WO2019079856A1 - Implant pour fractures tibiales - Google Patents

Implant pour fractures tibiales

Info

Publication number
WO2019079856A1
WO2019079856A1 PCT/AU2018/051153 AU2018051153W WO2019079856A1 WO 2019079856 A1 WO2019079856 A1 WO 2019079856A1 AU 2018051153 W AU2018051153 W AU 2018051153W WO 2019079856 A1 WO2019079856 A1 WO 2019079856A1
Authority
WO
WIPO (PCT)
Prior art keywords
implant
tibial
tibia
tibial plate
support portion
Prior art date
Application number
PCT/AU2018/051153
Other languages
English (en)
Inventor
Xinhua Wu
Ton Tran
Chung Lun Jerome Pun
Bernard Chen
Original Assignee
Monash University
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2017904322A external-priority patent/AU2017904322A0/en
Application filed by Monash University filed Critical Monash University
Publication of WO2019079856A1 publication Critical patent/WO2019079856A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A61F2002/2892—Tibia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Definitions

  • the present invention relates to a tibial plate implant for treating or supporting a tibial fracture.
  • the present invention has been developed for treating a tibial fracture specifically when a knee implant has already been implanted, but it is not limited to such a use.
  • a tibia comprises the distal end of the tibia, the proximal end or head of the tibia and the length or shaft of the tibia between the distal and proximal ends.
  • the proximal end of the tibia (hereinafter the "proximal tibia") comprises the medial tibial condyle, the lateral tibial condyle and the tibial tuberosity.
  • a tibia 10 of the right leg is shown in anterior, lateral and posterior views and comprises a medial tibial condyle 1 1 , a lateral tibial condyle 12, a tibial tuberosity 13 and a tibial shaft 14.
  • a fracture of the proximal tibia is a bone fracture or break in the continuity of the bone occurring in the proximal part of the tibia.
  • Proximal tibial fractures affect the knee joint in terms of stability and motion.
  • Proximal tibial fractures may be low energy fractures, which are commonly caused by osteoporotic bone changes or they may be high energy fractures, which are commonly the result of falls, motor vehicle accidents or sports or exercise related injuries.
  • Common approaches to treating tibial fractures include plating and/or screw fixation.
  • Tibial plate implants for stabilising a fracture of the proximal tibia exist already.
  • These plate implants typically comprise an elongate support portion for attaching the implant to the length of the tibia, i.e. to the tibial shaft, and a head portion at one end of the support portion.
  • the head portion of the implant is typically wider than the width of the support portion and is dimensioned to be attached to the medial/lateral or posterior surfaces of the proximal tibia using screws inserted in a transverse orientation (transverse to the length of the tibia).
  • a total knee implant generally comprises three components, namely a femoral component, a tibial component, and a patellar component.
  • the tibial component of the total knee implant is implanted at the proximal end of the tibia and includes an intramedullary keel that is inserted into the medullary cavity at the proximal tibia to stabilise the tibial component.
  • a total knee implant presents a difficulty for the implantation of a tibial plate implant for stabilising a fracture of the proximal tibia.
  • the presence of the tibial component of the total knee implant and its intramedullary keel limits the area available for fixation of a tibial implant at the proximal tibia.
  • the intramedullary keel can present a barrier to the passage of fasteners into the tibia in a manner which allows adequate stability of the fracture and the tibial implant or prosthesis.
  • current tibial plate implant designs can not only preclude the restoration of bony stability but can also fail to provide support for the tibial component of the total knee implant.
  • existing proximal tibial plate implants can have two major disadvantages. Firstly, existing proximal tibial plate implants may not provide sufficient support around the proximal tibia and may not prevent subsidence of the tibial component of a total knee implant. Secondly, existing proximal tibial plate implants are not necessarily suitable or optimal for implanting to a tibia that has previously received a total knee implant.
  • the tibial plate implant of the present invention aims to address either or both of these disadvantages of existing proximal tibial plate implants.
  • the present invention provides a tibial plate implant including, an elongate support portion for connection to, and support of, a lengthwise section of the tibia and a connection portion extending laterally from the support portion for connection to an anterior surface of a proximal part of the tibia.
  • a tibial plate implant according to the invention advantageously provides a connection portion for connection to an anterior surface of the proximal part of the tibia. This differs from prior art tibial plate implants that connect to the other surfaces of the proximal tibia.
  • the fasteners that are used to make the connection can extend past the intramedullary keel of the tibial component of a total knee implant (hereinafter just referred to as a "knee implant") and so the fasteners can extend further into the proximal tibia and thus provide improved connection between the tibial plate implant and the tibia. This will also promote better mechanical strength of the final construct.
  • the elongate support portion of the tibial plate implant is provided for fastening to a lengthwise section of the tibial shaft along its lateral side.
  • the length of the support portion extending from the connection portion can be in the range of about 150 mm to about 250 mm. This allows the support portion to extend down the tibial shaft to stabilise a fracture of the tibial shaft. This will allow the implant of the present invention to accommodate various fracture extensions.
  • the tibial plate implant will generally be made of titanium or a titanium alloy and with such a material, the thickness of the support portion can be in the range of about 3 mm to about 4 mm.
  • the support portion is intended to overlie and be connected to the lateral surface of the tibial shaft.
  • the junction or connection between the support portion and the connection portion is intended to be made at the anterolateral corner of the proximal tibia with the support portion of the implant extending down and along the lateral side of the tibial shaft.
  • the implant of the present invention is intended to rest closely against the surface of the tibia at both the support portion and the connection portion.
  • the implant of the present invention can include sections that are spaced from the surface of the tibia if required or if acceptable. This might allow for example, a more generic form of implant to be employed across a range of anatomically different tibia shapes or configurations.
  • the profile or contour of the implant can change depending on the anatomical location and bone size of the patient.
  • the support portion and connection portion have a profile or contour that allows the tibial implant to be in substantially flush, flat or surface-to-surface contact with the surface of the tibia when the support portion is connected to the lateral surface and the connection portion is in substantially flush, flat or surface-to-surface contact with the anterior surface of the proximal part of the tibia.
  • the proximal part of the tibia comprises the medial condyle, lateral condyle and tuberosity.
  • connection portion is in substantially flush, flat or surface-to-surface contact with the tibial condyles (medial and lateral) and tuberosity when the connection portion is attached to the medial and lateral tibial condyles.
  • the support portion and connection portion may also have a profile or contour that allows the tibial implant to hug the lateral surface of the tibia when the support portion is connected to the lateral surface and the connection portion is connected to the tibial condyles and tuberosity.
  • This preferred form of the invention is expected to provide improved support for a peri-prosthetic tibial fracture.
  • the profile or contour of the support portion can include a lengthwise curvature or arch as the support portion extends in use from a position remote from the proximal tibia to a position closer to the proximal tibia and actually at the proximal tibia.
  • This curvature or arch can occur progressively along the length of the tibial shaft, or more likely, will occur towards the proximal tibia as the diameter of the tibia increases from the tibial shaft to the proximal tibia.
  • the width of the support portion can be substantially constant along its length or it can vary, such as increasing from the free end which in use is remote from the proximal tibia towards the proximal tibia. An increase in width can occur close to the junction or connection between the support portion and the connection portion.
  • the width of the support portion can be in the range of 10 mm to 20 mm and example widths of the support portion include 15 mm and 20 mm.
  • the free end of the support portion can be tapered and chamfered to facilitate submuscular and mini-invasive placement.
  • the support portion can include openings along its length for allowing the insertion of fasteners for fastening the support portion to the tibial shaft. Any number of openings can be provided and they can be provided in any position. In some forms of the invention, openings are provided in a substantially linear line along the length of the support portion.
  • connection portion extends laterally and in some forms of the invention, substantially perpendicularly from a proximal end of the support portion.
  • the connection portion therefore forms a cantilever with the support portion and distributes the load placed upon the proximal tibia and the connection portion, to the support portion.
  • the support portion in turn distributes the load along the length of the tibial shaft.
  • the angle at which the connection portion extends from the support portion may be in the region of between about 70 degrees and about 100 degrees and includes angles of about 70 degrees, about 75 degrees, about 80 degrees, about 85 degrees, about 90 degrees, about 95 degrees and about 100 degrees.
  • Example prototypes of the implant of the invention include an angle of about 90 degrees.
  • connection portion extends from the support portion can be taken from the general lengthwise extension of the support portion, rather than from the section of the support portion that actually connects to the connection portion.
  • the section of the support portion that actually connects to the connection portion can be at an angle to the remainder of the support portion. That is, the section of the support portion that actually connects to the connection portion can deviate from remainder of the support portion so as to engage or connect to the connection portion at an angle that is less than the angle between the connection portion and the remainder of the support portion.
  • connection portion is for connecting the implant to the anterior surface of the proximal part of the tibia (the proximal tibia).
  • the length of the connection portion is such that the connection portion extends substantially circumferentially from the lateral surface of the tibia to the medial tibial condyle.
  • the length of the connection portion may be in the region of between about 50 mm to about 90 mm.
  • the implant is a peri-articular implant, wherein the length of the connection portion allows the connection portion to extend circumferentially from the lateral surface of the tibia to the medial surface of the medial condyle.
  • connection portion can be curved and have a profile or contour so as to be in substantial surface-to-surface contact with the lateral surface of the tibia and the anterior surface of the tibial condyles and preferably in substantial surface-to-surface contact with the lateral surface of the lateral tibial condyle and the medial surface of the medial condyle. In situ, the tibial implant is anterolateral of the tibia.
  • the cross section of the connection portion can be substantially rectangular or any other suitable shape or configuration.
  • the width of the connection portion may be in the region of between about 10 mm and about 30 mm. Example widths of the connection portion include about 12 mm and about 15 mm.
  • the thickness of the connection portion may be in the region of between about 3 mm and about 4mm. Example thicknesses of the connection portion include about 3 mm and about 4 mm.
  • the connection portion can comprise three areas as will be later described in the figures.
  • the first area is closest to the support portion and as such can be identified as being at or adjacent the junction or connection between the support portion and the connection portion.
  • the first area is the part of the connection portion that is in contact with the lateral tibial condyle. Openings can be provided in this first area to facilitate insertion of fasteners into the lateral proximal tibial condyle in an anterior-posterior orientation.
  • the fasteners may be inserted substantially perpendicularly to the connection portion or they may be inserted at an angle to the connection portion. The positioning of the openings may provide for or facilitate straight or angular insertion of the fasteners or screws that are to be used.
  • the insertion of fasteners anterior-posteriorly through the lateral tibial condyle has the advantage of having an unobstructed or substantially unobstructed path. That is, the intramedullary keel of the tibial component of a knee implant does not obstruct the insertion of the fasteners. Furthermore, the length of fasteners that may be used is also not restricted by the presence of the intramedullary keel and thus the length of fasteners can be such as to extend substantially the full distance from one surface of the tibial condyle to the opposite surface.
  • the second area is the part of the connection portion that is in contact with the tibial tuberosity.
  • this area of the connection portion is contoured to provide a tendon accommodating portion.
  • the tendon accommodating portion is thus disposed approximately centrally, lengthwise of the connection portion.
  • the contour can thus underlie the patellar tendon, which lies anteriorly to and is in contact with the tendon accommodating portion when the implant is implanted.
  • the tibial implant of the invention either has minimal interference with or in fact does not interfere with the biomechanical function of the patellar tendon.
  • connection portion extends to connect to an anterior surface of a tibial condyle of the tibia, which, as described above, differs from prior art tibial implants that connect to the lateral surface of the lateral tibial condyle.
  • the contour facilitates substantial surface-to-surface contact between the tendon accommodating portion and the tibial tuberosity, and the region of the proximal tibia proximal to the tibial tuberosity and located between the medial condyle and the lateral condyle.
  • the tendon accommodating portion is absent openings for fasteners.
  • the third area is the area of the connection portion that is remote from the support portion and that is in contact with the medial tibial condyle. Openings provided in this area facilitate insertion of fasteners into the medial tibial condyle in an anterior-posterior orientation.
  • the fasteners may be inserted substantially perpendicularly to the connection portion or they may be inserted at an angle to the connection portion. In some forms of the present invention, the positioning of the openings may provide for or facilitate straight or angular insertion of the fasteners or screws that are to be used.
  • the insertion of fasteners anterior-posteriorly through the medial tibial condyle has the advantage of having an unobstructed or substantially unobstructed path.
  • the intramedullary keel of the tibial component of a knee implant does not obstruct the insertion of the fasteners.
  • the length of fasteners that may be used is also not restricted by the presence of the intramedullary keel and thus the length of fasteners can be such as to extend substantially the full distance from one surface of the medial tibial condyle to the opposite surface.
  • an array of three openings is provided in each of the first and third areas for the receipt of one, two or three fasteners in each area.
  • the implant of the present invention allows fasteners to be inserted in a region of the proximal tibia that is not obstructed by the keel of the tibial component of a knee implant and thus longer fasteners may be used.
  • the use of longer fasteners provides more secure fastening of the implant to the tibia, specifically the proximal tibia and can also support a greater load without failure. This also has the advantage of reducing the chance of the implantation of the tibial implant causing further weakening of the structure of the proximal tibial.
  • Tibial plate implant fasteners can be inserted through an opening, a fastener hole or slot, also described as transfixation holes and screw holes as provided in the tibial plate implant for the purpose of attaching or connecting the tibial plate implant to a tibia.
  • the use of locking screws is also an option depending upon the severity of the tibial bone damage. Static locking, by insertion of screws in proximal and distal locations of the implant, neutralizes rotational stresses while preventing shortening of the limb.
  • Exemplary fasteners may be locking screws, cortical screws, cannulated screws and cancellous screws. Any suitable fastener may be used.
  • the openings in the tibial plate implant comprise thread portions or are threaded for threaded engagement with a fastener.
  • the thread portion may be configured with different thread pitches to accommodate bone screws commonly used to secure plate implants.
  • One or more of the openings may also be countersunk to accommodate the head of a fastener so that the fastener head is substantially flush with the outer surface of the tibial plate implant after insertion.
  • the openings are provided at an angle from the orthogonal orientation to allow for variable direction of screw insertion.
  • the angle from the orthogonal orientation is about 5 degrees, about 6 degrees, about 7 degrees, about 8 degrees, about 9 degrees, about 10 degrees, about 1 1 degrees, about 12 degrees, about 13 degrees, about 14 degrees, about 15 degrees, about 16 degrees, about 17 degrees to about 20 degrees.
  • the number of openings provided is dependent on the requirements of the tibial plate implant, such as the size of the implant. For example, an implant having a long support portion could have more openings along the length of the support portion as compared to an implant having a shorter support portion.
  • the openings may be of different shapes.
  • the openings can be circular.
  • Other possible opening shapes include an elongate opening, such as a slot that facilitates placement of the implant by allowing the implant to move relative to the shaft of the fastener prior to final fastening.
  • movement of the implant on the tibia after final fastening might be a characteristic that is found to be advantageous and which could be provided by openings in the form of slots.
  • Such slots could be straight or curved and could be of varying width such as tapered.
  • the distal end of the support portion of the tibial plate implant is tapered for facilitating submuscular placement of the implant of the support portion during surgery.
  • the tapered end is formed by reducing the thickness of the support portion at the distal end, for example from about 4 mm to 0.5 mm over about 40 mm of the support portion.
  • the edges of the tibial implant of the present invention may be chamfered to reduce chance of soft tissue injury during and after implantation.
  • the chamfer may be by rounding of the edges.
  • the tibial plate implant may be manufactured by additive manufacturing. Suitable materials for manufacturing the implant are biocompatible materials such as stainless steel, cobalt-chromium alloys, titanium, titanium alloys, ceramic, etc. Any suitable biomaterial may be used.
  • the implant may also be manufactured by known manufacturing processes such as casting.
  • One aspect of the present invention is a method of treating a patient in need of a tibial plate implant, comprising implanting the patient with a tibial plate implant according to the invention as hereinbefore described.
  • the implant is implanted to a tibia with a pre-existing knee implant.
  • an advantage of the tibial plate implant of the present invention is the ability to secure the implant to the tibia by way of fasteners inserted anterior-posteriorly into the medial and the lateral tibial condyles.
  • the insertion of fasteners anterior-posteriorly through the medial and lateral condyles has the advantage of having an unobstructed or substantially unobstructed path, in which the intramedullary keel of the tibial component of a knee implant does not obstruct the insertion of fasteners.
  • the length of screws that may be used is also not restricted by the presence of the intramedullary keel.
  • the tibial plate implant of the present invention allows the screws to be inserted in a region of the proximal tibia that is not obstructed by the keel of the tibial component of a knee implant and thus longer screws may be used.
  • the use of longer screws provides more secure fastening of the tibial plate implant to the tibia and can also support a greater load without failure. This also has the advantage of reducing the chance of failure of the final construct.
  • the dimensions of the patient's tibia are used to manufacture the tibial plate implant according to the invention as hereinbefore described.
  • the dimensions of a patient's tibia may be obtained by any suitable method such as X-ray, cross-section tomography (CT scan), magnetic resonance imaging (MRI), etc.
  • Figures 1 A and 1 B illustrate an example form of a tibial plate implant of the present invention in posterior and anterior views in which Figure 1 A shows the tibial plate implant without fastener openings and Figure 1 B shows the tibial plate implant with fastener openings.
  • Figures 2A and 2B illustrate the tibial plate implant of Figures 1 A and 1 B from top and side views, in which in the side view of Figure 2B, only the proximal end of the tibial plate implant is illustrated.
  • Figures 3A and 3B illustrate respectfully, the tibial plate implant of Figures 1 A and 1 B in situ with a knee implant present in the proximal end of the tibia.
  • Figure 4 illustrates a cross section view taken through IV-IV of the implanted tibial implant of Figure 3B.
  • Figures 5A, 5B and 5C respectfully illustrate an anterior view, a lateral view and a posterior view of a tibia of the right leg for the purpose of assisting the understanding of the construction of the tibial plate implant of the present invention.
  • Figure 1 A illustrates two views of an example form of a tibial plate implant (hereinafter a tibial implant) according to the present invention.
  • Figure 1 A is intended for illustrating the shape of the tibial implant of the present invention and does not include fastener openings as shown in Figure 1 B.
  • the tibial implant of Figures 1 A and 1 B will also be described with general reference to the tibia illustrated in Figures 5A, 5B and 5C, in order for the position of implantation of the tibial implant to be understood.
  • tibia of Figures 5A, 5B and 5C is not fractured and represents a general tibia shape so that the present invention is not restricted to the specific form of tibia illustrated in Figures 5A, 5B and 5C.
  • Figure 1 A illustrates a tibial implant 20 which has an elongate support portion 21 , which may be attached along the length of the tibial shaft 14 and to the lateral surface 23 of the tibial shaft 14. The attachment is by bone screws inserted through openings in the support portion 21 . Neither the bone screws or openings are shown in Figure 1 A, however openings are illustrated in the later figures and will be discussed later in relation to those figures.
  • the support portion 21 has a profile or contour that includes a slight curvature and the cross-section of the support portion 21 is substantially rectangular except at the end 22 of the support portion 21 .
  • the slight curvature in the support portion 21 allows the support portion 21 to be in substantially surface-to-surface contact with the lateral surface 23 of the tibia 10 when the support portion 21 is connected to the lateral surface 23.
  • the support portion 21 has a range of length of 150 mm to about 200 mm and a width of about 13 mm.
  • connection portion 24 extends laterally and substantially perpendicularly (at an angle a) from a proximal end 25 of the support portion 21 .
  • the angle a at which the connection portion extends from the support portion is shown between the proximal end 25, which is the section of the support portion 21 that actually connects to the connection portion 24, rather than between the connection portion 24 and the remainder of the support portion below the proximal end 25.
  • the angle a can be taken as shown in Figure 1 A or between the connection portion 24 and the remainder of the support portion below the proximal end 25.
  • the connection portion 24 may be connected to an anterior surface of a tibial condyle.
  • connection portion 24 is such that the connection portion 24 extends circumferentially from the lateral surface of the tibia to the medial tibial condyle.
  • the connection portion 24 has a profile or contour that includes a curve so as also to be in substantial surface-to-surface contact with the lateral surface of the tibia and the anterior surfaces of the tibial condyles. In situ, the tibial implant is anterolateral of the tibia.
  • the cross section of connection portion 24 is substantially rectangular.
  • the length of the connection portion 24 is about 90 mm, which means the connection portion 24 extends from the lateral surface of the lateral condyle to the medial surface of the medial condyle.
  • the width of the connection portion 24 is about 15 mm and is about 3 mm thick.
  • connection portion 24 comprises areas 26, 27 and 28.
  • areas 26 and 27 are each provided with a pattern or array of three openings 29 and 30, respectively, to facilitate the use of bone screws or fasteners to connect the connection portion 24 to the anterior surfaces of the tibial condyles.
  • These openings 29 and 30 in the respective arrays are provided at an angle of about 15 degrees from the orthogonal orientation.
  • the area 28 is a tendon accommodating portion and is free of openings so that bone screws or fasteners are not driven through that area of the connection portion 24. Additionally, the tendon accommodating portion 28 is contoured to receive the patellar tendon, which lies anteriorly to and is in contact with the tendon accommodating portion 28 when the tibial implant 20 is implanted.
  • a projection 32 is formed by the support portion 21 being offset from the end of the connection portion 24.
  • the projection 32 further increases the contact surface between the tibial implant 20 and the proximal tibia.
  • All the edges of the support portion 21 and connection portion 24 are finished to remove sharp edges that may otherwise damage surrounding tissue after the tibial implant 20 is implanted. Suitable finishing methods include rounding and chamfering.
  • Figure 1 B shows that the support portion 21 is provided with a plurality of openings 34 along its length to facilitate the use of bone screws or fasteners to connect the support portion 21 to the lateral surface of the tibia. These openings 29 and 30 are provided at an angle of about 15 degrees from the orthogonal orientation. The diameters of the openings 34 are such that common bone screws used for securing implants and/or plates to bone may be used.
  • the end 22 of the support portion 21 that is distal to the connecting portion 24 is tapered and chamfered to facilitate submuscular placement of the support portion 21 during surgery.
  • Figure 2A shows a top down view of the tibial implant 20 of the earlier figures.
  • the contour of the tendon accommodating portion 28 relative to the contour of areas 26 and 27 can be seen in this view.
  • the contour of the tendon accommodating portion 28 is intended to have a complementary curvature to the tibial tuberosity 13 of Figure 5, so that the connection portion 24 is flush or flat against the tibial tuberosity or in substantial surface-to-surface contact with the tibial tuberosity.
  • Figure 2B shows a side view of a portion of the implant 20 in which the majority of the support portion 21 is not shown. The curvature of the connection portion 24 and the areas 26, 27 and 28 can be seen in this view.
  • Figure 3A shows in anterior view a representative tibia 10 of the right leg with the implant 20 in position against the lateral surface of the tibia and the anterior surface of the tibial condyles of the tibia 10.
  • the implant 20 is shown as in Figure 1 A in which no fastener openings are provided.
  • the proximal end of the tibia 10 comprises the medial condyle 1 1 , the lateral condyle 12 and the tibial tuberosity 13 as shown in Figure 5.
  • Figure 3B shows the same view as Figure 3A but with the implant 20 as shown in Figure 1 B in which fastener openings are provided. Bone screws are not shown in Figure 3B but would be inserted for implantation of the tibial implant 20 on the tibia 10.
  • the tibial component of a total knee implant 31 is shown including an intramedullary keel 45.
  • the intramedullary keel 45 would not be visible ordinarily as it would be concealed within the tibial head, but its position is shown in Figures 3A and 3B in broken line for the purpose of explanation.
  • the tibial implant 20 is anterolateral of the tibia 10.
  • the support portion 21 is in substantial surface-to-surface contact with the lateral surface 23 of the tibia 10 and the connection portion 24 extends circumferentially from the lateral tibial condyle 12 to the medial tibial condyle 1 1 .
  • the tendon accommodating portion 28 is substantially in line with the tibial tuberosity 13.
  • the positions of the openings 29 and 30 are shown relative to the keel 45 and relative to the medial condyle 1 1 , the lateral condyle 12 and the tibial tuberosity 13.
  • the tibial implant illustrated in Figures 1 to 3 is manufactured as a unitary device using additive manufacturing.
  • the material used is titanium alloy or other biocompatible metallic.
  • Figure 4 is a cross sectional view taken approximately through IV-IV of Figure 3B.
  • Figure 4 thus shows in cross section, the connecting portion 24 of the tibial implant 20 in close surface to surface contact with the anterior surface of the tibial condyle of the tibia.
  • the keel 45 of the total knee implant is also shown in cross-section.
  • the remaining portion of Figure 4 is the body of the proximal tibia.
  • the portion of the tibial implant that would connect to the tibial head would extend only around the lateral surface of the proximal tibia so that the fasteners would need to extend through the shaded portions of the tibial bone marked 50 and 51 . Further fasteners could be driven into the tibial bone through the further shaded section marked 52. The fasteners would thus be driven into the tibial bone generally laterally to the direction in which they are driven in Figure 4.
  • fasteners 54 can be driven into the tibial bone on either side of the implant keel 45 and the fasteners thus have a greater area of bone in which to extend and a greater length of bone to accommodate longer fasteners.
  • three fasteners 54 are shown inserted through area 26, while two fasteners 54 are shown inserted through area 27. This simply reflects the approximate nature of the cross sectional view taken approximately through IV-IV of Figure 3B.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne un implant de plaque tibiale (10) comprenant une partie support allongée (21) pour la connexion à, et le support de, une section longitudinale (14) d'un tibia (10), et une partie connexion (24) s'étendant latéralement à partir de la partie support (21) pour une connexion à une surface antérieure de la partie proximale du tibia (10). En particulier lorsque la plaque est utilisée conjointement avec un implant de genou total, l'agencement de la plaque fournit une liaison mécaniquement résistante à la surface antérieure d'une partie proximale du tibia, du fait que des éléments de fixation insérés à travers la plaque peuvent s'étendre de part et d'autre d'une quille intramédullaire d'un composant tibial de l'implant de genou total.
PCT/AU2018/051153 2017-10-25 2018-10-25 Implant pour fractures tibiales WO2019079856A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AU2017904322A AU2017904322A0 (en) 2017-10-25 Implant for Tibial Fractures
AU2017904322 2017-10-25

Publications (1)

Publication Number Publication Date
WO2019079856A1 true WO2019079856A1 (fr) 2019-05-02

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111904570A (zh) * 2020-09-21 2020-11-10 山东大学齐鲁医院(青岛) 一种胫骨结节骨折用固定结构
CN114557757A (zh) * 2022-01-21 2022-05-31 承德医学院附属医院 一种胫骨平台后柱骨折新型结构钛板

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Publication number Priority date Publication date Assignee Title
US20100030277A1 (en) * 2008-07-31 2010-02-04 Haidukewych George J Periarticular bone plate with biplanar offset head member
FR2980967B1 (fr) * 2011-10-10 2013-11-15 D L P Sarl Plaque d'osteosynthese pour une technique d'osteotomie tibiale de valgisation par addition interne
US20170209194A1 (en) * 2016-01-21 2017-07-27 Biomet Manufacturing, Llc Anatomic plates for medial proximal tibia

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Publication number Priority date Publication date Assignee Title
US20100030277A1 (en) * 2008-07-31 2010-02-04 Haidukewych George J Periarticular bone plate with biplanar offset head member
FR2980967B1 (fr) * 2011-10-10 2013-11-15 D L P Sarl Plaque d'osteosynthese pour une technique d'osteotomie tibiale de valgisation par addition interne
US20170209194A1 (en) * 2016-01-21 2017-07-27 Biomet Manufacturing, Llc Anatomic plates for medial proximal tibia

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"4.5mm Proximal Tibia Plate with Round Holes", AUXEIN, 6 October 2017 (2017-10-06), XP055594239, Retrieved from the Internet <URL:https://www.auxein.com/product/4-5mm-proximal-tibia-plate-with-round-holes/> [retrieved on 20181123] *
"Spoon Plate", SURGIVAL, 23 November 2018 (2018-11-23), XP055594221, Retrieved from the Internet <URL:https://www.surgival.com/en/portfolio-item/placa-cuchara> *
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111904570A (zh) * 2020-09-21 2020-11-10 山东大学齐鲁医院(青岛) 一种胫骨结节骨折用固定结构
CN114557757A (zh) * 2022-01-21 2022-05-31 承德医学院附属医院 一种胫骨平台后柱骨折新型结构钛板

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