WO2020202217A1 - Table pédiatrique avancée d'application de spica - Google Patents

Table pédiatrique avancée d'application de spica Download PDF

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Publication number
WO2020202217A1
WO2020202217A1 PCT/IN2020/050326 IN2020050326W WO2020202217A1 WO 2020202217 A1 WO2020202217 A1 WO 2020202217A1 IN 2020050326 W IN2020050326 W IN 2020050326W WO 2020202217 A1 WO2020202217 A1 WO 2020202217A1
Authority
WO
WIPO (PCT)
Prior art keywords
foot
support
spica
traction
hip
Prior art date
Application number
PCT/IN2020/050326
Other languages
English (en)
Inventor
Ashish Sharma
Prashant Kumar Sharma
Original Assignee
Ashish Sharma
Prashant Kumar Sharma
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 Ashish Sharma, Prashant Kumar Sharma filed Critical Ashish Sharma
Publication of WO2020202217A1 publication Critical patent/WO2020202217A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/0036—Orthopaedic operating tables
    • A61G13/0081—Orthopaedic operating tables specially adapted for hip surgeries
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G2200/00—Information related to the kind of patient or his position
    • A61G2200/10—Type of patient
    • A61G2200/14—Children

Definitions

  • the present invention relates generally to the field of orthopedics and related apparatus and equipment. More specifically, this invention pertains to advanced pediatric spica table which is used to apply Spica Cast to treat Femur Bone Fractures , after Close & open reduction of DDH(Developmental dysplasia of Hip) and immobilize hip joint after hip surgeries in Children.
  • Femur bone also called thigh bone, is the strongest and longest bone in human body. Despite the size and strength of the femur, it gets fractured in adults and in children. It may be due to vehicle accident on road, a fall from bed or in playground or accidental hitting with a piece of furniture at home or anything which might result in broken leg. The severity of fracture may vary from hairline crack to complex injury involving damage to surrounding soft tissues as well.
  • Methods of treating Femur bone fractures in children While treating such fractures in children, some unique factors and considerations must be kept in mind. These factors include the configuration of the fracture, level of fracture, patient’s size and age as well as adjoining soft tissue injury. Sometimes shortening of bone is also a cause of concern while treating fracture.
  • L Pavlik harness (Prior art Fig 1) - Fractures in these very young children and in infants are usually treated by placing the child in a Pavlik harness, (Prior art Fig 1) a cloth brace that helps hold the thigh in the proper position while it heals.
  • the Spica Cast (Prior art Fig 2) - Among children in this age group, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. This procedure takes place in the operating room.
  • the Spica cast usually extends from mid-chest down the length of the affected leg and halfway down the other leg. This is the most acceptable treatment method of fracture shaft femur in age group six months to five years. Children remain in the spica cast for a period ranging from six weeks to three months. It continues to be the safest and least complicated method for treating fractures among this age group and yields excellent results. 3.
  • Elastic Stable Intramedullary Nails(ESIN) or Rods (Prior art Fig 3) - Pediatric
  • orthopedists have started using intramedullary nails or rods made from strong, lightweight, and flexible titanium to stabilize femur fractures in children aged five and older. After using this nail or rod, generally no casting is required.
  • Anatomical terms of movement are used to describe the actions of muscles on the skeleton. Muscles contract to produce movement at joints, and the subsequent movements can be precisely described using the terminology below. As for anatomical terms of location, the terms used assume that the body starts in the anatomical position. Flexion and extension (Prior art Fig 3) are movements that occur in the sagittal plane. They refer to increasing and decreasing the angle between two body parts:
  • Flexion refers to a movement that decreases the angle between two body parts. When the knee flexes, the ankle moves closer to the buttock, and the angle between the femur and tibia gets smaller. Extension refers to a movement that increases the angle between two body parts. Extension of the knee straightens the lower limb.
  • Abduction and adduction are two terms that are used to describe movements towards or away from the midline of the body.
  • Abduction is a movement away from the midline, just as abducting someone is to take them away. For example, abduction of the shoulder raises the arms out to the sides of the body.
  • Adduction is a movement towards the midline. Adduction of the hip squeezes the legs together. In fingers and toes, the midline used is not the midline of the body, but of the hand and foot respectively. Therefore, abducting the fingers spreads them out.
  • Medial rotation is a rotational movement towards the midline. It is sometimes referred to as internal rotation. To understand this, we have two scenarios to imagine. Firstly, with a straight leg, rotate it to point the toes inward. This is medial rotation of the hip. Secondly, imagine you are carrying a tea tray in front of you, with elbow at 90 degrees. Now rotate the arm, bringing your hand towards your opposite hip (elbow still at 90 degrees). This is internal rotation of the shoulder.
  • ABOUT SPICA TABLE Spica table is a table or a platform which provides both stability and maneuverability while applying a hip spica cast in the treatment of pediatric femur bone fractures , Close and open Reduction of developmental dysplasia of Hip and immobilization hip joint after surgeries aroud hip joint. Therefore it should be adjustable, efficient and user friendly.
  • Spica Tables can be seen in prior art fig 6, 7, 8, 9 and 10. A few companies are selling these tables under trade names like PELVI PEDAL and ORTHOPEDIATRICS SPICA TABLE
  • Patent application no. US 8,001,633 B2 discloses a spica table, collapsible for storage, which includes stabilizing legs, a separate adjustable Support for the upper body and the buttock, to accommodate patients of differing sizes and individual infinitely adjustable leg and foot supports.
  • Patent application no. US 2012/0180797 A1 discloses a modular table for supporting a patient during application of a spica cast.
  • the table has a support for the patient's upper body and a separate support for the patient's lower body.
  • the supports have coupling members that interface with existing examination or operating tables, or with additional members attached thereto.
  • the coupling members may be placed into features shaped to receive them in one or more spaced-apart positions, or in other embodiments may slide through T-shaped slots or tracks that guide relative alignment of the Supports.
  • the tracks for the two supports may be the same or different; straight or curved; and parallel, perpendicular, or skew.
  • Additional fixtures attach to the table or additional members to assist in applying traction to the patient during the application.
  • Patent application no. US 4,342,451 discloses a generally upright open framework, having patient forearm and hand supports and having a horizontal seat intermediate its height, is supported by a platform mounted on a vertically adjustable pedestal base.
  • Back and torso support members telescopically received by sockets on the platform, form a back rest when the frame is in cast chair position.
  • Base supported universal joint connected foot rests support the feet and legs of a seated patient.
  • the back and torso members are movable to a second position on the platform to form a torso and head support for a supine patient.
  • Telescopic tube extensions are supported by other sockets on the platform and include universal joint connected feet enveloping members for supporting the feet and legs of a supine patient when the frame is in spica table position. Substantially all components forming the frame and supports for a patient or his limbs are movable toward and away from the platform and relative to each other when supporting a patient, either seated or supine, for casting, splinting or bandaging the torso and/or limbs.
  • Traction unit assembly in one of these is for adults bone fracture that tracts whole leg (foot-tibia-thai bone-limb) when applying implant into the bone(for adults) and is not suitable for children.
  • "EXTERNAL ROTATION" of the limb can't be perform on this tables.
  • both the foot travel together so we can't give different abduction and flexion angle movement and height to a single leg. Therefore the patient with different type of fracture (needs different degree of adjustment each one) may not be operatable on these tables.
  • the present invention provides individual foot stability and angle movement.
  • the main objective of present invention is effectively reduction of fracture femur in acceptable alignment and apply spica cast in desired position of hip flexion, abduction and external rotation.
  • hip joint movement flexion, abduction & external rotation
  • independent knee flexion not dependent on hip joint flexion
  • Another object of the present invention is to disclose a spica table which has means to provide accurate and reproducible measurement of angle of hip abduction and flexion.
  • Another object of the invention is to disclose a spica table which has means to provide sustained in-line traction in desired hip abduction and flexion.
  • Yet another object of the present invention is to disclose a spica table which has means to allow controlled external rotation so that distal fracture fragment rotationally aligned with proximal fragment, hence avoiding a least remodeling potential rotational mal union.
  • Yet another object of the present invention is to disclose a spica table which has sliding lower torso platform so that anesthesia induction can be perform on this spica table itself.
  • One more object of the present invention is to disclose a spica table which reduces manpower.
  • One more object of the present invention is to disclose a spica table which is comparatively low in cost despite providing all these exclusive and fundamental desired features.
  • the present invention discloses an advanced spica table which has inbuilt bi-axial angle measurement instrument with the help of which accurate and reproducible values of hip abduction and flexion can be taken.
  • a traction unit which provides sustained in-line traction in desired hip abduction and flexion and external rotation is also part of the spica table.
  • the spica table of present invention has means to allow controlled external rotation so that distal fracture fragment rotationally aligned with proximal fragment, hence avoiding a least remodeling potential rotational mal union along with a sliding platform to support lower torso so that anesthesia induction can be perform on this spica table itself.
  • Fig 1 Prior art - Pavlik harness on a child with developmental hip dysplasia
  • Fig 2 Prior art - Spica cast on a child which immobilizes the leg after realignment.
  • Fig 3 Prior art - X-ray showing flexible intramedullary nails in place.
  • the advanced spica table of present invention is a complete solution with adjustable features in many ways keeping in view the child age group 6 months to 5 years. While setting the spica cast, first of all we need to provide a platform or support for the patient’s head neck and upper torso and sacrum. We also need to provide support to both the feet. Then there is a requirement of flexion, abduction and external rotation movement of hip joint and independent flexion of knee (not dependent on hip flexion) for proper reduction of the fracture and apply spica cast in acceptable position. Advanced Spica Table of present invention is capable of providing all these movements effectively, precisely and values are reproducible increasing validity of machine. There is also need of measurement of accurate hip abduction and flexion angle which is presently done in a manual manner by the doctor or his assistant. It sometimes causes human error and the accuracy is compromised. But the
  • Present invention overcomes this limitation by having a detachable bi-axial angle measuring instrument which is the heart of this invention.
  • the main frame of the table is rested on a foundation (4) with legs (5) fitted with hinge (27) and Foundation rear support (6) for improved stability of the table.
  • the arm supports (3) are adjustable as per age and height of patient. Patient’s arms can be put on these supports (3). It further consists of sub elements (la, lb, lc, Id and le).
  • Base plate (1) also accommodates sliding platform (2) which is utilized to support lower torso till patient induced by anesthetist.
  • a sliding sacral support unit (7) which can be adjusted to support pelvis as according to the patient age or height and can be locked at that position is also provided.
  • Foot and Traction Unit Support (Right-16, Left- 17) is provided to fix foot position firmly with shoes (22) attached on the foot plate (21) located on both sides.
  • the required external rotation of the hip can be adjusted for the accurate alignment and position of the broken femur bones.
  • Traction Bar (8) is attached to counter the force created by the traction unit (19) during the femur alignment procedure.
  • a bi-axial angle measuring instrument (9) is installed at the counter-traction bar (8) for simultaneous measurement of hip abduction and flexion angle which helps in reproducible values of hip angulation to correct fracture alignment.
  • the same bi-angular measuring instrument (9) is also used to measure the angle of Abduction angle of the patient hip which is varied with the help of Abduction setter (10) which is supported with the help of support setter (11).
  • the same bi-angular measuring instrument (9) is also used to measure patient’s hip flexion angle which is adjusted with the help of Flexion-Extension Sliding controller
  • bi-axial angle measuring instrument 9 which is detachable and various scales of angle measurement are so positioned such that it can measure hip abduction and flexion angles.
  • This instrument can be easily detached whenever it is not required during the cast fitting so that it does not obstruct in doctor’s working. But it is so designed such that it gets fitted into the counter-traction bar (8) through mount (9f) during use.
  • Device is foldable (demands less space for storage and facilitate portability)
  • Foundation (4) and abduction setter (10) are made of Carbon Fiber.
  • the machine Foundation (4) may also be designed in form of solid rectangular flat plate in place of hollow rectangular tube.
  • the present invention is Semi-automatic as Base place (1) Height, Sliding Sacral Support central Unit (7) height, Sliding platform (2), Abduction Setter (10) and Right & Left Flexion - Extension Sliding Controller -FESC (12&13) are automatically operated while the rest components/elements are manually operated.
  • the novelty of the present invention lies in a complete working solution to the doctor in the form of advanced spica table.
  • This table can provide all kinds of limb movements which are required to reduce Femur bone fracture in children, can measure all fundamental angles during fixation whenever required, can provide stabilization of either foot at desired angle and height, can also provide inline traction and adjustment in traction whatever is required and lastly, can provide lower torso sliding platform that enables on- spica table anesthesia. None of the existing similar spica tables have all these features in single table. Some of the cited prior art tables have a few common features but the manner in which these are achieved is different than the present invention.
  • angle measurement is a mandatory requirement so that the bone is not fitted at any wrong angle. Angles of movement during hip flexion abduction and in external rotation of limb done manually while holding the limb, may result in inaccuracy as well as additional manpower. This also increased the time of complete procedure.
  • the present invention is developed keeping in view the applicability in pediatric orthopedics.
  • the Spica cast is used for treatment of fractures of femur bone, DDH, immobilization after Surgeries around hip in children.
  • a Spica table is needed. Everywhere in the world, spica cast is used so is the spica table.
  • the invention duly clears this test as it can be manufactured at industrial scale and has a market too.

Abstract

La présente invention concerne une table avancée d'application de spica qui comprend une plaque de base (1) pour la tête du patient et un support pour la partie supérieure du torse et un support adjacent réglable pour le bras (3). La plaque de base (1) reçoit une plate-forme coulissante (2) utilisée pour supporter la partie inférieure du torse. Un support (droite-16, gauche-17) pour pieds et pour unités de traction est prévu pour fixer solidement la position des pieds, des chaussures (22) étant fixées sur la plaque pour pieds (21) située des deux côtés. Un dispositif (14, 15) de réglage de hauteur de pieds et de rotation externe aide à ajuster la hauteur des pieds selon les besoins. Une unité de traction (19), montée sur un dispositif de montage (18) d'unité de traction, est un élément permettant de suspendre un seau de traction (20) et de le fixer à un dispositif de traction coulissant (19b). Un instrument de mesure d'angle bi-axial (9) est installé au niveau de la barre de contre-traction (8) pour une mesure simultanée de l'angle d'abduction et de l'angle de flexion de la hanche.
PCT/IN2020/050326 2019-04-04 2020-04-03 Table pédiatrique avancée d'application de spica WO2020202217A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IN201911013647 2019-04-04
IN201911013647 2019-04-04

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WO2020202217A1 true WO2020202217A1 (fr) 2020-10-08

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114191231A (zh) * 2021-12-26 2022-03-18 陈辉霞 一种便于双角度调节的医疗床

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5658315A (en) * 1994-02-23 1997-08-19 Orthopedic Systems, Inc. Apparatus and method for lower limb traction
WO2010099358A1 (fr) * 2009-02-25 2010-09-02 Orthopediatrics Corporation Table pour application d'un plâtre spica

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5658315A (en) * 1994-02-23 1997-08-19 Orthopedic Systems, Inc. Apparatus and method for lower limb traction
WO2010099358A1 (fr) * 2009-02-25 2010-09-02 Orthopediatrics Corporation Table pour application d'un plâtre spica

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114191231A (zh) * 2021-12-26 2022-03-18 陈辉霞 一种便于双角度调节的医疗床

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