WO2011019259A1 - Intra-extra articular reducers for percutaneous patellar osteosynthesis - Google Patents
Intra-extra articular reducers for percutaneous patellar osteosynthesis Download PDFInfo
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- 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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- articular
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
- A61B2017/0268—Joint distractors for the knee
Definitions
- the present invention relates to the field of orthopedic surgery of the knee extensor apparatus in patellar fractures, more specifically, it refers to a reducing device capable of reducing bone fragments to facilitate the placement of an implant, applicable to the disruption of the extensor apparatus and knee fractures displaced from the knee.
- the present invention relates to a reducing device, called only as a reducer, of bone fragments due to fractures of the patella or patella by clamping and immobilizing the knee extensor apparatus for handling said fragments in a more efficient and safe way.
- the reduction refers specifically to the action of joining or joining two bone fragments, bringing them together or assembling the fragments as they were before fracturing.
- this technical difficulty makes the orthopedic surgeon choose to perform an open surgery, increasing the probability of presenting the postoperative complications of this technique in percentage from about 45% up to 67%, since the reduction is made based on the skill of each surgeon, through tools that are not designed for the technique and this causes it to be done with uncertainty and without a specific methodology the steps to achieve reconstruction of the extensor apparatus and at the end allow to speed up the reduction of the fragments with guides to finish the surgical act by placing an implant in any direction.
- the implant or osteosynthesis material can include different modalities according to the surgeon's criteria, the implants can be: Kirschner pins, 1.2 asif wire, cannulated or non-cannulated compression screws, number 5 polyester suture or any osteosynthesis material that allows stabilization the fragments fracture them and initiate an immediate movement of the affected limb.
- a patellar percutaneous osteosynthesis system is shown that allows a more precise implant to be placed and with minimal dissection for any type of patellar fracture.
- the first step to perform the Surgical correction of patella fractures is to face the fragments.
- this step as described can be done with two Steinman nails placed by two 5 mm lateral portals and through the perforation of the quadricipital tendon and patella and thus, manually allow the reduction of the fractured patellar bone fragments, but with this maneuver there is no control of the rotation, lateralization and / or tilting of the fragments with a single Steinman nail, in addition to the need to drill the quadricipital tendon and patellar with more damage to the extensor apparatus than is due to trauma.
- the intra and extra-articular reducers hold the extensor apparatus in three points, two external and one internal and thus the tendons are not perforated and the fragments are fixed enough to face them avoiding turns, tilts and rotations and therefore perform a more satisfactory reduction , fast and effective; and as a second step as described in the art place the system of Percutaneous osteosynthesis and perform the compression of the fragments and the final correction of joint congruence in more detail.
- the present reducer was designed for application in orthopedic knee surgery, it is a tool that allows to reduce sharply the fragments of the patella or patella fractures and / or the extensor apparatus by minimally invasive technique and avoiding dissecting soft tissues to decrease the transoperative technical difficulty and the postoperative comorbidity, and thus, increase the effectiveness of the technique of reduction of the bone fragments of the extensor apparatus of the pelvic limb in the knee.
- the reducer is also composed of a manual parallel closing of two arms, which, one has an extension that is placed intra-articular below the extensor apparatus of the quadriceps and the other is placed extra-articular on the anterior aspect of the knee, When the parallel closure is made, the fragment is trapped, fracturing it in its anterior face and below in the extensor apparatus.
- a reducer is designed for the proximal region of the extensor apparatus and another reducer for the distal region of the extensor apparatus.
- the clamping arms open and close to contain any measure in thickness or size of the width of the extensor apparatus or fractured patella, the closure traps any type of extensor apparatus in its dimension and this allows control of the fractured fragments even by percutaneous means.
- the reducers perform a more accurate and effective reduction than other existing techniques, with the advantage that the time required to perform the surgery is reduced and the technical difficulty involved in reducing the fragments without any tool designed for this type of surgery is avoided. reduction, which is usually done by manual technique and based on calculation and approximation.
- the present invention has the objective of making a more exact and effective reduction in the stability of the fragments, in order to place an implant by means of a minimally invasive technique and with greater accuracy with direct visualization of the fragments by arthroscopic surgery.
- the device is designed so that through its operation, the fasteners can immobilize the fragments and keep them stable, keep the extensor apparatus in a direction controlled by the external fasteners, and help to perform a more effective articular congruence of the patellar fracture, and by a minimum dissection, with arthroscopic visualization of the articular surface, to subsequently stabilize the fragments, place Some fixation device or place the implant by previously manipulating the fragments.
- the clamping of the extensor apparatus is carried out in three points, one of them is intra-articular (intra-articular clamping) and corresponds to the Steinman nail and two external points (extra-articular clamping) at the closing of the reducers, the control of the fragments and keep the fragments stable while seeking a stabilization of the fragments by placing a patellar percutaneous osteosynthesis system that allows the placement of any type of implant or fixation method. It is an aid to reduce fracturing fragments of the extensor apparatus in order to improve the technique of fixation and stabilization in displaced kneecap fractures.
- the present invention refers to reducers that allow approximation of the ends in the disruption of the knee extensor apparatus and include the ability to reduce patella or patella fractures. of the knee with greater efficacy and precision through minimal dissection or wide dissection in knee surgery.
- the reducer of the invention makes it possible to reduce the fractures of the fractured patella and keep the fragments in a desired longitudinal direction and allows the fragments to be manipulated manually after closing the closing arms it possesses, in addition to the visualization of the articular surface Using arthroscopy, it is possible to reduce the fracture manually by means of the reducers and then proceed to the placement of the fixation method.
- the extensor apparatus in the quadricipital tendon region and the patellar tendon through a parallel closure mechanism that it has and with a curvature to adapt to the curved shape of the anterior and subcutaneous part of the face kick anterior.
- the fastener presented by the reducer is manually regulated by a closure that is determined by a zipper that keeps the reducer's closure stable until the desired pressure, advantageously, can cover any type of extensor apparatus in terms of length and thickness, of quadricipital tendon, patellar and any kneecap dimension due to its wide opening.
- the fastening is carried out by means of a Steinmann nail, of the number of thickness four or five, intra-articular attached to the reducer and, on the other hand, through an external vane with curvature that adapts to the anterior region of the patella and the closure of both arms, it allows to hold the distal and proximal fragments, supported by the zipper that is manually deactivated.
- Intra and extra-articular bras are in number of two but a third or fourth can be attached to give greater stability to the fragments. It presents a manual mechanism for modifying the approach or removal of both fasteners in the part of the fastener arm and this allows to co-fit any dimension of the patella or patella to be treated, and thus, to hold any size of extensor or patella apparatus to perform the appropriate reduction of the fragments Thus, there is a better control of the fragments that are to be reduced and the inverse force of distraction of the extensor apparatus can be contained manually in a disruption with these reducers, and finally to be able to perform a reduction of the fragments with better efficacy and safety, unlike how it is usually done with tools not designed for this maneuver. Reducers Operation
- the reducer is opened at full capacity, in the part of the Steinmann nail which is inserted intra-articularly, the articular region of the articular surface of the fracture fragment that corresponds to the base of the kneecap is palpated and slides towards the quadricipital tendon, after this, the Manually closing the reducer and the other semi-circular clamping arm that corresponds to the anterior part of the patellar face on the outside, the extensor apparatus is closed and held and maintained by the zipper closure, we proceed to hold the anchored quadricipital tendon on the anterior face of the kneecap and repeat the maneuver with another fastener for the patellar tendon region and distal or pole bone fragment.
- both reducers are taken manually and the fragments are joined or reduced, the reduction can be controlled by arthroscopic vision, fluoroscopy, direct palpation, through a blunt instrument or digital palpation . Once the reduction is achieved, the reduction can be maintained and the implant placed with the percutaneous osteosynthesis system to keep the fragments stable, maintain already reduced joint congruence and place the implant and initiate early limb mobility.
- Figure 1 shows a conventional view of the system, with the two main arms that are articulated by a movable cross mechanism at one end, a zipper to regulate the closing or opening, one or two "vanes" are curved in one of the arms and the other lower clamp arm has a cylindrical adaptation to introduce a Steinmann nail.
- the system is composed of two upper and lower main arms (1 and 2) respectively, which can have a cylindrical, quadrangular or circular shape, from the upper arm an extension called "vane" emerges (3) which can be in number of two or three and be directed in different slope to adapt to the anterior anatomy of the knee being articulated to the main upper arm (1) by means of a dynamic mechanism (4) to modify the distance between both paddles or remove the paddle to the bra in distance according to the surgeon's preference and adapt to any variation in the anatomy of the knee to be treated, the paddle (3) is parallel to the right in the direction of the upper main arm (1) and that It is articulated to the upper arm (1), which determines that it can be used for the base of the kick if it's right knee or kick polo if it's left knee.
- the articulation of the pallet to the upper arm is based on the dynamic mechanism (4) which, by manually decompressing, can allow the mobility of the vanes (3), if corrected for an adaptation to any variation of the knee anatomy before If the fasteners are closed, this dynamic mechanism (4) is circular and preferably can be manipulated manually or by a mechanical mechanism (4) through a "T" key, Alien key or rotating manual knob, when turning, you can remove or bring the vane (3) to the main arm (1) or between the same vanes and thus allow greater coverage of the dimensions of the patella and the extensor apparatus.
- the dynamic mechanism (4) which, by manually decompressing, can allow the mobility of the vanes (3), if corrected for an adaptation to any variation of the knee anatomy before If the fasteners are closed, this dynamic mechanism (4) is circular and preferably can be manipulated manually or by a mechanical mechanism (4) through a "T" key, Alien key or rotating manual knob, when turning, you can remove or bring the vane (3) to the main arm (1) or between the same vanes and
- the vane (3) considered as the extra-articular bra, is, as mentioned, parallel or with an inclination to the main arm (1).
- the palette has an "L" shape in a top-bottom view, but in a side view it has a concave lower deformity (5) to adapt to the anatomy of the anterior knee region, the palette (3) corresponds to the extra-articular bra since, when closing the reducer, it rests on the skin of the anterior region of the knee just on the anterior face of the anterior fragment of the base of the patella if used on the knee right, or on the anterior face of the kneecap and skin of the pole region on the left knee.
- the vanes (3) are articulated to the main closing arms by means of an angulation (6) in the upper view of the vanes to be able to manually manipulate the fragments and not "collide” the vane placed on the pole of the pallet and the vane placed at the base, and thus allow a better coverage of manipulation of fracture fragments.
- the lower main arm (2) is articulated with the upper main arm (1) by means of a dynamic mechanism like "cross system” (11) formed by two structures that they are held in half their length by a bolt that allows the upper main arm
- the lower arm (2) in its distal part has a cylindrical opening (14) of 4 or 5 millimeters that continues with the direction of the main arm to introduce a Steinmann nail (15) that serves as an intra-articular fastener and keep it immobile by a compressor screw mechanism (16) in the thickness of the distal part of the lower main arm
- the reducers can be made of stainless steel, aluminum, titanium, plastic with the norm for surgical instruments or any material that allows sterilization of the equipment without altering its operation and that is regulated for the manufacture of surgical instruments as an aid to perform the surgical technique in the reduction of patella fractures or disruption of the extensor apparatus.
- the vanes can be of any material that is approved for surgical instruments, from plastic, steel, stainless steel, aluminum or to any structure that can contain the force necessary to perform the compression, even any existing biodegradable material or that is not yet design
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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
REDUCTORES INTRA-EXTRA-ARTICULARES PARA OSTEOSINTESIS INTRA-EXTRA-ARTICULAR REDUCERS FOR OSTEOSYNTHESIS
PERCUTÁNEA PATELAR PERCUTANEO PATELAR
CAMPO DE LA INVENCIÓN FIELD OF THE INVENTION
La presente invención se relaciona con el campo de la cirugía ortopédica del aparato extensor de la rodilla en fracturas de patela, más específicamente, se refiere a un dispositivo reductor capaz de reducir fragmentos óseos para facilitar la colocación de un implante, aplicable a la disrupción del aparato extensor y fracturas de rótula desplazadas de la rodilla. The present invention relates to the field of orthopedic surgery of the knee extensor apparatus in patellar fractures, more specifically, it refers to a reducing device capable of reducing bone fragments to facilitate the placement of an implant, applicable to the disruption of the extensor apparatus and knee fractures displaced from the knee.
ANTECEDENTES DE LA INVENCIÓN BACKGROUND OF THE INVENTION
La presente invención se refiere a un dispositivo reductor, denominado solamente como reductor, de fragmentos óseos debido a las fracturas de rótula o patela mediante la sujeción e inmovilización del aparato extensor de la rodilla para la manipulación de dichos fragmentos de una forma más eficaz y segura. En terminología médica la reducción se refiere específicamente a la acción de unir o juntar dos fragmentos óseos, aproximarlos o armar los fragmentos como estaban antes de fracturarse.
Existen diversas formas de reducir los fragmentos en las fracturas de patela de la rodilla, como la forma percutánea con mínima disección de la piel o a través de una incisión lo suficientemente amplia para visualizar los fragmentos y realizar la maniobra de reducción, el inconveniente de realizar la reducción quirúrgica es la dificultad técnica que presentan las maniobras de reducción y fijación ya que se trata de técnicas manuales o con abrazaderas (conocidas en el arte como "clamps") que no están diseñadas para realizar estos procedimientos, y no existe una herramienta que permita realizar una reducción, estabilización y fijación que mantenga el control de los fragmentos para realizar la colocación del implante y mantener la congruencia articular de la región articular patelar. The present invention relates to a reducing device, called only as a reducer, of bone fragments due to fractures of the patella or patella by clamping and immobilizing the knee extensor apparatus for handling said fragments in a more efficient and safe way. . In medical terminology the reduction refers specifically to the action of joining or joining two bone fragments, bringing them together or assembling the fragments as they were before fracturing. There are several ways to reduce fragments in knee fractures of the knee, such as the percutaneous form with minimal dissection of the skin or through an incision wide enough to visualize the fragments and perform the reduction maneuver, the inconvenience of performing the Surgical reduction is the technical difficulty presented by the reduction and fixation maneuvers since these are manual or clamp techniques (known in the art as "clamps") that are not designed to perform these procedures, and there is no tool that allows perform a reduction, stabilization and fixation that maintains control of the fragments to perform implant placement and maintain joint congruence of the patellar joint region.
Esto se traduce en una dificultad técnica descrita en los antecedentes de revistas ortopédicas indizadas, a su vez esta dificultad técnica hace que el cirujano ortopedista opte por realizar una cirugía abierta, haciendo que aumente la probabilidad de presentar las complicaciones postoperatorias propias de esta técnica en porcentaje desde aproximadamente un 45%
hasta un 67%, ya que la reducción se realiza con base en la habilidad de cada cirujano, por medio de herramientas que no están diseñadas para la técnica y esto provoca que se realice con incertidumbre y sin una metodología especifica los pasos para conseguir la reconstrucción del aparato extensor y al final permitir agilizar la reducción de los fragmentos con guías para terminar el acto quirúrgico colocando un implante en cualquier dirección. This translates into a technical difficulty described in the background of indexed orthopedic journals, in turn this technical difficulty makes the orthopedic surgeon choose to perform an open surgery, increasing the probability of presenting the postoperative complications of this technique in percentage from about 45% up to 67%, since the reduction is made based on the skill of each surgeon, through tools that are not designed for the technique and this causes it to be done with uncertainty and without a specific methodology the steps to achieve reconstruction of the extensor apparatus and at the end allow to speed up the reduction of the fragments with guides to finish the surgical act by placing an implant in any direction.
El implante o material de osteosíntesis puede incluir diferentes modalidades según el criterio del cirujano, los implantes pueden ser: clavillos Kirschner, alambre asif de 1.2, tornillos de compresión canulados o no canulados, sutura poliéster del numero 5 o cualquier material de osteosíntesis que permita estabilizar los fragmentos fracturarlos e iniciar un movimiento inmediato de la extremidad afectada. The implant or osteosynthesis material can include different modalities according to the surgeon's criteria, the implants can be: Kirschner pins, 1.2 asif wire, cannulated or non-cannulated compression screws, number 5 polyester suture or any osteosynthesis material that allows stabilization the fragments fracture them and initiate an immediate movement of the affected limb.
En la memoria descriptiva de la solicitud PCT con número de publicación Internacional WO 2007/148953 se muestra un sistema de osteosíntesis percutáneo patelar que permite colocar un implante más preciso y con una mínima disección para cualquier tipo de fractura de patela. El primer paso para realizar la
corrección quirúrgica de las fracturas de patela es afrontar los fragmentos. Antes de colocar un sistema percutáneo de osteosíntesis, los fragmentos óseos fracturarlos deben ser acercados, afrontados, o reducidos, este paso como se ha descrito puede realizarse con dos clavos Steinman colocados por dos portales laterales de 5 milímetros y a través de la perforación del tendón cuadricipital y patelar y así, manualmente permitir la reducción de los fragmentos óseos fracturados patelares, pero con esta maniobra no se tiene control de la rotación, lateralización y/o basculación de los fragmentos con un solo clavo Steinman, además de que se tiene que perforar el tendón cuadricipital y patelar con mas daño al aparato extensor del que se tiene por traumatismo. In the descriptive report of the PCT application with International Publication Number WO 2007/148953, a patellar percutaneous osteosynthesis system is shown that allows a more precise implant to be placed and with minimal dissection for any type of patellar fracture. The first step to perform the Surgical correction of patella fractures is to face the fragments. Before placing a percutaneous osteosynthesis system, the fractured bone fragments must be approached, faced, or reduced, this step as described can be done with two Steinman nails placed by two 5 mm lateral portals and through the perforation of the quadricipital tendon and patella and thus, manually allow the reduction of the fractured patellar bone fragments, but with this maneuver there is no control of the rotation, lateralization and / or tilting of the fragments with a single Steinman nail, in addition to the need to drill the quadricipital tendon and patellar with more damage to the extensor apparatus than is due to trauma.
Los reductores intra y extra-articulares sujetan el aparato extensor en tres puntos, dos externos y uno interno y así no se perforan los tendones y los fragmentos quedan lo suficientemente fijos para afrontarlos evitando giros, basculaciones y rotaciones y por ende realizar una reducción más satisfactoria, rápida y eficaz; y como segundo paso como se describe en la técnica colocar el sistema de
osteosíntesis percutáneo y realizar la compresión de los fragmentos y la corrección final de la congruencia articular con mas detalle. The intra and extra-articular reducers hold the extensor apparatus in three points, two external and one internal and thus the tendons are not perforated and the fragments are fixed enough to face them avoiding turns, tilts and rotations and therefore perform a more satisfactory reduction , fast and effective; and as a second step as described in the art place the system of Percutaneous osteosynthesis and perform the compression of the fragments and the final correction of joint congruence in more detail.
De esta forma se puede claramente observar que no existe ningún reductor para fracturas de rótula o patela a través de una técnica cerrada o abierta. In this way it can be clearly seen that there is no reducer for patella or patella fractures through a closed or open technique.
OBJETO DE LA INVENCIÓN OBJECT OF THE INVENTION
El presente reductor se diseñó para la aplicación en la cirugía ortopédica de la rodilla, es una herramienta que permite reducir establemente los fragmentos de las fracturas de rótula o patela y/o el aparato extensor mediante técnica de mínima invasión y evitando disecar tejidos blandos para disminuir la dificultad técnica transoperatoria y la comorbilidad postoperatoria, y así, aumentar la eficacia de la técnica de reducción de los fragmentos óseos del aparato extensor de la extremidad pélvica en la rodilla. The present reducer was designed for application in orthopedic knee surgery, it is a tool that allows to reduce sharply the fragments of the patella or patella fractures and / or the extensor apparatus by minimally invasive technique and avoiding dissecting soft tissues to decrease the transoperative technical difficulty and the postoperative comorbidity, and thus, increase the effectiveness of the technique of reduction of the bone fragments of the extensor apparatus of the pelvic limb in the knee.
Además proporciona un mejor control de los fragmentos fracturarlos durante la reducción anatómica de los fragmentos para reparar el aparato extensor de la extremidades pélvicas y una congruencia articular satisfactoria transoperatoria mediante un mecanismo de
movimiento de unos sujetadores, que posee, de cierre paralelo que realizan una sujeción del tendón del cuadríceps y están apoyados en la cara anterior del fragmento fracturarlo de la patela en el borde, y una sujeción del tendón patelar apoyado en la cara anterior del fragmento fracturarlo del polo rotuliano. It also provides a better control of the fractures during fracture anatomical reduction of the fragments to repair the extensor apparatus of the pelvic extremities and a satisfactory joint congruence transoperative through a mechanism of movement of some fasteners, which it has, of parallel closure that make a support of the quadriceps tendon and are supported on the anterior face of the fracture fracture of the patella on the edge, and a patellar tendon support supported on the anterior face of the fracture fragment of the patellar pole.
El reductor está compuesto además por un cierre paralelo manual de dos brazos, los cuales, uno presenta una extensión que se coloca intra-articular por debajo del aparato extensor del cuadriceps y el otro se coloca extra-articular en la cara anterior de la rodilla, al realizar el cierre paralelo se atrapa el fragmento fracturarlo en su cara anterior y por debajo en el aparato extensor. The reducer is also composed of a manual parallel closing of two arms, which, one has an extension that is placed intra-articular below the extensor apparatus of the quadriceps and the other is placed extra-articular on the anterior aspect of the knee, When the parallel closure is made, the fragment is trapped, fracturing it in its anterior face and below in the extensor apparatus.
Un reductor está diseñado para la región proximal del aparato extensor y otro reductor para la región distal del aparato extensor. Los brazos sujetadores se abren y cierran para contener cualquier medida en grosor o tamaño del ancho del aparato extensor o patela fracturada, el cierre atrapa a cualquier tipo de aparato extensor en su dimensión y esto permite tener control de los fragmentos fracturarlos incluso por medio percutáneo.
Los reductores realizan una reducción más exacta y eficaz que otras técnicas existentes, con la ventaja de que se disminuye el tiempo que se requiere para realizar la cirugía y además se evitar la dificultad técnica que implica reducir los fragmentos sin ninguna herramienta diseñada para este tipo de reducción, que habitualmente se hace mediante técnica manual y a base de cálculo y aproximación. A reducer is designed for the proximal region of the extensor apparatus and another reducer for the distal region of the extensor apparatus. The clamping arms open and close to contain any measure in thickness or size of the width of the extensor apparatus or fractured patella, the closure traps any type of extensor apparatus in its dimension and this allows control of the fractured fragments even by percutaneous means. The reducers perform a more accurate and effective reduction than other existing techniques, with the advantage that the time required to perform the surgery is reduced and the technical difficulty involved in reducing the fragments without any tool designed for this type of surgery is avoided. reduction, which is usually done by manual technique and based on calculation and approximation.
La presente invención tiene el objetivo de realizar una reducción más exacta y efectiva en cuanto a la estabilidad de los fragmentos, para poder colocar un implante mediante una técnica mínima invasiva y con mayor exactitud con visualización directa de los fragmentos mediante cirugía artroscópica. The present invention has the objective of making a more exact and effective reduction in the stability of the fragments, in order to place an implant by means of a minimally invasive technique and with greater accuracy with direct visualization of the fragments by arthroscopic surgery.
El dispositivo está diseñado para que a través de su actuación, los sujetadores puedan inmovilizar los fragmentos y mantenerlos estables, mantener el aparato extensor en una dirección controlada por los sujetadores externos, y coadyuvar a realizar una congruencia articular de la fractura patelar más eficaz, y mediante una mínima disección, con visualización artroscópica de la superficie articular, para posteriormente estabilizar los fragmentos, colocar
algún dispositivo de fijación o colocar el implante mediante la manipulación previa de los fragmentos . The device is designed so that through its operation, the fasteners can immobilize the fragments and keep them stable, keep the extensor apparatus in a direction controlled by the external fasteners, and help to perform a more effective articular congruence of the patellar fracture, and by a minimum dissection, with arthroscopic visualization of the articular surface, to subsequently stabilize the fragments, place Some fixation device or place the implant by previously manipulating the fragments.
La sujeción del aparato extensor se realiza en tres puntos, uno de ellos es intra-articular (sujeción intra-articular) y corresponde al clavo Steinman y dos puntos externos (sujeción extra-articular) al cierre de los reductores se tiene el control de los fragmentos y mantienen los fragmentos estables mientras se busca una estabilización de los fragmentos mediante la colocación de un sistema percutáneo patelar de osteosíntesis que permite la colocación de cualquier tipo de implante o método de fijación. Es una ayuda para reducir los fragmentos fracturarlos del aparato extensor con el objetivo de mejorar la técnica de fijación y estabilización en las fracturas de rótula desplazadas. The clamping of the extensor apparatus is carried out in three points, one of them is intra-articular (intra-articular clamping) and corresponds to the Steinman nail and two external points (extra-articular clamping) at the closing of the reducers, the control of the fragments and keep the fragments stable while seeking a stabilization of the fragments by placing a patellar percutaneous osteosynthesis system that allows the placement of any type of implant or fixation method. It is an aid to reduce fracturing fragments of the extensor apparatus in order to improve the technique of fixation and stabilization in displaced kneecap fractures.
SUMARIO DE LA INVENCIÓN SUMMARY OF THE INVENTION
La presente invención, según se expresa en el enunciado de esta memoria descriptiva, se refiere a unos reductores que permiten realizar la aproximación de los extremos en la disrupción del aparato extensor de la rodilla e incluyen la capacidad de reducción en las fracturas de patela o rótula de la rodilla con mayor
eficacia y precisión a través de una mínima disección o disección amplia en la cirugía de rodilla. The present invention, as expressed in the statement of this specification, refers to reducers that allow approximation of the ends in the disruption of the knee extensor apparatus and include the ability to reduce patella or patella fractures. of the knee with greater efficacy and precision through minimal dissection or wide dissection in knee surgery.
El reductor de la invención permite realizar una reducción de los fragmentos de la patela fracturada y mantener los fragmentos en una dirección longitudinal deseada y permite manipular manualmente los fragmentos después de cerrar los brazos de cierre que posee, además de que la visualización de la superficie articular mediante la artroscopia permite reducir la fractura manualmente mediante los reductores y posteriormente proceder a la colocación del método de fijación. The reducer of the invention makes it possible to reduce the fractures of the fractured patella and keep the fragments in a desired longitudinal direction and allows the fragments to be manipulated manually after closing the closing arms it possesses, in addition to the visualization of the articular surface Using arthroscopy, it is possible to reduce the fracture manually by means of the reducers and then proceed to the placement of the fixation method.
A su vez tiene la característica de sujetar el aparato extensor en la región del tendón cuadricipital y el tendón patelar a través de un mecanismo de cierre paralelo que posee y con una curvatura para adaptarse a la forma curva de la parte anterior y subcutánea de la cara patelar anterior. La sujeción que presenta el reductor está regulada manualmente por un cierre que está determinado por una cremallera que mantiene el cierre del reductor estable hasta la presión deseada, de manera ventajosa, puede abarcar cualquier tipo de aparato extensor en cuanto a longitud y grosor, de
tendón cuadricipital, patelar y cualquier dimensión de rótula por su apertura amplia. La sujeción se realiza mediante un clavo Steinmann, del número de grosor cuatro o cinco, intra-articular sujetado al reductor y, por otro lado, a través de una paleta externa con curvatura que se adapta a la región anterior de la rótula y el cierre de ambos brazos, permite sujetar los fragmentos distal y proximal, sostenido el cierre por la cremallera que se desactiva manualmente. In turn, it has the characteristic of holding the extensor apparatus in the quadricipital tendon region and the patellar tendon through a parallel closure mechanism that it has and with a curvature to adapt to the curved shape of the anterior and subcutaneous part of the face kick anterior. The fastener presented by the reducer is manually regulated by a closure that is determined by a zipper that keeps the reducer's closure stable until the desired pressure, advantageously, can cover any type of extensor apparatus in terms of length and thickness, of quadricipital tendon, patellar and any kneecap dimension due to its wide opening. The fastening is carried out by means of a Steinmann nail, of the number of thickness four or five, intra-articular attached to the reducer and, on the other hand, through an external vane with curvature that adapts to the anterior region of the patella and the closure of both arms, it allows to hold the distal and proximal fragments, supported by the zipper that is manually deactivated.
Los sujetadores intra y extra-articulares son en número de dos pero puede adherirse un tercero o cuarto para darle mayor estabilidad a los fragmentos . Presenta un mecanismo manual de modificación de acercamiento o retiro de ambos sujetadores en la parte del brazo sujetador y esto permite coaptar cualquier dimensión de rótula o patela a tratar, y así, sujetar cualquier tamaño de aparato extensor o rótula para realizar la reducción adecuada de los fragmentos. Así se tiene un mejor control de los fragmentos que se van a reducir y manualmente se puede contener la fuerza inversa de distracción propia del aparato extensor en una disrupción con estos reductores, y finalmente poder realizar una reducción de los fragmentos con mejor
eficacia y seguridad, a diferencia de como se realiza habitualmente con herramientas no diseñadas para esta maniobra . Funcionamiento De Los Reductores Intra and extra-articular bras are in number of two but a third or fourth can be attached to give greater stability to the fragments. It presents a manual mechanism for modifying the approach or removal of both fasteners in the part of the fastener arm and this allows to co-fit any dimension of the patella or patella to be treated, and thus, to hold any size of extensor or patella apparatus to perform the appropriate reduction of the fragments Thus, there is a better control of the fragments that are to be reduced and the inverse force of distraction of the extensor apparatus can be contained manually in a disruption with these reducers, and finally to be able to perform a reduction of the fragments with better efficacy and safety, unlike how it is usually done with tools not designed for this maneuver. Reducers Operation
Una vez realizada una mínima incisión de 5 milímetros, aproximadamente 3 mililitros en región lateral en la base de la rótula o patela y región de polo patelar de la rodilla, o una incisión abierta habitual, se abre el reductor a toda su capacidad, en la parte que se encuentra el clavo Steinmann el cual se introduce intra-articularmente, se palpa la región articular de la superficie articular del fragmento fracturario que corresponde a la base de la rótula y se desliza hacia el tendón cuadricipital, posterior a esto, se inicia el cierre del reductor manualmente y el otro brazo sujetador de forma semi-circular que corresponde a la parte anterior de la cara rotuliana en la parte externa, se cierra y mantiene sujeto el aparato extensor y se mantiene por el cierre de la cremallera, se procede a sujetar el tendón cuadricipital anclado en la cara anterior de la rótula y se repite la maniobra con otro sujetador para la región del tendón patelar y
fragmento óseo distal o del polo. Una vez que se tienen sujetos ambos extremos, se toman manualmente ambos reductores y se procede a juntar o reducir los fragmentos, el control de la reducción puede realizarse mediante vista artroscopica, fluoroscopia, palpación directa, a través de un instrumento romo o una palpación digital. Una vez conseguida la reducción puede mantenerse la reducción y colocar el implante con el sistema de osteosíntesis percutáneo para mantener estables los fragmentos, mantener la congruencia articular ya reducida y colocar el implante e iniciar una movilidad temprana de la extremidad. Once a minimum incision of 5 millimeters, approximately 3 milliliters in the lateral region at the base of the patella or patella and the patellar pole region of the knee, or a usual open incision, the reducer is opened at full capacity, in the part of the Steinmann nail which is inserted intra-articularly, the articular region of the articular surface of the fracture fragment that corresponds to the base of the kneecap is palpated and slides towards the quadricipital tendon, after this, the Manually closing the reducer and the other semi-circular clamping arm that corresponds to the anterior part of the patellar face on the outside, the extensor apparatus is closed and held and maintained by the zipper closure, we proceed to hold the anchored quadricipital tendon on the anterior face of the kneecap and repeat the maneuver with another fastener for the patellar tendon region and distal or pole bone fragment. Once both ends are held, both reducers are taken manually and the fragments are joined or reduced, the reduction can be controlled by arthroscopic vision, fluoroscopy, direct palpation, through a blunt instrument or digital palpation . Once the reduction is achieved, the reduction can be maintained and the implant placed with the percutaneous osteosynthesis system to keep the fragments stable, maintain already reduced joint congruence and place the implant and initiate early limb mobility.
BREVE DESCRIPCIÓN DE LA FIGURA BRIEF DESCRIPTION OF THE FIGURE
Los detalles característicos de este novedoso reductor se muestran claramente en la siguiente descripción y en la figura acompañante, siguiendo los mismos signos de referencia para indicar las partes de la figura mostrada. The characteristic details of this novel reducer are clearly shown in the following description and in the accompanying figure, following the same reference signs to indicate the parts of the figure shown.
La figura 1 muestra una vista convencional del sistema, con los dos brazos principales que se encuentran articulados mediante un mecanismo de cruz movible en un extremo, una cremallera para regular el
cierre o la apertura, en uno de los brazos se encuentran una o dos "paletas" de forma curva y el otro brazo sujetador inferior presenta una adaptación cilindrica para introducir un clavo Steinmann. Figure 1 shows a conventional view of the system, with the two main arms that are articulated by a movable cross mechanism at one end, a zipper to regulate the closing or opening, one or two "vanes" are curved in one of the arms and the other lower clamp arm has a cylindrical adaptation to introduce a Steinmann nail.
DESCRIPCIÓN DETALLADA DE LA INVENCIÓN DETAILED DESCRIPTION OF THE INVENTION
A la vista de la comentada figura, puede observarse que el sistema está compuesto de dos brazos principales superior e inferior (1 y 2) respectivamente, que pueden tener forma cilindrica, cuadrangular o circular, del brazo superior se desprende una prolongación denominada "paleta" (3) la cual puede ser en número de dos o tres y estar dirigida en diferente desnivel para adaptarse a la anatomía anterior de la rodilla encontrándose articulada al brazo superior principal (1) mediante un mecanismo dinámico (4) para modificar la distancia entre ambas paletas o retirar en distancia la paleta al sujetador según la preferencia del cirujano y adaptarse a cualquier variación de la anatomía de la rodilla a tratar, la paleta (3) se encuentra paralela hacia la derecha en dirección al brazo principal superior (1) y que está articulada al brazo superior (1) , lo que condiciona que pueda ser utilizada para la base de la
patela si es rodilla derecha o polo de patela si es rodilla izquierda. In view of the aforementioned figure, it can be seen that the system is composed of two upper and lower main arms (1 and 2) respectively, which can have a cylindrical, quadrangular or circular shape, from the upper arm an extension called "vane" emerges (3) which can be in number of two or three and be directed in different slope to adapt to the anterior anatomy of the knee being articulated to the main upper arm (1) by means of a dynamic mechanism (4) to modify the distance between both paddles or remove the paddle to the bra in distance according to the surgeon's preference and adapt to any variation in the anatomy of the knee to be treated, the paddle (3) is parallel to the right in the direction of the upper main arm (1) and that It is articulated to the upper arm (1), which determines that it can be used for the base of the kick if it's right knee or kick polo if it's left knee.
La articulación de la paleta al brazo superior es con base en el mecanismo dinámico (4) que al descomprimir manualmente puede permitir la movilidad de las paletas (3) , en caso de corregir para una adaptación a cualquier variación de la anatomía de la rodilla antes de realizar el cierre de los sujetadores, éste mecanismo dinámico (4) es de forma circular y de preferencia se puede manipular manualmente o mediante un mecanismo mecánico (4) a través de una llave en "T", llave Alien o perilla manual giratoria, al girar puede retirar o acercar la paleta (3) al brazo principal (1) o entre las mismas paletas y así permitir una mayor cobertura de las dimensiones de la patela y el aparato extensor. The articulation of the pallet to the upper arm is based on the dynamic mechanism (4) which, by manually decompressing, can allow the mobility of the vanes (3), if corrected for an adaptation to any variation of the knee anatomy before If the fasteners are closed, this dynamic mechanism (4) is circular and preferably can be manipulated manually or by a mechanical mechanism (4) through a "T" key, Alien key or rotating manual knob, when turning, you can remove or bring the vane (3) to the main arm (1) or between the same vanes and thus allow greater coverage of the dimensions of the patella and the extensor apparatus.
La paleta (3) , considerada como el sujetador extra-articular, se encuentra, como se mencionó, paralela o con una inclinación al brazo principal (1) . La paleta presenta una forma de "L" en una vista superior-inferior, pero en una vista lateral presenta una deformidad cóncava inferior (5) para adaptarse a la anatomía de la región anterior de la rodilla, la paleta
(3) corresponde al sujetador extra-articular ya que al realizar el cierre del reductor se posa sobre la piel de la región anterior de la rodilla justo en la cara anterior del fragmento anterior de la base de la patela en caso de utilizarse en la rodilla derecha, o en la cara anterior de la rótula y piel de la región de polo en la rodilla izquierda. Las paletas (3) se encuentran articuladas a los brazos principales de cierre mediante una angulación (6) en la vista superior de las paletas para poder manipular manualmente los fragmentos y no "chocar" la paleta colocada en el polo de la patela y la paleta colocada en la base, y así permitir una mejor cobertura de manipulación de los fragmentos fracturarios . The vane (3), considered as the extra-articular bra, is, as mentioned, parallel or with an inclination to the main arm (1). The palette has an "L" shape in a top-bottom view, but in a side view it has a concave lower deformity (5) to adapt to the anatomy of the anterior knee region, the palette (3) corresponds to the extra-articular bra since, when closing the reducer, it rests on the skin of the anterior region of the knee just on the anterior face of the anterior fragment of the base of the patella if used on the knee right, or on the anterior face of the kneecap and skin of the pole region on the left knee. The vanes (3) are articulated to the main closing arms by means of an angulation (6) in the upper view of the vanes to be able to manually manipulate the fragments and not "collide" the vane placed on the pole of the pallet and the vane placed at the base, and thus allow a better coverage of manipulation of fracture fragments.
En el otro extremo del sujetador principal superior se encuentra una hendidura o diente (7) el cual desliza y se ancla sobre la cremallera dentada (8) en cada diente para mantener el cierre, o desactivar mecánicamente el cierre y abrir el reductor o ambos brazos principales (1 y 2) ; el brazo principal inferior (2) se encuentra articulado con el brazo principal superior (1) por medio de un mecanismo dinámico como "sistema de cruz" (11) formado por dos estructuras que
se encuentran sujetas en la mitad de su longitud por un perno que permite acercar el brazo principal superiorOn the other end of the upper main fastener is a slit or tooth (7) which slides and is anchored on the toothed rack (8) in each tooth to maintain the closure, or mechanically deactivate the closure and open the reducer or both arms main (1 and 2); the lower main arm (2) is articulated with the upper main arm (1) by means of a dynamic mechanism like "cross system" (11) formed by two structures that they are held in half their length by a bolt that allows the upper main arm
(1) con el brazo principal inferior (2) a través del movimiento mecánico del sistema de cruz que se encentra fijo en la porción distal (12 y 13) de ambos brazos principales (1 y 2) deslizándose el extremo proximal de los componentes de la cruz (9 y 10) sobre la longitud de ambos brazos principales (1 y 2) , lo que permite un cierre paralelo del reductor y así sujetar o mantener inmóvil el aparato extensor. (1) with the lower main arm (2) through the mechanical movement of the cross system that is fixed fixed in the distal portion (12 and 13) of both main arms (1 and 2) by sliding the proximal end of the components of the cross (9 and 10) over the length of both main arms (1 and 2), which allows a parallel closure of the reducer and thus hold or hold the extensor apparatus.
El brazo inferior (2) en su parte distal presenta una abertura cilindrica (14) de 4 ó 5 milímetros que se continúa con la dirección del brazo principal para introducir un clavo Steinmann (15) que sirve de sujetador intra-articular y mantenerlo inmóvil mediante un mecanismo de tornillo compresor (16) en el espesor de la parte distal del brazo principal inferior The lower arm (2) in its distal part has a cylindrical opening (14) of 4 or 5 millimeters that continues with the direction of the main arm to introduce a Steinmann nail (15) that serves as an intra-articular fastener and keep it immobile by a compressor screw mechanism (16) in the thickness of the distal part of the lower main arm
(2) . En el otro extremo del brazo sujetador inferior (2) , se encuentra un sistema de bisagra (17) que alberga la cremallera dentada para mantener el cierre de los sujetadores. (2) . At the other end of the lower fastener arm (2), there is a hinge system (17) that houses the toothed rack to maintain the fastener closure.
Los materiales, formas y tamaño están sujetos a variabilidad siempre y cuando no comprometan los
mecanismos descritos y la alteración de la esencia de la función de los reductores. Los reductores pueden fabricarse de acero inoxidable, aluminio, titanio, plástico con la norma para instrumental quirúrgico o cualquier material que permita realizar una esterilización del equipo sin alterar su funcionamiento y que se encuentre normado para fabricación de instrumental quirúrgico como ayuda para realizar la técnica quirúrgica en la reducción de las fracturas de rótula o disrupción del aparato extensor. Asimismo, las paletas pueden ser de cualquier material que este aprobado para instrumentos quirúrgicos, desde plástico, acero, acero inoxidable, aluminio o hasta cualquier estructura que pueda contener la fuerza necesaria para realizar la compresión, incluso cualquier material biodegradable existente o que aún no se diseñe.
Materials, shapes and size are subject to variability as long as they do not compromise the mechanisms described and the alteration of the essence of the function of the reducers. The reducers can be made of stainless steel, aluminum, titanium, plastic with the norm for surgical instruments or any material that allows sterilization of the equipment without altering its operation and that is regulated for the manufacture of surgical instruments as an aid to perform the surgical technique in the reduction of patella fractures or disruption of the extensor apparatus. Likewise, the vanes can be of any material that is approved for surgical instruments, from plastic, steel, stainless steel, aluminum or to any structure that can contain the force necessary to perform the compression, even any existing biodegradable material or that is not yet design
Claims
1. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de rótula desplazadas de rodilla, el cual está compuesto básicamente por dos brazos sujetadores principales (1, 2) que se colocan uno intra-articular y otro extra- articular, que a su vez contiene dos sujetadores (3) a desnivel para adaptarse a la anatomía propia de la rodilla en el aparato extensor de la rodilla, 1. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced kneecap fractures, which is basically composed of two main support arms (1, 2) that are placed one intra-articular and another extra-articular, which in turn contains two fasteners (3) at unevenness to adapt to the anatomy of the knee in the knee extensor apparatus,
Caracterizado porque: Characterized because:
El brazo sujetador principal superior extra- articular (1) presenta un mecanismo dinámico (4) para mover una extensión del reductor, que es paralelo al brazo principal (1) para contener cualquier dimensión del fragmento fracturarlo durante la sujeción del aparato extensor; The extra-articular upper main clamp arm (1) has a dynamic mechanism (4) for moving an extension of the reducer, which is parallel to the main arm (1) to contain any dimension of the fragment to fracture it during the clamping of the extensor apparatus;
El brazo sujetador principal superior (1)
contiene una, dos o las paletas (3) necesarias como extensión a diferente nivel de altura modificable, en donde la paleta (3) presenta forma anatómica con una curvatura cóncava (5) para adaptarse a la anatomía de la cara anterior de la rótula; The upper main clamp arm (1) It contains one, two or the vanes (3) necessary as an extension at a different level of height that can be modified, where the vane (3) has an anatomical shape with a concave curvature (5) to adapt to the anatomy of the anterior face of the patella;
El brazo sujetador principal inferior intra- articular (2) contiene un orificio (14) para contener una extensión ya sea un clavo Steinmann o un clavo canulado (15) , o cualquier extensión que permita al cierre del reductor mantener estable el fragmento fracturario; y porque The intra-articular lower main clamp arm (2) contains a hole (14) to contain an extension either a Steinmann nail or a cannulated nail (15), or any extension that allows the closure of the reducer to keep the fracture fragment stable; and because
Por medio de los dos brazos principales (1, 2), el reductor se cierra paralelamente acercándose uno con otro lo que permite sujetar el aparato extensor a través de sus tendones y fragmentos óseos fracturados . By means of the two main arms (1, 2), the reducer closes in parallel, approaching one another, which allows to hold the extensor apparatus through its fractured tendons and bone fragments.
2. Reductor intra-extra-articular para osteosintesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1, caracterizado porque las paletas (3) se encuentran paralelas al sujetador principal (1) . 2. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the vanes (3) are parallel to the main fastener (1).
3. Reductor intra-extra-articular para osteosintesis percutánea patelar aplicable a disrupción
del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 2, caracterizado porque las paletas (3) se encuentran articuladas a los brazos principales (1, 2) mediante una angulación (6) que permite alejar un sujetador del otro y así poder manipular con mayor facilidad los fragmentos . 3. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 2, characterized in that the vanes (3) are articulated to the main arms (1, 2) by means of an angulation (6) that allows one fastener to move away from the other and thus be able to manipulate the fragments more easily.
4. Reductor intra-extra-articular para osteosintesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1, caracterizado porque el brazo sujetador principal superior (1) presenta movimiento de acercamiento o alejamiento mediante un mecanismo mecánico o manual con un mecanismo dinámico movible (11) , y además presenta una hendidura (7) para controlar la cremallera de cierre (8) . 4. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the upper main clamp arm (1) exhibits approach or withdrawal movement by means of a mechanism mechanical or manual with a movable dynamic mechanism (11), and also has a slit (7) to control the closing zipper (8).
5. Reductor intra-extra-articular para osteosintesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1, caracterizado porque el orificio (14) es de 4 ó 5 milímetros, el cual continúa con la dirección del brazo
principal (1) para introducir un clavo Steinraann o un clavo canulado (15) . 5. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the hole (14) is 4 or 5 millimeters, which continues with the arm direction main (1) to introduce a Steinraann nail or a cannulated nail (15).
6. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 5, caracterizado porque mediante un mecanismo de tornillo compresor (16) en el espesor de la parte distal del brazo principal inferior (2) , el clavo Steinmann (15) sirve de sujetador intra-articular y se mantiene inmóvil . 6. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 5, characterized in that by means of a compressor screw mechanism (16) in the thickness of the distal part of the lower main arm (2), the Steinmann nail (15) serves as an intra-articular bra and remains immobile.
7. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1, caracterizado porque la apertura del reductor es lo suficiente para contener cualquier tipo de fractura y lo suficientemente amplio para abordar cualquier dimensión de rodilla a tratar. 7. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the opening of the reducer is sufficient to contain any type of fracture and sufficiently wide to address any knee dimension to be treated.
8. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1,
caracterizado porque un mismo sujetador (3) puede utilizarse en ambas rodillas, y se necesitan de dos como mínimo para realizar la reducción. 8. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the same bra (3) can be used on both knees, and at least two are needed to perform the reduction.
9. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y a fracturas de patela desplazadas de rodilla, según la reivindicación 1, caracterizado porque el control de la reducción puede llevarse a cabo mediante fluoroscopía, artroscopía, rayos X, palpación directa o mediante palpación intra- articular a través de algún instrumento romo. 9. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that the control of the reduction can be carried out by fluoroscopy, arthroscopy, X-rays, direct palpation or by intra-articular palpation through a blunt instrument.
10. Reductor intra-extra-articular para osteosíntesis percutánea patelar aplicable a disrupción del aparato extensor y fracturas de patela desplazadas de la rodilla, según la reivindicación 1, caracterizado porque además posee un sistema de cierre paralelo (11) , el cual se podrá articular con los reductores y realizar la compresión de los fragmentos con guías para colocar el implante en cualquier dirección.
10. Intra-extra-articular reducer for patellar percutaneous osteosynthesis applicable to disruption of the extensor apparatus and displaced knee fractures according to claim 1, characterized in that it also has a parallel closure system (11), which can be articulated with the reducers and compress the fragments with guides to place the implant in any direction.
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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 |
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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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Cited By (1)
| 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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| 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)
| 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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