WO2022003378A1 - Device for the manipulation of fractured tubular bones - Google Patents

Device for the manipulation of fractured tubular bones Download PDF

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Publication number
WO2022003378A1
WO2022003378A1 PCT/HU2021/050035 HU2021050035W WO2022003378A1 WO 2022003378 A1 WO2022003378 A1 WO 2022003378A1 HU 2021050035 W HU2021050035 W HU 2021050035W WO 2022003378 A1 WO2022003378 A1 WO 2022003378A1
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WO
WIPO (PCT)
Prior art keywords
shaft
bone
block
straight
secured
Prior art date
Application number
PCT/HU2021/050035
Other languages
French (fr)
Inventor
János BARTHA
Original Assignee
Bartha Janos
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 Bartha Janos filed Critical Bartha Janos
Publication of WO2022003378A1 publication Critical patent/WO2022003378A1/en

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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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/645—Devices extending alongside the bones to be positioned comprising a framework
    • 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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6416—Devices extending alongside the bones to be positioned with non-continuous, e.g. hinged, pin-clamp connecting element
    • 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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6466—Devices extending alongside the bones to be positioned with pin-clamps movable along a solid connecting rod
    • 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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms

Definitions

  • the object of the present invention relates to an external device that is capable of moving, rotating and securing fractured tubular bones.
  • Bones constitute a rigid, solid frame in the human body. Because of their rigidity these bones are sensitive to sudden and/or intense mechanical impacts, which may cause a fracture or fractures in them. In the case of such fractures it is important to restore the original status of the human skeleton as much as possible so that locomotor abnormalities do not develop in the patient.
  • Bone fractures may be caused by the direct impact of trauma, when the fracture occurs as the direct result of force at the same position as the force (defence, compression or penetration fractures), or as a result of indirect trauma, when a fracture occurs as a consequence of force exerted at a location further away from the fracture (tear, bend, twist, compression or combined mechanism fracture).
  • a fracture is called a pathological fracture if the fracture was caused with the involvement of minimal force due to the weakening of the bone.
  • Such fractures are caused by osteoporosis or by certain tumours.
  • Spontaneous fractures are when fractures occur in healthy bones without any external force. Such fractures may be caused by the sudden, intensive contraction of the muscles, or in the case of stress fractures, when the bone fracture is caused as a result of the continuous repetition of a force that would not cause a fracture under normal circumstances.
  • the bone parts created as a result of the fracture may move as compared to each other in the lateral or longitudinal directions with the bone parts moving away from each other or moving closer to each other, with bone axis dislocation or with a rotational difference after twisting. These movements are usually combined. Such movements usually occur because as a result of the bone fracture a reduced and/or different direction of resistance occurs against the tractive forces exerted by the muscles attached to the bones.
  • the various fractures may be open fractures, when the fracture can be seen visually, and closed fractures, when the fracture is covered by the body tissue.
  • an open fracture always involves injury to the soft tissues and the skin (skin, tendons, musculature, blood vessels and nerves), but injury to these tissues may also occur in the case of closed fractures, when the injuries are more difficult to identify (Sebeszet [Surgery], issue 10, ed. Csaba Gaal, 10 th edition, Medicina Publishers, Budapest, 2016, pp. 1094-1099).
  • plaster casts Fractures that do not involve bone movement are secured with plaster casts until the fracture is fully healed. Plaster casts cannot be used in cases of soft tissue damage or open fractures due to the great risk of infection. Furthermore, in the case a plaster cast is used, tissue necrosis and nerve damage may occur if there is tissue swelling.
  • Intramedullary nails and plates may be used for the repositioning of fractured bones in those cases when the patient has not suffered life-threatening, severe injuries (for example, several bones were fractured at the same time or the nervous system or internal organs were also injured when the fracture took place), or if the patient does not take anticoagulant medication, or has not suffered large-scale soft tissue injury. Otherwise, patients may not be primarily treated using intramedullary nails or plates due to the possible complications.
  • External manipulators are characteristically used when repositioning open fractures and fractures that have caused severe soft tissue damage.
  • Such external manipulators are presented by patent documents number EP1364620A1 and EP1434531B1.
  • the external manipulator is a device consisting of two parts, which two parts are connected to each other along a common shaft, and both parts contain protruding units, bone screws, which may be secured in the bone. As the two parts may be moved independently of each other along the common shaft, the bone parts may be moved to their original positions.
  • the disadvantage of this device is, on the one part, that the movements are performed manually, due to this the use of the device demands intensive physical effort on the part of the operating personal in the case of a thighbone fracture, for example.
  • the degree to which the bones may be moved with this device is limited, and, for example, the rotation of bones around the axis of the bone is not possible, and the bone parts may not be precisely joined up to each other in the case that bone parts have slipped over one another in the case of the solution according to patent document number EP1364620A1.
  • the broken bone parts have to be significantly pulled apart from each other so that they may be subsequently aligned and joined properly. This large degree of pulling apart usually causes soft tissue injury for the patient.
  • the bone screws securing the bone may only be positioned in specific places on the device, so the types of bone fracture in which this external manipulator may be used are limited.
  • Patent document number US2007225704A1 presents an external manipulator that is electro-mechanically or electro- pneumatically operated and that may be used by the operation personnel for moving bone parts with less physical exertion. Its disadvantage is that the device is unable to move misaligned bone parts in the plane perpendicular to the longitudinal axis of the bone. Furthermore, the electrically operated devices necessarily require a power source and their cleaning and sterilising is difficult and costly. As the individual bone parts are secured to the external manipulator with bone screws screwed into the bone, a sterile environment is required in order to maintain the risk of bone marrow infection at the lowest level.
  • the bone screws cannot be screwed into the bone parts polyaxially, as a result in the case of complex fractures, such as periprosthetic fractures (the bone next to a prosthetic implant is fractured) their use is limited. In other words only screws that are inserted at the same angle in the bone, in parallel may be secured on a given element of the device.
  • Patent document number US20060276786A1 presents an external manipulator containing ring-shaped elements, which surrounds the entire limb to be treated and pushes the bone into the correct position from the outside, via the skin (the injured soft tissue).
  • the disadvantage of the device is that in order to restore the correct position of the misaligned bone parts is exerts a force from the outside onto the tissues, due to which they may become injured, and so is only of any help in the case of certain types of misalignment.
  • the device only enables lateral movement of the bones, it is not suitable for performing rotation and in the case of moving the bone along its axis, the injured limb must be pulled manually until the two parts of the bone are separated to the extent when they can be restored to the correct position, with this possibly causing further soft tissue damage to the patient.
  • the circular structure of the external manipulator it cannot be used in the case of all bones; for example, it cannot be used in the case of fractures to the upper section of the thighbone.
  • the surgeon will only have limited access to the limb without disassembling the external manipulator.
  • this fact further limits the types of fracture in which the device may be put to use.
  • Patent document number EP2152177B1 presents a similar, ring- shaped external manipulator with the difference that the movement of the bone parts is performed in the conventional way using bone screws secured in the bone. Due to the ring structure this device is able to move the bones to the sufficient extent. However, due to the ring arrangement this device cannot be used either in the case of all types of fracture, as the device must be able to completely surround the limb. For example, the device has limited application in the case of thighbone fractures. In addition, the structure of the device is complicated and occupies a great deal of space, so it restricts the access a person skilled in the art has to the patient.
  • Robot-controlled external manipulators have also appeared, examples of which are the devices presented by patent documents numbers EP2819596B1, WO2017213602A1 and W02010138715A1 .
  • the majority of such devices are able to move and rotate the bone parts in all directions.
  • This is not required in order to move the bones, as the work is performed by motors, and hydraulic, pneumatic components.
  • the present invention is based on the recognition that a device may be created with rotatable and/or movable units secured on three shafts and an arc piece with releasable connections with which fractured tubular bones may be manipulated independently of the location of the fracture in the case of the large majority of fracture types.
  • the present invention relates to a device that has shafts, a first part and one first straight shaft in this adapted for accommodating at least one bone screw secured in the bone, a second part and one second straight shaft in this adapted for accommodating at least one bone screw secured in the bone, and it is characteristic of the device that the first part has a first rotatable unit connected to the first straight shaft to rotate it, a first block connected to the first rotatable unit, an arc piece connected to the first block, where the first block may be moved along the arc piece, the second part also has a second rotatable unit connected to the second straight shaft to rotate it, a third rotatable unit connected to the second rotatable unit to rotate it, a vertical shaft connected to the third rotatable unit, a second block connected to the vertical shaft, where the vertical shaft is formed in a way so as to be able to move as compared to the second block, a lateral shaft connected to the second block, where the second block is formed in a way so as to
  • the rotatable units, the first block and the second block are provided with quick-release fasteners.
  • the rotatable units are provided with cogwheels.
  • the first straight shaft and the second straight shaft are adapted for receiving at least two bone screws.
  • the bone screws secured into the bone may also be secured polyaxially to the first straight shaft and the second straight shaft.
  • the device also contains a pivot joint in the spacer piece between the horizontal shaft and the lateral shaft.
  • the device contains at least one first clamp and one second clamp.
  • the first and second straight shafts are made from metal and/or plastic that may be sterilised.
  • the entire device is made from metal and/or plastic that may be sterilised.
  • the first straight shaft and the second straight shaft are adapted for accommodating at least two bone screws.
  • Figure 1 shows a perspective view of the device according to the invention
  • Figure 2 shows a perspective bottom view of the first part of the device according to the invention
  • Figure 3 shows a perspective side view of the second part of the device according to the invention.
  • the essence of the device according to the invention lies in that with its use fractured bone parts may be moved at any angle and in any direction without the problems according to the state of the art.
  • the main parts of the device are the first part 100a and the second part 100b.
  • the first part 100a depicted in figure 2 consists of a first clamp 11, an arc piece 3, a first block 4, a first rotatable unit 12 and a first straight shaft 1.
  • the second part 100b depicted in figure 3 consists of a pivot joint 9, a second clamp 10, a second block 5, a lateral shaft 13, a vertical shaft 14, a second rotatable unit 6, a third rotatable unit 7 and a second straight shaft 2.
  • the first part 100a and the second part 100b are connected by a horizontal shaft 15.
  • the first block 4 and second block 5, the first 12, second 6 and third rotatable units 7 and the first 11 and second clamps 10 are secured in a releasable way so that these elements may be adjusted during the use of the device 100, but also so that they may be secured after the individual elements have been used.
  • a preferred releasable securing element is a quick- release fastener, during the use of which quick-release fastener it is sufficient to move a lever in order to place the element in the secured or released state of the given element. In the case of surgical procedures it is especially important to be able to adjust the individual elements as quickly as possible.
  • the X-axis is understood to mean the horizontal shaft 15
  • the Y- axis is understood to mean the lateral shaft 13
  • the Z-axis is understood to mean the vertical shaft 14.
  • the individual bone parts may be secured to the first 1 and second straight shafts 2 with the use of bone screws (neither the bones nor the bone screws used for securing the bones are depicted in the figures).
  • At least two bone screws are secured preferably polyaxially into the individual bone parts by drilling and then these bone screws may be secured on the first 1 and second straight shafts 2.
  • the polyaxial securing of the bone screws is understood to mean that the bone screws do not have to be parallel to each other. They may also be secured into the bone at varying angles while also being secured on the first 1 or second straight shaft 2.
  • the possibility of securing the bone screws only monoaxially is not excluded, nor is securing just one bone screw on the straight shafts.
  • embodiments that are not straight are not excluded in the case of the first 1 and second straight shafts 2, such as a U-shape, which shape facilitates the securing of the bone screws drilled into the bone at various angles on the first 1 or second straight shaft 2.
  • the first rotatable unit 12 located in the first part 100a makes it possible to turn the first straight shaft 1 around in the plane perpendicular to it, thereby making it possible to secure the bone part secured to the first straight shaft 1 at the ideal angle.
  • the first rotatable unit 12 is held by the first block 4.
  • the first block 4 may be pulled onto the arc piece 3 and moved along it with the use of a cogwheel (not illustrated).
  • the horizontal shaft 15 connects the first part 100a to the second part 100b (figure 1).
  • the first part 100a and the second part 100b may be caused to slide on the horizontal shaft 15.
  • the horizontal shaft 15 is preferably a threaded shaft (preferably with at least one guide along the longitudinal axis in order to eliminate the rotational forces), onto which the first part 100a is connected using the second clamp 10 and the second part 100b using the first clamp 11. In this way the distance of the first part 100a and the second part 100b with respect to each other may be adjusted by moving the clamps 10, 11, so that the device 100 may be adapted for securing bones of various size.
  • a perpendicular spacer piece 9a links the first clamp 11 to the lateral shaft 13, which perpendicular spacer piece 9a is also positioned perpendicular to the horizontal shaft 15 and the lateral shaft 13.
  • the pivot joint 9 is located on the perpendicular spacer piece 9a.
  • the function of the pivot joint 9 is to enable the extension of the device 100 in the plane of the X-axis, as a result of this the bone screws may be drilled into the centre-point of the bone on both sides of the bone parts, even at an angle of 180 degrees, because the straight shafts 1, 2 may be connected to the bone screws in this way as well.
  • the lateral shaft 13, on which the second block 5 is located, is connected to the perpendicular spacer piece 9a at a right angle.
  • the position of the second block 5 may be adjusted along the length of the lateral shaft 13, for this the lateral shaft 13 is preferably formed as a toothed rack.
  • the vertical shaft 14, which is located on the second block 5, may be moved as compared to the lateral shaft 13, also preferably using a toothed rack.
  • the second rotatable unit 6 is located in the part under the lateral shaft 13 in such a way that it is connected to the vertical shaft 14 via the third rotatable unit 7.
  • the second rotatable unit 6 makes it possible to move the second straight shaft 2 and the bone part secured to it in the direction of the Z-axis, in other words the second rotatable unit 6 facilitates the rotation of the second straight shaft 2 around an axis perpendicular to it.
  • the third rotatable unit 7 is connected to the second rotatable unit 6.
  • the function of the third rotatable unit 7 is to facilitate the movement of the fractured bone part along the Y-axis via the second straight shaft 2.
  • By adjusting the third rotatable unit 7 it is possible to turn/correct the displacement of the secured bone part around the Y-axis.
  • bone screws preferably two are secured into each of the fractured bone parts.
  • self-tapping bone screws are used polyaxially.
  • the bone screws secured to the individual bone parts are secured to the first straight shaft 1 and to the second straight shaft 2 relating to the device 100 in such a way that two bone screws are connected to each of the first 1 and second straight shafts 2.
  • the securing of at least one of the rotatable units 6, 12 is released and by rotating the cogwheels 22 the appropriate orientation of the bone parts with respect to each other is adjusted by rotating them around the Z-axis preferably while monitoring the process using an X- ray machine. Following this the released rotatable units 6, 12 are once again secured.
  • Rotation around the Y-axis is performed after releasing the securing of the third rotatable unit 7 by rotating the cogwheel 22. And after the position of the fractured bone part has been adjusted according to the Y-axis, the third rotatable unit 7 is secured in the given position.
  • the fractured bones are adjusted to their state before the fracture according to the X-axis.
  • the reason for this is that the muscles usually overly pull the bone parts together following a fracture. This movement is facilitated by the threaded form of the horizontal shaft 15, due to which the clamps may be easily moved along the shaft 15, using a nut for example.
  • the correction of the rotation of the fractured bones around their own axis is performed using the first block 4. After releasing the securing of the first block 4 the given bone part is rotated around its own axis by moving the first block 4 along the arc piece 3. After the rotation has been performed the first block 4 is once again secured.
  • the position of the fractured bone part is adjusted on the lateral shaft 13 and on the vertical shaft 14 by moving the second block 5 so that the individual bone parts suitably join up to each other. In other words in this step the individual bone parts are joined up to each other.
  • the fractured bone pieces are adjusted in parallel according to the axis of the original bone (along the X-axis) using the rotatable units 6, 7, 12. Following this the original bone length is restored on the X-axis by turning the nut on the horizontal shaft, preferably under X-ray monitoring. Rotational displacement is corrected using the cogwheel on block 4. And the displacement of the bone pieces in the plane of the X-axis (the plane perpendicular to the bone) is corrected with the fine tuning of the cogwheels on the block 5, thereby joining up the individual bone parts. These cogwheels control the movement on the lateral shaft 13 and on the vertical shaft 14. It is in this way that the bone regains the anatomical shape it was in before the fracture.
  • first 1 and the second straight shafts 2 are linked together using a securing rod (not illustrated).
  • a securing rod (not illustrated).
  • the individual bone parts do not move from their now secured position and the first 1 and the second straight shafts 2 may be removed from the device 100. Due to this the device 100 does not prevent the patient from moving or recovering. All the patient has to carry are the first 1 and second straight shafts 2 and the securing rod linking these until the fractured bone heals.
  • Fractured bone parts quickly and gently repositioned preferably using the device 100 may be permanently secured using plates or intramedullary nails via a minimally invasive procedure (with minimal soft tissue damage and blood loss) unless the patient has suffered an open fracture, severe soft tissue injury, takes anticoagulant medication or is in a life-threatening condition.
  • the securing of the individual elements may be performed, for example, using a quick-release fastener 20, which is illustrated in the figures.
  • a quick-release fastener 20 which is illustrated in the figures.
  • the quick- release fastener 20 by pulling down the lever the given element is forced onto the shaft, rod to which it is connected. To release the fastening it is sufficient to pull up the lever.
  • the operation of the cogwheels 22 may be carried out, for example, by making the cogwheel 22 that performs the movement of the bone move by moving a smaller adjustment cogwheel 21.
  • cogwheel 22 is understood to mean a toothed belt and other equivalent components as well that facilitate the fine rotation of certain of the elements of the device 100.
  • the elements of the device 100 are preferably made from sterilisable metal (such as steel, aluminium, titanium) or plastic.
  • sterilisable metal such as steel, aluminium, titanium
  • plastic plastic.
  • the advantage of the solution according to the invention is that the manipulation of the fractured bone parts is performed spatially and not via the active manipulation of the injured limb (soft tissues), instead via the fine rotation of the cogwheels on the device 100, without greater exertion of force or over-pulling of the bone parts, preferably under X-ray monitoring. Due to this injury of blood vessels, nerves, skin and subcutaneous tissue may be prevented.
  • An additional advantage of the solution according to the invention is that the use of the device is simple and quick; there is no need for serious exploration in the vicinity of the fractured bone, in this way the fractured bone may be joined up in just a few minutes thereby shortening the duration of surgery.
  • Yet another advantage of the solution according to the invention is that there is no need for a power supply, therefore it may be used in the field, at the scenes of catastrophes, outside the operating theatre. Additionally, electromagnetic weapons may not be used against it during an operation, such as in a military hospital (military base), and its system cannot be hacked as it has no software part.
  • a military hospital military base
  • Another advantage of the solution according to the invention is that its use does not require any special further training apart from knowledge of surgery, so it may be used widely.

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  • Orthopedic Medicine & Surgery (AREA)
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Abstract

Device (100) for the manipulation of fractured tubular bones, which has shafts (13, 14, 15), a first part (100a) and one first straight shaft (1) in this adapted for accommodating at least one bone screw secured in the bone, a second part (100b) and one second straight shaft (2) in this adapted for accommodating at least one bone screw secured in the bone, characterised by that the first part (100a) has a first rotatable unit (12) connected to the first straight shaft (1) to rotate it, a first block (4) connected to the first rotatable unit (12), an arc piece (3) connected to the first block (4), where the first block (4) may be moved along the arc piece (3), the second part (100b) also has a second rotatable unit (6) connected to the second straight shaft (2) to rotate it, a third rotatable unit (7) connected to the second rotatable unit (6) to rotate it, a vertical shaft (14) connected to the third rotatable unit (7), a second block (5) connected to the vertical shaft (14), where the vertical shaft (14) is formed in a way so as to be able to move as compared to the second block (5), a lateral shaft (13) connected to the second block (5), where the second block (5) is formed in a way so as to be able to move along the lateral shaft (13), a spacer piece (9a) connected to the lateral shaft (13), which connects the lateral shaft (13) with a horizontal shaft (15), the first part (100a) and the second part (100b) are connected by the horizontal shaft (15), and there is at least one clamp (10, 11) located on the horizontal shaft connected to the first part (100a) or the second part (100b) in such a way that the first part (100a) and/or the second part (100b) provided with the clamp (10, 11) is formed so as to be able to move along the horizontal shaft (15), and the aforementioned rotatable or moveable connections may be reversibly secured.

Description

Device for the manipulation of fractured tubular bones
The field of the invention
The object of the present invention relates to an external device that is capable of moving, rotating and securing fractured tubular bones.
The state of the art
Bones constitute a rigid, solid frame in the human body. Because of their rigidity these bones are sensitive to sudden and/or intense mechanical impacts, which may cause a fracture or fractures in them. In the case of such fractures it is important to restore the original status of the human skeleton as much as possible so that locomotor abnormalities do not develop in the patient.
The various forms of fracture are bend fractures, spiral fractures, avulsion fractures, compound fractures, segmental fractures, comminuted fractures, and defect (bone loss) fractures. Bone fractures may be caused by the direct impact of trauma, when the fracture occurs as the direct result of force at the same position as the force (defence, compression or penetration fractures), or as a result of indirect trauma, when a fracture occurs as a consequence of force exerted at a location further away from the fracture (tear, bend, twist, compression or combined mechanism fracture). A fracture is called a pathological fracture if the fracture was caused with the involvement of minimal force due to the weakening of the bone. Such fractures are caused by osteoporosis or by certain tumours. Spontaneous fractures are when fractures occur in healthy bones without any external force. Such fractures may be caused by the sudden, intensive contraction of the muscles, or in the case of stress fractures, when the bone fracture is caused as a result of the continuous repetition of a force that would not cause a fracture under normal circumstances.
The bone parts created as a result of the fracture may move as compared to each other in the lateral or longitudinal directions with the bone parts moving away from each other or moving closer to each other, with bone axis dislocation or with a rotational difference after twisting. These movements are usually combined. Such movements usually occur because as a result of the bone fracture a reduced and/or different direction of resistance occurs against the tractive forces exerted by the muscles attached to the bones.
The various fractures may be open fractures, when the fracture can be seen visually, and closed fractures, when the fracture is covered by the body tissue. Obviously, an open fracture always involves injury to the soft tissues and the skin (skin, tendons, musculature, blood vessels and nerves), but injury to these tissues may also occur in the case of closed fractures, when the injuries are more difficult to identify (Sebeszet [Surgery], issue 10, ed. Csaba Gaal, 10th edition, Medicina Publishers, Budapest, 2016, pp. 1094-1099).
In order to repair bone fractures the bone parts that have moved are put back into their original positions to the extent possible, following this, the bones are secured in this restored position. The repositioning of the bones is characteristically performed manually by the doctors, possibly with the help of mechanical devices. This securing may be external (plaster cast, external manipulator) or internal (intramedullary nail, plate) (Sebeszet [Surgery], issue 10, ed. Csaba Gaal, 10th edition, Medicina Publishers, Budapest, 2016, pp. 1103-1107).
Fractures that do not involve bone movement are secured with plaster casts until the fracture is fully healed. Plaster casts cannot be used in cases of soft tissue damage or open fractures due to the great risk of infection. Furthermore, in the case a plaster cast is used, tissue necrosis and nerve damage may occur if there is tissue swelling.
Intramedullary nails and plates may be used for the repositioning of fractured bones in those cases when the patient has not suffered life-threatening, severe injuries (for example, several bones were fractured at the same time or the nervous system or internal organs were also injured when the fracture took place), or if the patient does not take anticoagulant medication, or has not suffered large-scale soft tissue injury. Otherwise, patients may not be primarily treated using intramedullary nails or plates due to the possible complications.
External manipulators are characteristically used when repositioning open fractures and fractures that have caused severe soft tissue damage. Such external manipulators are presented by patent documents number EP1364620A1 and EP1434531B1. The external manipulator is a device consisting of two parts, which two parts are connected to each other along a common shaft, and both parts contain protruding units, bone screws, which may be secured in the bone. As the two parts may be moved independently of each other along the common shaft, the bone parts may be moved to their original positions. The disadvantage of this device is, on the one part, that the movements are performed manually, due to this the use of the device demands intensive physical effort on the part of the operating personal in the case of a thighbone fracture, for example. On the other part, the degree to which the bones may be moved with this device is limited, and, for example, the rotation of bones around the axis of the bone is not possible, and the bone parts may not be precisely joined up to each other in the case that bone parts have slipped over one another in the case of the solution according to patent document number EP1364620A1. In addition, in the case of patent document number EP1434531B1, the broken bone parts have to be significantly pulled apart from each other so that they may be subsequently aligned and joined properly. This large degree of pulling apart usually causes soft tissue injury for the patient. Furthermore, the bone screws securing the bone may only be positioned in specific places on the device, so the types of bone fracture in which this external manipulator may be used are limited.
Patent document number US2007225704A1 presents an external manipulator that is electro-mechanically or electro- pneumatically operated and that may be used by the operation personnel for moving bone parts with less physical exertion. Its disadvantage is that the device is unable to move misaligned bone parts in the plane perpendicular to the longitudinal axis of the bone. Furthermore, the electrically operated devices necessarily require a power source and their cleaning and sterilising is difficult and costly. As the individual bone parts are secured to the external manipulator with bone screws screwed into the bone, a sterile environment is required in order to maintain the risk of bone marrow infection at the lowest level. The bone screws cannot be screwed into the bone parts polyaxially, as a result in the case of complex fractures, such as periprosthetic fractures (the bone next to a prosthetic implant is fractured) their use is limited. In other words only screws that are inserted at the same angle in the bone, in parallel may be secured on a given element of the device.
Patent document number US20060276786A1 presents an external manipulator containing ring-shaped elements, which surrounds the entire limb to be treated and pushes the bone into the correct position from the outside, via the skin (the injured soft tissue). The disadvantage of the device is that in order to restore the correct position of the misaligned bone parts is exerts a force from the outside onto the tissues, due to which they may become injured, and so is only of any help in the case of certain types of misalignment. Essentially, the device only enables lateral movement of the bones, it is not suitable for performing rotation and in the case of moving the bone along its axis, the injured limb must be pulled manually until the two parts of the bone are separated to the extent when they can be restored to the correct position, with this possibly causing further soft tissue damage to the patient. Furthermore, due to the circular structure of the external manipulator, it cannot be used in the case of all bones; for example, it cannot be used in the case of fractures to the upper section of the thighbone. Furthermore, if any unexpected problem occurs, the surgeon will only have limited access to the limb without disassembling the external manipulator. Finally, as it secures the upper and lower rings to the limb via the tissues and bone this fact further limits the types of fracture in which the device may be put to use.
Patent document number EP2152177B1 presents a similar, ring- shaped external manipulator with the difference that the movement of the bone parts is performed in the conventional way using bone screws secured in the bone. Due to the ring structure this device is able to move the bones to the sufficient extent. However, due to the ring arrangement this device cannot be used either in the case of all types of fracture, as the device must be able to completely surround the limb. For example, the device has limited application in the case of thighbone fractures. In addition, the structure of the device is complicated and occupies a great deal of space, so it restricts the access a person skilled in the art has to the patient.
Robot-controlled external manipulators have also appeared, examples of which are the devices presented by patent documents numbers EP2819596B1, WO2017213602A1 and W02010138715A1 . The majority of such devices are able to move and rotate the bone parts in all directions. As a result there is no need for the operation personnel to exert intensive physical effort, this is not required in order to move the bones, as the work is performed by motors, and hydraulic, pneumatic components.
The disadvantage of such devices is that they are robust and/or are located in a fixed position in the operating theatre, therefore if as a result of any unexpected event the surgeon needs to access the wound, it may be prevented by this device. Furthermore, as a result of their size and position, and due to the sensitivity of certain of their components it is not possible to completely sterilise them. This represents a serious problem with the view to that the bone marrow located inside bones is a blood-formation organ, so it is especially important for it not to become infected. In addition, as a result of their nature, these devices are complex, they require a power supply for their operation, sensitive sensors are required for their operation, therefore there is a greater chance of them breaking down as compared to purely mechanical devices. Naturally, a power supply is available in normal situations, but in the case of complex, multiple fractures the operation may take as much as several hours, which may cause the batteries to run down, and in the case of mains electricity there is always the risk of an unexpected power cut. In addition to the risks originating from the use of an electric power source, they cannot be used in other extraordinary situations either, such as when treating the fractures of victims who cannot be moved from their position in the case of earthquakes, the collapsing of buildings, or in mines and traffic accidents, or in the case of accidents occurring in nature, at remote locations far from healthcare institutions. Because of their size, weight, requirement for a power source, or merely because their sensors are only calibrated for operation within the framework of the operating theatre, these devices cannot be used in such situations, in the field. On the other hand, it is important to treat more serious fractures as quickly as possible, because with this the development of infections, later soft tissue injuries (blood vessel, nerve damage) and further bleeding or haematoma can be avoided. Even on their own these complications may seriously endanger the patient's life. Furthermore, information technology systems can be attacked from the outside, so unauthorised persons may gain control of such apparatuses, but at the very least continuously preventing such attacks using modern security systems involves serious material and resource costs.
As a consequence of the above there is a need for a device with which, in the case of a bone fracture, the bone parts that need to be repositioned in their original location may be moved, rotated in all directions so that they can be fitted back together as precisely as possible and in which the bone screws used for securing the device to the bone cannot only be positioned in a given place on the device so that it may be used in the case of as many types of bone fracture as possible. Furthermore, it is important for it to be unnecessary for the operation personnel to have to exert serious physical effort in order to use it, especially in the case of thighbone fractures where the personnel have to work against the largest muscles of the human body, the thigh muscles. It is also necessary for its dimensions to not obstruct the surgeon or operation personnel during the surgical procedure, and for it to suitable for use with as wide a scope of bone fractures as possible. Additionally, it is also important for the use of the device not to require special technical or information technology knowledge, only the anatomical and surgical knowledge fundamentally expected of a person skilled in the art in order for it to suitable for use by a wide scope of personnel. Finally, it is necessary to be able to sterilise the device in its entirety, and for it to be suitable for use even outside of the operating theatre, under extraordinary circumstances.
Brief description of the invention
The present invention is based on the recognition that a device may be created with rotatable and/or movable units secured on three shafts and an arc piece with releasable connections with which fractured tubular bones may be manipulated independently of the location of the fracture in the case of the large majority of fracture types.
In accordance with the above the present invention relates to a device that has shafts, a first part and one first straight shaft in this adapted for accommodating at least one bone screw secured in the bone, a second part and one second straight shaft in this adapted for accommodating at least one bone screw secured in the bone, and it is characteristic of the device that the first part has a first rotatable unit connected to the first straight shaft to rotate it, a first block connected to the first rotatable unit, an arc piece connected to the first block, where the first block may be moved along the arc piece, the second part also has a second rotatable unit connected to the second straight shaft to rotate it, a third rotatable unit connected to the second rotatable unit to rotate it, a vertical shaft connected to the third rotatable unit, a second block connected to the vertical shaft, where the vertical shaft is formed in a way so as to be able to move as compared to the second block, a lateral shaft connected to the second block, where the second block is formed in a way so as to be able to move along the lateral shaft, a spacer piece connected to the lateral shaft, which connects the lateral shaft with a horizontal shaft, the first part and the second part are connected by the horizontal shaft, and there is at least one clamp located on the horizontal shaft connected to the first part or the second part in such a way that the first part and/or the second part provided with the clamp is formed so as to be able to move along the horizontal shaft, and the aforementioned rotatable or moveable connections may be reversibly secured.
According to a preferred embodiment of the device according to the invention the rotatable units, the first block and the second block are provided with quick-release fasteners.
According to a preferred embodiment of the device according to the invention the rotatable units are provided with cogwheels.
According to a preferred embodiment of the device according to the invention the first straight shaft and the second straight shaft are adapted for receiving at least two bone screws.
According to a more preferable embodiment of the device according to the invention the bone screws secured into the bone may also be secured polyaxially to the first straight shaft and the second straight shaft.
According to a preferred embodiment of the device according to the invention the device also contains a pivot joint in the spacer piece between the horizontal shaft and the lateral shaft.
According to a preferred embodiment of the device according to the invention the device contains at least one first clamp and one second clamp.
According to a preferred embodiment of the device according to the invention the first and second straight shafts are made from metal and/or plastic that may be sterilised. According to a preferred embodiment of the device according to the invention the entire device is made from metal and/or plastic that may be sterilised.
According to a preferred embodiment of the device according to the invention the first straight shaft and the second straight shaft are adapted for accommodating at least two bone screws.
In the figures
Figure 1 shows a perspective view of the device according to the invention;
Figure 2 shows a perspective bottom view of the first part of the device according to the invention;
Figure 3 shows a perspective side view of the second part of the device according to the invention.
Detailed description of the invention
The essence of the device according to the invention lies in that with its use fractured bone parts may be moved at any angle and in any direction without the problems according to the state of the art.
The main parts of the device, marked in its entirety with reference sign 100 in figure 1, are the first part 100a and the second part 100b. The first part 100a depicted in figure 2 consists of a first clamp 11, an arc piece 3, a first block 4, a first rotatable unit 12 and a first straight shaft 1. The second part 100b depicted in figure 3 consists of a pivot joint 9, a second clamp 10, a second block 5, a lateral shaft 13, a vertical shaft 14, a second rotatable unit 6, a third rotatable unit 7 and a second straight shaft 2. As shown in figure 1, the first part 100a and the second part 100b are connected by a horizontal shaft 15.
The first block 4 and second block 5, the first 12, second 6 and third rotatable units 7 and the first 11 and second clamps 10 are secured in a releasable way so that these elements may be adjusted during the use of the device 100, but also so that they may be secured after the individual elements have been used. A preferred releasable securing element is a quick- release fastener, during the use of which quick-release fastener it is sufficient to move a lever in order to place the element in the secured or released state of the given element. In the case of surgical procedures it is especially important to be able to adjust the individual elements as quickly as possible.
In the case of the device 100 according to the invention the X-axis is understood to mean the horizontal shaft 15, the Y- axis is understood to mean the lateral shaft 13 and the Z-axis is understood to mean the vertical shaft 14. It should be noted here that the attributes "horizontal" and "vertical" used in the cases of the shafts serve for better understanding of the invention and the figures, and when the device is actually used these shafts are not necessarily in horizontal or vertical position, as is obvious for a person skilled in the art.
The individual bone parts may be secured to the first 1 and second straight shafts 2 with the use of bone screws (neither the bones nor the bone screws used for securing the bones are depicted in the figures). At least two bone screws are secured preferably polyaxially into the individual bone parts by drilling and then these bone screws may be secured on the first 1 and second straight shafts 2. The polyaxial securing of the bone screws is understood to mean that the bone screws do not have to be parallel to each other. They may also be secured into the bone at varying angles while also being secured on the first 1 or second straight shaft 2. Naturally, the possibility of securing the bone screws only monoaxially is not excluded, nor is securing just one bone screw on the straight shafts. Furthermore, embodiments that are not straight are not excluded in the case of the first 1 and second straight shafts 2, such as a U-shape, which shape facilitates the securing of the bone screws drilled into the bone at various angles on the first 1 or second straight shaft 2.
With the use of a cogwheel 22 the first rotatable unit 12 located in the first part 100a (figure 2) makes it possible to turn the first straight shaft 1 around in the plane perpendicular to it, thereby making it possible to secure the bone part secured to the first straight shaft 1 at the ideal angle. The first rotatable unit 12 is held by the first block 4. The first block 4 may be pulled onto the arc piece 3 and moved along it with the use of a cogwheel (not illustrated).
In this way it becomes possible to rotate the bone part secured to the first straight shaft 1 via the bone screws drilled into the bone along the X-axis.
The horizontal shaft 15 connects the first part 100a to the second part 100b (figure 1). The first part 100a and the second part 100b may be caused to slide on the horizontal shaft 15. The horizontal shaft 15 is preferably a threaded shaft (preferably with at least one guide along the longitudinal axis in order to eliminate the rotational forces), onto which the first part 100a is connected using the second clamp 10 and the second part 100b using the first clamp 11. In this way the distance of the first part 100a and the second part 100b with respect to each other may be adjusted by moving the clamps 10, 11, so that the device 100 may be adapted for securing bones of various size. Furthermore it is also important to be able to adjust the distance of the first part 100a and the second part 100b with respect to each other in order to be able to separate bone parts that have moved so that they overlap each other by separating the first part 100a and the second part 100b along the horizontal shaft 15, as the first step of the activity aimed at restoring the bones.
A perpendicular spacer piece 9a links the first clamp 11 to the lateral shaft 13, which perpendicular spacer piece 9a is also positioned perpendicular to the horizontal shaft 15 and the lateral shaft 13. The pivot joint 9 is located on the perpendicular spacer piece 9a. The function of the pivot joint 9 is to enable the extension of the device 100 in the plane of the X-axis, as a result of this the bone screws may be drilled into the centre-point of the bone on both sides of the bone parts, even at an angle of 180 degrees, because the straight shafts 1, 2 may be connected to the bone screws in this way as well.
The lateral shaft 13, on which the second block 5 is located, is connected to the perpendicular spacer piece 9a at a right angle. The position of the second block 5 may be adjusted along the length of the lateral shaft 13, for this the lateral shaft 13 is preferably formed as a toothed rack.
The vertical shaft 14, which is located on the second block 5, may be moved as compared to the lateral shaft 13, also preferably using a toothed rack. The second rotatable unit 6 is located in the part under the lateral shaft 13 in such a way that it is connected to the vertical shaft 14 via the third rotatable unit 7. The second rotatable unit 6 makes it possible to move the second straight shaft 2 and the bone part secured to it in the direction of the Z-axis, in other words the second rotatable unit 6 facilitates the rotation of the second straight shaft 2 around an axis perpendicular to it.
The third rotatable unit 7 is connected to the second rotatable unit 6. The function of the third rotatable unit 7 is to facilitate the movement of the fractured bone part along the Y-axis via the second straight shaft 2. By adjusting the third rotatable unit 7 it is possible to turn/correct the displacement of the secured bone part around the Y-axis.
During the operation of the device according to the invention it is generally prudent to perform a preliminary step of manually moving the bone parts that have been dislocated, twisted by the muscles (as much as necessary) along their longitudinal axis so that their position approaches the original position (their length approaches that of the original bone) to make it easier to join up the bone parts. If there is the risk of injuring soft tissues the person skilled in the art must consider whether it is necessary to perform this step or leave it out in order to avoid more serious injury.
Following this, small incisions are made in the skin at the height of the fractured bone parts of the patient that has suffered a bone fracture. In this present description a bone fracture is assumed that has a fracture in one position, in other words two bone parts must be joined to each other in the course of the operation. After performing the incisions bone screws, preferably two are secured into each of the fractured bone parts. Preferably, self-tapping bone screws are used polyaxially. The bone screws secured to the individual bone parts are secured to the first straight shaft 1 and to the second straight shaft 2 relating to the device 100 in such a way that two bone screws are connected to each of the first 1 and second straight shafts 2.
In the following step the securing of at least one of the rotatable units 6, 12 is released and by rotating the cogwheels 22 the appropriate orientation of the bone parts with respect to each other is adjusted by rotating them around the Z-axis preferably while monitoring the process using an X- ray machine. Following this the released rotatable units 6, 12 are once again secured.
Rotation around the Y-axis is performed after releasing the securing of the third rotatable unit 7 by rotating the cogwheel 22. And after the position of the fractured bone part has been adjusted according to the Y-axis, the third rotatable unit 7 is secured in the given position.
After the bone parts have been appropriately positioned with respect to each other in the Y- and Z-axes, using the clamps 10, 11 and by moving the first part 100a and/or the second part 100b along the X-axis the fractured bones are adjusted to their state before the fracture according to the X-axis. In other words the length of the bone before the fracture is restored, the reason for this is that the muscles usually overly pull the bone parts together following a fracture. This movement is facilitated by the threaded form of the horizontal shaft 15, due to which the clamps may be easily moved along the shaft 15, using a nut for example.
The correction of the rotation of the fractured bones around their own axis is performed using the first block 4. After releasing the securing of the first block 4 the given bone part is rotated around its own axis by moving the first block 4 along the arc piece 3. After the rotation has been performed the first block 4 is once again secured.
Following this the securing of the second block 5 is released. The position of the fractured bone part is adjusted on the lateral shaft 13 and on the vertical shaft 14 by moving the second block 5 so that the individual bone parts suitably join up to each other. In other words in this step the individual bone parts are joined up to each other.
Whether or not both of the bone parts are in the proper position is checked using an X-ray machine and if they are the second block 5 is secured once again.
Thus, first the fractured bone pieces are adjusted in parallel according to the axis of the original bone (along the X-axis) using the rotatable units 6, 7, 12. Following this the original bone length is restored on the X-axis by turning the nut on the horizontal shaft, preferably under X-ray monitoring. Rotational displacement is corrected using the cogwheel on block 4. And the displacement of the bone pieces in the plane of the X-axis (the plane perpendicular to the bone) is corrected with the fine tuning of the cogwheels on the block 5, thereby joining up the individual bone parts. These cogwheels control the movement on the lateral shaft 13 and on the vertical shaft 14. It is in this way that the bone regains the anatomical shape it was in before the fracture.
Following this, the first 1 and the second straight shafts 2 are linked together using a securing rod (not illustrated). In this way the individual bone parts do not move from their now secured position and the first 1 and the second straight shafts 2 may be removed from the device 100. Due to this the device 100 does not prevent the patient from moving or recovering. All the patient has to carry are the first 1 and second straight shafts 2 and the securing rod linking these until the fractured bone heals. Fractured bone parts quickly and gently repositioned preferably using the device 100 may be permanently secured using plates or intramedullary nails via a minimally invasive procedure (with minimal soft tissue damage and blood loss) unless the patient has suffered an open fracture, severe soft tissue injury, takes anticoagulant medication or is in a life-threatening condition.
The securing of the individual elements may be performed, for example, using a quick-release fastener 20, which is illustrated in the figures. During the operation of the quick- release fastener 20 by pulling down the lever the given element is forced onto the shaft, rod to which it is connected. To release the fastening it is sufficient to pull up the lever.
The operation of the cogwheels 22 may be carried out, for example, by making the cogwheel 22 that performs the movement of the bone move by moving a smaller adjustment cogwheel 21.
In the context of the invention cogwheel 22 is understood to mean a toothed belt and other equivalent components as well that facilitate the fine rotation of certain of the elements of the device 100.
The elements of the device 100 are preferably made from sterilisable metal (such as steel, aluminium, titanium) or plastic. The advantage of the solution according to the invention is that the manipulation of the fractured bone parts is performed spatially and not via the active manipulation of the injured limb (soft tissues), instead via the fine rotation of the cogwheels on the device 100, without greater exertion of force or over-pulling of the bone parts, preferably under X-ray monitoring. Due to this injury of blood vessels, nerves, skin and subcutaneous tissue may be prevented.
An additional advantage of the solution according to the invention is that the use of the device is simple and quick; there is no need for serious exploration in the vicinity of the fractured bone, in this way the fractured bone may be joined up in just a few minutes thereby shortening the duration of surgery.
Yet another advantage of the solution according to the invention is that there is no need for a power supply, therefore it may be used in the field, at the scenes of catastrophes, outside the operating theatre. Additionally, electromagnetic weapons may not be used against it during an operation, such as in a military hospital (military base), and its system cannot be hacked as it has no software part.
Another advantage of the solution according to the invention is that its use does not require any special further training apart from knowledge of surgery, so it may be used widely.

Claims

Claims
1. Device (100) for the manipulation of fractured tubular bones, which has shafts (13, 14, 15), a first part (100a) and one first straight shaft (1) in this adapted for accommodating at least one bone screw secured in the bone, a second part (100b) and one second straight shaft (2) in this adapted for accommodating at least one bone screw secured in the bone, characterised by that the first part (100a) has a first rotatable unit (12) connected to the first straight shaft (1) to rotate it, a first block (4) connected to the first rotatable unit (12), an arc piece (3) connected to the first block (4), where the first block (4) may be moved along the arc piece (3), the second part (100b) also has a second rotatable unit (6) connected to the second straight shaft (2) to rotate it, a third rotatable unit (7) connected to the second rotatable unit (6) to rotate it, a vertical shaft (14) connected to the third rotatable unit (7), a second block (5) connected to the vertical shaft (14), where the vertical shaft (14) is formed in a way so as to be able to move as compared to the second block (5), a lateral shaft (13) connected to the second block (5), where the second block (5) is formed in a way so as to be able to move along the lateral shaft (13), a spacer piece (9a) connected to the lateral shaft (13), which connects the lateral shaft (13) with a horizontal shaft (15), the first part (100a) and the second part (100b) are connected by the horizontal shaft (15), and there is at least one clamp (10, 11) located on the horizontal shaft connected to the first part (100a) or the second part (100b) in such a way that the first part (100a) and/or the second part (100b) provided with the clamp (10, 11) is formed so as to be able to move along the horizontal shaft (15), and the aforementioned rotatable or moveable connections may be reversibly secured.
2. Device (100) according to claim 1, characterised by that the rotatable units (6, 7, 12), the first block (4) and the second block (5) are provided with quick-release fasteners (20).
3. Device (100) according to claims 1 to 2, characterised by that the rotatable units (6, 7, 12) are provided with cogwheels (22).
4. Device (100) according to claims 1 to 3, characterised by that the first straight shaft (1) and the second straight shaft (2) are adapted for receiving at least two bone screws.
5. Device (100) according to claim 4, characterised by that the bone screws secured into the bone may also be secured polyaxially to the first straight shaft (1) and the second straight shaft (2).
6. Device (100) according to claims 1 to 5, characterised by that the device (100) also contains a pivot joint (9) in the spacer piece (9a) between the horizontal shaft (15) and the lateral shaft (13)).
7. Device (100) according to claims 1 to 6, characterised by that the device contains at least one first clamp (11) and one second clamp (10).
8. Device (100) according to claims 1 to 7, characterised by that the first and second straight shafts (1, 2) are made from metal and/or plastic that may be sterilised.
9. Device (100) according to claim 8, characterised by that the entire device (100) is made from metal and/or plastic that may be sterilised.
PCT/HU2021/050035 2020-07-01 2021-05-31 Device for the manipulation of fractured tubular bones WO2022003378A1 (en)

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HU2000217A HUP2000217A1 (en) 2020-07-01 2020-07-01 Tool for manipulating broken long bones

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2391537A (en) * 1943-09-27 1945-12-25 Anderson Roger Ambulatory rotating reduction and fixation splint
US5397322A (en) * 1990-08-03 1995-03-14 Jaquet Orthopedie S.A. Manipulator for external bone fixation devices
US5863292A (en) * 1996-09-26 1999-01-26 Tosic; Aleksandar Articulated external orthopedic fixation system and method of use
US6001097A (en) * 1996-01-18 1999-12-14 Jaquet Orthopedie S.A. Fracture reducing apparatus
US6428540B1 (en) * 1996-11-13 2002-08-06 Synthes (U.S.A.) Device for repositioning fractured bone fragments
WO2014140855A2 (en) * 2013-03-15 2014-09-18 Biomet C.V. Clamping assembly for external fixation system

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2391537A (en) * 1943-09-27 1945-12-25 Anderson Roger Ambulatory rotating reduction and fixation splint
US5397322A (en) * 1990-08-03 1995-03-14 Jaquet Orthopedie S.A. Manipulator for external bone fixation devices
US6001097A (en) * 1996-01-18 1999-12-14 Jaquet Orthopedie S.A. Fracture reducing apparatus
US5863292A (en) * 1996-09-26 1999-01-26 Tosic; Aleksandar Articulated external orthopedic fixation system and method of use
US6428540B1 (en) * 1996-11-13 2002-08-06 Synthes (U.S.A.) Device for repositioning fractured bone fragments
WO2014140855A2 (en) * 2013-03-15 2014-09-18 Biomet C.V. Clamping assembly for external fixation system

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