WO2009115337A1 - Guide for distal screws through intramedullary nail - Google Patents

Guide for distal screws through intramedullary nail Download PDF

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Publication number
WO2009115337A1
WO2009115337A1 PCT/EP2009/002065 EP2009002065W WO2009115337A1 WO 2009115337 A1 WO2009115337 A1 WO 2009115337A1 EP 2009002065 W EP2009002065 W EP 2009002065W WO 2009115337 A1 WO2009115337 A1 WO 2009115337A1
Authority
WO
WIPO (PCT)
Prior art keywords
nail
contoured
distal
screw
bone
Prior art date
Application number
PCT/EP2009/002065
Other languages
French (fr)
Inventor
Giuseppino Mela
Original Assignee
Mikai S.P.A.
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 Mikai S.P.A. filed Critical Mikai S.P.A.
Publication of WO2009115337A1 publication Critical patent/WO2009115337A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • 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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue

Definitions

  • the present invention relates to an apparatus for intramedullary fixation.
  • the technique of intramedullary fixation is adapted to re-establish the continuity of a fractured bone and keep it stable by inserting a temporary or permanent prosthesis within the medullary cavity of the bone.
  • the surgical technique normally used to insert the intramedullary nail provides for the use of an external template provided with holes; the template is connected to the nail and is arranged parallel to the nail.
  • the nail has a slender shape in the distal part and is threaded on the proximal side.
  • the nail is fixed by means of distal and proximal bicortical screws, which couple it to the bone.
  • the holes on the external template guide the insertion of the screws.
  • the above system has a problem: no matter how accurate the templates might be, the nail, due to its length, undergoes a mechanical deformation that is more conspicuous in the distal part.
  • a deformation of 1 ⁇ 2 mm is sufficient to have difficulties in positioning the screws.
  • the aim of the present invention is to provide an apparatus that overcomes the drawbacks of the cited prior art.
  • an object of the invention is to provide an apparatus that can facilitate the insertion of distal screws.
  • a further object of the present invention is to provide an apparatus which, by virtue of its particular constructive characteristics, is capable of giving the greatest assurances of reliability and safety in use.
  • an apparatus for intramedullary fixation characterized in that it comprises a nail provided with a contoured tip, a screw with a contoured cross-section that can be inserted in the bone and is adapted to engage said contoured tip so as to correct any deformations of said nail when it is inserted in the bone, a distal template to be mounted on said contoured screw in order to act as a guide for the insertion of distal screws in the bone.
  • Figure 1 is a partial perspective view of the nail and of the distal guide of the apparatus according to the invention
  • Figure 2 is a perspective view of the apparatus according to the present invention.
  • Figure 3 is a perspective view of the distal portion of the nail
  • Figure 4 is a perspective view of the triangular screw
  • Figure 5 is a front view of the distal guide of the apparatus according to the present invention
  • Figure 6 is a perspective view of the external alignment operation
  • Figure 7 is a perspective view of the operation of inserting the nail
  • Figure 8 is a perspective view of the operation of inserting the wire by means of the positioning template
  • Figure 9 is a perspective view of the operation of milling the bone and inserting the screw having a triangular cross-section
  • Figure 10 is a perspective view of the operation of striking the nail into its seat and inserting the guiding template for the screws;
  • Figure 11 is a perspective view of the operation of inserting the screws by means of the template.
  • the apparatus for intramedullary fixation substantially comprises a nail 2, a distal template 3 and a screw 4 having a contoured cross-section.
  • the nail 2 has a distal end provided with a tip 5 that is V- shaped so that it can be engaged by the apex 6 of the screw 4, that is appropriately contoured for this purpose.
  • the apex 6 of the screw 4 preferably has a triangular cross-section.
  • the distal portion of the nail 2 has a series of holes 7 that are adapted to accommodate locking screws 8.
  • the distal template 3 has a plurality of seats 9, that guide the locking screws 8, and a seat 10, which accommodates the shank of the contoured screw 4.
  • Figure 6 illustrates the initial operation of external alignment of the nail 2 by means of a supporting tool 11 , which supports a positioning template 12 for a guiding wire 13.
  • the procedure begins with the partial insertion of the nail 2 in the bone 14 and the subsequent insertion of the wire 13 by means of the positioning template 12, as shown in Figure 8.
  • the bone 14 is then milled and the screw 4 having a triangular cross-section is inserted, as shown in Figure 9.
  • the nail 2 is hammered in and the V- shaped tip 5 is blocked on the apex 6 of the screw 4 having a triangular cross-section, as shown in Figure 10. In this manner it is possible to compensate for any deformation of the nail, forcing the tip 5 to center the axis of the contoured screw 4.
  • proximal screws are inserted by using a proximal template as in standard surgical procedure.
  • the invention achieves the intended aim and objects, providing an apparatus that is capable of facilitating the insertion of distal screws by virtue of the particular shape of the tip of the nail 2 that engages the contoured screw 4 on which the novel distal template 3 is then mounted.
  • the combined action of the nail 2, provided with the special V-shaped tip 5, with the contoured screw 4 allows to compensate for a deformation of the nail of 1 ⁇ 2 mm.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Neurology (AREA)
  • Dentistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Surgical Instruments (AREA)

Abstract

An apparatus for intramedullary fixation includes a nail provided with a contoured tip, a screw with a contoured cross-section that can be inserted in the bone and is adapted to engage the contoured tip so as to correct any deformations of the nail when it is inserted in the bone, a distal template to be mounted on the contoured screw in order to act as a guide for the insertion of distal screws in the bone.

Description

GUIDE FOR DISTAL SCREWS THROUGH INTRAMEDULLARY NAIL
The present invention relates to an apparatus for intramedullary fixation. As is known, the technique of intramedullary fixation is adapted to re-establish the continuity of a fractured bone and keep it stable by inserting a temporary or permanent prosthesis within the medullary cavity of the bone.
The surgical technique normally used to insert the intramedullary nail provides for the use of an external template provided with holes; the template is connected to the nail and is arranged parallel to the nail.
The nail has a slender shape in the distal part and is threaded on the proximal side. The nail is fixed by means of distal and proximal bicortical screws, which couple it to the bone.
The holes on the external template guide the insertion of the screws. The above system has a problem: no matter how accurate the templates might be, the nail, due to its length, undergoes a mechanical deformation that is more conspicuous in the distal part.
Generally, no problems occur on the proximal side, while inserting the screws, because the distance between the insertion point of the nail and the screw holes is minimal and the deformation is therefore negligible.
On the distal side, instead, since the distance is considerable, it is difficult to center the holes on the nail and this entails exposure of the patient and especially of operators to considerable radiation in order to assist positioning.
A deformation of 1÷2 mm is sufficient to have difficulties in positioning the screws. The aim of the present invention is to provide an apparatus that overcomes the drawbacks of the cited prior art. Within the scope of this aim, an object of the invention is to provide an apparatus that can facilitate the insertion of distal screws.
A further object of the present invention is to provide an apparatus which, by virtue of its particular constructive characteristics, is capable of giving the greatest assurances of reliability and safety in use. This aim and these and other objects that will become better apparent hereinafter are achieved by an apparatus for intramedullary fixation, characterized in that it comprises a nail provided with a contoured tip, a screw with a contoured cross-section that can be inserted in the bone and is adapted to engage said contoured tip so as to correct any deformations of said nail when it is inserted in the bone, a distal template to be mounted on said contoured screw in order to act as a guide for the insertion of distal screws in the bone.
Further characteristics and advantages will become better apparent from the description of preferred but not exclusive embodiments of the invention, illustrated by way of non-limiting example in the accompanying drawings, wherein: Figure 1 is a partial perspective view of the nail and of the distal guide of the apparatus according to the invention;
Figure 2 is a perspective view of the apparatus according to the present invention;
Figure 3 is a perspective view of the distal portion of the nail;
Figure 4 is a perspective view of the triangular screw; Figure 5 is a front view of the distal guide of the apparatus according to the present invention;
Figure 6 is a perspective view of the external alignment operation;
Figure 7 is a perspective view of the operation of inserting the nail;
Figure 8 is a perspective view of the operation of inserting the wire by means of the positioning template;
Figure 9 is a perspective view of the operation of milling the bone and inserting the screw having a triangular cross-section;
Figure 10 is a perspective view of the operation of striking the nail into its seat and inserting the guiding template for the screws; Figure 11 is a perspective view of the operation of inserting the screws by means of the template.
With reference to the cited figures, the apparatus for intramedullary fixation according to the invention, generally designated by the reference numeral 1 , substantially comprises a nail 2, a distal template 3 and a screw 4 having a contoured cross-section. According to the invention, the nail 2 has a distal end provided with a tip 5 that is V- shaped so that it can be engaged by the apex 6 of the screw 4, that is appropriately contoured for this purpose.
The apex 6 of the screw 4 preferably has a triangular cross-section.
The distal portion of the nail 2 has a series of holes 7 that are adapted to accommodate locking screws 8.
The distal template 3 has a plurality of seats 9, that guide the locking screws 8, and a seat 10, which accommodates the shank of the contoured screw 4.
The operation of the apparatus according to the present invention is shown schematically in the sequence of Figures 6-11. Figure 6 illustrates the initial operation of external alignment of the nail 2 by means of a supporting tool 11 , which supports a positioning template 12 for a guiding wire 13.
As shown schematically in Figure 7, the procedure begins with the partial insertion of the nail 2 in the bone 14 and the subsequent insertion of the wire 13 by means of the positioning template 12, as shown in Figure 8. The bone 14 is then milled and the screw 4 having a triangular cross-section is inserted, as shown in Figure 9.
Once the contoured screw 4 has been inserted, the nail 2 is hammered in and the V- shaped tip 5 is blocked on the apex 6 of the screw 4 having a triangular cross-section, as shown in Figure 10. In this manner it is possible to compensate for any deformation of the nail, forcing the tip 5 to center the axis of the contoured screw 4.
At this point it is sufficient to mount the distal template 3 on the contoured screw 4 in order to insert the distal screws 8 at the holes 9 of the template, as shown schematically in Figure 11. Finally, the proximal screws are inserted by using a proximal template as in standard surgical procedure.
In practice it has been found that the invention achieves the intended aim and objects, providing an apparatus that is capable of facilitating the insertion of distal screws by virtue of the particular shape of the tip of the nail 2 that engages the contoured screw 4 on which the novel distal template 3 is then mounted. The combined action of the nail 2, provided with the special V-shaped tip 5, with the contoured screw 4 allows to compensate for a deformation of the nail of 1÷2 mm.
This application claims the priority of Italian Patent Application No. GE2008A000021 filed on March 21 , 2008, the subject matter of which is incorporated herein by reference.

Claims

1. An apparatus for intramedullary fixation, characterized in that it comprises a nail provided with a contoured tip, a screw with a contoured cross-section that can be inserted in the bone and is adapted to engage said contoured tip so as to correct any deformations of said nail when it is inserted in the bone, a distal template to be mounted on said contoured screw in order to act as a guide for the insertion of distal screws in the bone.
2. The apparatus according to claim 1 , characterized in that said tip is V-shaped, said contoured screw having an apex that has a triangular cross-section.
3. The apparatus according to claim 1 or 2, characterized in that said distal template has a plurality of seats that guide said locking screws and a seat that accommodates the shank of said contoured screw.
PCT/EP2009/002065 2008-03-21 2009-03-20 Guide for distal screws through intramedullary nail WO2009115337A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ITGE2008A000021 2008-03-21
ITGE20080021 ITGE20080021A1 (en) 2008-03-21 2008-03-21 EQUIPMENT FOR ENDOMIDOLLAR FIXATION

Publications (1)

Publication Number Publication Date
WO2009115337A1 true WO2009115337A1 (en) 2009-09-24

Family

ID=40292780

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2009/002065 WO2009115337A1 (en) 2008-03-21 2009-03-20 Guide for distal screws through intramedullary nail

Country Status (2)

Country Link
IT (1) ITGE20080021A1 (en)
WO (1) WO2009115337A1 (en)

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4846162A (en) * 1987-09-14 1989-07-11 Moehring H David Orthopedic nail and method of bone fracture fixation
US4913137A (en) * 1988-02-09 1990-04-03 Orthopedic Designs, Inc. Intramedullary rod system
US5100404A (en) * 1990-09-04 1992-03-31 Beth Israel Hospital Intramedullary nailing method and apparatus

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4846162A (en) * 1987-09-14 1989-07-11 Moehring H David Orthopedic nail and method of bone fracture fixation
US4913137A (en) * 1988-02-09 1990-04-03 Orthopedic Designs, Inc. Intramedullary rod system
US5100404A (en) * 1990-09-04 1992-03-31 Beth Israel Hospital Intramedullary nailing method and apparatus

Also Published As

Publication number Publication date
ITGE20080021A1 (en) 2009-09-22

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