WO2005053545A2 - Broche pour le col du femur et ensemble d'instruments pour l'insertion de cette broche - Google Patents

Broche pour le col du femur et ensemble d'instruments pour l'insertion de cette broche Download PDF

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Publication number
WO2005053545A2
WO2005053545A2 PCT/EP2004/013139 EP2004013139W WO2005053545A2 WO 2005053545 A2 WO2005053545 A2 WO 2005053545A2 EP 2004013139 W EP2004013139 W EP 2004013139W WO 2005053545 A2 WO2005053545 A2 WO 2005053545A2
Authority
WO
WIPO (PCT)
Prior art keywords
rod
rod according
femur
extension
bush
Prior art date
Application number
PCT/EP2004/013139
Other languages
English (en)
Other versions
WO2005053545A3 (fr
Inventor
Paolo Trentani
Claudio Trentani
Original Assignee
Trentani, Federico
Zella, Adriana
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 Trentani, Federico, Zella, Adriana filed Critical Trentani, Federico
Publication of WO2005053545A2 publication Critical patent/WO2005053545A2/fr
Publication of WO2005053545A3 publication Critical patent/WO2005053545A3/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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1668—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the upper femur
    • 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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7097—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants
    • A61B17/7098—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants wherein the implant is permeable or has openings, e.g. fenestrated screw
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B2017/1602—Mills
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B2017/922—Devices for impaction, impact element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin

Definitions

  • the present ' invention relates to a rod for the neck of the femur and to the instrument set for inserting the rod.
  • Background Art As a good standard of quality of life becomes widespread and as discoveries in the medical field advance, there is a constant increase in lifespan expectation. Accordingly, the number of elderly people increases every year in the population of the most industrialized countries. One of the consequences of this longevity is that some diseases, which previously affected only a minimal fraction of the population, are currently more widespread (and it is presumable that there will be further increases in the number of people affected by these diseases in the future).
  • Bone fragility osteoporosis
  • Rarefaction of bone tissue entails reduced structural strength: accordingly, bones fracture more easily both due to external traumatic actions and due to degenerations that lead to inability to bear the normal load (the bones are no longer capable of bearing the weight of the body).
  • a very high percentage of the fractures that occur following this bone rarefaction affects the neck of the femur. This neck is in practice the portion that connects the greater trochanter to the head (epiphysis), which in turn is articulated in the acetabular cavity of the pelvis.
  • the neck of the femur Due to its shape, the neck of the femur is subjected to a rather intense load: while the remaining part of the femur is subjected almost exclusively to compression (axial load), the neck is subjected to a mixed load, in which it is possible to identify a compression component and an important shearing component, which entails the presence of a moment of flexure.
  • the presence of these components is due to the shape of the neck of the femur, which forms an angle of approximately 128° with the diaphysis of the femur.
  • an object of the present invention is to allow to insert substances that have a medicinal or curative function directly inside the bone.
  • the present rod for the neck of the femur and by the present instrument set for inserting said rod characterized in that it has a substantially tubular shape, is suitable to be inserted f om the fossa of the greater trochanter from below and from the outside toward the acetabular cavity, substantially in axial alignment with the neck of the femur through an opening that passes through the cortex of the femur, which has a tapered front insertion end and is crossed by a plurality of through holes.
  • Figure 1 is a side view of a rod and of the corresponding instrument set according to the invention, assembled together;
  • Figure 2 is a side view of a stem of a rod according to the invention;
  • Figure 3 is a side view of a milling cutter for providing an opening in the cortex in order to insert a rod according to the invention;
  • Figure 4 is a sectional side view of a rod according to the invention;
  • Figure 5 is a side view of a thread protecting plug of a rod according to the invention;
  • Figure 6 is a sectional side view of an extension of a rod according to the invention;
  • Figure 7 is a sectional side view of a bush of a rod according to the invention;
  • Figure 8 is a partially sectional side view of the insertion of a stem in a fe
  • the reference numeral 1 generally designates a rod for the neck of the femur.
  • the rod 1 is a tubular element that is shorter than the distance between the internal surface of the cortex 2 of the head (epiphysis) 3 of the femur 4 and the outer surface of the trochanteric cortex 2 of the femur 4.
  • the length of the rod 1 is preferably variable between 80 and 110 mm, and the rod is provided in all the intermediate sizes, with length steps of 5 mm between one size and the next, so as to have available a rod 1 that is suitable for every size of femur 4 (which of course depends on various parameters, including the height of the patient).
  • the cross-section of the rod 1 is preferably circular, with an outside diameter comprised, by way of example, between 8 and 10 mm and a diameter of the internal channel 6 that is comprised between 6 and 8 mm.
  • Each rod 1 is provided with through holes 5, which are arranged symmetrically and distributed uniformly, radially and longitudinally: the holes 5 are preferably provided in a number comprised between 4 and 8, and have a diameter of preferably 4 mm and are mutually offset substantially by a right angle.
  • the front end 7 of the rod 1 is tapered, in order to facilitate its insertion in the ' femur 4, after milling the outer cortex 2 with an appropriately provided instrument 2a, while the rear end 8 is provided with means 9 for coupling to an extension 10.
  • the coupling means 9 are constituted by a female thread, which is suitable to be associated with a male thread 11 provided at the front end of the extension 10 or with other elements described hereinafter.
  • the rear end 8 may also be provided with an end flaring (not shown in the figure), which is suitable to prevent the penetration of the rod 1 in the femur 4.
  • the outer surface of the rod 1 is normally smooth, since this solution facilitates its insertion in the neck 12 of the femur 4: it can be convenient to provide rods 1 with a rough outer surface, coated with osteoinducing ceramic materials (for example alumina, hydroxyapatite and trabecular metal), or provided with crests (optionally arranged at a specific angle, for example 60°, in order to constitute a grip thread) in order to provide better anchoring of the rod 1.
  • the rod 1 can have a polygonal (preferably polygonal) cross-section, so that it cannot rotate about its own axis of symmetry due to geometric interference with the bone that accommodates it.
  • the extension 10 also is a tubular element, which has a length that can vary on average between 150 and 200 mm, and is chosen according to the physical characteristics of the patient in order to be able to work percutaneously (from the outside) in the easiest way.
  • the outside and inside diameters of the extension 10 are substantially the diameters of the rod 1; the outer surface is smooth.
  • the extension 10 has, at its rear end, a female thread 13 for coupling to a bush 14 (cannulated handle).
  • the extension 10 further has an end flaring 13a, which is suitable for coupling to an injector, which is generally made of polyethylene (not shown in the figure).
  • the bush 14 (cannulated handle) is provided longitudinally with two mutually opposite elongated slots 15 in order to assess the insertion of the rod 1 in the femur 4 and has, at the front end, a male thread 16 for coupling to the extension 10.
  • a metallic stem 17 (guiding wire) is substantially a slender element that is slightly longer (by approximately 2 or 3 mm) than the overall length of the rod 1, of the extension 10 and of the cannulated portion of the bush 14 when mutually coupled, and has a diameter that is slightly smaller than the inside diameter of the rod 1 and of the extension 10 (the diameter is on the order of 3-4 mm).
  • the stem 17 (guiding wire) is provided, at the front, with a piercing sharp end 18.
  • the rod 1, the extension 10, the bush 14 (cannulated handle) and the stem 17 (guiding wire) are preferably made of titanium or other metallic materials, such as for example surgical steel.
  • the materials can be combined, adopting more noble materials (such as titanium) to provide the rod 1 and other materials (such as surgical steel) for the other elements of the instrument set.
  • the rod 1 can be made of a particular material and then be coated with other materials, obtaining composite materials (for example a rod 1 made of titanium coated with a layer of hydroxyapatite or alumina or trabecular metal et cetera).
  • a polyethylene injector can be connected to the outer rear end of the extension 10, particularly to the flaring 13 a, and it is possible to insert through said injector, and through the extension 10 inside the rod 1, and therefore inside the neck 12 and the head 3 of the femur 4, different materials, such as acrylic cement (with the aim of structurally reinforcing the neck 12 of the femur 4), substances that have a substantially local action (stem cells, platelet gel, chemotherapy substances) or radioactive isotopes.
  • acrylic cement with the aim of structurally reinforcing the neck 12 of the femur 4
  • substances that have a substantially local action stem cells, platelet gel, chemotherapy substances
  • radioactive isotopes radioactive isotopes.
  • the operation of the invention is as follows: once the patient has been subjected to valid diagnostic methods such as X-rays, bone densitometry, computerized axial tomography and nuclear magnetic resonance, it is possible to determine very precisely the state of osteoporosis of a bone. In particular, it is possible to identify, within the intact bone tissue 19, the presence of rarefactions 20 of the tissue or the presence of regions in which the tissue is completely absent (neoplastic disorder) and predict with good precision the risk of fracture of the neck 12 of the femur 4. The patient is then subjected to local anesthesia and an incision of approximately 10 mm is produced at the trochanteric fossa.
  • the stem 17 is inserted through the incision (as shown in Figure 6) inside the femur 4 until the sharp end 18 arrives in the vicinity of the internal cortex 2 of the head 3 of the femur 4.
  • the direction along which the stem 17 (guiding wire) is to be inserted is visualized by using an image intensifier (this is a device that is normally present in facilities that perform orthopedic surgical treatments).
  • An opening 2b is provided in the subtrochanteric cortex 2 by means of the appropriately provided instrument 2a, which is substantially a milling cutter provided with an axial channel and with a shoulder at a distance of approximately 15 mm from the tip in order to prevent excessive removal of material, having a diameter comprised between 8 and 10 mm, following the stem 17 (guiding wire) for a depth of approximately 15 mm.
  • the rear end of the stem 17 (guiding wire) is inserted in the front opening of the rod 1 (so that the stem 17 acts as a guide) and by percussion, by using a hammer (not shown in the figure) against the percussion end of the bush 14 (cannulated handle), the rod 1 is inserted (as shown in Figure 7) inside the femur 4 until it is inserted completely (as shown in Figure 8).
  • the stem 17 (guiding wire) can be seen through the slot 15 of the bush 14 (cannulated handle); by unscrewing the bush 14 (cannulated handle) from the extension 10 (as shown in Figure 8), it is possible to remove the stem 17 (as shown in Figure 9).
  • the plug 21 can preferably be frustum-shaped and can have a length preferably on the order of 10 to 15 mm, in which the thread affects only an end portion that is no more than 6-8 mm long.
  • the rod 1 may have an end flaring, in order to prevent it from entering the femur 4 completely; if this flaring is not provided, it is possible to consider applying the plug 21 fixed to the thread 9 of the rod 1, which has or not a rear end provided with a shoulder.
  • the time required for insertion of the rod 1, stabilization thereof and skin suture are on the order of 15-20 minutes and the patient can walk immediately by placing his weight normally on the treated limb.
  • a patient suffers breakage of the neck 12 of the femur 4 and must be subjected to an osteosynthesis or prosthetic procedure on that femur 4 (for example the left one), he can be advantageously subjected, during the same operating session, to the insertion of a rod 1 according to the invention in the other femur 4 (the right one), which is certainly at risk (since its condition is certainly similar to the condition of the fractured femur, which is the left one in this example).
  • the patient can plate all of his body weight on the limb in which the rod 1 has been implanted (for example the right limb), ensuring greater stability of contralateral support.

Abstract

L'invention concerne une broche (1) pour le col (12) du fémur (4) ainsi qu'un ensemble d'instruments pour insérer cette broche. Cette dernière présente une forme sensiblement tubulaire et est adaptée pour être insérée à partir du bas et à partir de l'extérieur vers l'intérieur de l'articulation, sensiblement en alignement axial avec le col (12) du fémur (4) à travers une ouverture (2b) qui traverse le cortex (2) du fémur (4). Cette broche présente une extrémité d'insertion antérieure effilée (7) et comporte une pluralité de trous traversants (5).
PCT/EP2004/013139 2003-11-20 2004-11-18 Broche pour le col du femur et ensemble d'instruments pour l'insertion de cette broche WO2005053545A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT000698A ITBO20030698A1 (it) 2003-11-20 2003-11-20 Infibulo per il collo del femore e strumentazione per il suo inserimento.
ITBO2003A000698 2003-11-20

Publications (2)

Publication Number Publication Date
WO2005053545A2 true WO2005053545A2 (fr) 2005-06-16
WO2005053545A3 WO2005053545A3 (fr) 2007-12-21

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2004/013139 WO2005053545A2 (fr) 2003-11-20 2004-11-18 Broche pour le col du femur et ensemble d'instruments pour l'insertion de cette broche

Country Status (2)

Country Link
IT (1) ITBO20030698A1 (fr)
WO (1) WO2005053545A2 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009089637A1 (fr) * 2008-01-15 2009-07-23 Ao Technology Ag Canule et dispositif pour une irrigation d'os par jet liquide
EP2140823A1 (fr) * 2008-06-23 2010-01-06 National Cancer Center Ensemble de broche pour opérations
WO2010076836A1 (fr) * 2008-12-31 2010-07-08 Overmed S.R.L. Système et procédé chirurgicaux d'injection d'une substance dans un os, en particulier le fémur
EP2455014A1 (fr) * 2010-11-17 2012-05-23 Hyprevention Dispositif implantable pour le traitement préventif ou curatif de fractures du fémur, ancillaire associé
US9131970B2 (en) 2008-06-23 2015-09-15 National Cancer Center Pin assembly for operation capable of introducing drug

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2537070A (en) * 1948-12-27 1951-01-09 Puy Mfg Company Inc De Surgical appliance and method for fixation of bone fragments
US5429640A (en) * 1992-11-27 1995-07-04 Clemson University Intramedullary rod for fracture fixation of femoral shaft independent of ipsilateral femoral neck fracture fixation
US6048343A (en) * 1999-06-02 2000-04-11 Mathis; John M. Bone screw system
DE19931670C1 (de) * 1999-07-08 2001-02-15 Eska Implants Gmbh & Co Set für die Erstellung eines modularen Prophylaxe-Implantates
US20030045885A1 (en) * 2001-08-28 2003-03-06 Margulies Joseph Y. Method and apparatus for augmentation of the femoral neck
EP1405607A1 (fr) * 2002-10-04 2004-04-07 BIEDERMANN MOTECH GmbH Vis à os et vis à os avec élement de maintien

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2537070A (en) * 1948-12-27 1951-01-09 Puy Mfg Company Inc De Surgical appliance and method for fixation of bone fragments
US5429640A (en) * 1992-11-27 1995-07-04 Clemson University Intramedullary rod for fracture fixation of femoral shaft independent of ipsilateral femoral neck fracture fixation
US6048343A (en) * 1999-06-02 2000-04-11 Mathis; John M. Bone screw system
DE19931670C1 (de) * 1999-07-08 2001-02-15 Eska Implants Gmbh & Co Set für die Erstellung eines modularen Prophylaxe-Implantates
US20030045885A1 (en) * 2001-08-28 2003-03-06 Margulies Joseph Y. Method and apparatus for augmentation of the femoral neck
EP1405607A1 (fr) * 2002-10-04 2004-04-07 BIEDERMANN MOTECH GmbH Vis à os et vis à os avec élement de maintien

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9072529B2 (en) 2008-01-15 2015-07-07 Ao Technology Ag Cannula and device for liquid jet irrigation of bone
WO2009089637A1 (fr) * 2008-01-15 2009-07-23 Ao Technology Ag Canule et dispositif pour une irrigation d'os par jet liquide
AU2008347598B2 (en) * 2008-01-15 2013-05-09 Ao Technology Ag Cannula and device for liquid jet irrigation of bone
EP2140823A1 (fr) * 2008-06-23 2010-01-06 National Cancer Center Ensemble de broche pour opérations
US9131970B2 (en) 2008-06-23 2015-09-15 National Cancer Center Pin assembly for operation capable of introducing drug
WO2010076836A1 (fr) * 2008-12-31 2010-07-08 Overmed S.R.L. Système et procédé chirurgicaux d'injection d'une substance dans un os, en particulier le fémur
EP2455014A1 (fr) * 2010-11-17 2012-05-23 Hyprevention Dispositif implantable pour le traitement préventif ou curatif de fractures du fémur, ancillaire associé
KR20130103776A (ko) * 2010-11-17 2013-09-24 하이프레방씨옹 대퇴골의 골절을 예방하거나 치유하는 처치를 하기 위한 임플란트가능한 디바이스, 및 연관된 보조 디바이스
CN103269651A (zh) * 2010-11-17 2013-08-28 海普瑞万迅公司 用于预防性或治疗性处理股骨骨折的可植入装置及相关辅助设备
WO2012066236A1 (fr) * 2010-11-17 2012-05-24 Hyprevention Dispositif implantable pour le traitement preventif ou curatif de fractures du femur, ancillaire associe
RU2585732C2 (ru) * 2010-11-17 2016-06-10 Ипревансьон Имплантируемое устройство для профилактической или лечебной терапии переломов бедренной кости, соответствующее вспомогательное средство
CN103269651B (zh) * 2010-11-17 2016-09-21 海普瑞万迅公司 用于预防性或治疗性处理股骨骨折的可植入装置及相关辅助设备
US10405899B2 (en) 2010-11-17 2019-09-10 Hyprevention Sas Devices, methods and systems for remedying or preventing fractures

Also Published As

Publication number Publication date
ITBO20030698A1 (it) 2005-05-21
WO2005053545A3 (fr) 2007-12-21

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