WO2008073949A1 - Coupe-câble - Google Patents

Coupe-câble Download PDF

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Publication number
WO2008073949A1
WO2008073949A1 PCT/US2007/087138 US2007087138W WO2008073949A1 WO 2008073949 A1 WO2008073949 A1 WO 2008073949A1 US 2007087138 W US2007087138 W US 2007087138W WO 2008073949 A1 WO2008073949 A1 WO 2008073949A1
Authority
WO
WIPO (PCT)
Prior art keywords
cable
sleeve
another
handles
distal
Prior art date
Application number
PCT/US2007/087138
Other languages
English (en)
Inventor
Alberto A. Fernandez Dell'oca
Original Assignee
Synthes (U.S.A.)
Synthes Gmbh
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 Synthes (U.S.A.), Synthes Gmbh filed Critical Synthes (U.S.A.)
Publication of WO2008073949A1 publication Critical patent/WO2008073949A1/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
    • A61B17/88—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, 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
    • A61B17/8861—Apparatus for manipulating flexible wires or straps

Definitions

  • the present invention relates to orthopedics, and more particularly to a device for minimally invasively cutting excess surgical cable remaining after cable has been secured around a reduced fracture.
  • Bone cerclage using cable and crimps is a well-known technique. Since the development of the wire passer disclosed by A. Fernandez Dell' Oca in US Patent Application Publication No. 2007/0043377, the insertion and the loop of the cable around the fractured bone can be achieved via a minimal incision, reducing tissue injury. Thereafter, a long-nosed crimp pliers for deforming such a deeply located crimp via a minimal incision was disclosed by A. Fernandez Dell' Oca, in U.S. Provisional Patent Application No. 60/793623.
  • Cable cutter are tools specially designed to cut the excess cable remaining after the cable has been looped around and secured to a fractured bone.
  • Existing cable cutters have the disadvantage of requiring significant spreading of the incision and intervening muscle tissue increasing trauma and requiring increased space in which to operate.
  • An example of such a device is disclosed by Whiteside et al in US Patent No. 5,772,666.
  • the present invention consists in two preferred embodiments and provide a cable cutter which works in a scissor-like way that comprises a pair of operating handles attached to a long cutting system that reaches the cable next to the bone through a minimal incision, said long cutting system has a concave cutting side or hole which pull together the thin wires constituting the cable while performing the cut, thus achieving a neat and easy cut and preventing the spread of said thin wires in the cable stump.
  • the present invention is directed to a device for cutting cable within a living body, the device comprising a first sleeve defining a first lumen and extending to a first distal opening sized to receive a cable in combination with a second sleeve received within the first lumen, the second sleeve defining a second lumen extending therethrough to a second distal opening sized to receive a cable, the second distal opening being positioned so that, in a first configuration, the first and second distal openings align to create a path from an exterior of the first sleeve to the second lumen, the first and second sleeves being moveable relative to one another to a second configuration in which the first and second distal openings are moved out of alignment with one another to cut a cable received therethrough.
  • FIG. 1 shows a perspective view of a cable cutter according to a first embodiment of the invention
  • Fig. 2 shows a side view of the cable cutter of Fig. 1 ;
  • FIG. 3 shows a perspective view of components of the cable cutter of Fig. 1 ;
  • Fig. 4 shows a perspective view of the cable cutter of Fig. 1 ;
  • Fig. 5 shows a side view of the cable cutter of Fig. 1 with a surgical cable passing therethrough and with a knob thereof unscrewed;
  • Fig. 6 shows a side view of the cable cutter of Fig. 5, after the knob has been screwed in pushing the inner sleeve thereof toward an outer sleeve;
  • Fig. 7 shows a perspective view of the cable cutter of Fig. 5 with the surgical cable passing through holes of cutting sleeves thereof;
  • Fig. 8 shows a perspective view of the cable cutter of Fig. 7 after handles thereof have been pushed together and the surgical cable has been cut;
  • Fig. 9 shows a side view of a cable cutter according to a second embodiment of the invention.
  • Fig. 10 shows a perspective view of the cable cutter of Fig. 9 passing through a minimal skin incision in an open position
  • Fig. 1 1 shows a perspective view of the cable cutter of Fig. 9 passing through a minimal skin incision in a closed position
  • Fig. 12 shows a side view of the cable cutter of Fig. 9 in position adjacent to a crimp
  • Fig. 13 shows a side view of the cable cutter of Fig. 12 after pulling up from the surgical cable
  • Fig. 14 shows a side view of the cable cutter of Fig. 12 after the surgical cable has been cut next to the crimp;
  • Fig. 15 shows a side view of the cable cutter of Fig. 14, after the cable has retraceted into the crimp.
  • the present invention relates to the treatment of bone fractures and, in particular, relates to internal fixation devices for treating fractures.
  • Exemplary embodiments of the present invention provide a minimally invasive means for cutting surgical cable or wire after it has been reduced around a fractured bone.
  • Figs. 1-8 show a first exemplary embodiment of a device of the present invention.
  • the device comprises a pair of handles 4a, 4b, rotatably coupled to one another with each handle 4a, 4b being connected to a corresponding sleeve.
  • the handle 4a may, for example, be connected to an outer sleeve 5, while the handle 4b is connected to an inner sleeve 6 housed within the outer sleeve 5.
  • the device further comprises a knob 10 attached to a swivel 9.
  • the outer sleeve 5 is substantially tubular and extends from a proximal end 18 to a distal end 20.
  • the proximal end 18 may be open and is connected to the handle 4a while the distal end 20 is closed by a distal surface 20a except for a hole 7, which is preferably sized to accommodate a surgical cable 2.
  • the inner sleeve 6 is also substantially tubular and extends from a proximal end 22 to a distal end 24.
  • the proximal end 22 is open and connected to the handle 4b.
  • the distal end 24 is closed by a distal surface 24a except for a hole 8, which may be substantially the same size as the hole 7 to accommodate the diameter of the surgical cable 2.
  • Diameters of the outer and inner sleeves 5, 6 are preferably selected such that the outer and inner sleeves 5, 6 may pass through a minimal skin incision 3 and a length of the outer and inner sleeves 5, 6 is selected such that the distal ends 20, 24 extend far enough from the handles 4a, 4b to reach a target bone 1 when passed through the skin incision 3.
  • the diameter of the sleeves 5, 6 may range from 6mm to 10mm while the length of the sleeves 5, 6may range from 150mm to 200 mm.
  • the diameter of the inner sleeve 6 is preferably less than the inner diameter of the outer sleeve 5 by an amount selected to permit a desired degree of relative movement of the inner sleeve 6 within the outer sleeve 5 as will be described in more detail below.
  • the handles 4a, 4b are rotatably coupled to one another such that they move relative to one another about the sleeves 5, 6. That is, each handle 4a, 4b is connected to a respective one of the sleeves 5, 6 such that longitudinal axes of the sleeves 5, 6 are substantially perpendicular to a direction of the rotational movement of the handles 4a, 4b. Thus, when the handles 4a, 4b are drawn together, the outer sleeve 5 and the inner sleeve 6 move relative to one another about their longitudinal axes.
  • outer sleeve 5 is described as connected to the handle 4a and the inner sleeve 6 is described as connected to the handle 4b, thos skilled in the art will understand that the sleeves 5, 6 may be connected to either of the handles 4a, 4b so long as one sleeve is connected to one handle and the other is connected to the other handle.
  • the device of the present invention may further include a knob 10 attached to a swivel 9 via a screw mechanism 26.
  • the swivel 9 is attached the handle 4b such that it rotates about a pivot 16, as shown in Fig. 3.
  • the swivel 9 may be rotated about the pivot 16 to move the knob 10 out of a position over the proximal ends 18, 22 of the sleeves 5, 6, respectively, as shown in Figs. 3 and 4 so that the inner sleeve 6 may be inserted into or removed from the outer sleeve 5 and then rotated back into position over the proximal ends 18, 22 of the sleeves 5, 6, respectively.
  • the knob 10 also includes a lumen 28 aligned with the open proximal ends 1 8, 22 of sleeves 5, 6 so that they are in communication.
  • the screw 26 screws into the swivel 9 so that an end of the screw 26 pushes down on the proximal end 22 of the inner sleeve 6 pushing the inner sleeve 6 further into the outer sleeve 5 until the distal end 24 of the inner sleeve 6 abuts the distal end 20 of the outer sleeve 5.
  • a flexible wire or surgical cable 2 is passed around a fractured bone 1 via a minimal skin incision 3 as would be understood by those skilled in the art.
  • the fracture may be reduced by applying tension to the cable 2 and, once a desired tension has been obtained, a crimp may be used to secure the cable 2 around the bone 1 maintaining the desired tension.
  • a crimp may be used to secure the cable 2 around the bone 1 maintaining the desired tension.
  • Figs. 1 and 5-8 shown an exemplary surgical technique for cutting this excess cable 2 via a minimal skin incision 3.
  • the extending portion of the cable 2 is inserted through the holes 7, 8 and passed through the sleeves 5, 6 until it passes out of the lumen 28.
  • the device is then slid along the cable 2 through the incision 3 until the distal end 20 of the outer sleeve abuts the crimp or other securing member to which the cable 2 is secured around the fractured bone 1.
  • the cable 2 is inserted into the holes 7, 8 with the handles 4a. 4b in an open position in which the holes 7, 8 are aligned with one another.
  • the knob 10 is positioned over the proximal ends 18, 22 of the sleeves 5, 6 by swiveling swivel 9 about the pivot 16 such that the lumen 28 is in communication with the open proximal ends 18, 22 of the sleeves 5, 6, respectively, so that the cable 2 may easily pass through the entire device.
  • the knob 10 is turned to screw the screw 26 into the swivel 9 so that a distal end of the screw 26 pushes down on the proximal end 22 of the inner sleeve 6 moving the distal end 24 of the inner sleeve 6 further into the outer sleeve 5 until the distal end 24 of the sleeve 6 abuts the distal end 20 of the outer sleeve 5, as shown in Fig. 6
  • the holes 7, 8 remain aligned, as shown in Fig. 7.
  • the handles 4a, 4b arc drawn closed, as shown in Fig.
  • the outer sleeve 5 rotates in direction opposite that of the inner sleeve 6. For example, if the outer sleeve 5 rotates clockwise, the inner sleeve 6 rotates counter-clockwise, and vice versa. Thus, the drawing the handles 4a, 4b closed, moves the holes 7, 8 away from one another.
  • the clearance between the outer diameter of the inner sleeve 6 and the inner diameter of the outer sleeve 5 is at least equal to the diameter of the holes 7 and 8 or, if one of these boles is made smaller than the other, at least equal to the diameter of the smaller of the holes 7 and 8. This permits the inner sleeve 6 to move relative to the outer sleeve 5 so that the holes 7 and 8 no longer even partially overlap and edges of these holes 7, 8 or one of these holes 7,8 which are sharpened to act as blades cut the cable 2.
  • the cable 2 that passes through the holes 7, 8 snaps, leaving a neat and grouped cable stump 13.
  • the close contact between the distal end 20 of outer sleeve 5 and the distal end 24 of inner sleeve 6 prevents the cable from merely bending when handles 4a, 4b are closed and the sleeves 5, 6 rotate relative to one another.
  • the close contact between the distal ends 20, 24 causes the cable 2 to be rapidly cut with the rotation of the sleeves 5, 6 leaving a grouped stump 13 and preventing fraying of end the cut cable 2.
  • the device may be removed and the incision 3 sutured.
  • a distal end of the handle 4a is coupled to a proximal end 30 of a first one of a pair of blades 15a while a distal end of the handle 4b is coupled to a proximal end 30 of the other of the blades 15b.
  • Distal ends of the blades 1 5a, 15b form a pair of opposed jaws 1 1.
  • the blades 15a, 15b are rotatably coupled to one another at a pivot 32 so that, when the handles 4a, 4b are moved away from one another, proximal ends of the blades 15a, 15b rotate in opposite directions so that the opposed jaws 1 1 open and move away from one another.
  • the jaws 1 1 are rotated about the pivot 32 toward one another to the closed position.
  • the device according to this embodiment further comprises an optional locking mechanism 14 to prevent the handles 1 5a, 15b from being inadvertenlly moved relative to one another.
  • the locking mechanism 14 includes a bar 38 coupled to the handle 4b and a channel member 39 coupled to the handle 4a with a screw/locking nut 40 extending from the bar 38, through the channel member 39.
  • a screw/locking nut 40 extending from the bar 38, through the channel member 39.
  • the opposed jaws 11 are formed at an angle to the blades 15a. 15b. which are bowed inward such that, in an open position, as shown in Fig. 10, substantial portions of the blades 15 a, 15b overlap one another.
  • the opposed jaws 1 1 arc formed with a concave inner surface such that the opposed jaws 1 1 together form a space 34 in which the cable 2 may be accommodated.
  • the pivot 32 is located proximally of the opposed jaws 11 such that when the handles 4a, 4b are drawn closed, as shown in Fig.
  • the blades 15a, 15b cross over one another bringing proximal ends of the opposed jaws 1 1 closer together such that the proximal ends 36 of the opposed jaws 1 1 also overlap, thereby eliminating the space 34.
  • the blades 15a, 15b are designed to be overlapping and inwardly curved so that the device may be inserted into an existing minimal incision 3 without requiring significant spreading of the incision 3, thereby reducing muscle trauma and tissue damage.
  • a width of the blades 15a, 15b may be such that the blades 15a, 15b may be inserted into a minimal skin incision 3 without having to significantly spread the incision 3.
  • a length of the blades 15a, 15b is preferably selected so that the opposed jaws 1 1 may reach a crimp 12, or other fastener maintaining the cable 2 secured around the bone 1.
  • the angle of the opposed jaws 1 1 to the blades 15a, 15b is such that the jaws 1 1 may reach a point of the cable 2 as close to the crimp 12 as possible.
  • the device may be used to cut a remaining length of the cable 2 once the cable 2 has been secured around a fractured bone 1.
  • the cable 2 may be secured around the fractured bone using a crimp 12.
  • the device and method of the present invention may be used to cut an excess portion of the cable 2 regardless of the fashion in which it has been secured around the bone 1.
  • the cable 2 is inserted into the space 34 and the opposed jaws 1 1 of the device are slid along the cable to through a minimal skin incision 3 to the crimp 12 or other fastener.
  • the device As the device is being slid along the cable 2, the device is locked in the open position, as shown in Fig. 10. In the open position, the blades 15a, 15b of the device overlap to close off the space 34 and maintain the cable 2 therewithin. In this position, the handles 4a, 4b may not be moved relative to one another preventing the cable 2 from being cut or released from the space 34 before the device is in a desired position adjacent to the crimp 12 with a bottom surface 42 of the opposed jaws 11 abutting a surface of the crimp 12, as shown in Fig. 12.
  • the blades 15a, 15b move to the crossed configuration, the blades rotate about the pivot 32 such that the proximal end 36 of the opposed jaws 11 move closer to one another, eventually crossing over one another and eliminating the space 34 between the opposed jaws 1 1 cutting the cable 2 leaving a neat and grouped cable stump 13, as shown in Fig. 14.
  • the cable 2 is released from between the opposed jaws 1 1 such that the cable stump 13 falls back into place and the stump 13 is substantially hidden by the crimp 12, as shown in Fig. 15.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (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 dispositif qui permet de couper un câble à l'intérieur d'un corps vivant, lequel dispositif comprend un premier manchon définissant une première lumière et s'étendant jusqu'à une première ouverture distale d'une taille qui lui permet de recevoir un câble, et un second manchon qui est reçu dans la première lumière, le second manchon définissant une seconde lumière qui s'étend le long du manchon jusqu'à une seconde ouverture distale d'une taille qui lui permet de recevoir un câble, la seconde ouverture distale étant placée de manière que dans une première configuration, la première et la seconde ouverture distale sont alignées l'une sur l'autre, créant une trajectoire entre l'extérieur du premier manchon et le second manchon, le premier et le second manchon pouvant se déplacer l'un par rapport à l'autre jusque dans une seconde configuration dans laquelle la première et la seconde ouverture distale se désalignent l'une de rapport à l'autre pour couper un câble reçu à l'intérieur des ouvertures.
PCT/US2007/087138 2006-12-12 2007-12-12 Coupe-câble WO2008073949A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US87426206P 2006-12-12 2006-12-12
US60/874,262 2006-12-12

Publications (1)

Publication Number Publication Date
WO2008073949A1 true WO2008073949A1 (fr) 2008-06-19

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ID=39167807

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2007/087138 WO2008073949A1 (fr) 2006-12-12 2007-12-12 Coupe-câble

Country Status (1)

Country Link
WO (1) WO2008073949A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2294996A1 (fr) * 2009-09-11 2011-03-16 Stryker Trauma SA Outil de découpe de broche
WO2018140265A1 (fr) * 2017-01-26 2018-08-02 DePuy Synthes Products, Inc. Outil de coupe pour fils et câbles chirurgicaux

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE1277515B (de) * 1965-09-02 1968-09-12 Feinmechanik Vormals Jetter & Schneidvorrichtung zum Abschneiden von Draehten fuer chirurgische Zwecke
US5772663A (en) * 1994-02-17 1998-06-30 Whiteside; Leo A. Surgical device for banding bone with cable
EP0928602A2 (fr) * 1996-01-24 1999-07-14 Werner Hermann Outil pour cisaillement d'implants
US5980547A (en) * 1998-10-26 1999-11-09 Beere Precision Medical Instruments, Inc. Rotary cutter
WO2004082492A1 (fr) * 2003-03-21 2004-09-30 Synthes Ag Chur Dispositif de coupe et de formage
US20050149086A1 (en) * 2003-11-20 2005-07-07 Osseus, Llc Method and device for cutting surgical wire or cable

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE1277515B (de) * 1965-09-02 1968-09-12 Feinmechanik Vormals Jetter & Schneidvorrichtung zum Abschneiden von Draehten fuer chirurgische Zwecke
US5772663A (en) * 1994-02-17 1998-06-30 Whiteside; Leo A. Surgical device for banding bone with cable
EP0928602A2 (fr) * 1996-01-24 1999-07-14 Werner Hermann Outil pour cisaillement d'implants
US5980547A (en) * 1998-10-26 1999-11-09 Beere Precision Medical Instruments, Inc. Rotary cutter
WO2004082492A1 (fr) * 2003-03-21 2004-09-30 Synthes Ag Chur Dispositif de coupe et de formage
US20050149086A1 (en) * 2003-11-20 2005-07-07 Osseus, Llc Method and device for cutting surgical wire or cable

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2294996A1 (fr) * 2009-09-11 2011-03-16 Stryker Trauma SA Outil de découpe de broche
US8701955B2 (en) 2009-09-11 2014-04-22 Stryker Trauma Sa Pin cutting tool
WO2018140265A1 (fr) * 2017-01-26 2018-08-02 DePuy Synthes Products, Inc. Outil de coupe pour fils et câbles chirurgicaux

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