WO2011019259A1 - Intra-extra articular reducers for percutaneous patellar osteosynthesis - Google Patents

Intra-extra articular reducers for percutaneous patellar osteosynthesis Download PDF

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Publication number
WO2011019259A1
WO2011019259A1 PCT/MX2009/000083 MX2009000083W WO2011019259A1 WO 2011019259 A1 WO2011019259 A1 WO 2011019259A1 MX 2009000083 W MX2009000083 W MX 2009000083W WO 2011019259 A1 WO2011019259 A1 WO 2011019259A1
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WO
WIPO (PCT)
Prior art keywords
patellar
articular
intra
extra
extensor
Prior art date
Application number
PCT/MX2009/000083
Other languages
Spanish (es)
French (fr)
Inventor
Daniel Luna Pizarro
Original Assignee
ORTEGA BLANCO, José Adán
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 ORTEGA BLANCO, José Adán filed Critical ORTEGA BLANCO, José Adán
Priority to PCT/MX2009/000083 priority Critical patent/WO2011019259A1/en
Publication of WO2011019259A1 publication Critical patent/WO2011019259A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • A61B2017/0268Joint distractors for the knee

Abstract

The invention relates to an intra-extra articular reducer for percutaneous patellar osteosynthesis, intended for a disruption of the extensor apparatus and displaced patella fractures of the knee. The invention is formed by two main arms hinged together with a movable "cross" mechanism which closes both arms in parallel, including upper arms that are extra-articular and are in contact with the skin and the anterior portion of the proximal or distal fragment of the disruption of the extensor apparatus and a lower arm formed by an intra-articular Steinmann pin. Both arms close in parallel in order to contain the fracture fragments or the quadriceps and patellar tendons, thereby securing the extensor apparatus on the proximal and distal portion thereof in order to reduce the extensor apparatus manually. Once reduced, a percutaneous osteosynthesis system can be put in place in order to assist in the longitudinal compression of the extensor apparatus and the final fixation thereof. The reducer facilitates surgical technique in the reduction of patella fractures and can be used to perform more effective surgery in the associated internal reduction and fixation technique.

Description

REDUCING INTRA-EXTRA-ARTICULAR for osteosynthesis

Percutaneous PATELLAR

FIELD OF THE INVENTION

The present invention relates to the field of orthopedic surgery extensor mechanism of the knee fractures patellar more specifically refers to a reducing system capable of reducing bone fragments to facilitate placement of an implant, applicable to the disruption of extensor and displaced fractures kneecap.

BACKGROUND OF THE INVENTION

The present invention relates to a reduction device, known only as a reductant, bone fragments due to fractures patella by clamping and immobilizing the extensor mechanism of the knee for handling such fragments more effectively and safely . In medical terminology reduction it refers specifically to the action of attaching or joining two bone fragments, fragments or assemble them closer as they were before breaking. There are several ways to reduce the fragments in fractures patella of the knee, such as percutaneously with minimal dissection of the skin or through a wide enough to display the fragments and the maneuver reduction incision, the disadvantage of making the surgical reduction is the technical difficulty that reduction maneuvers and fastening as it is manual or clamps (known in the art as "clamps") that are not designed to perform these procedures techniques, and there is a tool that allows perform a reduction, stabilization and fixation to maintain control of the fragments for implant placement and maintain joint congruity of the articular patellar region.

This results in a technical difficulty described in the background of orthopedic journals indexed turn this technical difficulty makes the orthopedic surgeon chooses to open surgery, by increasing the probability of presenting own postoperative complications of this technique in percentage from about 45% to 67%, since the reduction is performed based on the ability of each surgeon, using tools that are not designed for technical and this causes is made with uncertainty without a methodology specifies steps for the reconstruction of the extensor apparatus and eventually allow the reduction speed of the fragments with guides to complete the surgical procedure by placing an implant in any direction.

Implant or osteosynthesis material may contain different modes according to the surgeon's judgment, the implants can be: clavillos Kirschner, asif wire 1.2, compression screws cannulated or non-cannulated, polyester suture number 5 or osteosynthesis material for stabilizing fracturarlos fragments and start an immediate movement of the affected limb.

In the specification of PCT application number WO 2007/148953 International system patellar Percutaneous osteosynthesis place it allows a more precise and minimal dissection to any fracture of patella implant is shown. The first step in the surgical correction of patellar fractures is facing the fragments. Before placing a percutaneous osteosynthesis system, the fracturarlos bone fragments must be approached, addressed, or reduced, this step as described may be performed with two Steinman pins located two lateral portals 5 mm and through drilling quadriceps tendon and patellar and thus manually allow reduction of fractured bone fragments patellar but this maneuver is no control of the rotation, lateralization and / or tilting of the fragments with single nail Steinman, plus it has to pierce the patellar tendon with cuadricipital more damage to the stent apparatus that has trauma.

Intra- and extra-articular reducing hold extensor three points, two external and one internal and thus not tendons are drilled and fragments are sufficiently fixed to face them avoiding drafts, tiltings and rotations and therefore a more satisfactory reduction quickly and effectively; and as a second step as described in the art to place Percutaneous osteosynthesis system and perform compression of the fragments and the final correction of the articular congruence in more detail.

Thus it can be clearly seen that there is no reducing fracture of patella through an open or closed technique.

OBJECT OF THE INVENTION

This reducer is designed for application in the orthopedic surgery of the knee, is a tool to stably reduce the fragments of fractured patella and / or extensor by minimally invasive technique and avoiding dissect soft tissue to reduce intraoperative technical difficulty and postoperative morbidity, and thus increase the efficiency of reduction technique of the bone fragments of the extensor apparatus of the pelvic limb knee.

It also provides better control of fracturarlos fragments during anatomic reduction of the fragments to repair the extensor apparatus of the pelvic limb and joint congruence satisfactory transoperative by a moving mechanism fasteners, which has, parallel closure performing a clamping the quadriceps tendon and are supported on the front face of the patella fracturing fragment on the edge, and clamping of the patellar tendon supported on the front face of fracturing fragment patellar pole.

The reducer is further comprised by a parallel manual closing two arms which one has an extension which is placed intraarticular below the extensor quadriceps and extra-articular the other is placed on the front of the knee, to perform parallel closure fracturing fragment on its front face and below the extensor apparatus is trapped.

A reducer is designed to the proximal region of the extensor apparatus and other reductant to the distal region of the extensor mechanism. Gripper arms open and close to contain any extent thickness or size width extensor or fractured patella, the closure traps any extensor in dimension and this allows control of fracturarlos fragments even by percutaneous means. Reducers perform a more accurate and effective reduction than existing techniques, with the advantage that the time required to perform the surgery is diminished, and the technical difficulty in reducing the fragments without any tool designed for this type will prevent reduction, which is usually done by manual technique and calculation basis and approximation.

The present invention aims to make a more accurate and effective in terms of stability of the fragments reduced in order to place an implant through minimally invasive technique and with greater accuracy with direct visualization of the fragments by arthroscopy.

The device is designed so that by its action, the fasteners can secure shards and keep them stable, maintain the extensor apparatus in a controlled external fasteners direction, and cooperate to perform a joint congruity of the most effective patellar fracture, and by a minimal dissection, with arthroscopic visualization of the articular surface, eventually stabilizing fragments, placing a fixation device or implant placement by handling prior fragments.

Subjection of the extensor apparatus is performed at three points, one of them is intraarticular (intra-articular clamping) and corresponds to the nail Steinman and two external points (extra-articular subject) at the end of the reducers you have control of fragments and fragments remain stable while stabilization of the fragments is sought by placing a patellar percutaneous osteosynthesis system that allows the placement of any type of implant or fixation method. It helps to reduce the extensor apparatus fracturarlos fragments with the aim of improving the fixation and stabilization technique in fractures displaced patella.

SUMMARY OF THE INVENTION

The present invention, as expressed in the title of this specification, relates to reducing that allow the approximation of the ends in the disruption of the extensor mechanism of the knee and include the ability to reduce fractures patella or kneecap knee with efficiency and accuracy through minimal dissection or extensive dissection in knee surgery.

The reducing of the invention allows a reduction of the fragments of the fractured patella and keeping the fragments in a desired longitudinal direction and to manually manipulate the fragments after closing the latch arms having, in addition to the visualization of articular surface by arthroscopy reduces fracture manually by reducing and then proceed with the placement of fixation method.

In turn it has the characteristic of attaching the expander device in the region of the quadriceps tendon and the patellar tendon through a parallel closure mechanism having and with a curvature to conform to the curved shape of the anterior and subcutaneous part of the face patellar above. The subject having the gear is manually regulated by a closure which is determined by a rack that holds the closure stable reducing to the desired pressure, advantageously, you can encompass any type of extensor in length and thickness, tendon quadriceps, patellar and patellar any dimension by its wide opening. The clamping is performed by a Steinmann nail, the number of thickness four or five, intra-I articular subjected to reduction and, on the other hand, through an external palette curvature adapted to the anterior region of the kneecap and the closure both arms, allows securing the distal and proximal fragments, held closed by zipper manually turned off.

Intra- and extra-articular bras are two in number but can join a third or fourth to give greater stability to shreds. It presents a manual modification mechanism approach or removal of both fasteners on the part of the latch arm and this allows coapt any dimension patella treated, and thus hold any size of extensor or patella to perform the proper reduction fragments. So you have a better control of the fragments to be cut and manually can contain reverse force itself distraction of the extensor apparatus in a disruption with these reducing and ultimately to realize a reduction of the fragments with improved efficacy and safety, unlike as is usually done with tools not designed for this maneuver. Operation reducers

Once a minimal incision of 5 mm, about 3 milliliters side region at the base of the patella and region patellar pole of the knee, or a common open incision, the reducing opens at full capacity, the part is the Steinmann nail which is inserted intra-articularly, the joint region of the joint surface of the fracture fragment corresponding to the base of the head and slides into, after this quadriceps tendon is palpated, begins the closing the gearbox manually and the other latch arm of semi-circular shape corresponding to the front portion of the patellar face on the outside, is closed and held clamped extensor and maintained by closing the zipper, it proceeds to hold the anchored quadriceps tendon on the anterior aspect of the patella and the operation is repeated with another fastener for the region and distal patellar tendon bone fragment or pol or. Once are subject both ends, both gears are manually taken and proceeds to raise or reduce the fragments, the reduction control can be performed by arthroscopic view, fluoroscopy, direct palpation through a blunt instrument or digital palpation . Once achieved the reduction can be maintained reduction and place the implant with Percutaneous osteosynthesis system to maintain stable fragments maintain consistency and reduced joint and place the implant and initiate early mobility of the limb.

BRIEF DESCRIPTION OF THE FIGURE

The characteristic details of this novel reductant are shown clearly in the following description and in the accompanying figure, following the same reference signs to indicate the parts of the figure shown.

1 shows a conventional system view, with the two main arms are articulated by a mechanism movable cross at one end, a rack for the closure or opening in one of the arms are one or two " palettes "curved shape and a lower holding arm has a cylindrical adaptation to introduce a Steinmann nail.

DETAILED DESCRIPTION OF THE INVENTION

In view of the commented figure, it can be seen that the system consists of two main upper and lower arms (1 and 2) respectively, which may be cylindrical, square or circular, upper arm a prolongation emerges called "paddle" (3) which can be two in number to three and be directed in different slope to accommodate the anterior knee anatomy finding hinged to the main upper arm (1) by a dynamic mechanism (4) to modify distance between the two pallets or withdraw away the pallet to the fastener according to surgeon preference and adapt to any variations in the anatomy of the knee to be treated, the blade (3) is parallel to the right toward the upper main arm (1) and it is hinged to the upper arm (1), which determines which can be used for the base of the patella if right knee or patellar pole if left knee.

The articulation of the blade to the upper arm is based on the dynamic mechanism (4) decompressing manually can allow mobility of the blades (3), should correct for adaptation to any variation in anatomy of the knee before performing the closure of the fasteners, the dynamic mechanism (4) is circular and preferably can be operated manually or by a mechanical mechanism (4) through a key "T" key Alien or manual knob rotatable, round can remove or bring the blade (3) to the main arm (1) or between the blades and allow greater coverage of the dimensions of the patella and extensor.

The blade (3), considered as the extra-articular fastener, is, as mentioned, parallel or tilted to the main arm (1). The blade has a form of "L" in a top-bottom view, but in a side view has a lower concave deformity (5) to adapt to the anatomy of the anterior region of the knee, the vane (3) corresponds to the fastener extra-articular as to effect closure of the reducing settles on the skin of the anterior region of the right knee on the front of the previous piece of the base of the patella if used in the right knee, or face anterior patellar and skin pole region in the left knee. The vanes (3) are articulated to the main locking arms through an angle (6) in the top view of the blades to manually manipulate the fragments and not "hit" the paddle placed at the pole of the patella and the paddle placed at the base, thus allowing better coverage handling fracture fragments.

At the other end of the upper main holder is a groove or tooth (7) which slides and is anchored on the toothed rack (8) on each tooth to maintain the closure, or mechanically deactivating the closing and opening reducer or both arms main (1 and 2); the lower main arm (2) is hinged to the upper main arm (1) by means of a dynamic mechanism such as "system cross" (11) consists of two structures which are subject in the middle of its length by a bolt which allows to bring the upper main arm

(1) with the lower main arm (2) through the mechanical movement system cross encentra fixed in the distal portion (12 and 13) of both main arms (1 and 2) sliding the proximal end of the components the cross (9 and 10) over the length of both main arms (1 and 2), which allows a parallel and so reducing end supporting or holding extensor stationary.

The lower arm (2) at its distal part has a cylindrical opening (14) of 4 to 5 mm which is continuous with the direction of the main arm for introducing a Steinmann (15) nail serves fastener intra-articular and keep it stationary by screw compressor mechanism (16) in the thickness of the distal portion of the lower main arm

(2) . At the other end of the lower holding arm (2) is a hinge system (17) that houses the toothed rack to maintain the closure of the fasteners.

The materials, shapes and size are subject to variability provided they do not compromise the mechanisms described and alteration of the essence of the function of reducers. Reducers can be made of stainless steel, aluminum, titanium, plastic with standard surgical instrument or any material that allows a sterilization of equipment without altering its operation and that is normed for manufacturing surgical instruments to help perform the surgical technique in the reduction of patella fractures or disruption of the extensor mechanism. In addition, the blades may be of any material that is approved for surgical instruments, from plastic, steel, stainless steel, aluminum or even any structure that may contain the necessary to perform compression force, including any existing biodegradable material or not yet design.

Claims

NOVELTY OF THE INVENTION Having described my invention as background, I consider as a novelty and claim my property the contained in the following: CLAIMS
1. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and displaced patella fractures knee, which basically comprises two main locking arms (1, 2) placed one intra-articular and other extra- articular, which in turn contains two fasteners (3) to accommodate underpass own anatomy of the knee extensor apparatus of the knee,
Characterized in that:
The upper master carrier arm extra- articular (1) has a dynamic mechanism (4) to move a gear extension, which is parallel to main arm (1) to contain any dimension fragment fracturing during clamping of the extensor apparatus;
The upper master carrier arm (1) contains one, two or pallets (3) necessary as an extension to different level modifiable height, wherein the palette (3) has anatomically shaped with a concave curvature (5) to fit the anatomy the anterior aspect of the patella;
The lower master carrier arm intra- articular (2) contains a hole (14) for containing an extension either a Steinmann nail or nail cannulated (15) or an extension that allows the end of reducing the fracture fragment maintain stable; and because
Through the two main arms (1, 2), the reducing closes parallel approaching each other allowing secure extensor tendons through and fractured bone fragments.
2. Reducer intra-extra-articular for percutaneous patellar osteosynthesis applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 1, wherein the vanes (3) are parallel to the main holder (1).
3. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 2, wherein the vanes (3) are articulated to the main arms (1, 2) by an angle (6) away allowing a fastener to another and thus easily manipulate the fragments.
4. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 1, wherein the main upper clamping arm (1) has movement towards or away through a mechanism mechanical or manual with a dynamic mechanism movable (11), and further has a slit (7) for controlling the zip closure (8).
5. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 1, wherein the opening (14) is 4 or 5 mm, which keeps direction of the main arm (1) for introducing a Steinraann cannulated nail or nail (15).
6. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 5, characterized by a screw mechanism compressor (16) in the thickness of the distal lower main arm (2), Steinmann nail (15) serves as intraarticular fastener and held still.
7. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 1, wherein the opening of the reducer is enough to contain any type of fracture and wide enough to address any dimension knee to be treated.
8. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and fractures displaced patella knee according to claim 1, characterized in that one holder (3) can be used in both knees, and need two at least for the reduction.
9. Reducer intra-extra-articular for percutaneous patellar osteosynthesis applicable to disruption of the extensor mechanism and patellar fractures displaced knee according to claim 1, wherein the reduction control can be accomplished by fluoroscopy, arthroscopy, X rays, directly or by palpation palpation intra- articular by a blunt instrument.
10. Reducer intra-extra-articular Percutaneous osteosynthesis patellar applicable to disruption of the extensor mechanism and fractures displaced patella of the knee according to claim 1, characterized in that it further comprises a system of parallel closure (11) which may articulate with reducing and perform compression of the fragments with guides to position the implant in any direction.
PCT/MX2009/000083 2009-08-14 2009-08-14 Intra-extra articular reducers for percutaneous patellar osteosynthesis WO2011019259A1 (en)

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PCT/MX2009/000083 WO2011019259A1 (en) 2009-08-14 2009-08-14 Intra-extra articular reducers for percutaneous patellar osteosynthesis

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Application Number Priority Date Filing Date Title
PCT/MX2009/000083 WO2011019259A1 (en) 2009-08-14 2009-08-14 Intra-extra articular reducers for percutaneous patellar osteosynthesis

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014072555A1 (en) * 2012-11-06 2014-05-15 Fundación Pública Andaluza Progreso Y Salud Surgical forceps for the alignment and reduction of bone fragments

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4633862A (en) * 1985-05-30 1987-01-06 Petersen Thomas D Patellar resection sawguide
US4706660A (en) * 1985-05-30 1987-11-17 Petersen Thomas D Patellar clamp
US5108401A (en) * 1991-04-12 1992-04-28 New York Society For The Relief Of The Ruptured And Crippled, Maintaining The Hospital For Special Surgery Patella cutting clamp

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4633862A (en) * 1985-05-30 1987-01-06 Petersen Thomas D Patellar resection sawguide
US4706660A (en) * 1985-05-30 1987-11-17 Petersen Thomas D Patellar clamp
US5108401A (en) * 1991-04-12 1992-04-28 New York Society For The Relief Of The Ruptured And Crippled, Maintaining The Hospital For Special Surgery Patella cutting clamp

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014072555A1 (en) * 2012-11-06 2014-05-15 Fundación Pública Andaluza Progreso Y Salud Surgical forceps for the alignment and reduction of bone fragments

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