WO2009021624A1

WO2009021624A1 - Device for fixing bone fractures

Info

Publication number: WO2009021624A1
Application number: PCT/EP2008/006246
Authority: WO
Inventors: Marc A. Riner; Ernst Kehrli; Stephan Ingold; Frank Sautter; Pierre Hoffmeyer
Original assignee: Smith & Nephew Orthopaedics Ag
Priority date: 2007-08-10
Filing date: 2008-07-29
Publication date: 2009-02-19
Also published as: DE102007037872A1

Abstract

A device (10) for fixing bone fractures, in particular in the proximal region of a humerus, comprising a nail, shaft or similar implant (11, 18) that can be placed in the medullary canal of the broken bone or intramedullarly and a plate (14) that can be fixed on the implant (11, 18) by means of screws (12) or the like, wherein the plate (14) has bores (15) for receiving bone screws (16), in particular in an angularly stable manner. The plate (14) can be fixed in a predetermined position in relation to the implant (11, 18), if appropriate also at a distance from the bone, in such a way that it is stable in terms of the angle and the distance.

Description

Destruction for the fixation of bone fractures

Description

The present invention relates to a device for fixation of bone fractures, in particular in the proximal Beieich a humerus, distal, but also proximal region of a femur, and / or proximal Beieich a tibia, according to the Obeibegπff of claim 1.

The present case involves the healing of comorbid, joint-near multipart fractures of the proximal humerus, distal but also proximal femur and proximal tibia. It is important to fix the individual fragments with angular stability.

For complex humeral fractures, basically three different implant types are used:

1. Humeral nail, which are introduced intramedullary and fixed by means of screws, bolts and / or blades in the bone and stabilize this until Fraktuiheilung. The advantage of these implants is above all the less invasive introduction. Reference is made to US Pat. No. 5,472,444 A as an example of this prior art. For complicated multi-fragment fibrations, the abovementioned method is not sufficient

2. Screw plate systems, which are used in particular for the treatment of complicated multi-fragment fractures. In this regard, reference is made to CH 492 447, US 2006/0100623 A1 or US 5,190,544. This state of the

On the one hand, technology has the disadvantage that it has to be calculated with a large amount of soft tissue analysis. Furthermore, in this state of the art, a plate is fastened to an intramedullary implant by means of screws. This plate is either drawn to the bone by means of the screws and complements the bone Penost, which may lead to known lesions, or is fixed at the proximal end of a nail and "heaves around the bone". This voluminous fixation can lead to so-called "impingcment" and therefore also does not represent an ideal construction 3. Shoulder Prostheses be implanted in severe dislocated fractures with defective sliding surface of the ball head and foreseeable necrosis due to lack of blood flow. In the case of a fracture, implantation usually takes place only with the aid of humus. The intact glenoid is left, and the ball head articulates with the sliding surface of the anatomical glenoid.

In particular in so-called "four part fractures" with a humeral head which is no longer perfused, humeral prostheses are used for joint-preserving reconstruction After implantation of the prosthesis and reduction of the fracture scions, these are fixed by suture material both to the prosthesis and to one another. typically tuberculum minor and tuberculum major, the muscles of the shoulder musculature attack, and with early mobilization and poor fracture, they can dislocate bone-only fragments held by sutures due to the muscular forces that occur, and all these problems must be resolved.

Accordingly, the present invention has the object to provide a device for the fixation of bone fractures, especially complicated joint-near bone fractures available, with the improved repositioning of the original anatomical conditions can be achieved without the problem of Peπostkompression occurs. Also, the construction should be such that there is no "impmgement" hazard.

The Voiπchtung should be suitable for both a cemented and non-cementing implantation. If a prosthesis with a condyle is to be implanted, after the reduction of the fracture fragment, it must also be able to be fixed with the standard suture material

The above objects are erfmdungsgemaß solved by the features of claim 1, wherein advantageous structural details and embodiments are described in the subclaims, to which expressly referenced wnd If the previous egg is part of, for example, a humeral implant, this is It is modular in design and consists of plastic / metal and / or metal / metal and / or ceramic / metal and / or plastic / ceramic / metal or pure metal lead, which, as a sliding contact, is a natural type of hinge , ceramic, metal odei plastic. In this respect, there should be no limits to the design philosophy, whereby conventional biocompatible materials and material combinations are taken into account.

Due to the stable connection according to the invention between the plate and the implant, for example nail, the problem of the above-mentioned partial compression was avoided. The plate can be fixed angularly and distance stable with screws on the implant, for example, nail odci a body connected to the nail. As a spacer, the screws themselves, a blade, but also sleeves, through which the plate fixing screws extend, serve. Duich the am

Implant fixed plate can screw screws polyaxial, angle stable, odei polj-axial angle stable in the individual detached fragments screwed and thus fix relative to the nail stable

An essential point of the present invention is that the plate is fixable at both a predetermined distance from the implant, for example a nail or a shaft of the latter, both in terms of stability and spacing. In the prior art, instead of this, so-called "press plates" are always fixed on the nail introduced on the mtramedullar, meaning that the position of the plate is determined by the bone and not by the fixation on the nail or implant.

Below, more graze

and alternative construction details of the present invention with reference to a diagrammatically schematically illustrated modular Obeiaim- piothese explained. The drawing shows in:

Fig. 1 is a modular upper arm prosthesis according to the invention Voiichtung for

Fixation of Knochenfraktuicn in the vicinity of the joint of a humerus in longitudinal section;

2 shows the prosthesis according to FIG. 1 in a perspective view, FIG.

Figures 3 to 8 different Ausfuhiungs forms of Plattenfixiciung and

Spacer on the implant, for example nail or shaft or body, in each case in a schematic longitudinal section

The implant shown in Figures 1 and 2 represents a modular Obei aimpicture consisting of shaft 1 1, Koipus 1 8 and ball head f 1 9 is the connection between Body and shaft is a cone connection 20, which is fixed dutch by a proximi by the Koipus 1 8 hindiuchgefuhrte clamping screw 2 1

The head 19 is just if fixed by a cone-type connector 25 on an adapter 26. The adapter 26 is connected by a clamping screw 22 with the Koipus 18. The longitudinal axis of the clamping slide 22 is offset laterally relative to the head center axis 23. The head 1 9 is therefore eccentrically attached to the coaxial 1 8 The advantages of the voigc-called modulaic structure need not be discussed here, since the invention relates to a relative to the Koipus 18 angle and distance stable fixieibaie plate 14. This plate 14 is three-dimensionally shaped and adapted to the bone area to be fixed. The corresponding device for fixation is designated by the reference numeral 10. This device is not only suitable for fixation of bone fractures in the proximal region of a humerus, i. in association with an upper arm prosthesis, but also for the fixation of bone fractures in the distal or proximal region of a femur and / or proximal region of a tibia It comprises - as already mentioned - a plate 14, which at a nail in the medullary canal of the fractured bone or intiamedullar plazierbaren , Shank, od. Like. Implant, here body of a Oberaimprothese, by means of screws 12, a blade 13 and / or a clamping mechanism 17 on the implant 1 1 and 18 is fixieibar, wherein the plate 14 holes 1 5 for recording, in particular angularly stable recording of bone screws 16 has. The plate 14 is in a predetermined position relative to the implant 1 1 or 1 8, possibly even at a predetermined distance from the bone itself wmkel- and fixed in space stable. As already mentioned, the plate 14 is preferably shaped according to the outer shape of the bone area to be fixed.

The screws 12 and / or blade 13 and in particular also the clamping mechanism 17 are preferably connected to the plate 14 so that the plate 14 with the screws, blade and / or clamping mechanism relative to the implant 1 1 and 1 8 mitbewegbar is so, that a voibestimmte angular and distance-stable relative position between plate 14 and implant 1 1 or 1 8 is superimposed adjustable.

The bores 15 for the bone screws 16 are in the plate 14 in voi certain way emblazoned, so that the bone screws 16 are ausgespriechend within these Bohiungen. This allows the bone screws monoaxially einschiauben in fracture elements

However, it is also conceivable to form the bores 15 in the plate 14 for the purpose of receiving a polyvision bone screw 1 6. In this case, the bone fins have 1 6 voizugswcise Schraubkopfe whose at least the plate 14 zugekehitc side sth a- misphaiisch formed according to an approximately hemisphaπschen Aufnahmecoffnung on the bone πbgewandten side of the or holes 15 in the plate 14th

Finally, it is still possible to provide a polyaxial recording with angular stable fixation dei screws. The thread and / or the Bohiung in dei plate is designed so that the angle of the screw fell is adjustable When the final tightening or tightening of the screw is then a wmkelstabile blocking deiselben

In the case of the embodiment shown in FIGS. 1 and 2, the screws 12 can be screwed into the implant or into the coypus 18 by fixing the plate 14 relative to the implant 1 1 or in this case the body 18 through threaded shoulders 27. Windchulsen 27 itself also in threaded holes 28 of the plate 14 are screwed, so that duich countering these two threads between Schiaube 12 and threaded sleeve 27 on the one hand and between threaded sleeve 27 and plate 14 on the other hand fixation of the plate 14 at voibestimmtem distance from the implant 1 1 or 18 can be ordered. Preferably, for this purpose, the slopes of the aforementioned threads are different.

As Fig. 2 can be seen very well, the plate 14 at the upper proximal end two smaller holes 29, which serve Zui attachment of suture.

3 shows an alternative Ausfuhrungsfoim for the distance-stable Fixieiung the plate 14 against a nail or shank 1 1. Between plate 14 and shaft 1 1, a blade 13 is inserted with through hole 30. Through this through hole 30, a fastening screw 12 extends through which the Fixieiung on the shaft 1 1 eifolgt. On the Untciseite of the screw head 31 is a genffelte Anlagc- surface to fix the screw 12 in the screwed state

The blade 13 may also pierce through the shaft 11; Of course, then an axial stop for the blade 13 relative to the shaft 1 1 must be voigesehen to Fixie the blade 13 relative to the shaft and to the other and the plate 14th

4, the fixation of the plate 14 with respect to the shaft 11 is shown by a type of threaded rod, which is fixable within the shaft 11 with a distal screw shaft, in particular a sliding barrel 32. In the embodiment of Fig. 5, the fixation of the plate 14 with respect to the shaft 11 is similar to that of the embodiment of Fig. 4, with the underside, that the threaded rod which supports the fixation tube 12 against the plate 14 Implant defined in a threaded sleeve 33 is einschraubbai which λviedeium schiaubveunden with the shaft 1 1. In this respect, the threaded rod 12 is formed in two parts in this Ausfühiungsfoim

In the embodiment according to FIG. 8, a clamping mechanism 17 is used to fix the plate 14 relative to the implant, here coipus 18, for application Dicsci clamp chamfering comprises at least one, here two clamping pins 34, to which a thread 35 is formed at the end facing the implant Tamping pins 34 are screwed in at all points of the implant. In this case, the clamping pins 34 each have a threaded bore 36 in the plate 14. Within the threaded bore 36, the clamping pins 34 are firmly bound by a clamping sleeve 37 that can be inserted into the threaded portion 36 of the plate 14, so that the plate 14 is at a certain distance from it Implant 11 or 18 clamped on at least one clamping pin 34 is fixieibar The screwing and unscrewing of both clamping pin 34 and clamping sleeve 37 is indicated in Fig 8 with the double arrows 38, 39

The clamping sleeve 37 is preferably designed as Schlitzhulse with axial slot 40. Fei ner is the outward or the end facing away from the bone of the clamping sleeve 37 tπchteifor- mig extended, so that they biased when screwing into the zugcoidnete threaded bore 36 of the plate 14 radially inwardly against the clamping pin 34 wild For this purpose, the bone hole facing away from the threaded hole By means of the clamping sleeve 37, therefore, the plate 14 is fixated to the clamping pins 34 at a predetermined distance from the implant, ie co-tip 18 of an upper arm prosthesis

In FIGS. 6 and 7, the plates 14 are each provided with a through bore, into which sleeves 41 and 42, respectively, with internal threads are inserted, with the relative position of the sleeves 41, 42 inside the protruding holes in the plate 14 on the sleeves 41, 42 integrally formed peripheral flanges 43, 44 is determined

Scheiubmuttein 45, 46 zugeoidnet These have a Innengew inde corresponding to the internal thread of the sleeves 41, 42 on the eiw suspected Innengew inde serve ziu receiving dei mounting screws 12 fui the plate 14 relative to the implant, w obei the relative position of the plate 14 by locking of sleeve 41, 42 on the one hand and associated nut 45, 46 on the other hand can be fixed.

In the embodiment according to FIG. 6, the sleeve 41 protrudes in the bore of the plate 14 in a detrimental manner. The associated opening of the plate bore is extended according to a funnel.

In the embodiment of FIG. 7, the bore in the plate 14 is continuously cylindrical. At the plate 14 associated side of Schraubmuttcr 46 then a ring extension 47 is still provided, which serves for centering the nut 46 within the bore in the plate 14. This annular shoulder 47 further has a funnel-like widening opening towards the bone into which the associated end of the sleeve 42 can be fitted. This results in a mutual alignment of sleeve 42 and nut 46 within the bore in the plate 14th

In the embodiment of the embodiment shown in FIG. 6, the orientation of the threaded sleeve 41 is effected exclusively by the truncated cone-shaped outer periphery, which can be fitted into a corresponding funnel-like opening of the plate 14.

It should be noted that the plate 14 may also be designed so that no bone screws 16 are used, but only additional suture can be anchored to the plate 14.

The plate 14 can also be provided with integrally formed force carriers, via which the connection takes place to the intramedullary implant

The plate 14 may be anatomical bearing both symmetrical and as ₎ m metπsch trained. In any case, the plate should be adapted to the bone shape to be fixed

The present invention also relates to a Zielgerat for safely locating the holes in the intramedullary implant introduced, eg body 1 8 a humetus or Obeiarmprothese, which is characterized in that it is on the intramedullary implant introduced fixieibai. This target device may comprise a target globe extending proximally at the bone, with cylindrical sleeves directed toward the protrusions in the implant, and then passing the fastening screws for the plate 14 therethrough All maids kept open in the education submission days have been identified as having been individually or individually registered. in combination against the state of the art are new

S e c tio ns:

10 Voochtung zui fixation Knochen on Knochenfiaktuien

11 shaft

12 plate fixing screws 13 blade

14 plate

15 Bohiung

16 bone schiaube

17 Clamping Mechanism 18 Koipus of a modulatory obeia implant

19 ball head or condyle (with hemisphere sliding surface)

20 conical bond

21 clamping shaft

22 Clamping tube 23 Head center axis

24 Longitudinal axis of the clamping schiaubsee connection 22

25 cone plug binding

26 adapters

27 Gewidehulse 28 Gewindebohiung

29 Bohiung fui Suture File

30 duichgangbohiung

31 shooting head

32 Clamping screw 33 Geλ \ indehulse

34 clamping pin

36% by weight

37 clamping sleeve 38 double arrow

39 double arrow

40 Axialschhtz

41 inner sleeve Inner threaded sleeve

Circumference flange

nut

annular shoulder

Claims

Patent claims

1. Device (10) for fixing bone fractures, in particular in the proximal region of a humerus, distal, but also proximal region of a femur, and / or proximal region of a tibia, with a nail that can be placed in the corneal canal of the fractured bone or intramedullary nail, Shaft or the like Implant (11, 18) and a means of screws (12), a blade (13) and / or a clamping mechanism (17) on the implant (11, 18) fixieibaien plate (14), wherein the plate (14) Holes (15) for receiving, in particular angularly stable recording of Knochenschiauben (16), characterized in that ß the plate (14) in a predetermined position relative to the implant (11, 18), optionally also at a distance to the bone angle and distance fixieibai is.

2. The device according to claim 1, wherein the plate (14) is shaped in accordance with the external shape of the bone area to be fixed

3. Device according Anspiuch 1 or 2, characterized in that ß the screws (12), blade (13) and / or dei clamping mechanism (17) with the plate (14) are connected so that the plate (14) with the screws (12), the blade (13) and / or the clamping mechanism (17) relative to the implant (11, 18) mitbewegbar is such that a voibestimmte angular and distance-stable relative position between the plate (14) and implant (11, 18) is permanently adjustable.

4. The device according to one of Anspiuche 1 to 3, characterized in that ß the Bohiungen (15) in the plate (14) are aligned in vorbestimmtei way, so that the bone screws (16) within these holes (15) are appropriately illuminated ,

The device according to one of the preceding claims 1 to 3, wherein the holes (15) in the plate (14) are designed for the pole-axial accommodation of bone screws (16).

6. Device according to Anspiuch 5, characterized in that ß the bone screws (16) Schiaubkopfe whose at least the plate (14) facing side is formed approximately hemisphan corresponding to an approximately hemisphaπschen Aufnahmeoffnung on the side facing away from the bone or the Bohiungen (15 ) in the plate (14).

7. Device according to one of claims 1 to 6, characterized in that ß the clamping mechanism by means of which the plate (14) relative to the implant (11, 18) is fixable, through a threaded bore (36) in dei plate (14) therethrough - Fastenable and with the implant (11, 18) veibind-, in particular screwed clamping pin (34) which is so firmly enclosed by a in the Gewindebohiung (36) of the plate (14) einschraubbaicn clamping sleeve (37) that the plate ( 14) at a predetermined distance λ'om implant (11, 18) clamped on the Klcmmstift (34) can be fixed or held.

8 Voiπchtung to Anspiuch 7, characterized in that ß the Klcmmhulse (37) is a Schhtzhulse (axial slot 40)

9. The device according to claim 7 or 8, characterized in that ß the outer or the bone facing away from the end of the clamping sleeve (37) is extended dπchter- formig so that they when screwing into the associated threaded bohiung (36) of the plate (14) is biased radially inwardly against the clamping pin (34).

10. Device according to one of claims 1 to 6, characterized in that ß the screws (12) for Fixieiung the plate (14) relative to the implant (11, 18) through threaded sleeves (27) through into the implant (11, 18), and the gauze sleeves (27) themselves are also screwed into threaded holes (28) of the plate (14), so that these two threads between screw (12) and screw (27) on the one hand and between Gewmdchulse (27) and Plate (14) on the other hand, a fixation of the plate (14) can be produced.

11. The device according to claim 1, wherein the implant comprises a nail or shank, a body and / or a condyle, these parts being at least partially connected to one another in modular fashion.

12. The device according to one of claims 1 to 11, wherein a plate (14) comprises openings (29) or the like elements for concealing suture material.

13. Zielgerat for safely locating the holes in intramedullai implant introduced, for example, body (18) of a Humeiusprothese, in the screws (12) for Fixieiung a plate (14) are screwed relative to the implant, characterized ß this fixieibar implanted on intiamcdullar implant is.