WO2016083355A1 - Élément de consolidation - Google Patents

Élément de consolidation Download PDF

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Publication number
WO2016083355A1
WO2016083355A1 PCT/EP2015/077467 EP2015077467W WO2016083355A1 WO 2016083355 A1 WO2016083355 A1 WO 2016083355A1 EP 2015077467 W EP2015077467 W EP 2015077467W WO 2016083355 A1 WO2016083355 A1 WO 2016083355A1
Authority
WO
WIPO (PCT)
Prior art keywords
fastening element
element according
shaft
gripping device
bone
Prior art date
Application number
PCT/EP2015/077467
Other languages
German (de)
English (en)
Inventor
Fabian MUELLER-GRAF
Original Assignee
Universität Rostock
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 Universität Rostock filed Critical Universität Rostock
Publication of WO2016083355A1 publication Critical patent/WO2016083355A1/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
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1717—Guides or aligning means for drills, mills, pins or wires for applying intramedullary nails or pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/171—Guides or aligning means for drills, mills, pins or wires for external fixation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7241—Intramedullary pins, nails or other devices with special means of locking the nail to the bone the nail having separate elements through which screws pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/725—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with locking pins or screws of special form

Definitions

  • the invention relates to a fastening element with a shaft insertable into a bone for fastening the shaft in bone with a front (distal) and a rear (proximal) region, wherein the shaft by introduced into the bone transversely to its longitudinal extent fixing elements such as screws o.
  • fixing elements such as screws
  • fasteners inserted into the medullary cavity of the bones are used, which are attached to the bone fragments on both sides of the fracture, holding them together and making the bone resilient to a certain degree. They are driven longitudinally into the medullary cavity and fixed to the bone fragments to be held together by screws inserted transversely through the bone. A clamping device clamps the bone fragments together.
  • a fastening element designated as intramedullary nail is described in EP 0865769 A1.
  • EP 0374088 A1 a bone screw for fixing implants in cancellous bone tissue, the thread consists of a helix.
  • DE 3347 333 A1 shows a compression nail in order with an exciting mandrel, at the end clamping mandrel sheet is mounted with a hook-shaped recess. By turning a drill wire or a screw should be taken.
  • the object of the invention is to provide such a fastener that is easier and safer to attach in the bone.
  • the gripping device (25) has two mutually arranged and mutually rotatable elements.
  • the shaft can be rotatable in the bone and the gripping device for detecting at least one fixing element can be formed by rotation or hooking of the shaft.
  • the shaft can therefore be rotated about its axis from its insertion point and thereby engage in simultaneous forward movement or even sole forward movement about the fixing element, that is, for example, one or more transverse screws.
  • the gripping device and / or the shaft has a helical or helical structure.
  • the gripping device has a provided at the front end of the shaft single or multi-start helix with at least one free gripping tip is particularly advantageous.
  • a double-flighted helix is particularly preferred, the two helices of which can engage in front of and between two transversely introduced transverse screws.
  • the length of the helix may vary as needed, eg, the consistency of cancellous bone and the nature of the fracture. It introduces some elasticity in the manner of a coil spring into the system, which may be desirable in order to maintain tension between the bone fragments or the bone and a prosthesis. But it is also possible to form hook-like gripping elements in the front region of the shaft, when a longitudinal elasticity is undesirable.
  • the gripping device may be self-locking, e.g. through a recess into which the fixing element engages and is secured against disengagement by the longitudinal clamping.
  • the gripping device may be self-locking, e.g. through a recess into which the fixing element engages and is secured against disengagement by the longitudinal clamping.
  • the gripping device may comprise at least one element with a slit extending obliquely to the longitudinal axis of the shaft. This slot can accommodate the fixing element, ie a transverse screw.
  • the gripping device has two mutually arranged and mutually rotatable elements, preferably in the form of sleeves, each defining an obliquely to the longitudinal axis of the shaft slot, they can receive the fixing element and secure.
  • the two elements can be secured against rotation against each other, either by a blockage within the shaft or by the fixing elements which are screwed in the distal or proximal region.
  • the elements which are arranged one inside the other and are rotatable relative to one another in the form of helices.
  • the rotatable sleeves, which are mounted one inside the other, can each have slots which originate from the front end face and open into the latter with lateral recesses.
  • the fixing elements screws
  • the fixing elements can penetrate into this and by mutual rotation of the two sleeves, the fixing elements are fixed in the recesses on the shaft.
  • one of the sleeves preferably the inner sleeve, have in their slot a lateral recess, so that a hook-like projection is formed, which in the mutual rotation of the two sleeves against each other in cooperation with the boundaries of the slot in the other sleeve (outer sleeve) form-fitting and also in case of loads in the opposite direction safe connection forms.
  • one of the slots e.g. the inner slot is skewed with respect to the longitudinal axis of the fastener so that one of the slits delimiting the slot forms a sliding surface which rotates the inner sleeve into a locking position upon entry of the fastener into the slot in which the other inclined surface blocks the slot outwardly, So also limited to a hook-like projection.
  • the lock is automatically made by driving the fastener, so to speak by autorotation.
  • the invention makes it possible to attach and anchor the fastener in bone already used fixation elements, such as screws and therefore spares the tedious and unsafe in positioning drilling and screwing the lower, usually proximal fixation after insertion of the fastener. Thereafter, in the usual way from the rear, so usually proximal region forth the fastener are clamped so that the bone fractions are pressed firmly and securely to each other and the bone can also be exposed to a certain load.
  • the invention has been developed for long bones, such as tibia, femur, humerus, etc., but it is also advantageous for attachment to other bones. such as for fixing implants.
  • the fastener according to the invention is suitable for human and animal bones.
  • FIG. 1 is a schematic representation of a long bone (tibia) with an inserted and fixed fastener with gripping device according to the invention
  • Fig. 2 is a schematic representation of a detail with another
  • FIG. 5 shows a detail with a gripping device in the manner of a bayonet
  • FIG. 6 shows the diagram of a gripping device formed from nested sleeves which are mutually supportable
  • FIG. 7 is a side view of a detail of a gripping device according to FIG. 6,
  • FIG. 8 shows a further embodiment of a gripping device in a schematic oblique view in a position receiving the fixing elements
  • Fig. 1 indicates a tibial or tibial bone (tibia) 1 1 fractured at a fracture 12 into a forward (lower or distal) bone fracture portion 13 and a posterior (proximal) bone fracture portion 14 and operatively inserted by insertion of both Parts clamping fastener 15 is connected and fixed in the correct position to each other.
  • the soft tissues surrounding the bone are omitted in the drawing.
  • the fastening element 15 has a shaft 16 of a solid and biologically harmless material, such as titanium, etc., which is formed substantially tubular or sleeve-shaped.
  • a clamping device 18 is provided in its rear direction in the insertion direction 48 area 17. It has two mutually offset by 90 ° slots 19 in the shaft wall 20 through which, also offset by 90 °, helical fixing elements 21 engage, after they were screwed through holes 22 across the bone. They fix themselves mainly in the cortex, ie in their substantia compacta, on both sides, but penetrate both the periosteum (bone) and the bone marrow (cancellous bone).
  • the clamping device 18 includes a clamping screw 23 which can be screwed into an internal thread in the shaft.
  • the fastening element has a gripping device 25.
  • this has as a gripping member 26 from the shaft outgoing helix with a relatively large pitch, similar to a corkscrew, which ends in a tip 27.
  • the helix is designed such that it engages around two fixing elements 28, 28a in the form of screws which are inserted transversely into the bone, as described with reference to the fixing elements 21.
  • the fixing elements 28, 28a are each offset by 90 ° from each other in their longitudinal spacing as a function of the pitch of the helix and in its diameter so that they engage in the spaces formed by the helixes 29.
  • a locking element 30 is provided, which consists of a screwed into an internal thread 31 in the interior of the shaft pin and is longitudinally displaceable by rotation. Its end face 32 can be advanced against the proximal of the two fixing elements 28, 28a and press against them.
  • the fastener penetrates the bone marrow at its insertion, possibly after pre-drilling, and strikes the fixation elements 28, 28a.
  • Insertion can be done by driving, as with a tibia nail.
  • the fastener is at least in the last portion of its feed path by rotation, similar to a screw, be advanced because the helix acts like a screw at the front end. This could be assisted by a helical profiling of at least part of the outer surface of the shank 16 as a continuation of the helical pitch.
  • FIG. 1 a gripping device 25 is shown with a catchy helix.
  • FIG. 2 shows an embodiment with a double-flighted helix, in which the problem with the oblique passage 29 between the helical turns does not occur, since the helices are arranged so as to provide a straight passage for the fixing elements 28, 28a in the result Fig. 2 are shown schematically as pins.
  • the fixation elements as screws, which at the places where they find support in the cortex, have threads, but in between, ie in the medullary region, have a possibly recessed in diameter smooth or roughened shank of the gripping device can be more easily included.
  • an unintentional turning out of the coil can be hindered or prevented.
  • FIG. 2 shows a bevel of the helix tip 27, which lies with its surface substantially in a transverse plane to the shank 16 (approximately 90 ° to the shank axis 8)
  • Fig. 3 shows an embodiment of the tip 27 similar to a needle point, so centric, which facilitates the penetration of the bone marrow.
  • a long key such as a hexagon socket key
  • the locking element is then pressed with its end face 32 against one of the fixing elements 28, 28a, thus blocking the gripping device.
  • the proximal fixing elements 21 are screwed in after pre-drilling, through the slots 19 therethrough.
  • commercially available drilling jigs and similar devices are available.
  • the clamping screw 23 of the clamping device 18 is inserted from the opening of the shank in the rear area in this and pressed against the next fixing elements 21. This is done under X-ray control until the fracture gap is closed.
  • the clamping device can optionally be dispensed with, because the coil can already achieve a clamping effect.
  • the gripping device As needed, numerous advantageous developments of the gripping device are possible. Thus, different functions can be fulfilled by the surface design of the surfaces coming into contact with the fixing elements 28, 28a.
  • a smooth surface facilitates gripping, a rough and possibly even toothed surface secures the gripping device against twisting.
  • the helix has been shown here as a cylindrical helix with a circular cross section. But it is also possible to run it conically down and / or provide others, for example, rectangular cross-sections.
  • the gripping devices 25 shown in FIGS. 4 and 5 are suitable for fixing the fastening element 15.
  • Fig. 4 shows a hook-like gripping device 25. From the shaft wall 20, a hook-shaped portion 33 is worked out, which forms a lateral opening 34. Upon rotation of the shaft 20, the fixing element 28 can penetrate into this opening 34 until it rests against the rear wall 35 of the opening. After the fastening element, as described above, is tensioned, prevents the fixing elements 28 encompassing projection 36 that the shaft 16 is rotated relative to the fixing element.
  • a locking element 30 is also used in this embodiment as an inner element, as previously described, which is pre-screwed against the fixing elements 28 to provide a backup even when loaded in the opposite direction or rotation.
  • Fig. 5 shows a gripping device in the manner of a bayonet closure, which is cut in the shaft wall 20 at the end face 41.
  • An end opening 38 allows the fixing elements 28 to enter, which then enters by rotation of the shaft in a lateral extension 39 of the opening 38 and is finally locked in an undercut recess 37 after tightening. Again, the locking element 30 is used.
  • Fig. 6 shows schematically an embodiment of the gripping device, in which in the outer, the shank wall 20 forming sleeve 42, two inclined slots 40 are formed, which extend from the front end side 41 of the shaft over a certain length of the shaft.
  • a second sleeve 43 is rotatably mounted, which also has slots 44, but with respect to the slot 40 have an oppositely directed slope.
  • Fig. 7 now shows that when the fastener is advanced against the transverse fixing element 28, this can penetrate into the frontal mouth 45 of one of the slots 40, to which it is provided with a funnel-shaped inlet slope 46. With a corresponding rotational position of the inner sleeve 43 whose mouth 47 also covers the fixing element 28. Upon further advancement of the fastening element 15 in the direction of the arrow 48, the fixing element 28 in which from the superimposition of the caught in both slots 40, 44 forming diamond-shaped opening 49. With an appropriate arrangement, this is also done in the second, below 90 ° fixing element 28, which is caught in the respective second slot 40,44 of the sleeves.
  • the fastener 15 is fixed both in the longitudinal direction and against rotation relative to the fixing elements 28 so against the bone.
  • This rotation can be made from the proximal mouth 50 of the shaft 20 ago by a corresponding tool or, if the inner sleeve 43 extends over the entire length of the fastener, are also secured by the fixing screws 21.
  • FIGS. 4 to 7 only the gripping of a fixing element 28 is shown and described.
  • two fixing elements 28, 28a in intersecting arrangement are common.
  • an additional transverse screw is usually introduced subsequently, to which the invention is particularly suitable, because it not only facilitates the positioning of the second screw, but safely pretends, as will be explained below with reference to FIGS 11 to 13.
  • two arrangements of the type described in Fig. 4, 5 or 6 to 7 in the longitudinal and circumferential directions e.g. to provide 90 °, offset positioning in the shaft wall or otherwise attached to the shaft, as will be explained with reference to FIGS. 6 to 9.
  • Fig. 8 shows an embodiment in which, as in Fig. 6 and 7, within the shank wall 20 forming sleeve 42, an inner sleeve 43, this is rotatably mounted, is provided.
  • both sleeves 42, 43 are provided from the front end 41 outgoing, circumferentially opposed slots 64, 65 are provided, which, provided with an inlet slope, iw in the longitudinal direction, ie axially to the shaft 16, extend. They each end at a lateral, circumferentially facing recess 66, 67 which have on the outer and inner sleeves 42, 43 in each opposite circumferential direction.
  • Slots 68, 69 are provided in both sleeves 42, 43 at 90 °, which ends in lateral recesses 70, 71.
  • Slots 68, 69 and recesses 70, 71 are the same design as the slots 64, 65 and recesses 66, 67, but the slots 68, 69 in the direction of the shaft axis 8 longer, so that the recesses 70, 71 in an axial Distance from the recesses 66, 67 are.
  • the axial distance of the fixing elements 28, 28a from each other has been dimensioned at their insertion, that it corresponds to the difference in length of the slots 64, 65 of the slots 68, 69.
  • Fig. 8 shows schematically indicated the fixing elements (screws) 28, 28 a.
  • the shaft 16 is advanced in the direction of the arrow 48 against the introduced into the bone, intersecting and axially spaced fixation elements 28 and rotated relative to the fixing elements in the circumferential direction 72 until the fixation element 28, ie the proximal, in the superimposed Slots 68, 69 snaps into place.
  • the fastener 15 is only axially, ie advanced in the direction of arrow 48, whereupon the distal fixing element 28a in the superimposed slots 64, 65 penetrates.
  • both fixing elements 28, 28a lie in the region of the recesses 65, 66, 68, 69 and bear against the base 74 of the respective recesses.
  • the two sleeves 42, 43 in a position in which all the slots 64, 65, 66, 67 are superimposed, so aligned.
  • Figures 10 and 1 1 show an embodiment in which the shaft 16 has an outer sleeve 42, at the front, (distal) end face 41, a said opposing slots 64 open, extend the lateral boundaries in the direction of the longitudinal axis 8.
  • the inner sleeve 43 is arranged, which also have opposing slots 65 which are aligned in the receiving position shown in Fig. 10 with the slots 64 of the outer sleeve 42.
  • the inner sleeve 43 is easily rotatable in the front (distal) region 24 in the Outer sleeve out, so that the fastening element 15 may be formed in part of its length as a light but stable tube substantially.
  • the fixing element 28 comes to lie in the recess 67 and the projection 33 engages over it on one side. It should also be noted that by the arrangement of the bores 77, 78, these are now in the locking position of FIG. 1 1 one above the other, ie aligned continuously, so that there an additional screw can be used as a fixing element 28. At the same time it fixes the sleeves in locking position.
  • Figures 12 and 13 show a similar embodiment, which is similar to the figures 10, 1 1 with respect to the slots 64 in the outer sleeve 42 and the arrangement of the holes 77,78, the inner sleeve 43 but with respect to the axial direction 8 obliquely and slightly helical rotated slots 65 which are bounded by inclined surfaces 75, 76.
  • the inclined surfaces are curved so that the fixing element 28 abuts its penetration into the slot 65 with its outer circumference iw with line contact.
  • the slots are aligned only in the area of the end face 41.
  • the inclined surface 75 forms a sliding surface for the fixing elements 28.
  • the fixing element 28 slides on the inclined surface 75 and thereby automatically rotates the inner sleeve 43 in the counterclockwise locking position.
  • the opposite inclined surfaces 76 and the protrusions 33 formed therefrom lock the fixing element 28 in the cooperating slots 64, 65. It thus eliminates here a manual rotation of the slots, as this happens automatically.
  • the holes 77 and 78 are brought into alignment in the sleeves, so that an additional fixing elements 28a can be introduced, which also determines the inner sleeve in position.
  • the Position of the additional fixing elements of both the longitudinal and the angular position is set at appropriate distances from the position of the first gripped screw 28.
  • Extension 39 oblique slot 40 front face 41st

Abstract

Élément de consolidation pourvu d'une tige (16) pouvant être introduite dans un os afin de fixer ladite tige dans l'os, qui comporte dans sa zone avant (24) dans la direction d'introduction (48) un dispositif d'accouplement (25) qui saisit des éléments de fixation (28, 28a) vissés dans l'os perpendiculairement à la tige en forme de vis, pour rotation de la tige (16) ou rotation de deux douilles situées l'une dans l'autre, et qui est retenue par lesdites vis. Le dispositif d'accouplement peut être formé par des spirales qui provoquent simultanément, par leur rotation, une avance de l'élément de consolidation (15). L'élément de consolidation (15) sert en premier lieu à réunir et à fixer des parties d'un os long (11) cassé. L'élément de consolidation permet de saisir des vis préalablement installées dans l'os et de s'y fixer, ainsi que de positionner de manière sûre des vis inclinées introduites ensuite. Ledit élément d'accouplement peut également comporter des fentes (40, 44, 64, 65, 68 et 69) ainsi, éventuellement, que des évidements latéraux (66, 67, 70, 71) qui reçoivent les éléments de fixation.
PCT/EP2015/077467 2014-11-26 2015-11-24 Élément de consolidation WO2016083355A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102014117319.8 2014-11-26
DE102014117319.8A DE102014117319A1 (de) 2014-11-26 2014-11-26 Befestigungselement

Publications (1)

Publication Number Publication Date
WO2016083355A1 true WO2016083355A1 (fr) 2016-06-02

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Application Number Title Priority Date Filing Date
PCT/EP2015/077467 WO2016083355A1 (fr) 2014-11-26 2015-11-24 Élément de consolidation

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DE (1) DE102014117319A1 (fr)
WO (1) WO2016083355A1 (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102014119011A1 (de) 2014-12-18 2016-06-23 Universität Rostock Positionierungsvorrichtung für die Anbringung von Befestigungselementen in Knochen

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3347333A1 (de) * 1982-12-24 1984-06-28 Mecron Medizinische Produkte Gmbh, 1000 Berlin Kompressionsnagelanordnung
CH668173A5 (de) * 1984-05-14 1988-12-15 Synthes Ag Vorrichtung zum fixieren von roehrenknochenfrakturen mit einem knochenmarknagel und mindestens einem zur verriegelung dienenden querbolzen.
CH681273A5 (fr) * 1988-12-16 1993-02-26 Sulzer Ag
EP0865769A1 (fr) * 1997-03-19 1998-09-23 Osteo Ag Clou intra-médullaire modulaire
US20080312702A1 (en) * 2005-04-06 2008-12-18 Andre Schlienger Reference Pin
DE102007051136A1 (de) * 2007-05-23 2009-04-30 Eichhorn, Stefan, Dipl.-Ing. Verriegelbarer Marknagel und Vorrichtung zum Fixieren

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3924610A1 (de) * 1988-07-28 1990-03-22 Jawdat Dr Med Georges Distraktionsnagelanordnung zur anwendung bei knochenfrakturen
DE102007029090A1 (de) * 2007-06-21 2008-12-24 Plus Orthopedics Ag Vorrichtung zur Osteosynthese gelenknaher Knochenfrakturen

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3347333A1 (de) * 1982-12-24 1984-06-28 Mecron Medizinische Produkte Gmbh, 1000 Berlin Kompressionsnagelanordnung
CH668173A5 (de) * 1984-05-14 1988-12-15 Synthes Ag Vorrichtung zum fixieren von roehrenknochenfrakturen mit einem knochenmarknagel und mindestens einem zur verriegelung dienenden querbolzen.
CH681273A5 (fr) * 1988-12-16 1993-02-26 Sulzer Ag
EP0865769A1 (fr) * 1997-03-19 1998-09-23 Osteo Ag Clou intra-médullaire modulaire
US20080312702A1 (en) * 2005-04-06 2008-12-18 Andre Schlienger Reference Pin
DE102007051136A1 (de) * 2007-05-23 2009-04-30 Eichhorn, Stefan, Dipl.-Ing. Verriegelbarer Marknagel und Vorrichtung zum Fixieren

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