CA2168228A1

CA2168228A1 - Reticulated orthopaedic element to exploit the medullary canal of the long bones

Info

Publication number: CA2168228A1
Application number: CA002168228A
Authority: CA
Inventors: Gideon Raphael Tock
Original assignee: Individual
Current assignee: Individual
Priority date: 1993-07-30
Filing date: 1994-03-09
Publication date: 1995-02-09
Also published as: US5713901A; IT1261494B; DE69415810T2; EP0710091B1; EP0710091A1; WO1995003746A1; DE69415810D1; AU6290694A; ITRM930513A1; ES2129121T3; ITRM930513A0; ATE175336T1

Abstract

The invention concerns a new reticulated orthopaedic element to exploit the endomedullary canal of the long bones, characterized in that it provides at least a part made up of a reticulate of titanium or other biocompatible material. The reticulated structure allows the prosthetic transverse locking without the use of an image intensifier and/or other ionizing diagnostic apparatuses. The prostheses according to the invention can be used for the reduction of long bone fractures to support poweral, femural or knee articulations or to revise previously implanted prostheses that were origins of complications.

Description

wo 95/03746 2~ 2 8 PCT/lT94/00021 RETICULATED ORTHOPAE :)IC ELEMENT TO EXPLOIT THE
MEDULLARY CANAL OF THE LONG BONES

The present invention relates to reticulated orthopaedic 5 elements to exploit the medullary canal of the long bones.
More particularly, the invention concerns an element of the above mentioned kind, totally or partially reticulate, that, in order to be applied and transversely blocked, allows to operate without employing ray apparatuses.
As it is well known, every bone is modelled, as far as shape and mass are concerned, to satisfy to the particular mechanical necessity for the specific situation in the skeleton.
At the skeleton functional level, the bones satisfy the static and locomotion necessity. With respect to the shape, bones are divided in 15 long bones, bones having a mainly cylindrical extension with respect to the diameter, flat bones and short bones.
The long bones have an extended body, called diaphysis, and two terminal ends, more or less broadened, called epiphysis. The long bones at the diaphysial level, if seen along a sagittal section, or by a 20 radiographic examination, have a long and large lumen called medullary canal, surrounded by an osseous compact casing. At the epiphysial level the long bone has spongy osseous zones.
Object of the present invention is that of finding a new application technique for the reparation and rehabilitation of traumas of 25 long bones and of articulations, exploiting the medullary canal as bearing and support either of the prosthetic manufacture for the reparation and of the arthro - prosthetic manufacture.
At present, the orthopaedic prostheses can be classified as a) endoprostheses, arthro-prostheses ( hip joint, knee, elbow, humero-30 shoulder prostheses, etc.): they allow to replace one or both thearticulation heads with a metal prosthesis; b) revision endoprosteses arthro-prostheses (hip joint, knee, elbow, humero-shoulder prostheses, etc.): they allow to replace, in the second or subsequent intervention after the failure of the preceding prosthesis, only one or both the articulation 35 heads with a metal prosthesis.
There are also the trauma prostheses for long bones used to obtain the endomedullary osteosynthesis.

~ ~168228 In the prostheses for the articulations, the prosthetic stem is introduced by friction within the lumen of the medullary car~al to obtain a immediate primary stability.
Often, lacking this primary stabiiity, an "orthopaedic cement" is - 5 used in order to compensate the lacking of precision in the coupling between the prosthetic stem and the medullary lumen: in this way an immediate stability is obtained, but afterwards great problems for the osseous resorption are present: in some cases even the iost of the prosthetic manufacture can occur.
The osteosynthesis technique provides the union of two or more fractured bone segments by metallic parts.
An endomedullary nail is defined as the ostesynthesis element exploiting the endomedullary lumen of the long bones. It is indicated as a locked nail an endomedullary nail crossed by transverse or diagonal 1~ screws in correspondence of its distal and proximal ends.
EP-A~268115 describes an element for osteosynthesis made up of a reticulated of titanium or other biocompatible material.
At present, all the endomedullary nail requires for they distal locking the use of the image intensifier and/or other apparatuses irradiating ionizing rays during their application.
The main drawback that the present invention aims to solve is that of avoiding the necessity of using the above apparatuses to transversely introduce and lock the abovementioned implants.
Particularly, the innovative solution according to the invention consists in the exploitation for the bearing and the support of the arthro-prosthesys, of the revision artho-prosthesys or of the endomedullary nail, of the endomedullary lumen by a reticulate metallic structure made up by titanium or another bioco,1,,ualible material that assumes the shape and the total or partial length of the medullary lumen.
The tubular reticulate shape allows to obtain a transverse -anchoring in each point chosen by the operator to apply a transverse screwlclip/wire without the necessity of any control by an irradiant diagnostic apparatuses.
Simply, using the suitable mill a hole is realized. The mill in each spatial position will centre a mesh of the reticulate and will allow to screw the transverse screw.

~DE~ T

~ ~1682~8 ;. ;
~ . , - 2 ~is All the systems now available unavoidably necessity the utilization o~ the ray apparatus, The surgeon must find by the ;mage in~ensifier the preholed seat on the prosthetic manufacture and then mill ~EN~D S~

WO 95/03746 ~ 16 8 2 2 8 PCT/1194/00021 in the corresponding point through the bone to realize the transverse locking.
As it is well known, the simpie endomedullary nail alone cannot guarantee the control of rotations and cannot maintain the length of the 5 bone in case of metaphyseal fractures and in case of plurifragmentary fractures. The traditional locked nail solves both the situations, but it is absolutely necessary to introduce and lock it to use the image intensifier.
On the contrary, an endomedullary nail realized according to tlhe technical teachings according to the invention allows to immobilize the 10 complex diaphysial fractures transverse locked in every suitable position without the use of ray and in a simple and sure way.
A reticulated endomedullary nail realized according to the invention allows to transform the stabilization from static into dynamic, is able to promote the axial stresses on the focus thanks to the load, thus 15 obtaining an optimum stiffening.
The solution proposed according to the present invention allows to have a wide possibilities of applications for the treatment of the fractures of the long bones since it can be produced with every length and diameter that varies with the varying of the different ratios medullary 20 lumen/ osseous diameter in the various anatomical zones (femur, shinbone, humerus, radium, cubitus, etc.).
The solution according to the invention allows to make the treatment of the subtrochanteric fractures, of the fractures of the tertius distal, of the multiple, spiroidal and segmental fractures, of the 25 comminuted fractures, of the fractures involving the loose of the osseous substance, of the pathologic fractures, of the pseudarthrosis, of the defective consolidations, of the elongation and shortening osteotomias, of the osteosynthesis in closed air.
Still according to the invention, it is possible to transform all the 30 endomedullary nails and the primal arthroprosthesis and/or revision endomedullary stems in reticulate stems, increasing the contact surface prosthesis-bone so that a better primary and secondary coupling are obtained.
Further, according to the invention, a special advantage is 35 obtained eliminating the orthopaedic cement.
A further advantage is that of having the opportunity of obtaining a manufacture remarkably lighter than the prosthetic 21~822~

manufacture already available. The reticulate in the distal or proximal ends allows to realize the most suitable transverse/diagonal/sagittal/oblique locking without the necessity of using a specihc instrument or irradiating diagnostic apparatuses and thus - 5 guaranteeing to the patient a better primary and secondary stability.
It is therefore a specific object of the present invention a reticulate orthopaedic element characterized in that it is comprised of a central part or stem and of two ends parts, nemely a proximal end a distal end part, in that at least said two end parts are made up of a reticulate of titanium or other biocompatible material, in that it is used to exploit the medullary canal of the bones, in that the proximal end is provided with coupling means, for the temporaneous coupling with an introduction instrument, and in that the neshes of the reticulate allow to screw at least a transverse screw.
Particularly, according to the invention, said element can be completely reticulate.
Still according to the invention, the element is made up as a unique piece, or by separated coupable parts.
In case the element according to the invention is made up of coupable parts, the connections are realized by male-female threads and/or welds, or other kind of fixed joints.
In order to allow the easy removal from the patient of the element according to the invention, said reticulate parts can be covered with a sheath made up of biocompatible plastics, e.g. Teflon, polyethylene, or of a biocompatible thin lamina. In this case, the transverse locking is to be considered indispensable to increase the stability of the element.
Obviously, the dimensions, the thickness, the diameter and the meshes of the reticulation var,v in function of the specific application, of the kind of operation and of the patient.
Further, accor~ling to the invention, particularly in case of the realization of endomidullary nails, said prosthesis will be realized innerly hollow, and provided with longitudinal grooves along all or part of the extension of the prosthesis. Said grooves increase the elasticity and the flexibility of the element acco~ ~ing to the invention, making easier both the insertion and the removal of the same.

AMEN~. ~ Sl~F~

21~8228; -~bis In a preferred embodiment of the reticulate element accordingto the invention, it is realized in three parts, the central ~ne being not-- reticulate and having variable length and diameter, and the end ones being reticulate and standardized, coupable with each kind of central part - ~ is employed.

4~ EIY~ t?~." i ~ 21~8228 WO 9~/0374~ PCT/lT94/00021 Further, according to the invention, the proximal end of the reticulate can be provided with male or female mechanical coupling means, for the temporaneous coupling with the introduction instrument.
When a prosthesis for the collum femoris is realized, the stem 5 part of the prosthesis that is introduced within the meduilary canal of the diaphysis is made up of a very strong reticulated part that allows to absorb the stem, to increase the contact surface for the osteosynthesis, and to have the opportunity of transverse blocking, this opportunuty not existing with the prior art solutions.
The reticulate according to the invention will preferably have a thickness in the range between 0.05 mm and 7.0 mm.
Further, it can be made with a closely-woven or not closely-woven weft, or with a crossed weft.
The elements according to the invention can have any tridimensional shape is desired, e.g. undulated, pressed, with a loosen mesh, electrowelded, with a square or rectangular mesh, S-shaped, V-shaped, 0-shaped, with a right or left spiral mesh, with a plate bent at an angle between 5 and 90, with an expanded metal, etc.
The wire constituting the reticulate can have any shape, also if observed in section.
The present invention will be now described, in an illustrative and not limitative way, according to its preferred embodiments, with particular reference to the figures of the enclosed drawings, wherein:
figure 1 shows a preferred embodiment of an endomedullary nail according to the invention;
figure 2 shows a particular of the nail of figure 1;
figure 3 shows the application of the nail according to figures 1 and 2;
figure 4 is a diagrammatic view of a hip joint prosthesis according to the invention;
figure 5 is a diagrammatic view of a revision hip joint prosthesis acco, ding to the invention;
figure 6 is a diagrammatic view of a knee prosthesis according to the invention;
figure 7 diagramatically shows a diflerent shape of a stem for a knee prosthesis according to figure 6;
figure 8 shows the prosthesis of figure 6 in place;

WO 95/03746 ~ ~ ~ g 2 ~ 8 PCT/lT94/00021 ..

figure 9 is a diagrammatic view of a revision knee prosthesis according to the invention;
figure 10 shows the prosthesis of figure 9 in place;
figure 11 is a diagrammatic view of a humero-scapular 5 prosthesis according to the invention; and figure 12 is a diagrammatic view of an elbow prosthesis according to the invention.
The nail 1 of figure 1 has a central stem 2 and two end parts 3.
Being an endomedullary prosthesis, both the stem 2 and the 10 end parts 3 will be centrally hollow.
The three parts 2 and 3 are coupled each other, see particularly figure 2, by a thread 4, that obviously can be replaced by any other kind of standard coupling.
The t~vo end parts 3 are realized by a titanium reticulate, even 15 if a different suitable material can be used.
The meshes of the reticulation will obviously vary in function of the specific application of the prosthesis.
For example, in case of an adult of remarkable dimensions, it can have a stem having a diameter of 16 mm, wire of the reticulation 20 having a diameter of 2.5 mm and meshes having a side comprised between 2 and 6 mm, while in case of a child, the stem can have a thickness of 10 mm, the wire of the mesh a thickness of 0.5 mm and the meshes a side of 2-3 mm.
As it can be particularly seen in figure 2, the reticulate parts 3 25 are covered with a sheath 4 realized with a biocompatible plastic material, that avoids the direct contact between bone and reticulate, easing the removal at the end of the treatment.
At the proximal end of the reticulate part 3 a coupling 5 is provided for a plug 6, that allows the coupling with the insertion 30 instrument for the prosthesis, or with centring or measuring instruments.
Coming now to observe the figure 3, the application of the transverse self-threading screws 7 that are introduced through the reticulate part 3, previously drilled by a mill can be observed.
The transverse locking on both the ends allows to neutralize 35 the torsion stresses, and to maintain the same length of the segment.
Coming back to observe figure 1, it can be noted the ~lobal composition of the endomedullary nail realized according to the teachings wo 95/03746 21 ~ 8 ~ 2 8 PCT/11~94/00021 of the present invention, placed within the fractured femoral medullary lumen.
The transverse locking is realized without employing the image intensifier since the orthopaedic surgeon knows that in a zone 5 corresponding to the end parts 3 is in any case possible to realize the hole by the mill, and therefore it is sufficient that the mill centres the parts3 to have a hole useful for the transverse locking.
Coming now to particularly see figures 4 and 5, and beginning from the figure 4, it is shown a hip joint prosthesis 8. It has a reticulate 10 stem 9 that allows to obtain the following advantages with respect to the already known systems:
. application of the prosthesis with the growing of the medullary bone within the medullary lumen in the reticulation of the implant stem with a remarkable increasing of the prosthetic stability, and 15 of the osseous-implant contact surface;
. it can be avoided the use of the orthopaedic cement, and its serious drawbacks;
. it can be transversely blocked the hip joint prosthesis to the surrounding bone by the transverse fixing screws 10, without employing 20 irradiant diagnostic apparatuses;
. the shape and the length of the reticulate stem and the shape and the thickness of the reticulation can vary according to the specific clinical and operative necessitys;
. by the cemented or not cemented prosthetic stem a primary 25 stability of very high quality is obtained, and moreover a secondary stability having an unusual osseous-implant contact ratio is obtained.
In figure 5 a revision hip joint prosthesis 11 is shown: it is necessary since with the development of the clinical experience v~lith respect to the application of the cemented or not cemented hip joint 30 prostheses, a noticeable number of patients that after a certain period has clinical problems requiring the removal of the implant has been noticed.
The lost of the implant has also the consequence that the surrounding bone is damaged and is compromised in such a way not to be more able to sustain the static/dynamic load of the patient and/or not to be more 35 possible to be a suitable seat for the new implant. To this compensation of the loose of the surrounding bone, the invention asks the total or partial WO 95/03746 2 ~ ~ 8 2 2 8 PCT/1194tO0021 ~

`. ;. '- ` 8 exploiting of the femoral medullary lumen applying a long stem 12 transversely locked by the transverse screws 13.
The advantages obtained are those already mentioned herein before. Moreover, a further increasing of the prosthetic stability and a r 5 structural compensation for the bone are obtained as a consequence of the lost of the implant.
Coming now to observe figures 6-8, a knee joint prosthesis 14 is shown.
In the prosthetic articulation of the knee, the longitudinal 10 vertical part that is introduced in the femoral medullary lumen and in the tibial medullary lumen is realized by a tubular reticulate cylinder 15: in this way higher primary and secondary stability are guaranteed, with the opportunity and the easy of transversely locking the prosthesis 14 without image intensifier by the screws 16.
In figure 7 a stem 15' is shown having different shape and length.
It can also be realized a revision prosthesis 17 (see figure 9 and 10), introducing a reticulate tubular cylindrical stem 18 longer than the main stem so that it is possible to compensate the osseous lost and to 20 noticeably increase the ratio between the support osseous surface and the reticulate sur~ace of the stem, either the tibial or the femoral stem or both.
Further, since the stem is reticulate, it is possible the transverse locking of the same in every point of its extension by 25 transverse screw 19.
Coming now to observe figure 11, a humero-scapular prosthesis 20 is shown comprising a reticulate stem 21 introduced within a medullary lumen, allowing thus the transverse locking of the prosthetic manufacture by the screw 22 and further to lighten in a conclusive manner 30 the weight of the prosthetic manufacture.
Finally, observing figure 12, an elbow-humero-cubitus prosthesis 23 is shown providing a reticulate humero stem 24 and a reticulate cubitus stem 25 allowing a best performance and prosthetic stability with respect to the traction and rotation movements ahead and 35 backward stressing the elbow articulation.
Both the stem 24 and the stem 25 are fixed by the screws 26 and 27.

WO 95/0374G æ I ~ a 2 2 o PCT/IT94/00021 The present invention has been described in an illustrative and not limitative way, according to its preferred embodiments, but it is to be understood that changes and/or modifications can be introduced by those skilled in the art without departing from the scope of the invention as 5 defined by the enclosed claims.

Claims

12

1. Element for osteosynthesis characterized in that it is comprised of a central part or stem (2) and of two end parts (9), namely a proximal end a distal end part, in that at least said two end parts (3) are made up of a reticulate of titanium or other biocompatible material, in that it is used to exploit the medullary canal of the bones, in that the proximal end (3) is provided with coupling means (6), for the temporaneous coupling to an introduction instrument, and in that the meshes of the reticulate allow to screw at least a transverse screw.

2. Element for osteosynthesis according to claim 1, characterized in that said element is completely reticulated.

3. Element for osteosynthesis according to one of the preceding claims, characterized in that it is made up as a unique piece.

4. Element for osteosynthesis according to one of claims 1-2, characterized in that it is made up by separated coupable parts.

5. Element for osteosynthesis according to claim 4, characterized in that said coupable parts are coupled by male-female threads, welds, or other kind of fixed joints.

6. Element for osteosynthesis according to one of the preceding claims, characterized in that said reticulate parts are covered with a sheath made up of biocompatible plastics, e.g.
polytetrafluoroethylene or polyethylene, or of a biocompatible metal, thin titanium lamina.

7. Element for osteosynthesis according to one of the preceding claims, characterized in that, the dimensions, the thickness, the diameter and the meshes of the reticulation vary in function of the specific application, of the kind of operation and of the patient.

8. Element for osteosynthesis according to one of the preceding claims, characterized in that, said element is innerly hollow.

9. Element for osteosynthesis according to claim 8, characterized in that it is provided with longitudinal grooves along all or part of the extension of the prosthesis.

10. Element for osteosynthesis according to one of the preceding claims, characterized in that it is realized in three parts, the central one being not-reticulate and having variable length and thickness, and the end ones being reticulate and standardized, coupable with each central part is employed.

11. Element for osteosynthesis according to one of the preceding claims, characterized in that the proximal end of the reticulate is provided with male or female mechanical coupling means, for the temporaneous coupling to the introduction instrument.

12. Element for osteosynthesis according to one of the preceding claims, characterized in that when an element for the collum femoris is realized, the stem part of the prosthesis that is introduced within the medullary canal of the diaphysis is made up of a very strong reticulated part that allows to absorb the stem and to increase the contact surface for the osteosynthesis, and to have the opportunity of transverse blocking of the stem.

13. Element for osteosynthesis according to one of the preceding claims, characterized in that the reticulate has a thickness in the range between 0.05 mm and 7.0 mm.

14. Element for osteosynthesis according to one of the preceding claims, characterized in that said reticulate is made with a closely-woven or not closely-woven weft, or with a crossed weft.

15. Element for osteosynthesis according to one of the preceding claims, characterized in that it is used to realize an endomedullary nail.

16. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a hip joint prosthesis.

17. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a revision hip joint prosthesis.

18. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a knee prosthesis.

19. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a revision knee prosthesis.

20. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a scapolo-humero prosthesis.

21. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a revision scapolo-humero prosthesis.

22. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize an elbow (humero-cubitus) prosthesis.

23. Element for osteosynthesis according to one of the claims 1-14, characterized in that it is used to realize a revision elbow (humero-cubitus) prosthesis.