WO2010077309A2 - Appareil de fixation externe équipé d'un moyen de fixation de broches réglable et de broches osseuses convergentes - Google Patents

Appareil de fixation externe équipé d'un moyen de fixation de broches réglable et de broches osseuses convergentes Download PDF

Info

Publication number
WO2010077309A2
WO2010077309A2 PCT/US2009/006566 US2009006566W WO2010077309A2 WO 2010077309 A2 WO2010077309 A2 WO 2010077309A2 US 2009006566 W US2009006566 W US 2009006566W WO 2010077309 A2 WO2010077309 A2 WO 2010077309A2
Authority
WO
WIPO (PCT)
Prior art keywords
pin
housing
deformable
bone
mounting
Prior art date
Application number
PCT/US2009/006566
Other languages
English (en)
Other versions
WO2010077309A3 (fr
Inventor
Mohammed A. Hajianpour
Original Assignee
Nutek Orthopaedics, Inc.
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
Priority claimed from US12/316,830 external-priority patent/US8262657B2/en
Priority claimed from US12/460,680 external-priority patent/US8123747B2/en
Application filed by Nutek Orthopaedics, Inc. filed Critical Nutek Orthopaedics, Inc.
Publication of WO2010077309A2 publication Critical patent/WO2010077309A2/fr
Publication of WO2010077309A3 publication Critical patent/WO2010077309A3/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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6491—Devices extending alongside the bones to be positioned allowing small-scale motion of bone ends
    • 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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/645—Devices extending alongside the bones to be positioned comprising a framework

Definitions

  • This invention relates to apparatus for the external fixation of fractured bones, and, more particularly, to such apparatus having means for adjustably mounting and clamping a number of bone pins to a housing.
  • External fixation often provides the best method for holding bone fragments in place during he healing of a severe bone fracture, in which multiple bone fragments are formed.
  • bone pins or wires ate surgically attached to the individual bone fragments and to intact sections of bone, so that a desired alignment of multiple fragments can be maintained during the healing process.
  • the individual bone pins or wires are also attached to a frame that is external to the body to be held in a fixed configuration. Then, after the bone fragments have joined to one another in a satisfactory manner, the bone pins or wires are removed from the bones and from the body in another surgical procedure.
  • an ability to hold individual bone fragments in place often makes in possible to achieve results that cannot be achieved using other conventional techniques, such as casting.
  • a device for external fixation should be configured in a variety of different ways, reducing the number of different types of fixation devices that need to be held in inventory to meet expected demands.
  • the patent literature includes a number of descriptions of fixation devices that can be assembled from multiple elements in various ways or that can be adjusted to provide various configurational features.
  • a fixture may include several holes for clamping members to hold bone pins disposed within an elongated portion and a number of holes in a rectangular pattern, which can accommodate a variety of pin configurations.
  • a configuration for applying external fixation to a fractured tibia is also described as including a frame an elongated lower section for fastening the frame to the shaft of the tibia using bone pins extending along a straight line and an arcuate section extending from each side of the upper end of the elongated lower section for clamping bone pins extending into bone fragments within the upper portion of the tibia.
  • a fixture may include a number of clamping elements, each of which clamps a pair of bone pins extending parallel to one another and a rod to which the clamping elements are attached by means of a pair of pivoting clamps providing for rotational adjustment and clamping about two axes perpendicular to one another.
  • a fixation device may have a pair of elongated carriers, each of which supports a pair of bone screws that are movable along the carrier by rotating a spindle.
  • the carriers are joined to one another by a connector including a rigid rod and a ball at each end.
  • the balls are received by partly spherical sockets that can be fixed relative to the balls through screws.
  • An external fixation may include a fixation block from which one or more arms extend, with a ball and socket joint connecting each arm to the block for universal movement thereabout. Setscrews are then provided for tightening the ball and socket joints.
  • a fixation device may have a pair of clamping members, each of which includes a row of holes into which bone pins may be inserted and clamped, with the clamping members being connected by a tube, into which a rod extends from one of the clamping members, while a ball from the other connecting member extends into a partially spherical hole within the tube.
  • a common method for the treatment of a fractured distal radius involves the use of standard immobilizing cast techniques, preventing movement of the radiocarpal joint throughout the course of rehabilitation.
  • a problem with this method is that it sometimes results in inadequate internal fixation, which can cause deformity, pain, and prolonged disability.
  • the process of external pin fixation is alternately used in the repair of a fractured distal radius.
  • This process initially involves the surgical insertion of skeletal traction pins on both sides of the fracture, with a frame being connected to the pins for immobilizing the bones, and for holding them together until the fracture is mended.
  • Conventional methods for applying external pin fixation for the treatment of a fractured distal radius provide for the immobilization of the radiocarpal joint, so that the hand cannot be flexed.
  • frames used for this type of external fixation rigidly but adjustably connects a pair of pins extending into the metacarpal bones with a pair of pins extending into the radius on the proximal side of the fracture.
  • a fixation device may be configured to provide adequate fixation during the healing process while allowing flexure in the radiocarpal joint.
  • Such a fixation device includes a number of pins clamped within pin mounting holes. Each pin extends through a flexible sleeve and through a clamping nut.
  • Each pin-mounting hole includes a pilot hole guiding the pin and an internally threaded portion engaging an externally threaded portion of the clamping nut. As the clamping nut istightened, the flexible sleeve is longitudinally compressed, so that it expands transversely to clamp itself within the pin-mounting hole and to clamp the pin within itself.
  • the fixation device which is configured particularly for external fixation of a fractured distal radius, includes a first number of such pins configured for attachment within a shaft portion of the radius and a second number of such pins configured to attachment to one or more fragments of the fractured radius.
  • the fixation device also includes a sliding attachment block supporting a number of pins extending for lateral attachment to such a fragment.
  • a bone fixation device having the flexibility of adjusting the angle at which individual bone pins extend from a housing or frame, preferably with such an adjustment being provided through a clamping device that simultaneously clamps both the linear extension of the bone pin, along its length, and its angle relative to the housing or frame.
  • apparatus for external fixation of bone fragments including a housing, a plurality of bone pins, and a plurality of clamping members.
  • the housing includes first and second pluralities of internal mounting surfaces and first and second pluralities of apertures, with each of the internal mounting surfaces and each of the apertures being formed as rounded surfaces extending around and along a central axis of the internal mounting surface.
  • Each of the deformable pin holders which are held within the housing, includes a spherical external surface engaging one of the internal mounting surfaces within the housing, a pin mounting hole extending in a straight line through a center of the spherical external surface, and a first slot extending in a direction perpendicular to the pin mounting hole across the pin mounting hole and partially across the pin holder, displaced inward from a first end of the pin mounting hole, and forming a first deflectable portion of the pin holder between the first slot and the first end of the pin mounting hole.
  • the bone pins are each held within the pin mounting hole in one of the deformable pin holders to extend through one of the apertures.
  • An angle, relative to the housing, at which each of the bone pins extends through the aperture, is varied by pivoting the pin holder within the housing, with each of the bone pins being adjustable within a conical region about the central axis of the internal mounting surface.
  • the central axes of the first plurality of pin holders extend parallel to one another, while the central axes of the second plurality of pin holders extend along the housing through a first distance at acute angles relative to one another to hold bone pins to converge within a region of convergence spaced apart from the elongated portion and substantially shorter than the first distance.
  • the clamping members each engage ome of the deformable pin holders to hold the pin holder in place within the housing, while simultaneously deflecting the first deformable portion of the pin holder to hold the bone pin in place within the pin holder.
  • each of the deformable pin holders additionally includes a second slot extending in a direction perpendicular to the pin mounting hole across the pin mounting hole and partially across the pin holder, displaced inward from a second end of the pin mounting hole, forming a second deflectable portion of the pin holder between the second slot and the second end of the pin mounting hole.
  • the clamping member then simultaneously deflects the second deformable portion of the pin holder to hold the bone pin in place within the pin holder.
  • each clamping member includes a threaded surface and an annular surface engaging the first deformable portion of one of the deformable pin holders, while the housing includes a plurality of threaded surfaces, each disposed adjacent an aperture in the plurality of apertures, with the threaded surface of each of the clamping members engaging one of the threaded surfaces of the housing. Then, as each of the clamping members is rotated in a first direction, an engagement force between the spherically rounded surface of the pin holder clamped in place within the housing by the clamping member and the internal mounting surface within the housing is increased to hold the pin holder in place within the housing, and deflection of the deformable portion of the pin holder is increased to hold the bone pin in place within the pin holder.
  • the engagement force between the spherically rounded surface of the pin holder and the internal mounting surface within the housing is decreased to allow rotation of the spherically rounded surface of the pin holder within the internal mounting surface of the housing and to allow movement of the bone pin within the pin mounting hole of the pin holder.
  • apparatus for the external fixation of bone fragments within a fractured distal radius, with the apparatus including a housing, a plurality of deformable pin holders, a plurality of bone pins that are each held within one of the deformable pin holders, a plurality of shank attachment pins, a plurality of fragment attachment pins, and a clamping bracket.
  • the housing includes an elongated shank mounting portion, a fragment attachment pin array section at a first end of the elongated shank mounting portion, and a lateral fragment mounting section extending parallel to the elongated shank mounting portion and downward from an edge of the fragment attachment pin array section.
  • the elongated shank mounting portion of the housing includes a plurality of pin mounting structures.
  • the fragment attachment pin array section of the housing includes a first array of fragment attachment pin holes extending through the housing,
  • the lateral fragment mounting section includes a plurality of internal mounting surfaces and a plurality of apertures, with each of the internal mounting surfaces and each of the apertures being formed as rounded surfaces extending around and along a central axis of the internal mounting surface.
  • the plurality of deformable pin holders which are held within the housing, each includes a spherical external surface engaging one of the internal mounting surfaces within the housing, a pin mounting hole extending in a straight line through a center of the spherical external surface, and a first slot.
  • the first slot extends in a direction perpendicular to the pin mounting hole across the pin mounting hole and partially across the pin holder, being displaced inward from a first end of the pin mounting hole, forming a first deflectable portion of the pin holder between the first slot and the first end of the pin mounting hole.
  • the plurality of bone pins each extend through an aperture in the plurality of apertures, with an angle, relative to the housing, at which each of the bone pins extends through the aperture being varied by pivoting the pin holder within the housing.
  • the shank attachment pins are invividually held within the plurality of pin mounting structures within the shank mounting portion of the housing.
  • the plurality of fragment attachment pins extends through the first array of fragment attachment pin holes.
  • the clamping bracket includes a second array of fragment attachment pin holes.
  • the clamping bracket is mounted on the fragment attachment pin array section to be moved between a position in which the first and second arrays of fragment attachment pin holes are aligned with one another and a position in which the first and second arrays of fragment attachment pin holes are moved out of alignment with one another to clamp the plurality of fragment attachment pins within the fragment attachment array section.
  • one of the pin mounting structures within the elongated shank mounting portion includes an additional internal mounting surface and an additional aperture as described above, with the apparatus additionally including an additional deformable pin holder, held within the additional internal mounting surface, and an additional clamping member engaging the additional pin holder, and with one of the shank attachment pins being held within the pin mounting hole in the additional deformable pin holder.
  • the clamping bracket includes a first clamping plate having the second array of fragment attachment pin holes and a second clamping plate having a third array of fragment attachment pin holes, aligned with the first array of fragment attachment pin holes, with the first and second clamping plates being disposed on opposite sides of the fragment attachment pin array section of the housing.
  • one of the pin mounting structures within the elongated shank mounting portion includes a pin adjustment slot, with the apparatus additionally including a nut mounted to slide within the pin adjustment slot, a collet screw, a distraction clamp, and a distraction screw.
  • the nut includes inclined surfaces engaging the pin adjustment slot to prevent rotation of the nut within the pin adjustment slot and to prevent removal of the nut from the pin adjustment slot.
  • the collet screw additionally slides within the pin adjustment slot.
  • One of the shank attachment pins forms a linearly adjustable bone pin extending through a hole within the collet screw, which includes a deformable threaded portion engaging the nut.
  • an engagement force between the collet screw and the linearly adjustable bone pin is increased to hold the linearly adjustable bone pin in place collet screw and to hold the nut in place within the pin adjustment slot. Then, as the collet screw is rotated opposite the first direction, the engagement force between the collet screw and the linearly adjustable bone pin is decreased to release the linearly adjustable bone pin to move within the collet screw and the nut is released to slide within the pin adjustment slot.
  • the distraction clamp removably holds the linearly adjustable bone pin; and the distraction screw engaging the distraction clamp and the housing. Turning the distraction screw in a second direction moves the linearly adjustable bone pin toward a proximal end of the housing, hile turning the distraction screw opposite the second direction allows the linearly adjustable bone pin to move away from the proximal end of the housing.
  • apparatus for the external fixation of bone fragments, with the apparatus including a housing having a curved portion, extending in an arc around an arc axis, a plurality of internal mounting surfaces, with a first plurality of the internal mounting surfaces and apertures as described above disposed within the curved portion.
  • the central axis of . each of the internal mounting surfaces within the first plurality extends to the arc axis, a plurality of deformable pin holders as described above.
  • Pluralities of deformable pin holders, bone pins, and clamping members are disposed within the individual internal mounting surfaces.
  • the housing may also include a first linear portion, extending in a straight line parallel to the arc axis, including a second plurality of internal mounting surfaces.
  • the first linear portion may extend from a first end of the curved portion, with a second liner portion, including a third plurality of internal mounting surfaces, extending from the second end of the curved portion.
  • FIG 1 is a perspective view of a device for external fixation of bone fragments, shown as used for a proximal fracture of the humerus;
  • FIG. 2 is a perspective view of a device similar to the device of FIG. 1, shown as used for a proximal fracture of the tibia;
  • FIG. 3 is a fragmentary front elevation of the device of FIG. 1 ;
  • FIG. 4 is a perspective view of a pin holder within the device of FIG. 1 ;
  • FIG. 5 is a transverse cross-sectional elevation of a pin mounting structure within a housing built in accordance with the invention
  • FIG. 6 is a perspective view of the pin mounting structure of FIG. 5;
  • FIG. 7 is a lateral cross-sectional view of a bone fixation device built in accordance with a first embodiment of the invention, including a number of the pin mounting structures of FIG. 5;
  • FIG. 8 is a perspective view of a fixation device built in accordance with a second embodiment of the invention, shown as used with a distal fracture of the humerus;
  • FIG. 9 is a perspective view of the fixation device of FIG. 8, shown as used with a distal fracture of the tibia;
  • FIG. 10 is a perspective view of the fixation device of FIG. 8, shown as used with a proximal fracture of the tibia;
  • FIG. 1 1 is a perspective view of an alternative fixation device housing additionally built in accordance with the second embodiment.
  • FIG. 12 is an elevation of a fixation device using the housing of FIG. 11 , shown as used with a fractured phalange.
  • FIG. 13 is a perspective view of a device built in accordance with a third embodiment of the invention for the external fixation of fragments within a fractured distal radius;
  • FIG. 14 is a longitudinal cross-sectional view of the device of FIG. 13, taken as indicated by section lines 14-14 therein;
  • FIG. 15 is a transverse cross-sectional view of the device of FIG. 13, taken as indicated by section lines 15-15 therein;
  • FIG. 16 is a transverse cross-sectional view of the device of FIG. 13, taken as indicated by section lines 16-16 therein;
  • FIG. 17 is a perspective view of a device built in accordance with an alternative version of the third embodiment of the invention for the external fixation of fragments within a fractured distal radius.
  • FIG. 1 is a perspective view of a device 10 for the external fixation of bone fragments, including a housing 12 having a vertically elongated central portion 14 and a lateral portion 16 extending outward, in the directions of arrows 18, and rearward, in the direction of arrow 20, from each side of an upper end 22 of vertically elongated central portion 14:
  • the vertically elongated central portion 14 includes a first plurality of the internal mounting surfaces 24; each of which extends outwardly from an aperture 25 within the housing 12, while each lateral portion 16 includes at least one of the internal mounting surfaces 24 extending from an aperture 25.
  • Some of the internal mounting surfaces 24 mount pin holders 28 holding bone pins 28, with the pin holders 28 being held in place by clamping members 30 engaging threaded surfaces 32 of the housing 12.
  • This arrangement provides for the placement of bone pins 28 at various levels extending downward from the upper end 22 of the vertically elongated central portion 14, with the lateral portions 16 being inclined relative to one another so that bone pins 28 can extend inward around a fracture area from these portions 16.
  • the device 10 is shown with various bone pins 28 attached to a fractured humerus bone 34, holding a number of fragments 36 in place at an upper end 38 of the humerus bone 34, with bone pins 28 held within the vertically elongated central portion 14 of the housing 12 attached to the shaft portion 40 of the humerus bone 34.
  • Each of the bone pins 28 includes a threaded end 42 that is driven into engagement with a portion of the bone 34 by a driving tool (not shown) rotating a non-circular-surface (not shown) at an end of the bone pin 28 opposite the threaded end 42.
  • the bone pin 28 is preferably cut off outwardly adjacent the pin holder 26 in which it is held to limit the distance through which the bone pin 28 extends outwardly from the device 10.
  • the configuration of the device 10 is adjustable in several ways, with pin holders 26 being placed in a subset of the internal mounting surfaces 24, so that bone pins 28 are placed at locations appropriate for the external fixation of a particular fractured bone.
  • the individual pin holders 26 are angularly adjustable so that each bone pin 28 can be adjusted and clamped in place through a vertical angle of adjustment 44 and through a horizontal angle of adjustment 46, with the bone pin 28 additionally being adjustable along its axis in the directions of arrows 48.
  • FIG. 2 shows the device 10 with various bone pins 28 attached to a fractured tibia 49, holding a number of fragments 49a in place at the upper end 49b of the tibia, with bone pins 28 held within the vertically elongated portion 14 of the housing 12 attached to the shaft portion 49c of the tibia 49.
  • all bone pins 28 are fastened into the tibia 49 and fragments thereof 49a, with no bone pins being fastened into the fibia 49d or other bones.
  • FIG. 3 is a fragmentary front elevation of the device 10, showing one of the clamping members 30, which is provided with a noncircular surface 64 to facilitate rotation of the clamping member 30.
  • the clamping member 30 is tightened by rotation in a first direction, indicated by arrow 66, an engagement force between the spherically rounded surface 52 of the pin holder 26 clamped in place within the housing 12 by the clamping member 30 and the internal mounting surface 24 within the housing 12 is increased to hold the pin holder 26 in place within the housing 12 and deflection of the deformable portions 54 of the pin holder is increased to hold the bone pin 28 in place within the pin holder 26.
  • the engagement force between the spherically rounded surface 52 of the pin holder 26 and the internal mounting surface 24 within the housing 12 is decreased to allow rotation of the spherically rounded surface 52 of the pin holder 26 within the internal mounting surface 24 of the housing 12 and to allow movement of the bone pin 28 within the pin mounting hole 50 of the pin holder 26.
  • the device 10 may be provided with a box wrench (not shown) for loosening and tightening the clamping members 30.
  • FIG. 4 is a perspective view of one of one of the pin holders 26, which has a spherical external surface 68.
  • the clamping member 30 includes a pair of slots 58 extending perpendicular to the pin mounting hole 50, inward across the pin mounting hole 50 and partly across the pin holder 26, so that a deformable portion 54 is formed between each end 56 of the pin mounting hole 50 and the slot 58 that is nearer to the end 56.
  • FIG. 5 is a transverse cross-sectional elevation of a pin mounting structure 200 within a housing 202 built in accordance with the invention. Parts similar to those described above in reference to FIGS. 1 -4, are accorded like reference numbers.
  • a pin 28 is held within a pin holder 26, which is configured as described above in reference to FIG. 3, and which is clamped in place by a clamping member 30 having an outer threaded surface 206 engaging an inner threaded surface 208 within a mounting hole 210 of the housing 202.
  • the mounting hole 210 includes a spherically rounded inner surface 211, engaging a spherical surface 52 of the pin holder 28, and an aperture 212, extending to a surface 213 of the housing 202.
  • the inner threaded surface 208, the spherically rounded inner surface 21 1 , and the aperture 212 are coaxial with one another about a central axis 214.
  • the aperture 212 and a clearance hole 215, extending through the clamping member 30, include truncated conical surfaces 216, 218. These truncated conical surfaces 216, 218 together allow movement of the pin 28 between the position indicated by dashed lines 219 and the position indicated by dashed lines 220.
  • the pin 28 may be moved through an angle 222 of thirty degrees from the central axis 214 of the mounting hole 210 and at any angle 226 around the central axis 214.
  • the pin mounting hole 50 extends through a center of the spherical external surface 68, being divided by the slots 58 into a deflectable part 223 within each of the deformable portions 54 and a central part 224 extending between the slots 58.
  • the deformable portions 54 are deflected inward, bring the deflectable parts 223 of the pin mounting hole 50 out of alignment with the central part 224 thereof, so that the bone pin 28 is clamped in place within the pin mounting hole.
  • the clamping member is loosened by rotation opposite the opposite the direction of arrow 66 to decrease the engagement force holding the pin holder 20 in place
  • the deformable portions 54 return outward, so that the deflectable parts 223 of the pin mounting hole 50 return into alignment with the central part 224 thereof, allowing movement of the bone pin 28 within the pin mounting hole 50.
  • FIG. 6 is a perspective view of the pin mounting structure 200, showing the bone pin 28 as being adjustable within a conical region 227 about the central axis 214.
  • FIG. 7 is a lateral cross-sectional view of a bone fixation device 230 built in accordance with a first embodiment of the invention to include a housing 232 having an elongated portion 233 with a number of pin mounting structures 234, each configured as described above in reference to FIG. 6, except that the central axes 214 of the mounting holes 231 are disposed at various angles 236 relative to a surface 238 of the housing 232.
  • the pin mounting structures 234 are additionally arranged so that the central axes 214 converge within a region of convergence 240 that is spaced apart from the elongated portion 233.
  • FIG. 7 is a lateral cross-sectional view of a bone fixation device 230 built in accordance with a first embodiment of the invention to include a housing 232 having an elongated portion 233 with a number of pin mounting structures 234, each configured as described above in reference to FIG. 6, except that the central axes 214 of the mounting holes 231 are disposed at various angles 236 relative to a surface
  • the bone pins 28 may be individually adjusted within conical regions 227 about the central axes 214, allowing further movement of the pins 28 within the region of convergence 240.
  • This arrangement provides for placing a number of pins within the region of convergence 240, with the pins 28 entering the region from a wide variety of angles.
  • the region of convergence 240 may be located in a region of one or more fractures occurring within a bone, with the pins 28 being variously employed to hold bone fragments in place during the healing process.
  • the housing 232 extends in a first direction of arrow 242, with the pin mounting structures 234 being disposed within a first distance 244.
  • the region of convergence 240 is substantially shorter, in the first direction of arrow 242, than the first distance 244, allowing a concentration of the bone pins 28 within the region of convergence 240 to be much greater than the concentration of the bone pins along the surface 238 of the elongated portion 233.
  • the bone fixation device 230 is shown providing fixation for a proximal fracture 248 of the humerus 250, with surrounding tissues not being shown for clarity.
  • the bone fixation device 230 includes various features, such as outward extending sections 252 of the housing 232 supporting additional bone pins 28, and such as a pin mounting structure 254 that is outside the first distance 244. Due to the adjustability provided within the pin mounting structure 254 a pin 28 held by this structure 254 extends into the region of convergence 240 after entering the shaft portion 256 of the humerus 250 at a low angle 258.
  • fixation device 230 Using the flexibility of bone pin placement provided within the bone fixation device 230, regions 260 within the tissue adjacent to the fracture 248 having concentrations of nerves, ligaments, blood vessels, etc. that cannot be disturbed without significant damage to the patient can readily be avoided in the placement of bone pins 28. Since all of the bone pins 28 are fastened into the humerus 250, the fixation device 230 does not bridge the shoulder joint, allowing movement while holding various bone fragments in place.
  • FIG. 8 is a perspective view of a fixation device 270 built in accordance with a second embodiment of the invention with a housing 272 including an arcuate elongated portion 274 formed as an arc having an arc axis 276.
  • a plurality of bone pins 28 extend from an arcuate surface 278, also formed about the arc axis 276,
  • Each of the bone pins 28 is adjustably held in place by a pin mounting structure 200, configured as described above in reference to FIG. 12.
  • the central axis 214 of each of the pin mounting structures 200 passes through the arc axis 276, so that the central axes 214 are seen to converge upon a region of convergence 280 extending around the arc axis 276.
  • the housing 270 includes a linearly elongated portion 282 extending from each end of the arcuate elongated structure 274.
  • the linearly elongated portions 282 extend in the same direction, indicated by arrow 284, parallel to the arc axis 276.
  • Each of the linearly elongated portions 282 includes another plurality of bone pins 28, extending toward the arc axis 276, with each of the bone pins 28 being adjustably held in place by a pin mounting structure 200.
  • the fixation device 270 is shown as used to treat a fractured distal humerus 286, with the arcuate elongated portion 274 extending partly around the fractured area 288 at the distal end of the humerus 286 to hold various bone fragments 290 in place, and with the linearly elongated portions 282 extending along the bone shaft 292 to hold the fixation device 270 itself in place using bone pins 28 extending into the bone shaft 292. Since none of the bone pins 28 extend into the radius 294 or the ulna 296, the fixation device does not bridge across the elbow joint, allowing movement at the joint while holding the fragments together.
  • FIG. 9 is a perspective view of the fixation device 270 as used to provide fixation for a fractured distal tibia 300, with the arcuate elongated portion 274 extending partly around the fractured area 302 to hold various bone fragments 304 in place, and with the linearly elongated portions 282 extending along the bone shaft 306 to hold the fixation device 270 in place using bone pins 28 extending into the bone shaft 306. Since none of the bone pins 28 extend into the fibia 308 or other bones, except for the tibia 300, non-bridging fixation is achieved.
  • FIG. 10 is a perspective view of the fixation device 270 as used to provide fixation for a fractured proximal tibia 310, as shown in a dorsal view, with the arcuate elongated portion 274 extending partly around the fractured area 312 to hold various bone fragments 314 in place, and with the linearly elongated portions 282 extending along the bone shaft 316 to hold the fixation device 270 in place using bone pins 28 extending into the bone shaft 316. Again, since none of the bone pins 28 extend into the fibia 318 or other bones, except for the tibia 310, non-bridging fixation is achieved.
  • FlG. 1 1 is a perspective view of a housing 320 for a fixation device, additionally built in accordance with the second embodiment of the invention, with only a single linearly elongated portion 322, extending from one of the ends of an arcuate elongated portion 324.
  • Such fixation devices may be built in various sizes, with larger devices being used for attachment to bones of the arms and legs, and with smaller devices being used to provide fixation for fractured phalanges. Both the overall size of the fixation device and the size of the mounting devices 200 (shown in FIGS. 12 and 13) may be reduced to provide a greater density of smaller pins for use with a fractured phalange.
  • the housings 272, 320 are preferably composed of a thermoplastic resin that can be easily cut if it is necessary to shorten a part of the housing.
  • FIG. 12 is a perspective view of a fixation device 326, including the housing 320, as used to provide fixation for a fractured phalange 328, with the arcuate elongated portion 324 extending partly around the fractured area 330 to hold various bone fragments 332 in place, and with the linearly elongated portion 322 extending along a bone shaft 334 to hold the fixation device 326 in place using bone pins 28 extending into the bone shaft 334. Again, since all of the bone pins 28 extend through the phalange 328 and fragments thereof, non-bridging fixation is achieved.
  • FIG. 13 is a perspective view of a device 400 built in accordance with a third embodiment of the invention for the external fixation of fragments 401 within a fractured distal end 402 of a radius 403.
  • the device 400 includes an elongated shank mounting section 404, a fragment attachment pin array section 406, and a lateral fragment mounting section 408.
  • the elongated shank mounting section 404 includes an angularly adjustable shank mounting pin 410 extending downward, in the direction of arrow 411 , to be fastened into a shank portion 412 of the distal radius 402 and a linearly adjustable shank mounting pin 416, also extending downward, in the direction of arrow 41 1, to be fastened into the shank portion 412.
  • the fragment attachment pin array section 406 includes a plurality of attachment pins 418 extending downward, in the direction of arrow 41 1, to be fastened into a number of the bone fragments 401.
  • the lateral fragment mounting section 408 includes a number of angularly adjustable fragment mounting pins 420 extending laterally, generally in the direction of arrow 422 into a number of the bone fragments 401. (The directions described herein are established according to an assumption that the hand, not shown, but attached to the radius 412, is held outward with the palm facing downward, in the direction of arrow 41 1.)
  • Non-bridging fixation is achieved by fastening all of the pins 410, 416, 418, 420 of the device 400 into the fragments 401 and the shank portion 412 of the radius 403. None of these pins 410, 416, 418, 420 are fastened into the carpal bones, not shown, but adjacent to the fragments 401, or the bones of the hand, so that the hand and wrist can be flexed and moved normally, without a loss of mobility during the healing process requiring fixation.
  • FIG. 14 is a longitudinal cross-sectional view of the device 400, taken as indicated by section lines 14-14 in FIG. 13 to show means for attaching the angularly adjustable shank mounting pin 410 and the linearly adjustable shank mounting pin 416 to a shank mounting section 424 within a housing 430 of the device 400.
  • the angularly adjustable shank mounting pin 410 is rotatably mounted and clamped in place as described above in reference to FIGS. 4-4, with various similar elements being accorded like reference numerals.
  • FIG. 15 is a transverse cross-sectional view of the device 400, taken as indicated be section lines 15-15 in FIG. 16, showing means for attaching the linearly adjustable shank mounting pin 416, the angularly adjustable shank mounting pin 410, and the fragment attachment pins 412.
  • the collet screw 436 includes a non-circular section 438, a flange 440, a barrel 441 sliding within the slot 434, and a threaded section 442 engaging a nut 443.
  • the nut 443 slides within a slot 444, with dovetail surfaces 446 of the nut 443 engaging dovetail surfaces 448 of the slot 444 to prevent rotation of the nut 443 while allowing the nut 443 to slide within the slot 444.
  • the threaded section 442 of the collet screw 436 is mounted to slide along the shank mounting housing section 424 in the axial directions of arrows 432, 433, with a collet screw 436 sliding within an adjustment slot 434 in the housing section 424.
  • the collet screw 436 includes a non-circular section 438, a flange 440, a barrel 441 sliding within the slot 434, and a threaded section 442 engaging a nut 443.
  • the nut 443 slides within a slot
  • a distraction clamp 460 is provided to apply a distraction force in the direction of arrow 433 through the fragment mounting pins 418, 420 to the bone fragments 401 within the fractured distal end 402 of the distal radius 403 (shown in FlG. 19).
  • the distraction clamp 460 includes a pair of hooks 462 engaging the linearly adjustable shank mounting pin 416 and a threaded hole 464 engaging a distraction adjustment screw 466.
  • This distraction force is applied, after the surgical placement of the fragment mounting pins 418, 420 within the bone fragments 401 and after the surgical placement of the shank mounting pin 416 within the bone shank portion 412, but before the surgical placement of the adjustable shank mounting pin 410 within the bone shank portion 412, by turning the distraction adjustment screw 466 by means of a non-circular surface 468 to move the housing 430 in the distraction direction of arrow 433. Then, when a suitable level of distraction has been achieved, the linearly adjustable shank mounting pin 416 is clamped into place using the collet screw 436, and the adjustable shank mounting pin 410 is surgically installed within the bone shank portion 412 and clamped to the housing 430 using the clamping member 50.
  • the distraction clamp 460 is removed from the fixation device 401 by turning the distraction screw 466 so that it is disengaged from the proximal end 470 of the housing 430, and by disengaging the distraction clamp 460 from the linearly adjustable shank mounting pin 416, with the pin 416 passing through slots 472 of the distraction clamp 460.
  • FIG. 16 is a transverse cross-sectional view of the device 400, taken as indicated by section lines 16-16 in FIG. 13 to show means for mounting and clamping the plurality of fragment attachment pins 418 and the angularly adjustable fragment mounting pins 420.
  • similar patterns of holes 480 are provided within a distal portion 482 of the housing 430, within a top plate 484 of a U-shaped pin clamping bracket 486, and within a bottom plate 488 of the clamping bracket 486.
  • the U-shaped pin clamping bracket 486 is mounted to slide in and opposite the lateral direction of arrow 422, with inclined sides 494 of the plates 484, 486 within the clamping bracket 486 sliding along inclined sides 496 of the housing 430.
  • the alignment between the patterns of holes 480 within the clamping bracket 486 and the holes 480 within the housing 430 is adjusted using a pair of screws 500, each engaging a threaded hole 502 within the clamping bracket 486 to press an adjacent surface 504 of the housing 430.
  • the screws 500 are tightened, the holes 480 within the clamping bracket 486 are moved in the direction of arrow 41 1 relative to the holes 480 within the housing 430, so that forces from the surfaces of the holes 480 engaging the fragment attachment pins 418 in opposite directions hold these pins 418 in place.
  • a clamp retaining means 504 is additionally provided to hold the pin clamping bracket 486 in place on the housing 430 in the absence of any
  • the clamp retaining means 504 includes a pin 506 extending from the housing 430 within a hole 508 in each of the plates 484,
  • a ramp surface 510 is provided at an edge of each of the plates 484, 488 so that the pin clamping bracket 486 can be snapped in place over the pins 506.
  • the angularly adjustable fragment mounting pins 420 are each attached rotatably mounted and clamped in place as described above in reference to FIGS. 4-4, with various similar elements being accorded like reference numbers.
  • fragment mounting pins 418, 420 will be placed in only some of the positions provided for such pins within the device
  • a larger number of such positions are provided, and the angular adjustability of the fragment mounting pins 420 is further provided, so that the device 400 can be used to treat a wide number of different fracture conditions.
  • FIG. 17 is a perspective view of a device 520 built in accordance with an alternative version of the third embodiment of the invention to have an elongated shank mounting section 522 having two angularly adjustable shank mounting pins

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (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

La présente invention concerne un dispositif de fixation externe permettant le maintien en place de fragments osseux et comprenant un logement comportant un certain nombre de surfaces de montage internes, dans lequel des supports de broche réglables par rotation sont maintenus par divers éléments de fixation qui assurent simultanément la fixation du support de broche et de la broche à l'intérieur du support de broche. Certaines des surfaces internes sont disposées de façon à supporter des broches convergeant au niveau d'une région de convergence située à une certaine distance du logement. Un mode de réalisation est conçu pour maintenir en place les fragments osseux au sein de la partie distale d'un radius fracturé, tandis qu'un autre mode de réalisation comprend une partie arrondie en forme d'arc.
PCT/US2009/006566 2008-12-17 2009-12-16 Appareil de fixation externe équipé d'un moyen de fixation de broches réglable et de broches osseuses convergentes WO2010077309A2 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US12/316,830 US8262657B2 (en) 2007-08-16 2008-12-17 External fixation apparatus with adjustable pin clamping means and convergent bone pins
US12/316,830 2008-12-17
US12/460,680 2009-07-23
US12/460,680 US8123747B2 (en) 2007-08-16 2009-07-23 Apparatus for external fixation of a fractured distal radius with angularly adjustable pin clamping means

Publications (2)

Publication Number Publication Date
WO2010077309A2 true WO2010077309A2 (fr) 2010-07-08
WO2010077309A3 WO2010077309A3 (fr) 2010-10-07

Family

ID=42310449

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2009/006566 WO2010077309A2 (fr) 2008-12-17 2009-12-16 Appareil de fixation externe équipé d'un moyen de fixation de broches réglable et de broches osseuses convergentes

Country Status (1)

Country Link
WO (1) WO2010077309A2 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014207271A1 (fr) * 2013-06-28 2014-12-31 Technology Of Prosthesis S.L. Fixateur externe multidirectionnel pour extrémité discale de radium
JP2017529937A (ja) * 2014-09-29 2017-10-12 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 調整可能な関節窩ピン挿入ガイド
CN109044510A (zh) * 2018-06-26 2018-12-21 叶智江 指骨微型外固定器
CN112955085A (zh) * 2018-09-05 2021-06-11 Amdt控股公司 用于外部固定系统的可调节轨道装置
WO2022047593A1 (fr) * 2020-09-04 2022-03-10 Arbutus Medical Inc. Ensembles broche de traction, éléments constitutifs, systèmes et procédés

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6197027B1 (en) * 1999-09-08 2001-03-06 Mohammed Ali Hajianpour Device for external fixation of a fractured radius
US20030225407A1 (en) * 2002-02-28 2003-12-04 Estrada Hector Mark Apparatus for dynamic external fixation of distal radius and wrist fractures
US7153302B1 (en) * 2001-09-19 2006-12-26 Phoenix Orthopaedic Corporation Device for external fixation of bone fractures with clamping of multiple pins and with a fixture for applying extension to bone fragments
US7169149B1 (en) * 2003-07-24 2007-01-30 Phoenix Orthopaedic Corporation Device for external fixation of a proximal fracture of the ulna with a clamped medullar pin and multiple clamped pins holding bone fragments
US20080077142A1 (en) * 2004-03-26 2008-03-27 Smith & Nephew, Inc. Methods for treating fractures of the femur and femoral fracture devices

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6197027B1 (en) * 1999-09-08 2001-03-06 Mohammed Ali Hajianpour Device for external fixation of a fractured radius
US7153302B1 (en) * 2001-09-19 2006-12-26 Phoenix Orthopaedic Corporation Device for external fixation of bone fractures with clamping of multiple pins and with a fixture for applying extension to bone fragments
US20030225407A1 (en) * 2002-02-28 2003-12-04 Estrada Hector Mark Apparatus for dynamic external fixation of distal radius and wrist fractures
US7169149B1 (en) * 2003-07-24 2007-01-30 Phoenix Orthopaedic Corporation Device for external fixation of a proximal fracture of the ulna with a clamped medullar pin and multiple clamped pins holding bone fragments
US20080077142A1 (en) * 2004-03-26 2008-03-27 Smith & Nephew, Inc. Methods for treating fractures of the femur and femoral fracture devices

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014207271A1 (fr) * 2013-06-28 2014-12-31 Technology Of Prosthesis S.L. Fixateur externe multidirectionnel pour extrémité discale de radium
ES2539733A1 (es) * 2013-06-28 2015-07-03 Technology Of Prosthesis S.L. Fijador externo multidireccional para extremo discal de radio
JP2017529937A (ja) * 2014-09-29 2017-10-12 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 調整可能な関節窩ピン挿入ガイド
CN109044510A (zh) * 2018-06-26 2018-12-21 叶智江 指骨微型外固定器
CN109044510B (zh) * 2018-06-26 2020-11-20 叶智江 指骨微型外固定器
CN112955085A (zh) * 2018-09-05 2021-06-11 Amdt控股公司 用于外部固定系统的可调节轨道装置
WO2022047593A1 (fr) * 2020-09-04 2022-03-10 Arbutus Medical Inc. Ensembles broche de traction, éléments constitutifs, systèmes et procédés

Also Published As

Publication number Publication date
WO2010077309A3 (fr) 2010-10-07

Similar Documents

Publication Publication Date Title
US8123747B2 (en) Apparatus for external fixation of a fractured distal radius with angularly adjustable pin clamping means
US8628530B2 (en) External fixation apparatus with angularly adjustable drill guiding and pin clamping means
US7153302B1 (en) Device for external fixation of bone fractures with clamping of multiple pins and with a fixture for applying extension to bone fragments
US8419733B2 (en) External fixation apparatus with adjustable pin clamping means
US6162223A (en) Dynamic wrist fixation apparatus for early joint motion in distal radius fractures
US8262657B2 (en) External fixation apparatus with adjustable pin clamping means and convergent bone pins
US7147640B2 (en) External fixator
US7717916B2 (en) External fixation apparatus with adjustable pin clamping means
US5219349A (en) Spinal fixator reduction frame
US4554915A (en) Bone fixation frame
KR100477282B1 (ko) 공간프레임
EP0481697A1 (fr) Appareil à translation/rotation destiné à usage avec système de ostéosynthèse
US20090018541A1 (en) Multi-angle clamp
US6197027B1 (en) Device for external fixation of a fractured radius
JP2008538088A (ja) 脊椎ロッド接続具
US20120226277A1 (en) Orthopedic external fixator and method of use
WO2010077309A2 (fr) Appareil de fixation externe équipé d'un moyen de fixation de broches réglable et de broches osseuses convergentes
US5391167A (en) Articulating external fixation device
US20040167518A1 (en) Radiolucent frame element for external bone fixators
US8080016B2 (en) Wire retainer for surgical device
US8075560B2 (en) External fixator for distal radius fracture
US20090222006A1 (en) External fixator
KR101709585B1 (ko) 정형외과 수술용 관절부 고정장치
US20040123870A1 (en) Method and apparatus for limiting the movement of the head
GB2114891A (en) External bone-pin splint

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 09836499

Country of ref document: EP

Kind code of ref document: A2

NENP Non-entry into the national phase in:

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 09836499

Country of ref document: EP

Kind code of ref document: A2