WO2000067652A2 - Implant pour le traitement operatoire de fractures du col du femur ou similaires - Google Patents

Implant pour le traitement operatoire de fractures du col du femur ou similaires Download PDF

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Publication number
WO2000067652A2
WO2000067652A2 PCT/EP2000/004274 EP0004274W WO0067652A2 WO 2000067652 A2 WO2000067652 A2 WO 2000067652A2 EP 0004274 W EP0004274 W EP 0004274W WO 0067652 A2 WO0067652 A2 WO 0067652A2
Authority
WO
WIPO (PCT)
Prior art keywords
screw
sliding
implant
implant according
locking
Prior art date
Application number
PCT/EP2000/004274
Other languages
German (de)
English (en)
Other versions
WO2000067652B1 (fr
WO2000067652A3 (fr
Inventor
Gerhard Hehl
Original Assignee
Gerhard Hehl
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Gerhard Hehl filed Critical Gerhard Hehl
Priority to EP00938633A priority Critical patent/EP1124498A2/fr
Publication of WO2000067652A2 publication Critical patent/WO2000067652A2/fr
Publication of WO2000067652A3 publication Critical patent/WO2000067652A3/fr
Publication of WO2000067652B1 publication Critical patent/WO2000067652B1/fr

Links

Classifications

    • 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
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck

Definitions

  • Implant for the operative treatment of fractures of the femur and dql Implant for the operative treatment of fractures of the femur and dql.
  • the invention relates to an implant for the operative care of z.
  • Such implants for the operative treatment of fractures, in particular fractures of the femoral neck, have proven themselves.
  • the implant according to the invention is suitable for the operative care of a wide variety of fractures, for the sake of simplicity only the use of an embodiment of the implant for the operative care of a femoral neck fracture in the form of a slide screw according to the invention is described below. However, the invention is not limited to this.
  • the surgical treatment of a fracture of the femoral neck is carried out in such a way that the fracture is first reduced and a Kirschner wire is inserted between the femoral head and the femur in the planned course of the screw channel to be created. Once the Kirschner wire has been inserted in the correct position, the Kirschner wire is drilled through with a two-step drill and the two-part sliding screw is inserted into the resulting drilling channel.
  • the front part of the sliding screw has a screw thread with which it is screwed into the femoral head.
  • a sliding sleeve is used, which receives the bolt-side end of the sliding screw, and the sliding screw is supported in this sliding sleeve with axial play.
  • the invention is therefore based on the object of developing an implant of the type mentioned at the outset in such a way that it can be placed using a minimally invasive technique and that there is improved healing.
  • an essential feature of the inventive concept according to claim 1 is that the sliding pulse now at least partially has an external thread on the outer circumference with which the sliding sleeve can be screwed into the drilling channel.
  • the invention includes both a design of the sliding screw with a circumferentially provided thread on the outer circumference and another embodiment in which the screw thread is only partially present on the outer circumference.
  • the invention is also intended to protect a special locking device for implants. Protection in the form of independent independent claim 2 is sought for this locking device.
  • the basic principle of the locking device according to this feature of the invention is based on the fact that the guided sliding possibility of the implant causes the fracture to be subjected to compression when walking under weight. However, if the leg is relieved, the compression will undesirably decrease again. This is where the invention comes in, which ensures that the compression once achieved by loading remains secured in the long run. This is achieved by the locking device on the implant.
  • the principle of the arrangement of a locking device can therefore be applied to all implants that allow a so-called dynamic compression.
  • the invention also provides an area of application which also includes self-locking interfragmentary tension screws or intramedullary nails.
  • Such an intramedullary nail consists of a solid material (e.g. implant steel or titanium) with cross holes arranged at both ends. It is used to stabilize fractures of long tubular bones (e.g. thigh or lower leg) in the medullary cavity of the bone.
  • the intramedullary nail splits the fracture and allows axial compression of the bone fragments brought together and splinted through the intramedullary nail.
  • the rotation of the bone fragments must be prevented by a turnstile on the intramedullary nail.
  • bolts are provided in transverse bores of the intramedullary nail perpendicular to its longitudinal axis and act as a turnstile.
  • the transverse bores are each designed as an elongated hole oriented in the axial direction.
  • the bolts are therefore guided with play in the respective elongated hole in the transverse bore.
  • the sliding screw When the sliding screw is designed as an intramedullary nail, provision is therefore made for it to be telescopic and to have a locking device with which once compression is ensured and wound healing can thus be significantly improved.
  • Such a two-part implant consists of a sliding screw and the associated sliding sleeve. It can now be installed using a minimally invasive surgical technique because the sliding screw is anchored directly into the bone via the external thread. There is no screw-on plate. After the first pre-drilling with a Kirschner wire and after checking, the final drill channel can be drilled with a two-step drill over the lying Kirschner wire and the two-part sliding screw can be used immediately be screwed into the drilling channel via a skin incision. The screwing in is carried out in such a way that both the sliding screw itself and the sliding sleeve encompassing the sliding screw are screwed in together with a tool.
  • both the sliding screw is screwed into the femoral head in a single operation and at the same time - with the same rotation - the sliding sleeve is also screwed into the opposite femur, because the two parts are non-rotatably connected to each other by means of the tool and therefore the screwing movements in the screwing channel carry out.
  • the two-part implant is provided with a locking device between one and the other part.
  • This locking device only allows an axial displacement of the two parts in the direction in which the two parts are subjected to thrust. However, if the two parts are subjected to tension, the shift is locked.
  • the slide screw When designing the implant as a sliding screw, it is essential that the fracture surface is compressed, i. H. the slide screw should be constantly subjected to tension to allow compression of the fracture surfaces. In the opposite direction, however, axial play of the sliding screw in the sliding sleeve should be ensured. It is known that sintering occurs in the area of the fracture surfaces during the healing process, which therefore move and interlock with one another, as a result of which the sliding screw is subjected to thrust. This thrust is to be absorbed by the locking device and this ensures that no thrust forces acting on the fracture surfaces can occur.
  • the axial adjustment play of the sliding screw in the sliding sleeve should be selected so that the sliding, lateral end of the sliding sleeve does not come out of the sliding sleeve and leads to soft tissue irritation.
  • the locking device consists of a ratchet and this in turn consists of a ring that is radially inward in the Sliding sleeve is attached and which cooperates with an associated sawtooth-like catch on the outer circumference of the sliding screw.
  • a locking blade is provided instead of the locking ring, which also interacts with a sawtooth-like external toothing of the sliding screw.
  • slots are arranged on the sliding screw, into which slots the locking ring or the locking blade engage.
  • a kinematic reversal of the aforementioned embodiments provides that the sawtooth-like toothing is arranged on the inner circumference of the sliding sleeve, while the locking ring or the locking blade is connected to the sliding screw.
  • corresponding slots can be incorporated on the inner circumference of the sliding sleeve instead of the sawtooth-shaped latching.
  • spring-loaded bolts or other known machine elements can also be used, which implement such a locking mechanism.
  • Figure 1 schematically shows a femoral neck fracture with explanation of the parts
  • FIG. 1 the supplied by the two-part slide screw according to the invention
  • Figure 3 a two-part sliding screw in a first embodiment
  • Figure 4 a second embodiment of a two-part sliding screw
  • Figure 5 the front view of an embodiment of a sliding screw
  • FIG. 6 an embodiment of FIG. 4 modified from FIG.
  • FIG. 7 an embodiment of a modified compared to FIG. 5
  • FIG. 8 shows an embodiment of the FIG.
  • Figure 9 another embodiment of a locking device.
  • FIG. 1 A typical fracture of the femur is shown in FIG. 1, the femoral head 2 being broken off from the femur 1.
  • the fracture surfaces that form are labeled 3 and 4.
  • the fracture is first repositioned in order to bring the fracture surfaces 3, 4 together as shown in FIG. 2, then a Kirschner wire is first drilled from position 21 in the course of the planned course of the screw and the position is checked. The Kirschner wire is then drilled through with a two-stage drill and the two-part sliding screw 5, 7 is screwed into the bore in each case.
  • two two-part sliding screws are thus arranged next to one another. It consists of the sliding screw 7 itself and the associated sliding sleeve 5.
  • the sliding sleeve 7 consists of a screw 9 with a front threaded head 8, which is screwed into the femoral head 2.
  • the rear part of the screw bolt 9 is axially displaceably mounted in the receiving bore 10 of a sliding sleeve 5, which according to the invention is provided with an external thread 6.
  • the sliding screw 7 can move axially displaceably in the receiving bore 10 in the direction of the arrows 11, a sliding section 12 being provided which ensures that the rear end face of the screw bolt 9 does not protrude from the rear end face of the sliding sleeve 5, because otherwise this would lead to soft tissue irritation.
  • a tool is provided which engages both on the rear face of the sliding sleeve 5 and on the face of the screw bolt 9 and connects the two parts to one another in a rotationally fixed manner.
  • the two parts can be screwed simultaneously from position 21 in FIG. 2 into the screw channels aligned with one another.
  • a locking device is provided, which is shown in several exemplary embodiments in FIGS. 4 to 9.
  • the locking device In a first embodiment of the locking device, it consists of a locking ring 13 which is fixedly connected to the sliding sleeve 15, the radially inner part of the locking ring 13 being seated on barb-like locking teeth 14. In this way, it is ensured that the screw bolt 9 is under tension, because when the fracture surfaces 3, 4 are sintered, the screw bolt is displaced in the direction of arrow 11 'into the sliding sleeve 15, whereby the locking ring 13 jumps over a projection of the locking teeth 14 , and engages in the nearest locking teeth.
  • FIG. 5 shows that the locking teeth 14 need not be circumferentially arranged, it can also be provided that the locking teeth 14a are only partially provided on the circumference of the screw bolt 9.
  • FIG. 5 also shows indicated cannulas 19 which are arranged on the outer circumference of the sliding screw 7 and which are open to the outside in order to receive the Kirschner wire.
  • FIG. 6 shows as a modified exemplary embodiment that one or more latches 16 can be used instead of a latching ring 13.
  • the respective locking pawl is chamfered in its own direction and interacts with the steep flank of the locking teeth 14.
  • a sliding screw 27 can also be formed in that, instead of the locking teeth 14, slots 18 are machined in the surface of the space bolt 9, into which the locking ring 13 or the locking pawls 16 engage.
  • the bolt 9 does not have to be fully formed, it can also consist of a hollow material, so that the two-part sliding screw can be inserted over the lying Kirschner wire.
  • FIG. 9 shows the kinematic reversal of the function of the locking device compared to the locking devices according to FIGS. 4 to 8 described there. It is shown that the locking ring 13 or the locking pawls 16, which are associated with the locking teeth, can be connected to the screw bolt of the sliding screw 17 24 or slits cooperate on the inner circumference of a sliding sleeve 25.
  • a screw thread 20 is arranged on the outer circumference of the respective sliding sleeve 5, 15, 25, with which it is possible to insert and remove the two-part sliding screw by a minimally invasive intervention.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un implant en deux parties servant au traitement opératoire de fractures du col du fémur, par exemple, et constitué d'une vis coulissante qui présente, à l'extrémité avant, une tête filetée vissée dans une partie d'os et dont le boulon fileté s'étend au-delà de la surface de fracture, une douille coulissante munie d'un filetage sur sa circonférence étant vissée dans l'autre partie d'os. La vis coulissante en deux parties selon l'invention est implantée lors d'une intervention à invasion minimale. Entre les deux parties se situe un dispositif d'arrêt permettant uniquement un déplacement axial dans un seul sens d'une des parties par rapport à l'autre.
PCT/EP2000/004274 1999-05-11 2000-05-11 Implant pour le traitement operatoire de fractures du col du femur ou similaires WO2000067652A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP00938633A EP1124498A2 (fr) 1999-05-11 2000-05-11 Implant pour le traitement operatoire de fractures du col du femur ou similaires

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE29908360.8 1999-05-11
DE29908360U DE29908360U1 (de) 1999-05-11 1999-05-11 Gleitschraube zur operativen Versorgung von z.B. Schenkelhalsbrüchen

Publications (3)

Publication Number Publication Date
WO2000067652A2 true WO2000067652A2 (fr) 2000-11-16
WO2000067652A3 WO2000067652A3 (fr) 2001-04-19
WO2000067652B1 WO2000067652B1 (fr) 2001-06-07

Family

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PCT/EP2000/004274 WO2000067652A2 (fr) 1999-05-11 2000-05-11 Implant pour le traitement operatoire de fractures du col du femur ou similaires

Country Status (3)

Country Link
EP (1) EP1124498A2 (fr)
DE (1) DE29908360U1 (fr)
WO (1) WO2000067652A2 (fr)

Cited By (45)

* Cited by examiner, † Cited by third party
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EP1379186A1 (fr) * 2001-03-30 2004-01-14 Triage Medical, Inc. Dispositif d'ancrage distal d'os permettant la fixation d'un os au moyen d'une compression secondaire
WO2004069065A1 (fr) * 2003-02-10 2004-08-19 Cell Center Cologne Gmbh Vis télescopique dynamique pour épiphyse
EP1452146A1 (fr) * 2003-02-27 2004-09-01 Stryker Leibinger GmbH & Co. KG Vis à compression pour l'ostéosynthèse
EP1523278A2 (fr) * 2002-07-19 2005-04-20 Triage Medical, Inc. Procede et appareil de fixation vertebrale
US7044953B2 (en) 2003-02-27 2006-05-16 Stryker Leibinger Gmbh & Co. Kg Compression bone screw
EP2055252A1 (fr) * 2001-03-30 2009-05-06 Interventional Spine, Inc. Ancrages d'os distaux pour la fixation osseuse avec compression secondaire
US7591823B2 (en) * 2001-10-18 2009-09-22 Lagwire, Llc System and method for the fixation of bone fractures
US7686807B2 (en) 2001-03-22 2010-03-30 Interventional Spine, Inc. Tool for bone fixation device
EP2240103A1 (fr) * 2007-12-07 2010-10-20 OrthoIP, LLC Système et procédé pour la fixation de fractures osseuses
US7938832B2 (en) 2006-04-21 2011-05-10 Interventional Spine, Inc. Method and apparatus for spinal fixation
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US9060809B2 (en) 2001-10-18 2015-06-23 Orthoip, Llc Lagwire system and method for the fixation of bone fractures
US9408648B2 (en) 2001-03-30 2016-08-09 Interventional Spine, Inc. Method and apparatus for bone fixation with secondary compression
US9839530B2 (en) 2007-06-26 2017-12-12 DePuy Synthes Products, Inc. Highly lordosed fusion cage
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US10166056B2 (en) 2013-07-03 2019-01-01 DePuy Synthes Products, Inc. Method and apparatus for sacroiliac joint fixation
US10293147B2 (en) 2004-08-03 2019-05-21 DePuy Synthes Products, Inc. Telescopic percutaneous tissue dilation systems and related methods
US10390963B2 (en) 2006-12-07 2019-08-27 DePuy Synthes Products, Inc. Intervertebral implant
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EP1379186A4 (fr) * 2001-03-30 2006-07-26 Triage Medical Inc Dispositif d'ancrage distal d'os permettant la fixation d'un os au moyen d'une compression secondaire
US10349991B2 (en) 2001-03-30 2019-07-16 DePuy Synthes Products, Inc. Method and apparatus for bone fixation with secondary compression
US9408648B2 (en) 2001-03-30 2016-08-09 Interventional Spine, Inc. Method and apparatus for bone fixation with secondary compression
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EP1379186A1 (fr) * 2001-03-30 2004-01-14 Triage Medical, Inc. Dispositif d'ancrage distal d'os permettant la fixation d'un os au moyen d'une compression secondaire
EP2055252A1 (fr) * 2001-03-30 2009-05-06 Interventional Spine, Inc. Ancrages d'os distaux pour la fixation osseuse avec compression secondaire
US9060809B2 (en) 2001-10-18 2015-06-23 Orthoip, Llc Lagwire system and method for the fixation of bone fractures
US9028534B2 (en) 2001-10-18 2015-05-12 Orthoip, Llc Bone screw system and method
US7591823B2 (en) * 2001-10-18 2009-09-22 Lagwire, Llc System and method for the fixation of bone fractures
US9713486B2 (en) 2002-07-19 2017-07-25 DePuy Synthes Products, Inc. Method and apparatus for spinal fixation
EP1523278A2 (fr) * 2002-07-19 2005-04-20 Triage Medical, Inc. Procede et appareil de fixation vertebrale
US7993377B2 (en) 2002-07-19 2011-08-09 Interventional Spine, Inc. Method and apparatus for spinal fixation
US8109977B2 (en) 2002-07-19 2012-02-07 Interventional Spine, Inc. Method and apparatus for spinal fixation
EP2100565A1 (fr) * 2002-07-19 2009-09-16 Interventional Spine, Inc. Appareil de fixation de la colonne vertébrale
EP1523278A4 (fr) * 2002-07-19 2007-05-09 Triage Medical Inc Procede et appareil de fixation vertebrale
US7824429B2 (en) 2002-07-19 2010-11-02 Interventional Spine, Inc. Method and apparatus for spinal fixation
WO2004069065A1 (fr) * 2003-02-10 2004-08-19 Cell Center Cologne Gmbh Vis télescopique dynamique pour épiphyse
EP1452146A1 (fr) * 2003-02-27 2004-09-01 Stryker Leibinger GmbH & Co. KG Vis à compression pour l'ostéosynthèse
US7044953B2 (en) 2003-02-27 2006-05-16 Stryker Leibinger Gmbh & Co. Kg Compression bone screw
US7794483B2 (en) 2003-02-27 2010-09-14 Stryker Leibinger Gmbh & Co. Kg Compression bone screw
US10293147B2 (en) 2004-08-03 2019-05-21 DePuy Synthes Products, Inc. Telescopic percutaneous tissue dilation systems and related methods
US10070893B2 (en) 2004-12-08 2018-09-11 Decima Spine, Inc. Method and apparatus for spinal stabilization
US9962189B2 (en) 2004-12-08 2018-05-08 Decima Spine, Inc. Method and apparatus for spinal stabilization
US10639074B2 (en) 2004-12-08 2020-05-05 Decima Spine, Inc. Method and apparatus for spinal stabilization
US10667844B2 (en) 2004-12-08 2020-06-02 Decima Spine, Inc. Method and apparatus for spinal stabilization
US7938832B2 (en) 2006-04-21 2011-05-10 Interventional Spine, Inc. Method and apparatus for spinal fixation
US9101411B2 (en) 2006-04-21 2015-08-11 Interventional Spine, Inc. Method and apparatus for spinal fixation
US11660206B2 (en) 2006-12-07 2023-05-30 DePuy Synthes Products, Inc. Intervertebral implant
US10390963B2 (en) 2006-12-07 2019-08-27 DePuy Synthes Products, Inc. Intervertebral implant
US11642229B2 (en) 2006-12-07 2023-05-09 DePuy Synthes Products, Inc. Intervertebral implant
US10583015B2 (en) 2006-12-07 2020-03-10 DePuy Synthes Products, Inc. Intervertebral implant
US11432942B2 (en) 2006-12-07 2022-09-06 DePuy Synthes Products, Inc. Intervertebral implant
US11395626B2 (en) 2006-12-07 2022-07-26 DePuy Synthes Products, Inc. Sensor for intervertebral fusion indicia
US11712345B2 (en) 2006-12-07 2023-08-01 DePuy Synthes Products, Inc. Intervertebral implant
US11497618B2 (en) 2006-12-07 2022-11-15 DePuy Synthes Products, Inc. Intervertebral implant
US11273050B2 (en) 2006-12-07 2022-03-15 DePuy Synthes Products, Inc. Intervertebral implant
US10398566B2 (en) 2006-12-07 2019-09-03 DePuy Synthes Products, Inc. Intervertebral implant
US9839530B2 (en) 2007-06-26 2017-12-12 DePuy Synthes Products, Inc. Highly lordosed fusion cage
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WO2000067652B1 (fr) 2001-06-07
WO2000067652A3 (fr) 2001-04-19
EP1124498A2 (fr) 2001-08-22
DE29908360U1 (de) 2000-09-21

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