • the apparatus is suitable for use even if a cast is used.
  • the patient may exercise the lower portion of the leg in order to further alleviate the socket pressure and to stretch the tight muscles.
  • the limb is placed within a brace until complete ossification of the bone has occurred. The brace will relieve any undue stress on the apparatus and on the new bone before complete bone union occurs.
  • the bone ends will be completely joined after six months to one year.
  • the apparatus and brace may then be removed as soon as a new medullary canal forms.
  • An orthopedic apparatus as set forth in claim 1, and comprising:
  • said movement-imparting means includes means for imparting longitudinal movement in respective opposed directions to said first and second support members in response to rotational movement of said adjusting member.
  • said adjusting member includes driving gear means
  • said movement-imparting means comprises first and second gear means on the respective second portions of the first and second support members for simultaneous engagement with said driving gear means.
  • said movement-restricting means includes:
  • rotation-preventing means comprises:
  • rotational-movement mounting means comprises:
  • a fourth bore extending longitudinally within said second support member and axially aligned with said third bore.
  • said movement-imparting means comprises:
  • movement-imparting means further includes means for imparting longitudinal movement to one of said support members in response to rotational movement of said adjusting member.
  • said adjusting member comprises a threaded second rod including first and second opposed end portions
  • said rotational-movement mounting means comprises: r a. a third bore extending longitudinally within said first support member; and,
  • said movement-imparting means comprises:

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
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  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
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  • Orthopedics, Nursing, And Contraception (AREA)
US463463A 1974-04-24 1974-04-24 Apparatus for distracting or compressing longitudinal bone segments Expired - Lifetime US3900025A (en)

Priority Applications (6)

Application Number Priority Date Filing Date Title
US463463A US3900025A (en) 1974-04-24 1974-04-24 Apparatus for distracting or compressing longitudinal bone segments
CA221,773A CA1046371A (en) 1974-04-24 1975-03-11 Apparatus and method for distracting or compressing longitudinal bone segments
GB13366/75A GB1499566A (en) 1974-04-24 1975-04-01 Apparatus for distracting or compressing longitudinal bone segments
DE2515430A DE2515430C2 (de) 1974-04-24 1975-04-09 Orthopädisches Gerät
JP50045105A JPS5757136B2 (sv) 1974-04-24 1975-04-14
FR7511613A FR2268507B1 (sv) 1974-04-24 1975-04-15

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US463463A US3900025A (en) 1974-04-24 1974-04-24 Apparatus for distracting or compressing longitudinal bone segments

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US (1) US3900025A (sv)
JP (1) JPS5757136B2 (sv)
CA (1) CA1046371A (sv)
DE (1) DE2515430C2 (sv)
FR (1) FR2268507B1 (sv)
GB (1) GB1499566A (sv)

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JPS50159186A (sv) 1975-12-23
FR2268507B1 (sv) 1982-01-29
DE2515430A1 (de) 1975-11-13
GB1499566A (en) 1978-02-01
FR2268507A1 (sv) 1975-11-21
DE2515430C2 (de) 1987-02-19
JPS5757136B2 (sv) 1982-12-03
CA1046371A (en) 1979-01-16

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