WO2023066438A2 - Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools - Google Patents
Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools Download PDFInfo
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- WO2023066438A2 WO2023066438A2 PCT/EG2021/000035 EG2021000035W WO2023066438A2 WO 2023066438 A2 WO2023066438 A2 WO 2023066438A2 EG 2021000035 W EG2021000035 W EG 2021000035W WO 2023066438 A2 WO2023066438 A2 WO 2023066438A2
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Classifications
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
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- 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
- A61B17/683—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary pins, nails or other devices
- A61B17/7208—Flexible pins, e.g. ENDER pins
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- A61B17/72—Intramedullary pins, nails or other devices
- A61B17/7216—Intramedullary pins, nails or other devices for bone lengthening or compression
- A61B17/7225—Intramedullary pins, nails or other devices for bone lengthening or compression for bone compression
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- A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/74—Devices for the head or neck or trochanter of the femur
- A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
- A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
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- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8665—Nuts
Definitions
- Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools are used for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools.
- This invention concerned with management of bone fracture fixation, osteotomy, and bone deformity correction.
- the invention relatedtometal implants for stable fixation of long bone fractures and osteotomies at its metaphysis in wide medullay part and at epiphyseal part.
- the invention depends on using compatible composite of stiff metal implants and malleable metal implants under tension.
- the invention depends on designs of intramedullary implants that offer stable fixation of long bone fractures at its wide medullay part.
- the invention includes tools, and supplementary implants used.
- the aim of using these implants is to have stable fixation of most of long bone fractures with minimal soft tissue disruption and with all metals completely inside the body.
- Diagram 3-1 to 3-16 show various types of holders for cables and wires under tension force.
- Diagrams 5-1 to 5-9 show guiding tools for distal femur osteotomy.
- Diagrams 6-1 to 6-8 - show external fracture reduction tools.
- Tension wire with diameter of 1.5 - 2 mm and length of 60 cm.
- Large diameter end (6 - 10 mm in diameter).
- Diagrams 2-1 to 2-5: - show various types of orthopaedic washers.
- the diagrams from 2-1 to 2-5 show various types of orthopaedic washers that used to increase surface contact of cable and tension wire to bone aiming at distributing tension force over large surface area of bone surface and can be used are as follow: -
- tension wire (4) or cable (5) are applied through second hole of the double washer then through bone medulla to be fixed to short nail proximally (does not shown here and will be discussed latter in diagram 4-1, 4-2, 4-6 and 4-7).
- Diagram 3-1 to 3-16 show various types of holders for cables and wires under tension force.
- Serrated tunnel 1.5-2mm in diameter that accommodate serrated part of cable or tension wires (no 3 in diagram no 1-4 and 1-6).
- Serrated tunnel that accommodates serrated part of cable or tension wires (no 3 in diagram no 1-4 and diagram no 1-6).
- Diagrams no 3-5 shows assembly of headless screw and nut: -
- N.B.,) - Headless screw (in diagram 3-4) is designed in a way that with advancement of the nut, slit and tunnel of the screw become narrower around tension wire or cable.
- (A) is the holding nut of the screw, where No. 1 is the outer surface of the nut it and is hexagonal, and where No. 2 is the inner serrations for it and where No. 3 is the narrow nozzle of the nut where the inner diameter of No. 4 is narrower than the inner diameter of the serrations (core diameter) No. 5.
- (B) and (C) are two forms of screw holding on the cable or the wire under tension , where No. 6 is the outer serrations of the headless screw and is similar to the internal serrations of the nut (No. 2) and where No. 7 is the opening for passage the cable or wire inside the screw then passing through the inner channel No. 8 and then through No. 9 which is a dilated cavity (greaterthan the cable or wire channel), hexagonal with height about 2-3 mm and where number 11 is a longitudinal slit in the hexagonal part and the part of the wire or cable tunnel adjacent to it and where the outer portion of the screw surrounding the hexagonal part (No. 12) is spherical almost conical in shape with Its outer diameter number 13 is smaller than the inner diameter of the nozzle (No. 4).
- Socket wrench is applied to nut and cannulated screw driver applied to headless screw.
- Second serrated part of the nail wider in diameter than first part (same diameter of serration as serrated part of second bolt).
- Outer diameter of medullary part of the nail may be of different diameter to fit different bone medullary cavity.
- Tension wires are bended between first and second bolt.
- Tension wires (6 in number) are bended (after had been cut) between first and second bolt.
- N.B.J - The ability to use curve or bend nail (big curve and high angle bend) in this design of nail and flexibility of tension wires or cables allow us to use many entries of the nail as follow: - 1- Proximal humerus entry distal than usually used away from rotator cuff.
- Nail substance N. B.) 1-Outer diameter of medullary part of the nail may be of different diameter to fit different bone medullary cavity, also first and second serration diameter adjusted according to nail diameter.
- Tension wires (6 in number) are bended (after had been cut) between first and second bolt.
- Hemi arthroplasty stem can be fixed to femoral shaft using similar way (fenestrated stem with holes for passage of tension wire or cable that can passed through aiming device connected to stem proximally).
- Key hole openings on both sides of the nail allow passage of tension wire or cable (that used for reduction of bone fragments) from one side to other side of the nail.
- key hole opening has distal large 4 mm in diameter (4) on the side of wire or cable insertion and round hole 3 mm in diameter (6) on the other side. Both round holes connected proximally with linear slot 2mm wide and variable length from 1 to 3 cm (5).
- Diagram no 4-16 - A- Fully serrated olive tension wire (1.6 - 2 mm in diameter): -
- Nut (1.6- 2 mm) described in diagram 18 can be used to fix serrated wire (kind A in diagram no 4-16) on bone surface after fragments or butterfly reduction.
- Nut (3 - 4 mm) as the one described in diagram 18 can be used to fix serrated wire (kind B in diagram no 4-16) on bone surface after fragments or butterfly reduction.
- Tension device in diagrams 3-10 to 3-15, can be used to apply tension to serrated wire, smooth tension wire, or cable
- no. 1 is a part of a cylinder and where no. 2, 3, 4 and 5 are holes pointing towards centre of a cylinder circle and at same level so that they all go to one point (no. 6) And where the holes can be circular like hole no. 3 and 4 or can be cubical like holes 2 and 5.
- Diagrams from 4-28 to 4-31 show serrated hook and nut used in reduction of intramedullary cable or wire to bone fragment: -
- - as alternative serrated hook rod can be replaced with rod with slit (5) and 2 prominent ridges (6) inside.
- the serrated of the slit rod designed on a way that the cable or the wire introduced to slit through the opening (7) then with tightening of the nut (2) around the serration 5(8) the slit (5) become narrow so the prominent ridges (6) inside hold cable or the wire inside the slit.
- Diagram No 4-29 shows socket wrench and T-handle for tightening of nut over hooked serrated rod: -
- T-handle (2) Serrated end of T- handle of same diameter as serrated tunnel (no 4 in diagram no 36).
- hooked serrated rod works where tension wire (1) + (2) applied from distal end of femur (3) to proximal end of femur (4) but still fracture not reduced (5) then hooked serrated rod (6) connected to its parts (as described in diagram 4-30) applied around tension wire (2) through drill hole (7) in distal femur then nut (8) tighten (using socket wrench) to pull rod out hooking the wire -> reduction of fracture and augmentation of fixation.
- Diagram No 4-32 shows reduction of fracture using tension cable or wire: -
- Diagram No 5-1 and 5-2 Show external guide for dome shaped osteotomy can be done in distal part of the femur.
- 6- Screws that can narrow or expand the transverse rectangular slots to control movement of Shanz or Steinmann pin passed through slot (5) then to distal femur.
- A- Aiming device for osteotomy where: -
- N.B - Hole no 1, and slit no. 5, and 8 are made through whole width of the aiming device.
- Diagram No 5-3 shows the lateral external guide used to make the lateral and medial osteotomy drills in distal femur, as well as used in guided installation of the osteotomy tool (part of a circle) ⁇ in diagram 5- 10 and 5-12 ⁇ in its position in front of the thigh bone where: -
- Anteroposterior arm of the guide tool with its axis perpendicular to the axis of the lateral part (2).
- Cylindrical holes with a diameter of 8 mm. Its axis in line with axis of the middle of the lateral part and in same plan of the middle of the side (anteroposterior) arm.
- Diagram 5-4 -
- the bone osteotomy tool for the distal femur bone and the guide parts shows where: -
- Bone osteotomy guide (part of a circle) of 8 mm width and inside and outside diameter that fit diameter of slot (no 8 in diagram 5-1 and 5-2) and height of 2-3 cm where: -
- Rectangular hole accommodates width of head of bone osteotome (B).
- Head of the osteotome accommodates width of hole (3).
- Diagram 5-5 Show different kinds of osteotomies and different kinds of guiding blocks where: -
- Osteotome with hexagonal head Its width is of same width of slot (6) of anteroposterior limb of guide in diagram 5-3.
- Block no (4) is suitable to rectangular head osteotome.
- Block no (5) is suitable to hexagonal head osteotome.
- Block no (6) and (7) are suitable to different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin.
- Block no (8) is suitable to rectangular head osteotome.
- Block no (9) is suitable to hexagonal head osteotome.
- Block no (10) and (11) are suitable to different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin.
- Block no 12 is multipurpose suitable for square head osteotome and different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin.
- Diagram 5-6 and 5-7 Show 2 parts used and connected together to guide linear osteotomy in proximal tibia , distal tibia , and to lesser extent distal femur.
- N.B - hole no 1, and slit no. 5 are opened through whole width of the aiming device.
- This Shanz or Steinmann pin will control movement of the fixing interlocking nail inside to help in correction of bone deformity.
- Diagram 5-7 Show shape of the guide tool (second part) ⁇ the part that can be used to guide osteotomy ⁇ that to be used for the linear bone osteotomy of distal and proximal part of the tibia bone.
- - Part (C) has thickness of 2-3 cm and composed of two parts: - )ca(and)cb(connected together: - ca) Two longitudinal arms connected on one side to part (A) in diagram 5-6 through two tunnels (1) where: -
- Slot has 2 cm height with its shape is part of circle. Its virtual centre is passing beyond virtual line (2) at point (5).
- Block has 2 cm height and it width same as width of part (C) with its shape is part of circle. Its virtual centre is virtual point (5): -
- Block has 2 cm height. Its shape is part of circle (more than quarter of circle) with diameter of 20- 30 cm: - 1) Slot in the middle of the block, its shape is part of circle inside block that has shape of part of circle.
- the bone osteotomy tools that can be used for making guided dome distal femur bone osteotomy where: -
- Osteotomy tool part of a circle of different lengths depending on the width of the lower femur.
- -It consists of blade and two cylindrical parts.
- Blade for cutting bone Its width is approximately 1.5 cm and the thickness is 2 mm.
- Threaded hole with a diameter of 4 mm at the side bottom (it does not contradict the threading of the upper part).
- Threaded rod with a diameter of 4 mm.
- the tube (No. 7 in Diagram 5-12) is installed around the rod (no. 3 in diagram 5-12) and inserted through the slit (no. 8 in diagram 5-1 or 5-2) so that the rod (no 3 in diagram 5-12) and tube (no 7 in Diagram 5- 12) around it pass around the blade by passing the small rod (No. 6 in Diagram 5-12) through the slit of the blade.
- the osteotomy is made by hammering on the two assemblies (No. 3) after removing the guide arm (2).
- the guide arm (no.2) is re-installed through the anteroposterior arm of the guide device (no 6 in diagram 5- 3) ⁇ as before ⁇ .
- the assembly (No. 3) components has to be removed after removing the two nuts and the osteotomy tool is removed from the body.
- Non osteotomized part is subsequently completed using a small bone osteotome through small skin incisions after the partial fixation of the osteotomized part.
- wire will be fixed to bone by nuts or headless screw and nut (6) on each side ⁇ see diagrams 3-1 to 3-15 ⁇ and extra parts of the wire (7) to be cut and removed.
- Diagram 6-5 shows assembly of reduction part of reduction frame (superior one): -
- Diagram 6-8 shows assembly of reduction frame on one side of the fracture (half frame): -
- Rotation of nuts in assembly (6) will move serrated rod inside central block (6) in direction of broad arrow and on same time rotation of nuts in assembly (8) to move serrated rod inside central block (8) in direction of broad arrow will move bone fragment in same direction.
- central block (5) and central block (7) that hold limb will move and slide around serrated rods (9) and serrated rods (11) respectively in same direction of broad arrow.
- direction of movement of the bone fragment can be isolated (to be in one desired direction with little or no movement on perpendicular direction).
- each corner block will be used for passage of serrated rods (no 9 in diagram 46) fixed with nuts to connect corner block (in this half frame) to facing corner block (in other half frame on other side of fracture).
- Diagram 6-9 shows photo of assembly of reduction frame in one side (half frame).
- Diagrams 7- 1 and 7 - 2 shows cables used in bone lengthening and deformity correction.
- Diagram 8 - 1 to 8- 10 show design of intramedullary nails to be used (incorporated with cables) in bone lengthening and deformity correction.
- Diagram 8-1 -
- Diagram 8-2 -
- Threaded (outside threads) part that applied to bone cortex can be coated with hydroxyapatite.
- Threaded transverse tunnel (of same serration as screw D) for holding the inside cable if repositioning of the nut (B) needed.
- Cylinder (its diameter is larger than threads no 3 diameter), has: -
- Screw for holding the inside cable if repositioning of the nut (B) needed.
- Screw for holding the inside cable to the cylinder (C).
- Diagram 8 - 3 Same features as nail in diagram 8 - 1 from item No.l to item No. 6 with added modification where: -
- N.B., - the degree of rotation can be adjusted through adjustment of position of the start of slot in relation to its end.
- Diagram 8 - 4 -
- N.B., - the degree of angulation can be adjusted through adjustment of position of the start of slot in relation to its end.
- Diagram 8 - 5 -
- Diagram 8 - 6 Shows assembly of parts in diagram 8 - 2 to nail in diagram 8
- Diagram 8 - 7 -
- Diagram 8 - 11 Shows modification of design on nail in diagram 8 - 4 where the slots are modified to be in two stages: -
- screw (3) should be advanced to be fully inside cylindrical part or to be taken outside the body using suitable hexagonal screw driver through bone hole (22).
- - Screw (A) has longitudinal tunnel (1) 2-3 mm in diameter extend from screw surface to hexagonal socket.
- Screw (C) has same design as screw (B) but with longer cylindrical part (6) to allow application of more magnetizable pins (7) that generate more power in moving the screw when used magnetic field to move the screw.
- Diagram 9 - 4 Shows assembly of two cables inside screw (A) and cylindrical part (B) for combined correction of angulation and lengthening (like that was shown in diagram 8 - 13): -
- the distance (3) is the planned distance for correction of angulation without lengthening.
- Diagram 10 - 1 to 10 - 3 -
- Threads inside threads added to nail end for application of threaded parts in diagram 10 - 2.
- Diagram 10 - 2 -
- Threaded parts (inside threads) (one side clockwise and the other anti-clockwise) for application of threads (5) of screws (B)and (BR) (one screw with clockwise threads and the other with anti-clockwise) ⁇ if lengthening done using magnetic field ⁇ .
- B) And BR) are two screws (one screw with clockwise threads and the other with anti-clockwise).
- Peripheral parts - either angulation correction or rotation correction (Any other design for another function like diagram 10 - 2 can be utilized).
- E) And BR) are two screws (one screw with clockwise threads and the other with anti-clockwise).
- Peripheral parts - either for angulation correction or rotation correction (Any other design for another function like diagram 10 - 2 can be utilized).
- Diagram 12 - 1 to 12 - 4 -
- Diagram 12 - 1 -
- - Screw head has hexagonal socket (10) for application of the screw.
- Diagram 12 - 2 Shows assembly of modular nails shown in diagram 12 -1 where: -
- site (14) After partial correction of angle of deformity, site (14) will be cleared away from nail boy, then another polar screw can be applied just close to the nail and used for further bone angulation correction.
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Description
Title: -
Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools.
Technical field:-
This invention concerned with management of bone fracture fixation, osteotomy, and bone deformity correction.
Background of the invention: -
Field of the invention:-
The invention relatedtometal implants for stable fixation of long bone fractures and osteotomies at its metaphysis in wide medullay part and at epiphyseal part.
The invention depends on using compatible composite of stiff metal implants and malleable metal implants under tension.
The invention depends on designs of intramedullary implants that offer stable fixation of long bone fractures at its wide medullay part.
The invention includes tools, and supplementary implants used.
The aim of using these implants is to have stable fixation of most of long bone fractures with minimal soft tissue disruption and with all metals completely inside the body.
Discussion of the Related Arts:-
Fixation of long bone fractures involving using:-
A- Intramedullary solid nails forfixation of diaphyseal fracturesfFigure No ').
A- Intramedullary solid nails for fixation of diaphyseal fractures (Figure No 1).
1- Intramedullary nails are nearly cylindrical in shape either solid or cannulated (stiff in all situations).
2- Applied inside long bone medulla after creation of an entry and reaming of medulla to reach a diameter of medulla that accommodate desirable nail diameter.
3- Intramedullary nails are fixed to bone both sides of the fracture using serrated locked screws.
B- Circular frame external fixator using tensioned wires have been used for fixation of comminuted fractures (Figure No 2 and 3).
Tension wire was used previously in fixation of bone fractures, depending on passage of wires from outside skin then through bone.
Desired number of wires to be passed in each bone fragment and these wires to be fixed to the metal frame (outside the body) on one side, and then tension applied to each wire from other side then wire to be fixed to the frame on other side of the bone.
Repeating this to all wire passed through same bone and fixation to frame and repeat with each broken bone fragment and fixation to same frame and after reduction of bone fractures to the right place.
(Figure No 2: - showing the way and Image No 3: - showing X- ray image).
Problem or deficiencies in the prior art: -
A) In case of using interlocking nails fixed to bone with locked screws proximally and distally: -
1 - The need to ream bone medulla (bone shaft) in order to increase the efficiency of nail fixation with concomitant bleeding from the bone and transient disruption to the endosteum and possibility of fat embolism.
2 - The need for accurate location of entry point of the nail otherwise relatively stiff nail will break bone.
3. Not suitable for fixation of fractures in metaphyseal area near joints because nails will not fit to wide medulla on the joint side with resultant poor reduction of fracture.
4- Deficiency of reduction tools of certain fractures that obligate surgeon to use open reduction of the fracture rather to treat it in closed way.
5- Inability to use intramedullary implant in certain fractures with fracture line near bone end associated with diaphyseal comminution (like in diagram 3).
6- Deficiency in tools to do certain osteotomies that obligate surgeon to do it open with complications of open surgery like blood loss, infection, stiffness, and delayed union of bone osteotomy.
B) Using tension wires fixed to External frame: -
1. Big external frame needed for fixation of tension wires.
2. External frame is annoying to the patient.
3. High incidence of infections as a result of using external fixator.
4. Trans-fixation of tissues and muscles with wires leads to joint stiffness.
5. High incidence of tissue fibrosis and adhesions.
New in the invention: -
A- Designs of nails with cables or wires incorporated in it
1 - Designs of short nails (diagram no 4-1, 4-2 and 4-6, and 4-7) depend on incorporated tension wires or tension wire -> stable fixation of fracture especially in metaphyseal area with wide medulla at one side of fracture (articular side).
2 - Designs of short nails (diagram no 4-3) with ability to use high curved nail or high bending angle nail, so this will increase the spectrum on using nails because of wide range of nail entry site used -> stable fixation of fracture in certain bones like humerus (diagram 4-4) and certain age group like adolescent (diagram 4-5).
3 - Design of long nails (diagram no 4-8) depend on of tension wires and headless screw with nut in locking mechanism of nail in on one side instead of ordinary locked screws → stable fixation of comminuted epiphyseal fractures with preservation of soft tissue attached to bone fragments (diagram no 4-9, 4- 10).
4 - Serrated hook with nut and its application device (diagram no 4-28, 4-30) designed for reduction of fracture and for augmentation of fracture fixation (diagram no 4-31).
B- Designs of reduction nails - Designs include both sides reduction nail described in diagram no 4-14. - Designs include one side reduction nail described in diagram no 4-15.
C - Designs of cables or wires with its fixing nut (That used as a complementary fixation to nails).
1 - Designs of cables and tension wires (diagram no 1-1 to 1-4 and 1- 6 to 1- 12) used in fixation or for helping passage of wires through bone.
2 - Designs of washers (diagram no 2-2, 2-3, and 2-5) designed for distribution of tension forces over relatively large area of bone surface.
3 - Designs of nuts (diagram 3-1, 3-3) designed for fixation of serrated tension wires to bone after applying tension to it.
4 - Design of headless screw and nut (in diagrams 3-4, and figures from 3-6 to 3-8) used for fixation of tension wire to bone fragments.
D - Supplementary tools used for application of nails, wires, or cables
1 - Cannulated wrench and screw driver (diagrams 3-10 to 3-15) designed for tightening of headless screw, nut and tension wire together on surface of bone fragment.
2 - Wire tensioning device (diagram no 4-11) for tensioning one wire at a time.
3 - Wire tensioning device (diagram no 4-12) for tensioning many wires at a time.
4 - Wire cutting device (diagram no 4-13).
5 - Fracture reduction frame and its mobile reduction part (diagram no 6-1 to 6- 9).
E - Supplementary tools used for
Reduction of fracture with intramedullary nail introduced inside bone fragments.
1 - Guide tool for application of cable around nail inside medullary canal (diagram 4-23).
2- Bevelled sleeves for passage of passage of cables around intramedullary nail (diagram 4-24).
3-Tools for reduction of epiphyseal fragment of long bone which include: -
A - Design of plate can be used for fracture reduction (Diagram no 4-33).
B- Design of plate applicator including its 2 kinds (Diagram no 4- 33).
4-Design of plates and design of modified intramedullary nails which for reduction and fixation of very small epiphyseal fracture accompanied with diaphyseal comminution (Diagram no 4-39).
5- Deign of reduction push pull reduction tools for reduction of displaced bone fragment Diagram no 4-43 and 4-44.
F - Supplementary tools used for
Osteotomy of distal femur and correction of its deformity.
1 - Guide tools for drilling and osteotomy of distal femur (diagrams 5-1 to 5-9)- Distal femur Osteotomy tools and its application tools (diagrams 5-10 to 5-12).
SUMMARY OF THE INVENTION; -
The present invention overcomes the deficiencies of the prior art noted above by providing implants capable to reduce fracture and produce stable fixation of long bone fractures even theses fractures close to articular ends of the bone. The present invention depends on using of flexible (intramedullary cables or wires) incorporated in intramedullary nail with special design that help to hold and maintain tension preloaded to this cables or wires.
This will help to gain both malleability and on same time stability of fixation.
The invention further includes implants help to fix specific bone fragments to each other, also includes specific washers and nuts that help fixation of fractures and force distribution on bone surface.
The invention further includes complementary implants that help to fix highly comminuted fractures as specific nuts, cables, wires, bolts and washers, etc.
The invention further includes supplementary devices that can used for application of these implants.
BRIEF DESCRIPTION OF THE PREFERRED EMBODIMENTS
DIAGRAMS
Diagrams 1-1 to 1-13: - show various types of orthopaedic cables and wires liable to traction force.
Diagrams 2-1 to 2-5: - show various types of orthopaedic washers.
Diagram 3-1 to 3-16: - show various types of holders for cables and wires under tension force.
Diagram 4-1 to 4-32: - show various types of nails incorporated with cables and wires, and tools assisting its action.
Diagrams 5-1 to 5-9: - show guiding tools for distal femur osteotomy.
Diagrams 6-1 to 6-8: - show external fracture reduction tools.
Detailed Description
Diagrams 1-1 to 1-13: - show various types of orthopaedic cables and wires liable to traction force that can be used are as follows: -
Diagram No 1-1: -
Shows orthopaedic stainless-steel cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Blunt end.
N.B.,) Adding of enlarged parts to the shaft of the cable with diameter of 2 - 2.5 mm (4) {in 1.5mm cable} will help to keep cables away from inner surface of the bone so it will not disturb endosteum or allow its passage and growth between medullary surface of bone and cable substance.
Diagram No 1-2: -
Shows orthopaedic stainless-steel cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Sharp or Blunt end (like Kirschner wire end) of same diameter of the cable.
Diagram No 1-3: -
Shows orthopaedic stainless-steel cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 60 cm.
(2) Larger diameter end, cannulated and serrated from inside (size of serration is 1.5 - 2 mm).
(3) Blunt end (like blunt kirschner wire end).
Diagram No 1-4: -
Shows orthopaedic stainless-steel cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Serrated end with diameter of 1.5 - 2 mm and length of 1.5 - 2 cm.
Diagram No 1-5: -
Shows orthopaedic stainless-steel wires liable to tension composed of: -
(1) Wire liable to tension with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Sharp end.
Diagram No 1-6: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Wire liable to tension with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Serrated end with diameter of 1.5-2mm (same diameter as tension wire).
Diagram No 1-7: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Tension wire with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Blunt rounded end with diameter of 2.5 - 3 mm.
Diagram No 1-8: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Tension wire with diameter of 1.5 - 2 mm and length of 50 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Serrated part with diameter of 1.5-2 mm.
(4) Blunt rounded end with diameter of 2.5 - 3 mm.
Diagram No 1-9: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Tension wire with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Serrated part with diameter of 2.5 - 3 mm and length of 0.5 - 1 cm (larger in diameter than tension wire diameter).
(4) Blunt rounded end with diameter of 2.5 - 3 mm.
Diagram no 1-10: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Tension wire with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3)Serrated part with diameter of 2.5 - 3 mm and length of 0.5-lcm (larger in diameter than tension wire diameter).
(4) Blunt rounded end with diameter of 2.5 - 3 mm.
(5) Serrated part with diameter of 1.5 - 2 mm (same diameter as tension wire diameter).
(6) Enlargement of the shaft of the tension wire with diameter of 2 - 2.5 mm.
Diagram no 1-11 (passer cable): -
Shows orthopaedic stainless-steel cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 60 cm.
(2) Blunt end (like kirschner wire blunt end) with hole at the end.
(3) Blunt end of the cable.
Diagram no 1-12: -
Shows orthopaedic stainless-steel tension wire composed of: -
(1) Tension wire with diameter of 1.5 - 2 mm and length of 60 cm.
(2) Large diameter end (6 - 10 mm in diameter).
(3) Blunt end with diameter of 2.5 - 3 mm with hole at the end.
Diagram no 1-13: -
Shows orthopaedic cable and wire cable to tension force with serrated drill hole (no 1) can be used with serrated applicator for application.
Diagrams 2-1 to 2-5: - show various types of orthopaedic washers.
The diagrams from 2-1 to 2-5 show various types of orthopaedic washers that used to increase surface contact of cable and tension wire to bone aiming at distributing tension force over large surface area of bone surface and can be used are as follow: -
Diagram no 2-1: -
Shows orthopaedic stainless-steel washer with: -
(1) Tunnel accommodate diameter of cable or tension wires (with different diameter from 1.5 to 2 mm).
(2) Groove which is a part of a ball with 6 - 10 mm in diameter (that allow maximum contact with the largest diameter end of cable or tension wires).
Diagram no 2-2: -
Shows orthopaedic stainless-steel washer with: -
(1) Obliquely inclined tunnel accommodate diameter of cable or tension wires (with different diameter from 1.5 to 2 mm).
(2) Groove which is a part a ball of 6 - 10 mm in diameter (that allow maximum contact with the largest diameter end of cable or tension wires).
(3) Obliquely inclined surface of the washer (for maximum contact with bone surface).
Diagram no 2-3: -
Shows orthopaedic stainless-steel double way washer with: -
(1) Serrated tunnel with serration of 2.5 - 3 mm in diameter (accommodate serration beside largest diameter end of tension wire in diagram 1-9 and 1-10).
(2) Groove which is a part a ball of 6 - 10 mm in diameter (that allow maximum contact with the largest diameter end of cable or tension wires).
(3) Obliquely oriented serrated tunnel with serration of 2.5 - 3 mm in diameter (accommodate serration beside largest diameter end of tension wire in diagram 1-9 and 1-10).
(4) Groove which is a part a ball of 6 - 10 mm in diameter (that allow maximum contact with the largest diameter end of cable or tension wires).
N.B,) Serrated part of washer (one of them or both) can be replaced with tunnel of 1.5-2mm in diameter to accommodate cables or wires without serration of same diameter.
Diagram no 2-4: -
Shows orthopaedic stainless-steel double washers used in fixation of intercondylar femur fracture: -
Shows passage of tension wire (1) through (2) double washer (as shown in diagram no 15) then through distal femur then through another double washer (2) to be fixed by applying nut (3) (in diagram no 3-3) to tension wire.
Another tension wire (4) or cable (5) are applied through second hole of the double washer then through bone medulla to be fixed to short nail proximally (does not shown here and will be discussed latter in diagram 4-1, 4-2, 4-6 and 4-7).
Diagram no 2-5: -
Shows orthopaedic stainless-steel washer with: -
(1) Serrated Tunnel accommodates serrated part of tension wire in diagram 1-9 and 1-10 (diameter 2.5 or 3 mm).
(2) Groove which is a part a ball of 6 - 10 mm in diameter (that allow maximum contact with the largest diameter end of cable or tension wires).
(3) Slit 1.5 to 2 mm in width for passage of tension wire inside washer through its side (if its end already applied to bone).
Diagram 3-1 to 3-16: - show various types of holders for cables and wires under tension force.
Diagram no 3-1: -
Shows orthopaedic stainless-steel hexagonal nut with: -
(1) Serrated tunnel 1.5-2mm in diameter that accommodate serrated part of cable or tension wires (no 3 in diagram no 1-4 and 1-6).
Diagram no 3-2; -
Shows passage of orthopaedic stainless-steel serrated end tension wire (diagram no 1-6) from surface of bone fragment (1) to surface of bone fragment (2) where large diameter end of tension wires (3) rest on surface of bone fragment (1) then tension applied to wire and hexagonal nut (5) (in diagram no 3-1) applied to serrated end (4) (lag effect applied) till nut rest on surface of bone fragment (2) leading fixation of 2 bone fragments together.
Diagram no 3-3: -
Shows orthopaedic stainless-steel nut with: -
(1) Serrated tunnel that accommodates serrated part of cable or tension wires (no 3 in diagram no 1-4 and diagram no 1-6).
(2) Hexagonal groove for application of hexagonal cannulated screw driver to advance the nut.
Diagram no 3-4: -
Shows headless screw and nut for holding of tension wire or cable on surface of bone where: -
(A) Headless screw with: -
(1) Tunnel with size of 1.5 - 2 mm (same size of tension wire or cable used).
(2) Outer serration with size of 5 - 6 mm (same size of nut serration used).
(3) Hexagonal part to fit cannulated screw driver.
(4) Longitudinal slit in part of length of the headless screw.
(B) Nut with inside serration (5) of same size of outer serration of headless screw (2).
Diagrams no 3-5 shows assembly of headless screw and nut: -
Shows tension wire (1), headless screw (2) and same size nut (3).
N.B.,) - Headless screw (in diagram 3-4) is designed in a way that with advancement of the nut, slit and tunnel of the screw become narrower around tension wire or cable.
Diagram no 3-6 and 3-7: -
Show the design of the headless screws and nut used to fix the cable or the wire under tension (Diagram 3-6 is 3D and Diagram 3-6 is longitudinal section) where: -
(A) is the holding nut of the screw, where No. 1 is the outer surface of the nut it and is hexagonal, and where No. 2 is the inner serrations for it and where No. 3 is the narrow nozzle of the nut where the inner diameter of No. 4 is narrower than the inner diameter of the serrations (core diameter) No. 5.
(B) and (C) are two forms of screw holding on the cable or the wire under tension , where No. 6 is the outer serrations of the headless screw and is similar to the internal serrations of the nut (No. 2) and where No. 7 is the opening for passage the cable or wire inside the
screw then passing through the inner channel No. 8 and then through No. 9 which is a dilated cavity (greaterthan the cable or wire channel), hexagonal with height about 2-3 mm and where number 11 is a longitudinal slit in the hexagonal part and the part of the wire or cable tunnel adjacent to it and where the outer portion of the screw surrounding the hexagonal part (No. 12) is spherical almost conical in shape with Its outer diameter number 13 is smaller than the inner diameter of the nozzle (No. 4).
Note: -1- It is possible to make an internal serration (No. 14) to receive the serrated wire.
Diagram no 3-8: -
It is possible to make another design for the headless and nut so that the longitudinal slit (No. 1) and the spherical almost conical part (No. 2) are in one direction and the hexagonal part (No. 3) is on the other side with an adjustment to the surface of the narrow nozzle of the nut so that it becomes flat (no.5) to settle on the body of the bone is relatively large surface.
Diagram no 3-9: -
Shows the how the designing the headless and nut works to fix the cable or the wire under tension: - the cable or wire is installed (No. 1) (after leaving the bone body) into the headless screw through hole 2 to exit from hexagonal hole No. 3, and then through a hex screwdriver (with same size of the hexagonal size of the nut) is installed then hexagonal nut driver (with the same size of the nut) around the outer hexagonal part of the nut (No. 4). After applying tension on cable or wire, the nut switch is turned clockwise to close the nut around the headless screw so the spherical almost conical part of the screw moves toward the narrow nozzle of the nut so that the screw is compressed due to the presence of the longitudinal slit No. 5, thus
the screw hold the tension cable or the tension wire, where the level of the headless screw be inside the level of the nut (No. 7).
How to use headless screw and nut: -
(1) Socket wrench is applied to nut and cannulated screw driver applied to headless screw.
(2) Tension is applied to wire or cable.
(3) Nut is advanced in direction of hollow arrow.
(4) ->The slit and cannulated part become narrower to hold the tension wire or cable in its place and the assembly resting on bone surface (keeping the wire under tension).
Diagrams no 3-10, 3-12, 3-11, and 3-13: -
Show tools to be used for tightening of wire or cable and for assembly of headless screw with nut (diagrams no 3-4 and 3-5) and (diagrams no 3-6 to 3-9) over wire or cable: -
Diagrams no 3-10 and 3-12: -
Consists from 4 parts: -
(A) Cannulated socket wrench (to allow passage of cannulated screw driver through it) used to tighten nut over headless screw (diagrams no 3-4 and 3-5) and (diagrams no 3-6 to 3-9).
(B) Cannulated screw driver (to allow passage of tension wire through it) used to control headless screw (in diagrams 3-4, and 3- 6 to 3-9).
(C) Cannulated T- handle with side screw and inside serration.
(D) Cannulated T- handle with outside serration of same size of inside serration of T- handle (C).
N.B.,) Graduation may be added to it to calculate tension applied over wire or cable through unscrewing between both T- handles (C and D)
Where: -
(1) Tension wire.
(2) Hexagonal part of cannulated screw driver (for headless screw in diagrams 3-4, and 3-6 to 3-9) passed inside cannulated socket wrench (B).
(3) Screw connected to cannulated T- handle to hold wire or cable to cannulated T- handle.
(4) Socket wrench for nut tightening (in diagrams 3-4, and 3-6 to 3- 9).
Diagrams no 3-11 and 3-13: -
Another kind of assembly
Same as diagram 23 with the addition of serration (5) between Cannulated screw driver and cannulated socket wrench that help increase tension of the wire during tightening of the nut over slotted headless screw.
(1) Tension wire.
(2) Hexagonal part of cannulated screw driver (for headless screw in diagrams 3-4, and 3-6 to 3-9) passed inside cannulated socket wrench (B).
(3) Screw connected to cannulated T- handle to hold wire or cable to cannulated T- handle.
(4) Socket wrench for nut (in diagrams 3-4, and 3-6 to 3-9) tightening.
(5) Serration between Cannulated screw driver and cannulated socket wrench.
Diagrams 3-14 and 3-15: -
Same assembly in diagrams 3-11 and 3-13 with nut (6) and slotted headless screw (7).
Notes: -
(1) In diagrams 3-10 to 3-15 tension wire or cable pass thorough headless screw then nut then passed inside cannulated screw driver (B) and socket wrench (A) {screwed together} then passed inside T- handle (D) and T- handle (C) {screwed together} then screwing of screw (3) will hold wire or cable to T- handle (C).
(2) Process of wire or cable tightening started with headless screw (7) rested on bone surface, nut (6) applied to hexagonal end of headless screw, hexagonal part of cannulated screw driver (2) applied to headless screw, Socket wrench (4) applied over nut, T- handle (D) rested on end of socket wrench (A), T-handle (C) screwed in T-handle (D), and screw (3) holding wire or cable.
(3) Graduated tension applied to wire or cable through unscrewing of T-handie (C) over T-hanle (D) then tightening the nut over headless screw with slit in direction of hollow arrow (with the nut and headless screw resting on bone surface) the slit become narrower to hold the tension wire under same desired tension.
(4) Serration between screw driver (B) and socket wrench (A) will add more tension to wire or cable during application of nut over headless screw.
Diagram no 3-16; -
Diagram shows Y-shaped fracture of distal femur with medial fragment (1) and lateral fragment (2) and another shaft fracture (3). Tension wire (4) passed to fix with medial fragment (1) and lateral
fragment (2) using nut and headless screw with slit that rest on lateral surface of lateral fragment (2) after applying tension on tension wire and advancing the nut to fix headless screw with slot over tension wire. Washer with slot (6) ready to be applied around tension wire (7) introduced through distal fragment to pass inside proximal fragment, another cable (8) introduced through distal fragment to pass inside proximal fragment.
N.B.) Both tension wire and cable will be fixed to proximal fragment through using special nail (will be discussed latter in diagram 4-1 to 4- 7).
Diagram 4-1 to 4-32: - show various types of nails incorporated with cables and wires, and tools assisting its action.
Diagrams 4-1 to 4-7: -
Show different kinds of short nails: -
Diagram no 4-1: -
Shows first kind of short nail with: -
(1) End of the nail inside medulla with opening for longitudinal oblique tunnels (6 - 8 in number) with diameter of 1.5-2 mm.
(2) Obliquely oriented tunnels with diameter of 1.5 - 2 mm to allow passage of tension wires or cables. It starts at nail end to end inside the nail at point (3).
(3) Other end of tunnels inside nail at the start of conical part of the nail.
(4) Conical part of the nail (same angle of obliquity as conical part of first bolt).
(5) First serrated part of the nail (same diameter of serration as serrated part of first bolt).
(6) Second serrated part of the nail, wider in diameter than first part (same diameter of serration as serrated part of second bolt).
(7) Transverse drill holes for locked screws.
(8) Conical part of the first bolt (same angle of obliquity as conical part of nail).
(9) Serrated part of the first bolt (same diameter of serration as first serrated part of nail), with hexagonal socket on its top.
(10) Second serrated bolt (with serration of same diameter of serration as second serrated of the nail), with hexagonal socket on its top.
(A) Cut section at medullary end of the nail: -
(11) Opening for longitudinal oblique tunnels (6 in number) for entry of tension wires or cables.
(B) Cut section at conical part of the nail: -
(12) Inside part of the nail.
(13) Nail substance.
(C) Cut section at first serrated part of the nail: -
(14) Multiple grooves for passage of tension wires or cables outside the serration.
(15) Serration of first serrated part of nail.
N.B.,) - Outer diameter of medullary part of the nail may be of different diameter to fit different bone medullary cavity.
Diagram No 4-2: -
Shows first kind of short nail assembly with tension wires inside: -
(1) Tension wire.
(2) Opening for longitudinal oblique tunnels with tension wires inside.
(3) Obliquely oriented tunnels with wires inside.
(4) Exit hole for wires inside nail at the start of conical part of the nail with tension wire inside.
(5) Conical part of the nail and conical part of first bolt with wire in between.
(6) First serrated part of the nail and serrated part of first bolt with tension wires outside both serrations.
(7) Tension wires are bended between first and second bolt.
(8) Second serrated part of the nail and second bolt.
(9) Transverse drill holes for locked screws.
(A) Cut section at medullary end of the nail: -
(10) Opening for longitudinal oblique tunnels (6 in number) for entry of tension wires or cables with tension wire inside.
(B) Cut section at conical part of the nail: -
(11) Tension wires between conical part of the nail and conical part of first bolt.
(12) Conical part of first bolt.
(C) Cut section at first serrated part of the nail: -
(13) Multiple grooves for passage of tension wires or cables outside the serration with 6 tension wires inside grooves.
(14) Serration of first serrated part of first bolt.
(D) Cut section in between first and second bolt: -
(15) Tension wires (6 in number) are bended (after had been cut) between first and second bolt.
Diagram no 4-3: -
Shows same nail but designed as a curved or angulated nail with the curve or the angulation (3) between: -
(1) Exit of obliquely oriented tunnels (no 2 in diagram no 4-1). and
(2) Conical part of the nail (no 4 in diagram no 4-1).
N.B.J: - The ability to use curve or bend nail (big curve and high angle bend) in this design of nail and flexibility of tension wires or cables allow us to use many entries of the nail as follow: - 1- Proximal humerus entry distal than usually used away from rotator cuff.
2 - Distal humerus entry from lateral condyle or just superior to it (diagram no 4-4).
3 - Distal humerus entry superior to olecraneon fossa with less risk of bone fracture during nail application.
4 - Proximal ulna entry medially or laterally away from triceps tendon.
5 - Proximal femur entry more laterally and distal to insertion of hip abductors or away from trochanteric epiphysis (in adolescent) (diagram no 4-5).
6 - Retrograde distal femur entry from lateral condyle just superior to epiphysis (in adolescent) {medial and lateral can be used}.
7 - Proximal tibial entry distal to proximal tibial epiphysis (in adolescent) {medial and lateral can be used}.
8 - Retrograde supra-malleolar distal tibial entry superior to distal tibial epiphysis (in adolescent) {medial and lateral can be used} (diagram no 4-5).
Diagram no 4-6: -
Shows second kind of short nail with: -
(1) End of the nail inside medulla (towards fracture) with openings 1.5-3mm in diameter for longitudinal tunnels (6 - 8 in number).
(2) Tunnels with diameter of 1.5 - 3 mm to allow passage of tension wires or cables. It starts at nail end to end inside the nail at point (3).
(3) Other end of tunnels inside nail at the start of conical part of the nail (exit after first serrated the nail part of no 5).
(4) Conical part of the nail (same angle of obliquity as conical part of first bolt).
(5) First serrated part of the nail (same diameter as serrated part of first bolt).
(6) Second serrated of the nail, bigger in diameter than first part (same diameter as serrated part of second bolt).
(7) Transverse drill holes for locked screws.
(8) Conical part of the first bolt (same angle of obliquity as conical part of nail), with hexagonal socket on its top.
(9) Serrated part of the first bolt (same diameter as serrated part of nail).
(10) Second serrated bolt (with serration of same diameter as second serrated of the nail), with hexagonal socket on its top.
(A) Cut section at medullary end of the nail: -
(11) Opening for longitudinal tunnels (6 in number here) for entry of tension wires or cables.
(B) Cut section at first serrated part of the nail: -
(12) Multiple grooves for passage of tension wires or cables outside the serration.
(13) Serration of first serrated part of the nail.
(C) Cut section at conical part of the nail: -
(14) Inner part of the nail where tension wires or cables collect inside the nail.
(15) Nail substance
N. B.) 1-Outer diameter of medullary part of the nail may be of different diameter to fit different bone medullary cavity, also first and second serration diameter adjusted according to nail diameter.
Diagram No 4-7: -
Shows second kind of short nail assembly with tension wires inside:
(1) Tension wire.
(2) Opening for longitudinal tunnels with tension wires inside.
(3) Tunnels with wires inside.
(4) Exit hole inside nail at the start of conical part of the nail with tension wire inside.
(5) Conical part of the nail and conical part of first bolt with tension wires have been gripped in between.
(6) First serrated part of the nail and serrated part of first bolt with tension wires outside both serrations.
(7) Tension wires are bended between first and second bolt.
(8) Second serrated part of the nail and second bolt.
(9) Transverse drill holes for locked screws.
(A) Cut section at medullary end of the nail: -
(10) Opening for longitudinal tunnels (6 in number) for entry of tension wires or cables with tension wire inside.
(B) Cut section at first serrated part of the nail: -
(11) Multiple tunnels for passage of tension wires or cables outside the serration with 6 tension wires inside.
(12) Serrated part of first bolt (inside first serrated part of the nail).
(C) Cut section at conical part of the nail: -
(13) Tension wires between conical part of the nail and conical part of first bolt.
(14) Conical part of the bolt.
(15) Conical part of the nail.
(D) Cut section in between first and second bolt: -
(16) Tension wires (6 in number) are bended (after had been cut) between first and second bolt.
Diagram no 4-8: -
Shows diagrammatic assembly of long nail has two different diameters: -
1- Small diameter part no 5 (for example 7-llmm) has many transverse holes no 4 (1.5-2 mm in diameter), and
2- Large diameter part no 6, same as design of short nail, with holes no 2 (in transition ridge between the two different diameters). That holes will be used for passage of tension wires or cables from outside to inside the nail.
No (1) Show longitudinal tension wires applied through bone end to be introduced inside bone medulla (outside the nail till transition ridge between the two different diameters) then inside nail through openings (2).
Locking screws (3) to fix nail to bone on one side and another transverse tension wires (no 7) passing from one surface (and rested on it through enlargement in wire end with or without washers) to pass inside nail through transverse holes (4) then to other surface and
rested on it through fixation of wire with headless screws and nuts no 8 (described in diagram 3-4 to 3-9).
Diagram No 4-9: -
Shows: -
A) Same nail (in diagram 4-8) assembly inside femur bone as described in previous diagram.
B) Hemi arthroplasty stem can be fixed to femoral shaft using similar way (fenestrated stem with holes for passage of tension wire or cable that can passed through aiming device connected to stem proximally).
N.B.,: - same procedure can be done with distal femoral or proximal tibial insert in total knee arthroplasty.
Diagram No 4-10: -
- Shows drawing of femur with short nail (1) {same as that in diagram no 4-1 or 4-6} where four longitudinal tension wires (2) passed from distal fragment to be attached to nail proximally after applying tension to it. Proximal locking screw (3) fix nail to proximal fragment.
- Shows drawing of tibia fixed with long nail (4) {same as that in diagram no 4-8}, where transverse tension wires (5) fix the nail to distal fragment and two proximal locking screws (6) fixing nail to proximal tibial fragment.
Diagram No 4-11 (wire tensioning device for one wire) at a time: -
(1) Tension wire after its passage through nail.
(2) Tension wire entering tensioning device.
(3) End of the nail.
(4) Furrow in tensioning device to fit the end of the nail to rest inside it.
(5) Serrated shaft of tensioning device.
(6) Nut with inside serration of same diameter as serrated part of the tensioning device.
(7) Sleeve like (second part) passing around serrated shaft with wire in the middle.
(8) Screw applied to sleeve to hold tension wire or cable to sleeve part (where wire or cable pass in the middle of the sleeve through tunnel of same wire or cable diameter).
Cut sections: -
(A) Cut section through end of tensioning device shows wire inside and furrow (4).
(B) Cut section through serrated part of tensioning device shows wire in the middle and nut (6) around serrated part.
(C) Cut section through serrated part of tensioning device shows wire in the middle and sleeve like part (7) around serrated part.
Diagram No 4-12 (wire tensioning device for many wires in same time): -
(1) Tension wire after its passage through nail.
(2) Tension wire entering tensioning device.
(3) End of the nail
(4) Circular furrow in tensioning device (fit diameter of nail) for resting of the end of the nail inside tensioning device.
(5) Multiple Serrated tunnels (6-8 in number) that accept wires from inside end of the tunnels and allow application of serrated cannulated screws (6) of same serration diameter around the wire or cable from other end.
(6) Cannulated screws for passage of tension wire or cable inside.
(7) Bolt with serration for screw to hold the tension wire or cable to cannulated screw.
(8) Screw to hold the tension wire or cable.
(9) Screw driver passing inside tensioning device to tighten first bolt of the nail after applying desired tension to tension wire or cable.
(10) First bolt of the nail and its hexagonal socket in the middle.
Cut sections: -
(A) Cut section through entry of tensioning device shows six wires inside tunnels and circular furrow (4) around them, and screw driver in the middle.
(B) Cut section through first part of tensioning device shows six wires inside tunnels and shaft of screw driver in the middle.
(C) Cut section through serrated part of tensioning device (5), with tension wires inside and shaft of screw driver in the middle.
(D) Cut section through serrated part of tensioning device (5) shows six wires inside six cannulated screws (6) around them and shaft of screw driver in the middle.
Diagram No 4-13 (wire or cable cutting device): -
(1) Tension wire after applying tension and tightening of the first bolt (2).
(2) First bolt tightened to hold wires or cable after tension.
(3) Sharp mobile cutting end of the cutting device.
(4) First mobile part (moving in and out around wire or cable) of the cutting device.
(5) Second serrated part of the cutting device.
(6) Sleeve moving up and down around first and second part of the cutting device.
(7) Nut applied to serrated part to move sleeve towards the nail to move mobile part of cutting device to cut the wire or cable.
Cut sections: -
(A) Cut section through entry of cutting device shows wire or cable inside cutting end (3).
(B) Cut section through wide mobile part of cutting device shows wire or cable in the middle.
(C) Cut section through wide mobile part of cutting device shows wire in the middle and sleeve (6) around.
(D) Cut section through serrated part of cutting device shows wire or cable in the middle and sleeve (6) around.
(E) Cut section through serrated part of cutting device (5) shows wire or cable in the middle.
Diagrams no 4-14 and 4-15: -
Show nail incorporated with cable or wire used for reduction of displaced fracture and tools used for reduction of fracture after nail application and include: -
1) Bone fragments reduction nail (diagram no 4-14 and 4-15).
2) Serrated tension wire (diagram no 4-16).
3) Tension device (described before in diagrams 3-10 to 3-15).
4) Tension wire fixation nut (described before in diagram 3-1).
5) Headless screw and nut (described before in diagram 3-4 to 3-9).
Diagram no 4-14: -
Shows both sides fragments reduction nail where: -
1) Key hole openings on both sides of the nail allow passage of tension wire or cable (that used for reduction of bone fragments) from one side to other side of the nail.
key hole opening has distal large 4 mm in diameter (4) on the side of wire or cable insertion and round hole 3 mm in diameter (6) on the other side. Both round holes connected proximally with linear slot 2mm wide and variable length from 1 to 3 cm (5).
2+3) Round holes for insertion of locking screws distally and proximally.
• This kind of reduction nails can be used in reduction of mediolateral fragment or butterfly reduction in distal femur, proximal tibia, and distal tibia.
Diagram no 4-15: -
Shows one sides fragment reduction nail where: -
1) Key hole openings on one side of the nail allow passage of extended part (e.g., no 1 in diagram no 4-16) of tension wire or cable (that used for reduction of bone fragments) to inside the nail.
Key hole opening has distal large round 4 mm in diameter (4) connected proximally to linear slot 2mm wide and variable length from 1 to 3 cm (5).
2+3) Round holes for insertion of locking screws distally and proximally.
• This kind of reduction nails can be used in reduction of anteroposterior fragment or butterfly reduction in proximal femur, distal femur, proximal tibia, and distal tibia
Diagram no 4-16: -
A- Fully serrated olive tension wire (1.6 - 2 mm in diameter): -
1) Extended part (4 mm in diameter).
2) Serrated shaft (1.6- 2 mm in diameter) {to be fixed with 1.6- 2 mm nut after application of tension}.
B- Another kind of serrated olive tension wire (3 -4 mm in diameter): -
1) Extended part (4 mm in diameter).
3) Serrated shaft (3 -4 mm in diameter) {to be fixed with 3- 4 mm nut after application of tension}.
4) Constricted smooth part with width of 2 mm in one plane and 3-4 mm in perpendicular plane.
Diagram no 4-17: -
A) Nut (1.6- 2 mm) described in diagram 18 can be used to fix serrated wire (kind A in diagram no 4-16) on bone surface after fragments or butterfly reduction.
B) Headless screw with nut (described in diagram 3-4 to 3-9) can be used to fix smooth tension wire or cable on bone
. surface after fragment or butterfly reduction.
C) Nut (3 - 4 mm) as the one described in diagram 18 can be used to fix serrated wire (kind B in diagram no 4-16) on bone surface after fragments or butterfly reduction.
D) Tension device (in diagrams 3-10 to 3-15) can be used to apply tension to serrated wire, smooth tension wire, or cable
Diagrams no 4-18 to 4-20: -
Show how to use both sides fragment or butterfly reduction nail in reduction of displaced fragment or butterfly fragments: -
Diagram no 4-18: -
Shows using reduction nail and tension wire or cable in distal femur fracture: -
(A) Application of reduction wire or cable: -
- Application of the nail (1) inside both bone fragments and stop its advancement at position (2) shortly before its final position (3) {1 - 3 cm before final position}.
- Using target device or image intensifier do 4 mm drill holes (4) facing each big hole of the nail (no 4 in diagram no 4-14).
- Passing reduction wire or cable through skin then bone drill hole (4) then through the nail (5) firstly through 4 mm round hole of the nail (no 4 in diagram no 4-14) then out of the nail through 3 mm round hole of the nail (no 6 in diagram no 4-14) then other side of the bone then outside skin.
- Wire or cable will pass inside nail till 4mm extension part reach 3 mm hole of the nail, so it will stop inside the nail.
- Advancement of the nail to its final position (3) will make extension part of the wire or cable to stay between linear slots inside the nail (6).
B) Reduction of the fragment or butterfly: -
- Keep extension part of the wire or cable between linear slots inside the nail (6) and apply tension devices (7+ 8) to wire or cable and rest them (serrated nut or headless screw connected to tension device) on bone surfaces.
- Increasing and decreasing tension on wire or cable end will move bone fragment or butterfly from side to side causing its reduction to good position.
- Repeat same technique with other key hole of the nail.
- After reaching good position of bone fragment or butterfly: - wire or cable can be fixed on bone surface using serrated nut (in
diagram no 3-1) or using headless screw and nut (in diagram no 3- 4to 3-9) according to kind of wire or cable that used.
- Complete the procedure by application of locking screws proximally and distally.
Diagram no 4-19: -
Same technique as in previous diagram can be used in Distal tibia fracture.
A) Application of tension wires or cables.
B) Reduction of fracture with bone fragments distracted.
C) Impaction of bone fragments together.
N.B.,) Same technique can be used in proximal tibia fracture.
Diagram no 4-20: -
Same technique as in previous diagram can be used in Distal femur fracture.
A) Application of tension wires or cables.
B) Reduction of fracture with bone fragments distracted.
C) Impaction of bone fragments together.
Diagrams no 4-21 and 4-22: -
Show how to use one side fragment or butterfly reduction nail in reduction of displaced fragment or butterfly fragments: -
Diagram no 4-21: -
Shows using reduction wire or cable in proximal femur fracture: -
(A) Application of reduction wire or cable: -
- Application of the nail (1) inside both bone fragments and stop its advancement at position (2) shortly before its final position (3) {1 - 3 cm before final position}.
- Using target device or image intensifier do 4 mm drill holes (4) on anterior cortex of proximal femur facing round hole of the nail (no 4 in diagram no 4-15).
- Cut a tension wire or cable flushed with round extended part.
- Passing extended part of reduction wire or cable through skin then bone drill hole (4) then round hole of the nail (5) {no 4 in diagram no 4-15}.
- Wire or cable (6) will pass inside nail till 4mm extension part rest inside the nail.
- Advancement of the nail to its final position (3) will make extension part of the wire or cable to stay beneath linear slots inside the nail (7).
B) Reduction of the fragment or butterfly: -
- Keep extension part of the wire or cable to stay beneath linear slots inside the nail (7) and apply tension devices (8) to wire or cable and rest them (serrated nut or headless screw connected to tension device) on bone surfaces.
- Applying tension to wire or cable end will move bone fragment or butterfly in the direction of big, black arrow from unreduced position (9) to good position (10).
- After reaching good position of bone fragment or butterfly: - wire or cable can be fixed on bone surface using serrated nut (in diagram no 3-1) or using headless screw and nut (in diagram no 3- 4 to 3-9) according to kind of cable or wire used.
- Complete the procedure by application of locking screws proximally and distally (11 and 12).
Notes): -
1- Same technique can be used in reduction of distal femur fracture to push distal fragment or butterfly posteriorly.
2- Same technique can be used in reduction of distal tibia fracture to push distal fragment or butterfly posteriorly.
3- Same technique can be used in reduction of proximal femur fracture to push distal fragment or butterfly posteriorly.
Diagram no 4-22: -
- Sametechnique (as in previous diagram) can be used to correct varus deformity (1) and anterior translation of proximal fragment (2) through moving key hole of the nail (3) to anterolateral position instead of anterior position in previous diagram used to correct anterior translation.
- Angle of deviation of key hole of the nail from anterior to lateral directly proportional to increase of varus deformity compared with anterior translation of proximal fragment.
Diagrams 4-23 to 4- 27 show how to use cable around nail and inside bone to reduce displaced fractured bone fragment: -
Diagram No 4-23: -
Shows the guide tool that used for making holes and inserting the cable (used in the reduction of displaced bone fragment) through which no. 1 is a part of a cylinder and where no. 2, 3, 4 and 5 are holes pointing towards centre of a cylinder circle and at same level so that they all go to one point (no. 6) And where the holes can be circular like hole no. 3 and 4 or can be cubical like holes 2 and 5.
Diagram 4-24: -
Shows the shapes of the sleeves of inserting cables into the bone body, where no. 1 shows the shape of the circular sleeves, and where no. 2 shows the shape of the circular sleeves with a cubic end (no 3) in order to set the direction of the bevelled sleeve (No. 4) so that the bevelled parts of the sleeves face each other when introduced
through the guide (Diagram 4-23) while adjusting the direction of the bevelled hole in a circular sleeve (No. 1) using the laser line (No. 5).
Note: The angle of inclination of faced opening of the sleeves varies depending on the difference in angle between the sleeves (No. 6) and similar to the angle between the holes in Diagram 4-23 No. 7 and 8.
Diagram 4-25: -
Shows a cross section of the displaced bone part (1), the direction of its displacement (the cut arrow) from the intermedullary nail inside the bone (No. 2) and how the cable works, where holes are made to the bone body (No. 3) directed through the guide tool (not shown) then the sleeves (No. 4) are passed through the guide tool then the cable (No. 5) is passed through one of the sleeves to the inside of the bone and then through the other sleeve to the outside of the bone.
Diagram No 4-26: -
Shows a cross section of the displaced bone part (1) from the intermedullary nail (no.) where the sleeves (No. 4 in diagram 4-25) are removed and then thicker tubes (No. 3) are installed around the cable (No. 4) and then traction is applied to cables in the direction of the two arrows outward in a way that presses the free tip of the tubes so that the bone-touching end of the tube are presses against the bone, causing the displaced portion of the bone to move in the direction of the discontinuous arrow.
Diagram 4-27: - shows a longitudinal section (similar to Diagram 4-25 and Diagram 4- 26) of the broken bone that planned to be reduced and fixed where the intramedullary nail (1) passes through the non-displaced bone relative to the intramedullary nail (2) and also through the displaced bone (3) and then the cable (4) is passed To the inside of the displaced
bone (3) and then around the intramedullary nail (1) then the tension is applied on the cable (4) in the direction of the two arrows outward in a way that presses the end (no. 5) of the tubes (No. 6) so that it presses the tube (6) in the direction so that The bone-touching part (7) presses against the bone's body, causing the shifting part of the bone to move and reduce, after which the reduced part is fixed to the Interlocking nail using interlocking screws through holes No. 8.
Diagrams from 4-28 to 4-31 show serrated hook and nut used in reduction of intramedullary cable or wire to bone fragment: -
Diagram No 4-28 shows serrated hook rod with nut: -
(1) Serrated rod with diameter of 5-6mm.
(2) Nut of same inside serration diameter of the rod.
(3) Hook on one end of serrated rod with the opening accommodates diameter of tension wire or cable.
(4) Serrated tunnel from outside at other end.
NB.,): - as alternative serrated hook rod can be replaced with rod with slit (5) and 2 prominent ridges (6) inside. The serrated of the slit rod designed on a way that the cable or the wire introduced to slit through the opening (7) then with tightening of the nut (2) around the serration 5(8) the slit (5) become narrow so the prominent ridges (6) inside hold cable or the wire inside the slit.
Diagram No 4-29 shows socket wrench and T-handle for tightening of nut over hooked serrated rod: -
(1) T-handle.
(2) Serrated end of T- handle of same diameter as serrated tunnel (no 4 in diagram no 36).
(3) Cannulated T-handle.
(4) Socket hexagonal wrench end of same size as nut (no 2 in diagram 4-28).
Diagram No 4-30 (assembly to apply hooked serrated rode and nut):
Shows T-handle (1) to pass inside cannulated T-handle (2) and nut (3) then serrated end (4) screwed in serrated end (5) of hooked serrated rod (6). Socket wrench (7) applied around nut (3) to advance nut around the rod.
Diagram No 4-31 (how hooked serrated rod work?): -
Shows how hooked serrated rod works where tension wire (1) + (2) applied from distal end of femur (3) to proximal end of femur (4) but still fracture not reduced (5) then hooked serrated rod (6) connected to its parts (as described in diagram 4-30) applied around tension wire (2) through drill hole (7) in distal femur then nut (8) tighten (using socket wrench) to pull rod out hooking the wire -> reduction of fracture and augmentation of fixation.
Then T-handle with serrated end and socket wrench removed.
Diagram No 4-32: - shows reduction of fracture using tension cable or wire: -
-Shows drawing of distal femur fracture with multiple tension wires (1) fixing fragments together {N.B: - further fixation of fracture with another method need to be added to these tension wires}.
Diagram No 4-33 to 4-37: - show tools for reduction of epiphyseal fragment of long bones using plate and tension wire or cable (proximal femur as example here): -
Diagram No 4-33: -
Shows plates (A and B) used for reduction and their applicators (C and D) where: -
1) Longitudinal slot.
2) L shaped open slot.
3) Cylindrical hole.
4) Serrated longitudinal cylindrical hole.
5) Shaft of the applicator with rectangular cut section.
6) Serrated rod (part of plate applicator).
7) Serrated rod (part of plate applicator).
8) Nut of serrated rod.
9) Cylindrical tunnel for passage of serrated rod (of equal diameter).
10) Extension of the applicator that rest on surface of the plate on application to prevent rotation of the applicatbr.
N.B) Diameter of serration (4) equal to diameter of serration (6) and diameter of rod serration (7) and nut (8).
Diagram No 4-34 and 4-35: -
Show Assembly of plate to introducer, where any applicator (C and D) can be used with any plate (A and B).
Diagram No 4-34: -
Assembly of plate (A) to applicator (C) through screwing of serrated part of applicator to longitudinal serrated hole ending with surface of the plate parallel to surface of applicator.
N.B,): - Risk of mal-rotation of connection with applicator (C) is more than with applicator (D).
Diagram No 4-35: -
Assembly of plate (A) to applicator (D) through screwing of serrated rod of applicator to longitudinal serrated hole of the plate ending with surface of the extended part of the rod rested on surface of plate then fix the rod to the body of the applicator using nut.
Diagram no 4-36 and 4-37: -
Shows using plate with intramedullary nail in reduction of displaced proximal femur fracture: -
(A) Application of reduction wire or cable (see diagram 4-21): -
- Application of the nail (1) inside both bone fragments and stop its advancement at position (2) shortly before its final position (3) {1 - 3 cm before final position}.
- Using target device or image intensifier do drill holes on anterior cortex of proximal part of distal femur facing round hole of the nail and then apply 2 olive wires or olive cable in sequential manner (apply proximal one then advance the nail then apply distal wire or cable) keeping distance between wires almost same as distance between opening of slots of the plate
- Passing extended part of reduction wire or cable through skin then bone drill hole (4) then round hole of the nail (5).
- Wire or cable (6) will pass inside nail till 4mm extension part rest inside the nail.
- Advancement of the nail to its final position (3) will make enlarged part of the wire or cable to stay beneath linear slot inside the nail (7).
B) Application of the plate: -
Plate (A) applied through proximal wound using introducer (B) either free hand or connected to aiming device aiming at passage of cable or wire through slots of the plate and hole of the nail.
C) Reduction of the proximal fragment: -
- Keep olive part of the wire or cable to stay beneath linear slots inside the nail (7) and apply tension devices (8) to wire or cable then against the plate surface and rest plate on bone surfaces.
- Applying tension to wire or cable end will move the plate and accordingly bone fragment from unreduced position to good position.
- After reaching good position of bone fragment or butterfly: - wire or cable can be fixed on bone surface using serrated nut (8) (in diagram no 3-1) or using headless screw and nut (in diagram no 3- 4 to 3-9) according to kind of cable or wire used.
- Complete the procedure by application of locking screws proximally and distally (9).
D) Removal of introducer (B) after complete the procedure.
1) Plate (A in diagram 4-33) can be used through same steps but plate has to be applied first before application of tension wire or cables.
2) Augmentation of reduction and fixation can be achieved using third wire or cable (10) through proximal bone fragment and through plate hole (11) {it has to be applied before completing the procedure}.
Diagram no 4-38 to 4-42: -
Show design of plate connected to modified design intramedullary nail for reduction and fixation of very small epiphyseal fracture in
distal end of femur and any end of tibia accompanied with diaphyseal comminution.
Diagram no 4-38: -
Show level of epiphyseal fracture can be treated with this design of plate connected to modified design intramedullary nail: -
(1) Level of fracture in proximal end of tibia accompanied with diaphyseal comminution.
(2) Level of fracture in distal end of tibia accompanied with diaphyseal comminution.
(3) Level of fracture in distal end of femur accompanied with diaphyseal comminution.
Diagram no 4-39: -
Show design of plate connected to modified design intramedullary nail describing the modification in plate and nail (for proximal tibia fracture a example): -
(A) Locked proximal tibia plate L or J shaped: -
- Has proximal serrated locked holes (1) for screws (7) to fix the plate to proximal bone fragment.
- Has locked serrated hole (2) {like serrated hole no 4 in diagram 4-33} used to communicate the plate to applicator) {like applicator (D) in diagram 4-33} that can be connected to aiming device of the intramedullary nail for targeting screws from plate holes to nail holes.
- Has two to four serrated holes (3) for locked screws (8) on one line on the shaft of the plate.
(B) Modified design interlocking tibial nail: -
- Has proximal holes (4) for proximal locked screws (9).
- Has distal holes (5) for distal locked screws (10).
- Has modification no (6) which are two to four serrated holes for locked screws (8) on one same line on the shaft of the nail compatible with locked screws (3) of the plate.
N.B,) - Using plate applicator connected to aiming device of the nail, so screws (8) applied through holes (3) of the plate then can be targeted through holes (6) of the nail.
- Using plate applicator connected to aiming device of the locking screws of the nail, one or two screws (9) can be applied through holes (1) of the plate then targeted through one or two screws holes (4) of the nail.
Diagram no 4-40: -
Shows using plate connected to modified design intramedullary nail in treatment of very proximal fracture tibia with diaphyseal comminution using plate applicator (1) connected to aiming device of interlocking nail for targeting screw (2) and (3).
Diagram no 4-41: -
Shows using plate connected to modified design intramedullary nail in treatment of very distal fracture tibia with diaphyseal comminution where screws (2) applied through plate and nail by free hand way without aiming device (image intensifier can be used).
Diagram no 4-42; -
Shows using plate connected to modified design intramedullary nail in treatment of very distal fracture femur with diaphyseal comminution where screws (2) applied through plate and nail by
free hand way without aiming device (image intensifier can be used).
N.B,): - Plate can be applied using applicator connected to hole (1) and connected to aiming device of interlocking nail if the retrograde nail is used.
Diagram no 4-43 to 4-46: -
Show reduction push pull reduction tools for reduction of displaced bone fragment and how they work.
Diagram no 4-43: -
Shows first kind of push pull reduction tool which composed of 3 parts:
A) Outside sleeve: - metal sleeve (1) with triangular metal block (2) forming together L shape, on the other end cylindrical metal block (3) for detection of direction of triangular block during its presence inside patient body. Inside rod: - Serrated rod (4) equal inside diameter of the sleeve with triangular metal block (5) forming together L shape.
C) Nut: - for advancement of rod inside the sleeve.
Diagram no 4-44: -
Shows second kind of reduction tool which composed of 3 parts: -
A) Outside sleeve: - metal sleeve (1) with triangular metal block (2) forming together L shape, on the other end cylindrical metal block (3) for detection of direction of triangular block during its presence inside patient body.
B) Inside rod: - Serrated rod (4) equal inside diameter of the sleeve with one 3 mm hole (5) on one side and two 3mm holes (6) on the other side.
C) Nut: - for advancement of rod inside the sleeve.
D) Applicator of the inside rod: - longitudinal metal bar (7) with 2 cylindrical bars (8) on one side of same size of holes (6) and distance in between as distance between holes (6), one 6 mm hole (9) on other side targeting to hole (5) on the rod if rods (8) applied to holes (6).
N.B,): - rods (8) have 2 holes for passage of thin T shape rod (10) that touch by its end (11) main bone fragment surface (pull fragment) on resting of its transverse limb on the upper rod (8).
E) Sleeve with outside diameter 6 mm and inside diameter 3 mm to pass inside hole (9).
F) 3 mm Shanz screw or Steinmann pin: - Passed through the sleeve (E) through hole (9) then inside the bone (pull fragment) targeting to hole (5) in the rod (4) guided by rod (10) where its end (11) rested on bone surface with rods (7) applied to holes (6).
Diagram no 4-45: -
Shows how first kind of pull push reduction tool works in reduction of trochanteric fracture: -
1- Reduction tool assembly then introduce its end through small skin incision with the transverse limbs (blocks) parallel to each other in line with fracture line.
2- Rotate transverse block connected with rod to settle beneath main bone fragment (pull fragment) {1} and transverse block connected with sleeve to settle over displaced bone fragment (push fragment) {2}.
3- Advance nut over the rod to push the displaced bone fragment and pull the main fragment causing fracture reduction.
4- After stabilization of fracture (and before fracture impaction) reduction tool has to be rotated to be extruded outside bone and skin then fracture impaction to be done.
Diagram no 4-46: -
Shows how second kind pull push reduction tool works in reduction of trochanteric fracture: -
A -Reduction tool assembly (rod inside sleeve) then introduce its end through small skin incision till rod tip (1) pass in fracture line.
- Rotate the rod till holes face laterally then apply rods of applicator (2) to corresponding holes in the serrated rod.
- Guided by thin rod (3) applied through transverse rods till it rest by its tip on bone surface, by this way depth of serrated rod inside fracture can be controlled then 3 mm Shanz screw or Steinmann pin (4) applied through sleeve passed inside hole in the serrated rod to fix it to main bone fragment (5).
B - Advance nut (6) over the rod to push the displaced bone fragment (7) by the triangular block of the sleeve (8) and pull the main fragment (5) causing fracture reduction.
N.B, - After stabilization of fracture (and before fracture impaction) Shanz screw or Steinmann pin then reduction tool has to be extruded outside bone and skin then fracture impaction to be done.
Diagrams 5-1 to 5-9: - Show guiding tools for distal femur osteotomy: -
Diagram No 5-1 and 5-2: - Show external guide for dome shaped osteotomy can be done in distal part of the femur.
Diagram No 5-1: -
Show shape of the guide tool (first kind) for the bone osteotomy of distal part of the femur bone (part of a circle) which is a flat with thickness of 2-3 cm, where: -
1-Center of the osteotomy action, and it is a cylindrical hole with a diameter of 8 mm.
2-Screw to hold sleeve or Steinmann pin that pass through hole no (l).
3- Serrated tunnel (no 3) for passage of screw (2).
4- Longitudinal tunnel in the longitudinal arm of the aiming device (has to be in line with the centre of the shaft of the femur).
5- Transverse rectangular slots on each side of longitudinal arm and perpendicular to it with inside width of 6 mm.
6- Screws that can narrow or expand the transverse rectangular slots to control movement of Shanz or Steinmann pin passed through slot (5) then to distal femur.
7- Serrated channel number 7 for passage of screw (6).
8- Slot with a width of 8 mm (part of circle its centre is hole no 1).
N.B): - hole no 1, and slit no. 5, and 8 are made through whole width of the aiming device.
Diagram No 5-2: -
Show shape of the guide tool (second kind) for the bone osteotomy of distal part of the femur bone (part of a circle) which is a flat with thickness of 2-3 cm.
A- Aiming device for osteotomy where: -
1-Center of the osteotomy action, and it is a cylindrical hole with a diameter of 8 mm.
2-Screw to hold sleeve or Steinmann pin that pass through hole no (1).
3- Serrated tunnel (no 3) for passage of screw (2).
4- Longitudinal tunnel in the longitudinal arm of the aiming device (has to be in line with the centre of the shaft of the femur). ,, > . ,
5- One transverse rectangular slots perpendicular to longitudinal limb with inside width of 10- 12 mm.
6-Nut 6 mm that can narrow or expand the transverse rectangular slots.
7- Tunnel number 7 for passage of rod (11).
8- Slot with a width of 8 mm (part of circle its centre is hole no (1).
N.B): - Hole no 1, and slit no. 5, and 8 are made through whole width of the aiming device.
B- Guide block of 10- 12 mm to pass inside slot no (5) where: -
9 - Mark on the middle of the block.
10 - Cylindrical hole with diameter of 3 mm.
11 - Serrated rods 6 mm in diameter.
12 - Serrated tunnel 6 mm in diameter (for connection with rods no 11).
N.B.) In both kinds of guide device (diagram 5-1 and 5-2), after application of block (B) inside transverse rectangular slots (5) rods (11) to be passed through tunnel (7) to be connected to block (B) then nut is used to control movement of block inside slot to control movement of Shanz or Steinmann pin passed through holes (10) then to distal femur. This Shanz or Steinmann pin will control movement of the fixing interlocking nail during its movement inside bone to help in correction of bone deformity.
Diagram No 5-3: - shows the lateral external guide used to make the lateral and medial osteotomy drills in distal femur, as well as used in guided installation of the osteotomy tool (part of a circle) {in diagram 5- 10 and 5-12} in its position in front of the thigh bone where: -
1) Longitudinal part of the guide device.
2) Lateral part of the guide tool with its axis perpendicular to the axis of the longitudinal part.
3) Anteroposterior arm of the guide tool with its axis perpendicular to the axis of the lateral part (2).
4) Cylindrical holes with a diameter of 8 mm. Its axis in line with axis of the middle of the lateral part and in same plan of the middle of the side (anteroposterior) arm.
5) Cylindrical holes with a diameter of 8 mm (where its centre at a distance from hole no 4 equals a radius Slot circle No. 8 in diagram 5- 1 and 5-2).
6) Longitudinal slot through the anteroposterior arm of the guide tool in the same plane and parallel to the hole No. 4.
Diagram 5-4: -
The bone osteotomy tool for the distal femur bone and the guide parts shows where: -
A) Bone osteotomy guide (part of a circle) of 8 mm width and inside and outside diameter that fit diameter of slot (no 8 in diagram 5-1 and 5-2) and height of 2-3 cm where: -
1) And 2) Cylindrical holes of different diameter to accommodate diameter of sleeves (with drill bit inside), drill bit or Steinmann pin.
3) Rectangular hole accommodates width of head of bone osteotome (B).
B) Osteotome where: -
4) Head of the osteotome accommodates width of hole (3).
Diagram 5-5: -
Show different kinds of osteotomies and different kinds of guiding blocks where: -
1) Osteotome with rectangular head.
2) Osteotome with square head.
3) Osteotome with hexagonal head. Its width is of same width of slot (6) of anteroposterior limb of guide in diagram 5-3.
4-7) Guiding blocks: -Their width are of same width of anteroposterior limb of guide in diagram 5-3. Their height are 2-3 cm where: -
- Block no (4) is suitable to rectangular head osteotome.
- Block no (5) is suitable to hexagonal head osteotome.
- Block no (6) and (7) are suitable to different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin. -12 ) Guiding blocks: - part of circle Their width are 8 mm accomodate width of Slot (no 8 in diagram 5-1 and 5-2). Their height are 2-3 cm where: -
- Block no (8) is suitable to rectangular head osteotome.
- Block no (9) is suitable to hexagonal head osteotome.
- Block no (10) and (11) are suitable to different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin.
- Block no 12 is multipurpose suitable for square head osteotome and different diameter sleeve (with drill bit or Steinmann pin inside), drill bit, or Steinmann pin.
Diagram 5-6 and 5-7: -
Show 2 parts used and connected together to guide linear osteotomy in proximal tibia , distal tibia , and to lesser extent distal femur.
Diagram 5-6: -
Show shape of the guide tool (first part) which is flat with thickness of 2-3 cm {the part that fix to the end of the bone, proximal end in proximal osteotomy and distal part in distal osteotomy} to be used for the linear bone osteotomy of distal and proximal part of the tibia bone.
A- Part that carries the osteotomy guide and guide movement of intramedullary nail inside the medulla where: -
1-Hole for fixing the part to bone and it is a cylindrical hole with a diameter of 8 mm.
2-Screw to hold sleeve or Steinmann pin that pass through hole no (1).
3- Serrated tunnel (no 3) for passage of screw (2).
4- Longitudinal mark in the middle of longitudinal arm of the aiming device (has to be in line with the centre of the shaft of the tibia).
5- One transverse rectangular slots perpendicular to longitudinal limb with inside width of 10- 12 mm.
6-Nut 6 mm that can narrow or expand the transverse rectangular slots.
7- Tunnel number 7 for passage of rod (11).
8- Tunnel of diameter 6 mm for passage of rod (8a) that connect it to other part of the guide (diagram 5-7) and to be fixed with nuts (8b).
N.B): - hole no 1, and slit no. 5 are opened through whole width of the aiming device.
B- Guide block of 10- 12 mm to move inside slot no (5) where: -
9 - Mark on the middle of the block.
10 - Two cylindrical holes with diameter of 6 mm each, the distance between the inner edges and the mark (9) are equal, and the distance between the inner edge of both are equal to used nail size.
11 - Serrated rods 6 mm in diameter.
12 - Serrated tunnel 6 mm in diameter (for connection with rods no li).
N.B.): -
- after application of block (B) inside transverse rectangular slots (5) rods (11) to be passed through tunnel (7) to be connected to block (B) then nut is used to control movement of block inside slot to control movement of Shanz or Steinmann pin passed through holes (10) then to tibia.
- This Shanz or Steinmann pin will control movement of the fixing interlocking nail inside to help in correction of bone deformity.
Diagram 5-7: -
Show shape of the guide tool (second part) {the part that can be used to guide osteotomy} that to be used for the linear bone osteotomy of distal and proximal part of the tibia bone.
It has two parts: - C and D parts.
- Part (C) has thickness of 2-3 cm and composed of two parts: - )ca(and)cb(connected together: - ca) Two longitudinal arms connected on one side to part (A) in diagram 5-6 through two tunnels (1) where: -
1) Two tunnels 6 mm in diameter for passage of rod (no 8a in diagram 5-6) for fixation of this part to part (A) in diagram 5-6.
2) Indicate vvirtual line for direction of tunnels (1), and also after fixation for tunnels (8) in diagram 5-6.
3) De-rotation bars to prevent rotation of this part on part (A) after fixation. cb) Part of circle connected by its two edges to end of parts (ca) where: -
4) Slot has 2 cm height with its shape is part of circle. Its virtual centre is passing beyond virtual line (2) at point (5).
5) Indicate virtual point marking centre of slot (4).
6) Slot crossing perpendicular to circular slot (4) and in the plan of the middle of aiming device (C). Its width is 8 mm. Make with the circular slot shape of hollow cross
their cut section.
- This slot is for passage and control plan of movement of drill bit with or without sleeve or Steinmann pin (that pass from outer part of the slot to inside part (D) then again through inner part of the slot aiming to virtual point (5).
7) Two tunnels for passage of rod (8).
8) Rod and nut for control movement of part (D) inside circular slot (4) and so control movement of drill bit with or without sleeve or Steinmann pin.
D) Block has 2 cm height and it width same as width of part (C) with its shape is part of circle. Its virtual centre is virtual point (5): -
9) Two cylindrical drill holes their diameter are 8 mm passing from the outside circle to inside circle.
10) Two serrated tunnels for connection with rods (8).
Diagram no 5-8: -
Shows reconstruction of part (A) in diagram 5-6 with part (C) in diagram 5-7: -
- Construct to be fixed to bone by Shanz screw passing through hole (1) and to be hold by screw (2).
Diagram no 5-9: -
Block has 2 cm height. Its shape is part of circle (more than quarter of circle) with diameter of 20- 30 cm: -
1) Slot in the middle of the block, its shape is part of circle inside block that has shape of part of circle.
-This block is used to guide whole construct of diagram 5-8 to work from front (direction of vertical solid arrow) or from side of the bone (direction of transverse solid arrow) where Shanz screw passing through hole (1) in construct in Diagram no 5-8 then through slot (1) {either anteriorly or to the side} in this guide then to bone.
Diagram 5-10; -
The bone osteotomy tools that can be used for making guided dome distal femur bone osteotomy where: -
1) Osteotomy tool (part of a circle) of different lengths depending on the width of the lower femur.
-It consists of blade and two cylindrical parts.
2) Blade for cutting bone. Its width is approximately 1.5 cm and the thickness is 2 mm.
3) Two cylindrical parts. Its diameter is 8 mm is welded toedge of the blade.
4) Longitudinal threaded hole with a diameter of 4 mm in the middle of the cylinder (2) at its top.
5) Threaded hole with a diameter of 4 mm at the side bottom (it does not contradict the threading of the upper part).
-The longitudinal axis of hole no (5) is tangent to the circle of blade (2).
6) Cylindrical rod with a diameter of 8 mm.
7) Threaded ends with a diameter 4 mm same as threads of threaded hole (4).
8) Guide arm: - Parallel rectangle with a width of 8 mm and Height 8 mm.
9) End of the rectangle (8) and is part of a circle with a diameter of 8 mm.
10) Longitudinal tunnel in the bottom part of the rectangle with a diameter of 4 mm.
11) Threaded rod with a diameter of 4 mm.
12) Nut with an internal diameter of 4 mm.
13) Anteroposterior arm of the guide tool (no 6 in diagram 5- 3).
Diagram 5-11: -
Shows an alternative method and design of the osteotomy tool where: -
(1) Another design of osteotomy blade where: -
(2) Small cylindrical block with a diameter of 8 mm welded to edge the osteotomy blade
(3) Defective part of the blade so that when making the bone osteotomy the medial posterior and lateral posterior corners remain intact (they will be osteotomized latter on using narrow osteotome through the skin after securing the fixation of the osteotomized partially)
(4) Sloping cut in the blade with a width of 2 mm starting from point 6 inclined to end with point 7 above the middle of cylinder No. 2.
(5) Threaded hole with a diameter of 4 mm at the side.
- longitudinal axis of threaded hole has a tangent to the circle of blade number (1).
6) and 7) Represent start and end of the sloping cut.
8) Four longitudinal metal protrusions on both ends Blade (perpendicular to the longitudinal axis of the osteotomy blade and its outside edge is 4 mm from the middle of the cylinder (2).
Diagram 5-12: -
Shows full parts of alternative tools for osteotomy: -
1) Alternative osteotomy tool (described in diagram 5-11).
2) Guide arm (No. 8 in Diagram 5-10).
3) Cylindrical rod with a diameter of 5 mm.
4) Peripheral threaded part (5 mm in diameter) of cylindrical rod (no 3).
5) Longitudinal slit with a width of 2 mm on the other side of cylindrical rod and length almost equal the width of the blade.
6) Thin circular rod with a diameter of 2 mm inside the slit that connecting the middle of the two sides of the slit at little distance from the edge.
7) Tube with an outer diameter of 8 mm and the inner 5 mm.
8) Cut at the tip of the tube of width of 2 mm and length almost equal the width of the blade.
9) Nut with inner serration size 5 mm (similar to threads of peripheral threaded part No. 4).
Diagram 5-13: - represents assembly of the alternative method of bone osteotomy, where: -
1) Osteotomy blade.
2) Guiding arm (identical to parts no 8 and 11 and 12 in diagram 5-10) and guided in the same way through the anteroposterior arm of the guide (no 6 in diagram 5-3).
- After installing the osteotomy tool in front of the femur: - the tube (No. 7 in Diagram 5-12) is installed around the rod (no. 3 in diagram 5-12) and inserted through the slit (no. 8 in diagram 5-1 or 5-2) so that the rod (no 3 in diagram 5-12) and tube (no 7 in Diagram 5- 12) around it pass around the blade by passing the small rod (No. 6 in Diagram 5-12) through the slit of the blade.
- After the tube and rod are rested above the cylinder (No. 2 in Diagram 5-11) completely: -
-The nut is attached (No. 9 in Diagram 5-12) so that assembly (No. 3) is formed which can only be separated from the blade by loosening the nut where metal part (No. 8 in diagram 5-11) prevent side movement of assembly (No.
3).
-The osteotomy is made by hammering on the two assemblies (No. 3) after removing the guide arm (2).
- After performing the osteotomy in distal part of femur: - - the guide arm (no.2) is re-installed through the anteroposterior arm of the guide device (no 6 in diagram 5- 3) {as before}.
- The assembly (No. 3) components has to be removed after removing the two nuts and the osteotomy tool is removed from the body.
N.B.): -
- There will be intact (non-osteotomized) posteromedial and posterolateral corners of the femur bone (as a result of the presence of the deficient part of the osteotomy blade(no. 3 in the diagram 5-11).
- Non osteotomized part is subsequently completed using a small bone osteotome through small skin incisions after the partial fixation of the osteotomized part.
Diagram 5-14 to 5-16: -
How to do dome shaped guided osteotomy, how to correct deformity and how to fix it.
Diagram 5-14: -
Shows how to do guided preparatory drills for the distal femur osteotomy where: -
1) Intramedullary nail introduced inside intact deformed bone. Then
Tension wire with olive is applied inside nail (in same manner as in diagram 4-20)
3) Through distal anteroposterior hole of the intramedullary nail, Shanz screw has to be passed from anterior bone cortex till it hold posterior bone cortex.
4) Guide will be applied over Shanz screw through hole (no 1 in diagram 5-1 or 5-2).
5) Multiple drill hole then created by drill bit pass through sleeve and block (no 10 or 11 in diagram 5-5) that pass in slot (no 8 in diagram 5-1 or 5-2).
N. B.,: -
- Osteotomy can be completed be osteotome (like no 1 or 3 passing through (no 8 or 9 in diagram 5-5) that pass in slot (no. 8 in diagram 5-1 or 5-2).
- Small part of bone posterior to nail may be difficult to be cut by osteotome and can be completed by bone rotation of distal and proximal parts (around the intramedullary nail) in a reversed manner.
- Correction of deformity can be done using tension wire (in same way as in diagram 4-20).
- After complete correction of deformity, you can complete fixation of the nail with locked screws proximally and distally.
- Osteotomy site can be fixed with two thick crossing kirschner wire (6) if needed during the procedure till complete fixation.
Diagram 5-15: -
Shows how to install and use the osteotomy tool, where: -
A) Introduction of the osteotomy part over anterior surface of the femur; -
1) The osteotomy tool (1) is inserted to front of the femur through a wound in the anterolateral area in the planned bone osteotomy level. Where the bone osteotomy tool (1) (No. 1 in Diagram5-10) is attached to the guide arm (2) (No. 8 in Diagram 5-10) and then inserted through the anteroposterior arm of the guide tool (3) (No. 6 in Diagram5- 3).
2) Then the cylindrical rod (4) (No. 6 in Diagram 5-10) is attached to the Osteotomy Tool by passing them guided by their passage through the slit (part of a circle) (No. 8 in Diagram 5-1 and 5-2).
B) Osteotomy of distal femur: -
3) After the installation of arms No. 4, the guidance arm No. 2 is removed.
4) Then the bone osteotomy No. 5 (after multiple drills guided by slit (no. 8 in diagram 5-1 and 5-2) through small anterior knee wounds) is made by hammering (6) on the cylindrical rods (4).
C) Removal of osteotomy part: -
5) After Bone osteotomy (5), the guide arm (2) is installed through the anteroposterior arm of the guide device (3), then the cylindrical rods (4) are removed and the osteotomy tool is removed from the body guide by the guide arm.
N.B.,): -
- Posterior cortex will be left without cut by osteotomy tools and can be completed by bone rotation of distal and
proximal parts (around the intramedullary nail) in a reversed manner.
- Correction of deformity can be done using tension wire (in same way as in diagram 4-20).
- After complete correction of deformity, you can complete fixation of the nail with locked screws proximally and distally.
- Osteotomy site can be fixed with two thick crossing kirschner wire (6) if needed during the procedure till complete fixation.
Diagram 5-16: -
Shows how to use tension wire in correction of bone deformity where: -
A) Shows the nail applied inside the almost completely osteotomized femur: -
1) Osteotomy site.
2) Tension wire or cable with olive is applied inside nail (in same manner as in diagram 4-20).
B) Shows the nail applied inside the almost completely oteotomized femur and tension devices (3) and (4) applied to both ends of the tension wire or cable.
- Application of tension force on both sides of the wire or cable with the tension more on the direction of open arrow this will lead to movement of the bone fragment to other direction creating displacement of the distal fragment (5).
C) Stabilization of osteotomy after complete correction of the deformity: -
- After complete correction of the deformity, wire will be fixed to bone by nuts or headless screw and nut (6) on each side {see diagrams 3-1 to 3-15} and extra parts of the wire (7) to be cut and removed.
- Complete the fixation using lateromedial (8) and anteroposterior (9) locking screws.
Diagrams 6-1 to 6-8: - show external fracture reduction tools: -
Diagram from 6-1 to 6-8: - Shows reduction frame and description of its parts: -
Diagram No 6-l;-Shows reduction part of reduction frame: -
(1) Central block that allows passage of mobile reduction piece (no 5) and its mobility through it.
(2) Transverse tunnels for passage of two serrated rods connecting corner blocks (in diagram 6-6and 6-7) together.
(3) Two serrated rods that will pass inside central block and connect two corner blocks together.
(4) Longitudinal tunnel (4) for passage of serrated rod of mobile reduction piece.
(5) Mobile reduction piece.
(6) Curved bar of mobile reduction piece.
(7) Serrated rod of mobile reduction piece.
(8) Nuts connect mobile reduction piece to Central block.
N. B.) A- Serrated rod (7) pass through longitudinal tunnel (4) of central block.
I
B -Two nuts (8+8) that hold mobile reduction piece to central bar and allow its movement up and down in directions of open arrows.
Diagram No 6-2: - Shows photo of reduction part of reduction frame:
Shows central block (1) with two serrated rods (3) pass through two transverse tunnels (2).
Central block (1) has also one longitudinal tunnel (4) for passage of serrated rod (7) which is connected to curved bar (6).
Mobile reduction piece (5) consists of curved bar (6) connected to serrated rod (7).
Nut (8) before its application to serrated rod when it passes through central block.
Diagram 6-3 shows assembly of reduction part of reduction frame: -
Shows how rotation of nuts (1+1) can control movement of mobile reduction piece (2) inside central block (3): -
1-Rotation of nuts (1+1) in direction (4) -> movement of mobile reduction piece (2) in direction of open arrow (5).
2-Rotation of nuts (1+1) in direction (6) -> movement of mobile reduction piece (2) in direction of open arrow (7).
Diagram 6-4 shows photo of assembly of reduction part of reduction frame: -
Shows two tunnels (1) through which two serrated rods will pass to connect two corner blocks together.
Diagram 6-5 shows assembly of reduction part of reduction frame (superior one): -
Shows serrated rod (1) passed inside transverse tunnel (2) and serrated rod (3) passed inside transverse tunnel (4) to connect two superior corner blocks together.
Diagram No 6-6 shows corner block: -
Shows corner block where serrated rod (1) that pass inside tunnel (2) and serrated rod (3) that pass inside tunnel (4).
Serrated rod (5) that pass inside tunnel (6), and serrated rod (7) that pass inside tunnel (8).
Serrated rod (9) that pass inside tunnel (10).
N. B.): - 1- Serrated rod (1) in this diagram is the same as serrated rod (1) that pass inside central block (superior one) in diagram 6-5 to connect this block to corner block on other side.
2 - Serrated rod (3) in this diagram is the same as serrated rod (3) that pass inside central block (superior one) in diagram 6-5 to connect this block to corner block on other side.
3 - Serrated rod (5) in this diagram will pass inside central block (medial or lateral one) to connect this block to corner block inferiorly.
4 - Serrated rod (9) connect this corner block to facing block (in same position on other sided of fracture).
N.B.,) All these serrated rods to be connected to corner blocks using nuts on both sides of the block (see diagram 6-7).
Diagram 6-7 shows corner block: -
Diagram shows same corner block in diagram 6-6 (1) with rods (2) introduced inside the block and fixing nuts (3) in place.
Diagram 6-8 shows assembly of reduction frame on one side of the fracture (half frame): -
• Shows assembly of corner blocks (1, 2, 3 and 4) connected together with double serrated rods (9, 10, 11 and 12), where double serrated rods (9) connect corner blocks (1) with corner blocks (2) and double serrated rods (10) connect corner blocks (2) with corner blocks (3) and double serrated rods (11) connect corner blocks (3) with corner blocks (4) and double serrated rods (12) connect corner blocks (4) with corner blocks (1)
• Shows assembly of central blocks (5, 6, 7 and 8) with double serrated rods (9, 10, 11 and 12) passed inside respectively.
• Shows cut section of the broken limb (13) with the bone fragment (14) to be reduced.
N. B.): -
1 - As an example for how assembly work to reduce bone fragment: -
Rotation of nuts in assembly (6) will move serrated rod inside central block (6) in direction of broad arrow and on same time rotation of nuts in assembly (8) to move serrated rod inside central block (8) in direction of broad arrow will move bone fragment in same direction.
In same time central block (5) and central block (7) that hold limb will move and slide around serrated rods (9) and serrated rods (11) respectively in same direction of broad arrow.
By this way, direction of movement of the bone fragment can be isolated (to be in one desired direction with little or no movement on perpendicular direction).
2 - Tunnels (15) in each corner block will be used for passage of serrated rods (no 9 in diagram 46) fixed with nuts to connect corner block (in this half frame) to facing corner block (in other half frame on other side of fracture).
Diagram 6-9 shows photo of assembly of reduction frame in one side (half frame).
Diagrams 7- 1 and 7 - 2: - shows cables used in bone lengthening and deformity correction.
Diagrams 7-1: -
Shows three kinds of single cables
Shows orthopaedic stainless-steel, cobalt chrome or titanium cable composed of: -
(1) Cable with diameter of 1.5 - 3 mm and length of 80 cm.
(2) Large diameter part (3 - 6 mm in diameter).
(3) End with hole.
Diagrams 7-2: -
Shows three kinds of multiple end cable: -
Shows orthopaedic stainless-steel, cobalt chrome or titanium cable composed of: -
(1) Cable with length of 80 cm and diameter of the single cable end of 3 -4 mm and diameter of each cable of the divided end of 1.5 mm - 2 mm.
(2)Large diameter part (3 - 6 mm in diameter).
(3)End with hole.
Diagram 7 - 3: -
Represent one of the wire or cable holder (diagram 3-4 to 3-9) {any one can be used}.
Diagram 8 - 1 to 8- 10: - show design of intramedullary nails to be used (incorporated with cables) in bone lengthening and deformity correction.
Diagram 8-1: -
Shows first kind of lengthening and deformity correction nail with: -
(1) Hole in the nail end for passage of cable from outside the nail to inside {after its passage through bone (to be moved or corrected) from outside to inside the nail}.
(2) Cable can be passed from outside the nail to inside through nail end (2) {after its passage through bone (to be moved or corrected) from outside to inside the nail}.
(3) Obliquely oriented holes with diameter of 4mm - 5 mm to allow passage of cables from inside nail to outside (then through parts in diagram 8-2) to outside the body.
(4) Holes for interlocking screws for fixation of fixed bone fragment to the nail.
(5) Holes for interlocking screws for fixation of moving fragment to the nail after complete lengthening or deformity correction.
(6) Nail end for application of nail applicator and screws guiding frame.
Diagram 8-2: -
Shows parts applied to the nail (through screws guiding frame of the nail) and used for moving cables (so result in bone lengthening or deformity correction): -
A) Cannulated rod where: -
1) Rod end that applied to obliquely oriented holes of the nail (no 3 in diagram 8-1) for passage of cable through its end from inside the nail to inside the cannulated rod.
2) Threaded (outside threads) part that applied to bone cortex (can be coated with hydroxyapatite).
3) Threaded part (outside threads) (of same serration as nut
B).
4) Rod end for passage of cable from inside cannulated rod to outside the body then through the nut (B).
5) Threaded transverse tunnel (of same serration as screw D) for holding the inside cable if repositioning of the nut (B) needed.
B) Nut: - (of same serration as part 3 of the rod).
C) Cylinder: - (its diameter is larger than threads no 3 diameter), has: -
6) Longitudinal tunnel.
7)Transverse threaded tunnel (of same serration as screw D).
D) Screw: - for holding the inside cable if repositioning of the nut (B) needed.
E) Screw: - for holding the inside cable to the cylinder (C).
Diagram 8 - 3: -
Same features as nail in diagram 8 - 1 from item No.l to item No. 6 with added modification where: -
7)Two rotationally and obliquely oriented slots where their orientation is designed in a way that its start like points (8) and its end like points (9) in relation to nail {in cut section}. So, if two tension wires like (10) passed through the slots and fixed to moving bone fragment and with bone lengthening the moving fragment will rotate in relation to nail and subsequently to main bone fragment (fixed part).
N.B., - the degree of rotation can be adjusted through adjustment of position of the start of slot in relation to its end.
Diagram 8 - 4: -
Same features as nail in diagram 8 - 1 from item No.l to item No. 6 with added modification where: -
7)Two obliquely oriented slots where their orientation is designed in a way that its start like points (8) and its end like points (9) in relation to nail {in cut section}. So, if two tension wires like (10) passed through the slots and fixed to moving bone fragment and with bone lengthening the moving fragment will angulate in relation to nail and subsequently to main bone fragment.
N.B., - the degree of angulation can be adjusted through adjustment of position of the start of slot in relation to its end.
Diagram 8 - 5: -
Shows assembly of parts in diagram 8 - 2 to nail in diagram 8 - 3 (same features of items from 1 to 6) and direction of application of cables through them where: -
-Cable pass through drillhole in the bone fragment planned to be moved or corrected (11) near the osteotomy site.
-then pass either through hole (1) or through nail end (2).
-then pass longitudinally inside the nail to exit nail through oblique tunnel (3).
-then through the end of cannulated rod (12) to inside the rod {cannulated rod fixed to stationary bone fragment through hole (13)} then through the nut then through the cylinder to exit the cylinder at point (14).
How this assembly works to achieve bone lengthening?
After passage of cable through its way discussed before: -
- Fix cable on bone surface at point (11) using parts mentioned on diagram 3 - 7.
- Nut applied to cannulated rod in clock wise mode.
- Fix cable to cylinder (resting on nut surface) using screw (15) through cylinder hole.
- After 10- 14 day from osteotomy: - Rotate nut in anti-clock wise mode (1 mm / day).
-This will move the cable, in the direction of large solid arrow and so, bone fragment (planned to be moved) will move in direction of large vacant arrow.
- If more lengthening needed fix cable to rod using screw (16) through rod hole then release screw (15) and move the nut in clock wise mode then move the cylinder towards the nut and then repeat the process.
- After completing the lengthening: fix the moving bone fragment to the nail through holes (5) using interlocking screws.
Diagram 8 - 6: -
Shows assembly of parts in diagram 8 - 2 to nail in diagram 8
- 3 (same description of items from 1 to 10) and direction of application of cables through them where: -
-Cable passed through drillhole in the bone fragment planned to be moved (11) near the osteotomy site.
-then passed either through hole (1) of the nail or through nail end (2).
-then longitudinally inside the nail to exit nail through oblique tunnel (3).
-then passed through the start of cannulated rod (12) {cannulated rod fixed to stationary bone fragment through hole (13)} then through the cannulated rod nut then through the cylinder to exit the cylinder at point (14).
How this assembly works to achieve bone lengthening and rotation of the bone fragment: -
After passage of cable and fixing the fragment (planned to be moved) with tension wires (10) though slots (7) near osteotomy site: -
- Fix cable on bone surface at point (11) using parts mentioned on diagram 3 - 7.
- Nut applied to cannulated rod in clock wise mode.
- Fix cable to cylinder (resting on nut surface) using screw (15) through cylinder hole.
- After 10- 14 day from osteotomy: - Rotate nut in anti-clock wise mode (1 mm / day).
- This will move the cable in the direction of large solid arrow and so, bone fragment (planned to be moved or corrected) will move in direction of large vacant arrow. And this will lead bone lengthening also will lead to rotation of fragment in relation to nail and subsequently in relation to stationary fragment.
- If more lengthening or rotation deformity correction needed fix cable to rod using screw (16) to rod through rod hole then release screw (15) and move the nut in clock wise mode then move the cylinder towards the nut and then repeat the process.
- After completing the lengthening and rotation correction: - fix the moving fragment to the nail through holes (5) using interlocking screws.
Diagram 8 - 7: -
Shows assembly of parts in diagram 8 - 2 to nail in diagram 8 -4 (same no. of items from Ito 10) and direction of application of cables through them where: -
-Cable passed through drillhole in the bone fragment planned to be moved (11) near the osteotomy site.
-then either through hole (1) or through nail end (2).
-then longitudinally inside the nail to exit nail through oblique tunnel (3).
-then through the start of cannulated rod (12) {cannulated rod fixed to stationary bone through hole (13)} then through the cannulated rod then through the nut then through the cylinder to exit the cylinder at point (14).
How this assembly works to achieve bone lengthening and correction of angulation of the bone fragment: -
After passage of cable and fixing the fragment (planned to be moved or corrected) with tension wires (10) though slots (7) near osteotomy site: -
- Fix cable on bone surface at point (11) using parts mentioned on diagram 3 - 7.
- Nut applied to cannulated rod in clock wise mode.
- Fix cable to cylinder (resting on nut surface) using screw (15) through cylinder hole.
- After 10- 14 day from osteotomy: - Rotate nut in anti-clock wise mode (1 mm / day).
- This will move the cable in the direction of large solid arrow and so, bone fragment (planned to be moved or corrected) will move in direction of large vacant arrow. And this will lead to bone lengthening also will lead to correction of angulation of fragment in relation to nail and subsequently in relation to stationary bone fragment.
- If more lengthening or angulation correction needed fix cable to rod using screw (16) to rod through rod hole then release screw (15) and move the nut in clock wise mode then move the cylinder towards the nut and then repeat the process.
- After completing the lengthening and rotation correction: - fix the moving fragment to the nail through holes (5) using interlocking screws.
Diagram 8 — 8 : - ,
Shows assembly of parts in diagram 8 - 2 to nail similar to nail in diagram 8 - 3 but with reversed position of slots (towards proximal part of the nail) where: -
-Cable passed through drillhole in the bone fragment planned to be moved (1) near the osteotomy site till its enlarged part (or parts in diagram 7- 3 fixing the cable) rest on bone surface, -then cable passed through holes (3) of the nail.
-then longitudinally inside the nail to exit nail through oblique tunnel (4).
-then through the end of cannulated rod that rest to oblique tunnel (4).
- This diagram to show assembly through bone ends and to show ability to work for lengthening and rotation on proximal fragment.
Diagram 8 - 9: -
Shows assembly of parts in diagram 8 - 2 to nail similar to nail in diagram 8 - 4 but with reversed position of slots (towards proximal part of the nail) where: -
- Cable passed through drillhole in the bone fragment planned to be moved or corrected (1) near the osteotomy site till its enlarged part (or parts in diagram? - 3 fixing the cable) rest on bone surface.
- then cable passed through hole (3) of the nail.
- then longitudinally inside the nail to exit nail through oblique tunnel (4).
- then through the cannulated rod that rest to oblique tunnel (4).
- This diagram to show assembly through bone ends and to show ability to work for lengthening and angulation correction on proximal fragment.
Diagram 8 - 10: -
Shows modification of design on nail in diagram 8 - 3 where the slots are modified to be in two stages: -
- first stage (1) for lengthening only where slot position in relation to nail position (as regard rotation) does not change (from position 3 to position 4).
-second stage (2) for lengthening and rotation correction where slot position in relation to nail position (as regard rotation) change (from position 4 to position 5).
Diagram 8 - 11: -
Shows modification of design on nail in diagram 8 - 4 where the slots are modified to be in two stages: -
- first stage (1) for lengthening only where slot position in relation to nail position (as regard angulation correction) does not change (from position 3 to position 4).
-second stage (2) for lengthening and angulation correction where slot position in relation to nail position (as regard angulation correction) change (from position 4 to position 5).
Diagram 8 - 12: -
Shows modification of design on nail in diagrams 8 - 1 and 8 - 3 where: -
7) Prominent part of the inside of the nail on which disc (8) will rest.
8) Cylindrical disc of same diameter as inside part of the nail.
9) Two longitudinal (may be one tunnel) tunnel inside the disc of 2 mm diameter (just larger in diameter than cable used).
10) Transverse threaded tunnel of same length and diameter of screw (11).
11)headless screw with hexagonal groove on one end.
Diagram 8 - 13: -
Shows how nail in diagram 8 - 12 works in angulation correction where: -
- assemble cylindrical part (1) inside the nail (2) and fix it with screw (3).
- Introduce the nail inside the bone with cables applied as shown in the diagram where: -
• Cable (4) passed through cylindrical part with enlarged end (5) rested on cylindrical part surface then pass around nail end (7) and other end fixed on bone surface (as shown in diagram 7 - 3) (8) after its passage through bone hole (9) near osteotomy site (10).
• Second cable (11) with enlarged central part (12) introduced through hole (13) near osteotomy site (10) to pass around nail (14) then to inside cylindrical part (15) to exit nail through oblique tunnel to Cannulated rod (16) (see diagram 8 - 2 and diagram 8 - 5 to 8 - 9).
- Fix cable (4) with moderate tension to rest both ends (5 and 8) on cylindrical part and bone surface.
- Fix second cable (11) on bone surface (as shown in diagram 7 - 3) (17) in a way that keep distance (18) between enlarged part (12) and surface of cylindrical part (19) comparable to angulation need to be corrected.
- After latlent period (10 days - 14 days) of osteotomy: -
• Start moving the cable (11) using rod (16) and its nut (not shown here) this will lead to movement of the fragment in direction of arrow (20) on the side of part no (17) only this will lead to angulation correction {of bone fragment (A) in relation to bone fragment (B)} without lengthening on the other side.
• When the part (12) reach surface of the cylindrical part (19), screw (3) should be advanced to be fully inside cylindrical part or to be taken outside the body using suitable hexagonal screw driver through bone hole (22).
• By further movement of the cable (11) using rod (16) and its nut (not shown here) enlarged part (12) will push the cylindrical disc that will move the cable (4) through moving enlarged part (5), this will lead to movement of
the fragment in direction of arrow (21) on both sides leading to lengthening of bone on both sides.
Diagram 8 - 14: -
Shows modification of nail in diagram 8 - 1, 8 - 3, and 8
- 4 where: -
- Inside Threads (1) of the nail {same as threads of screw D that will be discussed latter} added either: -
• Instead of oblique tunnels as diagram A.
• Combined with oblique tunnels (2) as diagram B.
• Combined with transverse threaded tunnel {to hold the cylindrical disc (E) discussed in diagram 8 - 12 and 8 - 13} as diagram C.
Diagram 9 - 1 to 9 - 4: -
Show designs of screws for intramedullary nail application and to be used in bone lengthening and deformity correction.
Diagram 9 - 1: -
Shows design of screw (made from non- magnetizable material) to be applied inside nail (in diagram 8 -14) and to be used in bone lengthening and deformity correction where: -
-Threads of the screw (1) is the same as inside Threads of the nail in diagram 8 - 14.
-Tunnels perpendicular to long axis of the screw filled with small long pins (2) (of magnetizable material like steel) that can be used to move the screw using magnetic field outside the body.
- Hexagonal socket (3).
N.B.J -By application of the screw between two strong equal magnetic fields as A+A in the diagram the screw
will be oriented in a way that the magnetizable pins will be like line connecting the two sources of the magnetic fields.
-By slowly rotating the source of magnetic field (either clockwise or anti- clockwise), the screw will rotate following the magnetic sources.
Diagram 9 - 2: -
Shows modifications of design of screw (in diagram 9 - 1) where: -
- Screw (A) has longitudinal tunnel (1) 2-3 mm in diameter extend from screw surface to hexagonal socket.
- Screw (B) has cylindrical part (2) with Key hole tunnel (3) with the round part (4) equals the diameter of the enlarged part of the cable and the width of the longitudinal part (5) is 2-3 mm. (both created till the middle of the disc)
- Screw (C) has same design as screw (B) but with longer cylindrical part (6) to allow application of more magnetizable pins (7) that generate more power in moving the screw when used magnetic field to move the screw.
Diagram 9 - 3: -
Shows assembly of multiple end cable (1) (in diagram 7 - 2) inside screw (B) (kind A in diagram 9 - 2) as an example of one cable assembly inside the screw.
Diagram 9 - 4: -
Shows assembly of two cables inside screw (A) and cylindrical part (B) for combined correction of angulation and lengthening (like that was shown in diagram 8 - 13): -
• Cable (C) (in diagram 7 - 1) with its enlarged part (1) rested inside hexagonal socket (2) of the screw (A) (kind A in diagram 9 - 2).
• Cable (D) (in diagram 7 - 1) with its enlarged part (1) rested on cylindrical part (B) (No. 8 in diagram 8 - 12) and pass inside tunnel of the screw also.
• The distance (3) is the planned distance for correction of angulation without lengthening.
N.B.,) This assembly works through movement of screw (A) through using magnetic field with the same idea as assembly in diagram 8 - 13.
Diagram 10 - 1 to 10 - 3: -
Show modular kinds of nails that composed of two parts: -
- First parts in diagram 10 -1 and 10 - 3: - responsible for moving parts and fixation of nail body to bone.
- Second parts in diagram 10 -2 and 10 - 4: - responsible for adjustment of lengthening, angulation, and rotation correction.
- Diagram 10 - 1: -
Shows examples of modification of nails in diagrams 8 - 1 to 8 - 14 where: -
1) Threads (inside threads) added to nail end for application of threaded parts in diagram 10 - 2.
2) Nail holes for passage of cables working on deformity correction.
3) Nail holes for fixation of nail to bone after complete deformity correction.
A) Show modification of nails using parts in diagram 8 - 2.
B) To D) Show modification of nails (in diagram 8 - 14) using parts in diagram 9 - 1 to 9 - 4.
Diagram 10 - 2: -
Shows parts responsible for adjustment of lengthening, angulation correction, and rotation correction needed where:
1) Threads (outside threads) at end for application to threaded parts of nail in diagram 10 - 1.
2) Slots (in diagram A) used for both angulation correction, and lengthening (angle of correction can be adjusted by adjusting angle of oblique part of the slot in relation to its length).
3) Slots (in diagram B) used for both lengthening with rotation correction followed by slots No. (3+) for angulation correction (rotation and angle of correction can be adjusted by adjusting angle of oblique parts of 3 and 3+ of the slots in relation to its length).
4) Slots (in diagram C) used for lengthening.
5) Slots (in diagram D) used for rotation correction.
6) Slots (in diagram E) used for angulation correction.
Diagram 10 - 3: -
Shows another kind of modular nail that used hexagonal parts A and B (as an example) that move inside hexagonal slot (1) on the nail end that allow free movement of lengthening during deformity correction.
Diagram 11 - 1 to 11 - 4: -
Show bi-focal modular nails with same principle as modular nails in diagram 10 - 1 and 10 - 2 with the advantage of correction of deformity in two levels on both sides of central part that fixed to bone diaphysis.
Diagram 11 - 1: -
Shows bi— focal modular nail where: -
A) Central bone diaphyseal part: - has
1) Threaded (from outside) both ends for fixation to threaded part of both peripheral parts (C).
2) Holes for fixation to bone using interlocking screws.
3) Oblique tunnels for passage of cables to cannulated rods (if it used).
4) Threaded parts (inside threads) (one side clockwise and the other anti-clockwise) for application of threads (5) of screws (B)and (BR) (one screw with clockwise threads and the other with anti-clockwise) {if lengthening done using magnetic field}.
B) Screws (as in diagram 9 - 2). .
C) Peripheral epiphyseal parts: - has
6) Threaded end (from inside) for fixation to threaded part of central diaphyseal part (A).
7) Holes for passage of cables fixed to moving part to inside the nail.
8) Oblique slots for passage of tension wires fixed to moving fragment that help in angulation correction.
9) Holes for fixation to bone using interlocking screws after complete deformity correction.
Diagram 11 - 2: -
Shows modularity of bi— focal modular nail where: -
Central part can be connected to peripheral epiphyseal parts in combination either: -
- Connect to two peripheral parts with rotated slots (B+B) (for bi-focal rotation correction).
- Connect to two peripheral parts with angulated slots (C+C) (for bi-focal angulation correction).
- Connect to two peripheral parts one with rotated slot and one angulated slot (B+C) (for rotation correction on one side and angulation correction on the other side).
Diagram 11 - 3: -
Shows assembly of bi— focal modular nail where: -
A) Central part.
B) And BR) are two screws (one screw with clockwise threads and the other with anti-clockwise).
C) Peripheral parts: - either angulation correction or rotation correction (Any other design for another function like diagram 10 - 2 can be utilized).
Diagram 11 - 4: -
Shows assembly of bi— focal modular nail where: -
D) Central part.
E) And BR) are two screws (one screw with clockwise threads and the other with anti-clockwise).
F) Peripheral parts: - either for angulation correction or rotation correction (Any other design for another function like diagram 10 - 2 can be utilized).
1)Oblique oriented tunnels through which cables (4) pass to enter after in Cannulated rod that used for deformity correction, {like diagrams 8 -5 to 8 - 9}
2)Cables pass inside screw that used for deformity correction using magnetic field to rotate the screws
inside the nail (one screw with clockwise threads and the other with anti-clockwise) {like diagrams 9 - 1 to 9 - 4}
3)Tension wires fixing the moving fragments and helping angulation and deformity correction.
Diagram 12 - 1 to 12 - 4: -
Show kinds of modular nails with angle between their parts.
Diagram 12 - 1: -
Shows kinds of modular nails with angle between their parts where its modified parts: -
A) Any nail part in diagram 10-1 with threads (1) in its end.
B) Similar to any part in diagram 10- 2 {as regard slot shape (3)}and with the following differences: -
- Inside threads (2) same as inside threads (1) of part (A).
- Holes (4) for locking screws for fixation of bone to nail after completing the correction.
C) Connection parts between part (A) and part (B) composed of : -
-Threaded rod (outside threads) (5) of same threads as (1) and (2).
- Half cylinder end with one side has threaded hole (6) of same threads as screw (8).
- Other rod (7) has round hole (9) has diameter same as thread diameter of screw (8).
- Screw head has hexagonal socket (10) for application of the screw.
D) Cannulated rod and its other parts as in diagram 8 - 2.
10) Tension wires.
Diagram 12 - 2: -
Shows assembly of modular nails shown in diagram 12 -1 where: -
-Threaded rod (5) applied to part (A)
- Half cylinder end with one side has threaded hole (6) of same threads as screw (8).
- Other rod has round hole (7) applied to part (B).
- Screw (8) with hexagonal socket (9) applied through round hole (7) to integrate with threads (6) but not to be tight to allow mobility between parts for easy application inside bone medulla.
- After nail application inside bone medulla passing osteotomy site (12), make drill hole (11) through bone to pass hexagonal screw driver to socket (10) to tighten screw (8) to hols rods (5) and (7) and consequently parts (A) and (B) together with desired angle.
Diagram 12 - 3: -
Shows assembly of modular nails shown in diagram 12 -2 to show how to use polar screws in angular deformity correction where: -
G) Represent direction of bone angle deformity need to be corrected.
H) Represent direction of angle of nail applied inside bone medulla.
- After nail application inside bone medulla, make drill hole (11) through bone to pass hexagonal screw driver to socket (10) to tighten screw (8) to hols rods (5) and (7) and consequently parts (A) and (B) together with desired angle.
- Polar screw (13) Applied just close to the nail (part B) {in this time site (14) overlapping the nail body}.
- Lengthening of the bone (moving part F of the bone) is achieved using nail and by help of polar screw will help to correct angle of deformity.
- After partial correction of angle of deformity, site (14) will be cleared away from nail boy, then another polar screw can be applied just close to the nail and used for further bone angulation correction.
Diagram 12 - 4: -
Shows ability to modify nail in diagram 12 -1 to work as bifocal nail correcting deformity in two sites of the bone on same time through modification of part (A) either: -
- Design with two groups (B) and (C) of oblique oriented tunnels (as in diagram 11 - 1 to 11 - 4). or
- Another way to have design of the nail with two inside threads for two magnetizable screws (as in diagram 11 - I to 11 - 4). Or
- Combination of the two methods above mentioned.
EXPLOITATION AND UTILIZTION
This invention includes implants and supplementary devices used for fractures fixation either: -
A) Internal fixation of bone fragment together (using tension wires or cables incorporated in locked nail).
B) Internal fixation for certain fractures needs reduction of fragments or butterfly fragments after nail application.
C) Complementary internal fixation of bone fragment together (using tension wires or cables only).
D) Internal fixation of bone fragment together after its reduction (using cables inside medullary canal of bone fragment and around intramedullary nail).
E) Guide osteotomy of distal femur and reduction of its deformity, and fixing it after correction of its deformity.
F) Bone lengthening and deformity correction (rotational and angulation deformity).
A) Internal fixation of bone fragments together (using tension wires or cables and interlocking nail): -
This invention includes fixation of fractures using cables or tension wires incorporated in interlocking intramedullary nail.
Steps of Internal fixation of bone using tension wires or cables incorporated in interlocking nail using fluoroscopy ~
1- Short nail: -
• Applying of cables (diagram 1-1 to 1-4) or tension wires (diagram from 1- 5 to 1-10 and 1-12,1-13) with or without washers (diagram 2-1 to 2-5) through skin then bone fragment obliquely then inside bone medulla.
N. B: - 1- Cable in diagram no 1-3 can be used to help passage of cable in diagram 4 or tension wire in diagram no 6.
2-Cable in diagram no 1-11 can be used to help passage of tension wire in diagram 1-12.
• Reduction of fracture using reduction frame (diagram 6-1 to 6-9).
• Passage of cables or tension wires to inside medulla of other bone fragment after reduction.
• On the other end of bone and through small skin incision (Si): - Creation of entry from other bone end to bone medulla
• Passage of cables or tension wires from inside medulla through created entry to outside skin through skin incision.
• Passage of cables or tension wires to inside interlocking nail (diagram 4- 1,4-2, 4-3, and 4-6).
• Application of interlocking nail to its correct position then application of locking screws.
• Creation of tension on cables or tension wires using tension device (diagram 4-11 and 4-12).
• Fixation of cables or tension wires to interlocking nail using first bolt with conical part (diagram 4-11 and 4-12) also (diagram 4-2 and 4-7).
• Cutting of cables or tension wires at desired length using wire cutting device (diagram 4-13).
• Bending of cables or tension wires over first bolt with conical part.
• Fixation of cables or tension wires between first bolt with conical part and second bolt by applying second bolt (diagram 4-2 and 4-7).
• Serrated rod with hook (diagram no 4-28 to 4-30) can be used to reduce fracture or augment fixation (diagram no 4-31).
2-Long nail: -
Steps of Internal fixation of comminated bone using tension wires or cables incorporated in interlocking nail and using tension wires instead of locked screws for fixation of articular comminuted fractures (using fluoroscopy)? “
Same steps as short nail but long nail of two different diameter used instead of short nail where: -
• Wires or cables can introduce inside nail through holes in the middle of the nail (on transition ridge between different diameters of the nail) {diagram 4-8 to 4-10}.
• Nail end fixed to bone using tension wires shown in diagram 5 and 6 instead of ordinary locking screws (diagram 4-8 to 4-10) with advantage of maintaining bone length and ability to fix comminuted bone fragments (at this end of the bone) together.
B) Internal fixation for certain fractures needs reduction of fragments or butterfly fragments after nail application: -
- Details of utilization described in diagrams no 4-18 to 4-20 for both sides reduction nail that can be used in management of fractures of distal femur, proximal tibia, and distal tibia.
- Details of utilization described in diagrams no 4-21 and 4-22 for one side reduction nail that can be used in management of fractures of proximal femur, distal femur, proximal tibia, and distal tibia.
C) Internal fixation of bone fragments together (using tension wires or cables) as a fixation of bone fragment Complementary to interlocking nail: -
This invention includes fixation of bone fragments together using cables or tension wires with nuts or using cables or tension wires with headless screw and nut as a Complementary fixation to interlocking nail.
Steps of Internal fixation of bone fragments using tension wires or cables incorporated in nuts or headless screws and nuts using fluoroscopyZ -
• Reduction of fracture.
• Application of tension wires or cables (after preliminary drilling) (diagram 1-1, 1-2,1- 4,1- 5 andl- 6) with or without washers (diagram no 2-1 to 2- 5) through skin then bone fragment then through other bone fragment.
• Creation of tension on cables or tension wires.
• Fixation of cables or tension wires with: -
1- Nut (diagram no 3-1 to 3-3) if serrated wires or serrated cable used, or with
2- Headless screw and nut (in diagrams 3-4, 3-5, and from 3-6 to 3-9) using cannulated socket wrench and screw driver (diagrams no 3-10 to 3-15).
N. B.) 1- Using washers increase efficiency of tensile force through distribution of tensile force over relatively large surface of bone.
2- Maintenance of tension applied to cables or tension wires can be obtained through resting of big diameter part of cables or tension wires with or without washer on surface of bone on one side and resting of nut or headless screw and nut connected to cables or tension wires on surface of other bone fragment (diagram no 3-2 and 3-16).
D) Internal fixation of bone fragment together after its reduction (using cables inside medullary canal of bone fragment and around intramedullary nail): -
Details of utilization described in diagram 4-23 to 4-27.
E) Guide osteotomy of distal femur and reduction of its deformity, and fixing it after correction of its deformity: -
Details of utilization described in diagram 5-5 to 5-8.
G) Bone lengthening and deformity correction (rotational and angulation deformity).
This invention includes Bone lengthening and deformity correction (rotational and angulation deformity) using cables incorporated in interlocking intramedullary nail.
- Details of utilization for bone lengthening described in diagram no 8-5.
- Details of utilization for correction of angulation deformity described in diagrams no 8-6, 8-9, 8-11, 8-12, 8-13, 8-14, 9-4, 11-3, 11-4, and diagrams 12-1 to 12-4.
- Details of utilization for correction of rotational deformity described in diagrams no 8-7, 8-8, 8-10, 8-14, 11-3, 11-4, 12-3, 12- 4.
Exploitation methods of invention: -
Discussed before in diagrams description: -
1 - Tension wires and cables incorporated in interlocking nail with reduction frame and accessory parts (like hook serrated rod in diagram 39): - can be used for fixation of bone shaft fractures especially metaphyseal fractures with big butterfly fragments (diagram no 4-4 and 4-5 and 4-10).
2 - Curved or bended nail: - (with versatile entry) can be used for fixation of bone shaft fractures in adolescent age group, and for humerus fractures (diagram 4- 3).
3 - Long nail fixed to bone with tension wires, headless screws, and nuts instead of locking screws: - can be used for fixation of comminuted epiphyseal and metaphyseal fractures (diagram no 4-9 and 4-10).
4- Interlocking nails with its complementary parts (diagrams 8-1, 8-2, 8-3, 8-4, 8-10, 8-11, 8-12, 8-14, 9-1, 9-2, 10-1, 10-2, 10-3, 11-1, 11-2, 11-3, 12-1):- can used for bone lengthening and deformity correction (rotational and angulation deformity correction) as discussed in diagrams No. 8-5 (for bone lengthening), diagrams no 8-6, 8-9, 8-11, 8-12, 8-13, 8-14, 9-4, 11-3, 11-4, and diagrams 12-1 to 12-4 (angulation deformity correction), and diagrams no 8-7, 8-8, 8-10, 8-14, 11-3, 11-4, 12-3, 12-4 (for rotational and angulation deformity correction).
5- Cables in diagrams 7-1 and 7-2: - can used for bone lengthening and deformity correction (rotational and angulation deformity) as discussed before.
6 - Tension wires and cables: - can be used as a complementary fixation to fix broken bone fragments to each other (diagram no 3-16).
7 - Washers: - can be used to distribute tension force of tension of wires or cables on larger surface of bone and increase efficacy of fixation (diagram 3-16).
8 -Tools: - can be used for application of nails, wires, and cables
a - Cannulated wrench and screw driver (diagram no 3-11 to 3-15) designed for tightening of nut over headless screw to hold tension wire and rest on surface of bone fragment. b - Wire tensioning device (diagram no 4-11) for tensioning one wire at a time. c - Wire tensioning device (diagram no 4-12) for tensioning many wires at a time. d - Wire cutting device (diagram no 4-13). e - Fracture reduction frame and its mobile reduction part for reduction of long bone fractures (diagram no 6-1 to 6-9). f- Reduction tools with specially designed nail (diagram 4-18 to 4-22) can be used to reduce certain fractures like subtrochanteric fracture, fracture distal third femur, fracture proximal third of tibia, and fracture distal third of tibia. g- Reduction and augmentation of fixation of comminuted fracture of epiphyseal fragment with specially designed plate and tension wire or cable (diagram no 4-33 to 4-37). h- Reduction and augmentation of fixation of very small epiphyseal fragment accompanied with diaphyseal comminution at distal end of femur and any end of tibia using specially designed plate and specially designed intra medullary nail and its application tools (Diagram no 4-39 to 4-42). i-Reduction of displaced bone fragment using push pull reduction tools (diagrams no 4-45 and 4-46).
9 - Tools for creation of osteotomy, reduction of deformity and then fixation of osteotomy (diagram no 5-1 to 5-16).
Claims
(1) Designs of cables and tension wires (diagram 1-1,1- 2, 1-4, 1-6, 1-7, 1-8, 1-9, 1-10, and 1-12) for incorporation in nails (diagram 3-16, 4-4, 4-5, 4- 7, 4-8, 4-9, 4-10).
(2) Designs of cables and tension wires with enlargement at the end (diagram 1-1, 1- 2, 1- 4, and 1-6) for fixation of bone fragments together as a complementary to fixation with interlocking nail (diagram no 3-16 and 4-32).
(3) Designs of cables can be used for passage of other tension wires and cables (diagram no 1-3, 1-11).
(4) Designs of cables can be used for bone lengthening and deformities correction (diagrams no 7-1, 7-2).
F - Designs of washers and Nuts
Designs include implants to be used to improve and distribute tension force(washers), or to keep holding wires and cables in place after applying desired tension to them (nuts): - a - Washers: -
(1) Design of washers (closed or open) to be used to distribute tension force over larger surface area of bone and increase efficacy of tension (diagram no 2-2, 2-3, and 2-5). b - Nuts: -
(1) Design of nuts to be used for fixation of cable or tension wire (with serrated end) {in diagram 1-4 and 1-6} on surface of bone (diagram no 3-1 and 3-3).
(2) Design of nut with serrated rod with longitudinal slit (in diagram 3-4, and 3-6 to 3-9). with its application devices (diagrams no 3-10 to 3-15) to be used for fixation of cable or tension wire {in diagram 1-1,1- 2, and 1-5} on surface of bone (diagram no 3-16).
G — Designs of tools.
Designs of tools that help during surgery (its advantages and ideas have been explained in diagram description chapter and New in the subject invention chapter) and include: -
1 - Design of cannulated wrench and screw driver (diagrams no 3-10 to 3-15) designed for tightening of headless screw and nut to hold tension wire and rest on surface of bone fragment.
2 - Design of wire tensioning device (diagram no 4-11) for tensioning one wire or cable at a time.
3 - Design of wire tensioning device (diagram no 4-12) for applying tension to many tension wires or cables on same time.
4 - Design of wire and cable cutting device (diagram 4-13).
5 - Design of reduction frame and its mobile reduction part for reduction of long bone fractures (diagram no 6-1 to 6-9).
6 - Supplementary tools used for Reduction of fracture with intramedullary nail introduced inside bone fragments: -
A - Guide tool for application of cable around nail inside medullary canal (diagram 4-23).
B- Bevelled sleeves for passage of passage of cables around intramedullary nail (diagram 4-24).
3- Designs of tools for reduction of epiphyseal fragment of long bones using plate and tension wire or cable (diagram no 4- 33).
4-design of plate connected to modified design intramedullary nail for reduction and fixation of very small epiphyseal fracture in distal end of femur and any end of tibia accompanied with diaphyseal comminution (diagram no 4-39).
5- Designs of Push pull reduction tools for reduction of displaced bone fragment (diagrams no 4-43 and 4-44).
6- Supplementary tools used for Osteotomy of distal femur and correction of its deformity: -
A - Guide tools for drilling and osteotomy of distal femur (diagrams 5-1 to 5-9).
B- Distal femur Osteotomy tools and its application tools (diagrams 5-10 to 5-12).
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EG2021/000035 WO2023066438A2 (en) | 2021-10-20 | 2021-10-20 | Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EG2021/000035 WO2023066438A2 (en) | 2021-10-20 | 2021-10-20 | Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO2023066438A2 true WO2023066438A2 (en) | 2023-04-27 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/EG2021/000035 WO2023066438A2 (en) | 2021-10-20 | 2021-10-20 | Intramedullary implants for stable fixation of long bone fractures and bone lenghthening and deformities corrections, supplementary implants, and assisting tools |
Country Status (1)
| Country | Link |
|---|---|
| WO (1) | WO2023066438A2 (en) |
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2021
- 2021-10-20 WO PCT/EG2021/000035 patent/WO2023066438A2/en active Application Filing
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