Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
  • A61B17/8863—Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/82—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
  • A61B17/8861—Apparatus for manipulating flexible wires or straps
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/28—Surgical forceps
  • A61B17/2804—Surgical forceps with two or more pivotal connections
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • 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 or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/842—Flexible wires, bands or straps
• • 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
  • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
• • 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
  • A61B90/06—Measuring instruments not otherwise provided for
  • A61B2090/062—Measuring instruments not otherwise provided for penetration depth

Definitions

• the present invention relates to orthopedics, and more particularly to devices for securing surgical cable around bone.
• Bone cerclage in which a cable is looped about a fracture site and tightened in place using a crimp is a well known technique.
• a wire passer as described in U.S. Patent Application Serial No. 11/194,642 to A.Fernandez DelFOca filed August 2, 2005 and Published February 22, 2007 as 20070043377 (“the '642 application”), allows the insertion and loop of the cable around the fractured bone to be achieved via a small incision, minimizing trauma and discomfort.
• the entire disclosure of the '642 application is hereby incorporated by reference.
• the present invention provides an osteosynthetic device permitting minimally invasive crimping of a cable looped around a fractured bone and which reduces the time required for and tissue damage associated with the procedure.
• Apparatus includes a pair of crimp pliers comprising a pair of handles, two connected opposed jaws that reach the deeply located crimp through a minimal incision, two guiding ventral protrusions designed to guide the introduction of the pliers along an intermediate part of the cable, a depth level which indicates to the operator when the jaws are in position over the crimp to crush the deeply located crimp next to the fractured bone.
• the pliers include a lock which is released at this point so that the handles maybe pulled together forcing the distal ventral protrusions to close over and deform the crimp.
• FIG. 1 is a perspective view of the fractured bone with a cable looped therearound connected to a crimp for use in conjunction with the present invention
• Fig. 2 is a perspective view of a crimp pliers according to the invention running along a tube through which the cable extends to the crimp;
• Fig 3 is a perspective view of the crimp pliers positioned over the crimp
• Fig 4 is a perspective view of the crimp pliers with a lock released
• Fig 5 is a perspective: view of the pliers in an actuated position crushing the crimp.
• Fig. 6 is a perspective view of a bone cerclage tool that may be used to pass a wire around a fractured bone according to an exemplary surgical technique of the present invention, wherein the two separate members are not coupled.
• Fig. 7 is a side view of the bone cerclage tool of Fig. 6 inserted about a bone and wherein the two members are coupled together.
• Fig. 8 is a side view of the bone cerclage tool of Fig. 6, wherein the tool is disassembled to be removed from a body.
• the present invention relates to devices for treating fractures and, more specifically, relates to a device and method for minimally invasively securing cable around a fractured bone.
• Exemplary embodiments of the present invention provide a means for minimally invasively compressing a crimp over surgical cable looped around a fractured bone to maintain tension within the cable and stabilize the fracture.
• a system includes a crimp pliers 5 for compressing a crimp 3 over a cable 2 looped around a fractured bone 1 to lock the cable 2 in position and maintain the portions of the fractured bone 1 in a desired spatial relation to one another.
• the crimp pliers 5 includes a pair of operating handles 13a and 13b, opposed jaws 6a and 6b, a pair of distal crimp engaging protrusions 8 thereof and a pair of proximal protrusions 9.
• the crimp pliers 5 according to this embodiment further comprises a locking mechanism 10 and a depth level 11.
• the crimp pliers 5 is guided to the crimp 3 by sliding the proximal protrusions 9 along a tube 4 through which the cable 2 extends to the crimp 3.
• the handles 13a, 13b are drawn toward each other to bring the distal protrusions 8 together over the crimp 3 to crush the crimp 3 over the cable 2.
• the operating handles 13a, 13b and the opposed jaws 6a, 6b are connected such that drawing the operating handles 13a, 13b toward one another brings the opposed jaws 6a, 6b toward one another applying a compressive force to anything located between the jaws 6a, 6b. Furthermore, pulling the operating handles 13a, 13b away from one another opens the opposed jaws 6a, 6b.
• the operating handles 13a, 13b are rotatably coupled to one another at a pivot 15 so that moving the proximal ends 20 toward one another as shown in Fig. 5, moves distal ends 21 thereof away from one another.
• Each of the distal ends 21 of the handles 13a, 13b is pivotally coupled to a corresponding distal lever 22 at a pivot 16 and the levers 22 are rotatably coupled to one another at a pivot 17 so that, as the distal ends 21 of the handles 13a, 13b draw the proximal ends of the levers 22 away from one another, the jaws 6a, 6b at the distal ends of the levers 22 are rotated toward one another.
• the handles 13a, 13b are moved away from one another, this process is reversed and the proximal ends of the levers 22 are drawn toward one another separating the jaws 6a, 6b from one another as shown in Figs. 3 and 4.
• the distal protrusions 8 which extend ventrally from the opposed jaws 6a, 6b such that one protrusion extends from each jaw 6a, 6b.
• the distal protrusions 8 are formed such that when the opposed jaws 6a, 6b are drawn closed the distal protrusions 8 come together to compress the crimp 3.
• the proximal protrusions 9 also extend ventrally from the crimp pliers 5 and may be formed proximal to the distal protrusions 8.
• the proximal protrusions 9 are sized and shaped accommodate the tube 4 between them in order to slide along the tube 4 to guide the crimp pliers 5.
• the crimp pliers 5 is guided such that the distal tip 7 of the opposed jaws 6a, 6b and, consequently, the distal protrusions 8, are positioned over the crimp 3.
• a locking mechanism 10 operates to prevent movement of the handles 13 a, 13b relative to one another as the pliers 5 is moved into position over the crimp 3.
• the locking mechanism includes a bar 24 one end of which is pivotally coupled to the handle 13a while a second end includes a dowel 26 which, when in a locked position, is received within a slot 28 of the handle 13b.
• the bar 24 maintains a separation between the handles 13a, 13b, which corresponds to a maximum separation of the jaws 6a, 6b.
• the locking mechanism 10 When it is desired to move the handles 13a, 13b relative to one another (e.g., when the crimp 3 is positioned between the distal protrusions 8), the locking mechanism 10 is released by rotating the bar 24 to remove the dowel 26 from the slot 28. At this point the handles 13a, 13b are free to move relative to one another.
• a depth level 11 is also formed between the operating handles 13a, 13b of the pliers 5 according to this embodiment of the invention.
• the pliers 5 may be formed without either or both of the depth level 11 and the locking mechanism 10. These components are optional.
• the depth level 1 1 according to this embodiment, comprises a shaft that is attached to only one of the operating handles 13a, 13b (in this case, 13a) such that the operating handles 13a, 13b may still be drawn together without interference from the depth level 11.
• the depth level 11 includes a distally facing abutting surface 1 Ia located at a predetermined distance from the distal tip 7 of the distal protrusions 8.
• a flexible cable 2 is looped around the fractured bone 1.
• the cable 2 may be looped around the bone 1 using any known technique.
• the cable 2 may be looped around the bone 1 using a minimally invasive wire passing means: such as that disclosed in U.S. Patent Application Publication No. 2007/0043377 by Alberto Fernandez Dell' Oca, the entire disclosure of which is incorporated herein by reference.
• a cerclage tool comprises two members, each having a handle, a central part and a J shaped tube. When the central part of both members is firmly coupled together, both J shaped tubes conform a continuous tube through which a wire, cable, band or suture can be fed.
• the wire/cable passer 116 has two members 101 and 102, each including a handle 103, 104 by which the cable passer 116 is gripped and to bring members 101, 102 together when the handles 103, 104 are pulled close to one another.
• the member 101 includes a button 107 on a central part 105 thereof, while the member 102 includes a notch 8 in a central part 106 thereof.
• J shaped tubes 109, 1 10 form a continuous tube through which a wire 111 cable, band or suture can be fed.
• the members 101, 102 are successively inserted close to a bone 112 through a small skin incision 115, minimally disturbing skin 114 and underlying muscle 113, as shown in Fig. 7.
• both members 101, 102 have been inserted, they are drawn firmly together by pulling handles 103, 104 until the button 107 is inserted into the notch 108.
• the wire 111 can then be fed through the continuous tube formed by the two J shaped tubes 109, 110 which now surround the bone 112.
• the tool 16 is then disassembled and removed, as shown in Fig. 8 leaving the wire 111 in place looped about the bone 112.
• a cable 2 with one ball end and one free end is used.
• the free end of the cable 2 is inserted into a first one of the lumens of a crimp 3 having 2 side-by-side lumens and the free end of the cable 2 is pulled through the crimp 3 until the ball end lodges in the end of the crimp 3.
• the free end of the cable 2 is then passed around the bone 1, drawn out through the incision and inserted into the second lumen of the crimp 3 via an opening 3 a.
• the crimp 3 is slid down the cable 2 until it reaches the bone 1 and the free end of the cable 2 is passed through a tube 4 which is slid over the cable 2 until a distal end of the tube 4 abuts the crimp 3 adjacent to the opening 3a, as shown in Fig. 1.
• a distal end of the tube 4 is shaped to conform to a shape of a proximal side of the crimp 3 so that it fits snugly thereagainst. In this position, a distal end of the tube 4 and the proximal side of the crimp 3 are aligned with one another to form a substantially continuous outer surface.
• a tensioning device is attached to the end of the cable 2 extending from the tube 4 and tensioned as would be understood by those skilled in the art until a desired tension is obtained to maintain the fragments of the fractured bone 1 in a desired spatial relationship to one another.
• crimp pliers 5 may be used to crush the crimp 3 over the cable to maintain the desired tension in the cable 2.
• the distal protrusions 8 are placed on opposite sides of the tube 4 with the jaws 6a, 6b in the open state and the proximal protrusions 9 also engage the tube 4, as shown in Fig. 2.
• the crimp pliers 5 is then slid along the tube 4 until a proximal end 12 of the tube 4 abuts the depth level 11, as shown in Fig. 3.
• the length of the tube 4 is selected so that, when the proximal end 12 abuts the proximal face 11a of the depth level 11, the distal protrusions 8 are located on opposite sides of the crimp 3.
• the lock mechanism 10 is released to free the handles 13a, 13b for movement toward one another.
• the user then draws the handles 13a, 13b together closing the jaws 6a, 6b and drawing the protrusions 8 toward one another crushing the crimp 3 over the cable 2.
• the level 1 1 and the lock 10 are only attached to one of the operating handles 13a, the level 10 and lock 1 1 do not interfere with the drawing closed of operating handles 13a, 13b.
• the tube 4 is then removed and the portion of the cable 2 extending from the opening 3 a is cut and removed from the body.
• the crimp pliers 5 disclosed herein allows the desired tension to be maintained on the cable 2 without requiring significant spreading of the incision, reducing muscle trauma and tissue damage.

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

Priority Applications (6)

Applications Claiming Priority (2)

Publications (2)

Family

ID=39281475

Family Applications (1)

Country Status (11)

Families Citing this family (13)

Family Cites Families (7)

• 2007
  • 2007-12-05 EP EP07865248A patent/EP2117453B1/en not_active Not-in-force
  • 2007-12-05 KR KR1020097011923A patent/KR20090098806A/ko not_active Withdrawn
  • 2007-12-05 ZA ZA200903991A patent/ZA200903991B/xx unknown
  • 2007-12-05 BR BRPI0720034-0A2A patent/BRPI0720034A2/pt not_active IP Right Cessation
  • 2007-12-05 WO PCT/US2007/086523 patent/WO2008073782A2/en not_active Ceased
  • 2007-12-05 US US12/514,236 patent/US20090306668A1/en not_active Abandoned
  • 2007-12-05 JP JP2009541482A patent/JP2010512227A/ja not_active Abandoned
  • 2007-12-05 AU AU2007333240A patent/AU2007333240A1/en not_active Abandoned
  • 2007-12-05 CN CNA2007800460840A patent/CN101610726A/zh active Pending
  • 2007-12-05 CA CA002672123A patent/CA2672123A1/en not_active Abandoned
• 2009
  • 2009-06-25 CO CO09065758A patent/CO6190593A2/es not_active Application Discontinuation

Non-Patent Citations (1)

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