US20100036430A1 - Compression brace - Google Patents
Compression brace Download PDFInfo
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- US20100036430A1 US20100036430A1 US12/582,210 US58221009A US2010036430A1 US 20100036430 A1 US20100036430 A1 US 20100036430A1 US 58221009 A US58221009 A US 58221009A US 2010036430 A1 US2010036430 A1 US 2010036430A1
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- Prior art keywords
- fastener
- compression
- opening
- threaded
- brace
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
- A61B17/66—Alignment, compression or distraction mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8014—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the extension or compression force being caused by interaction of the plate hole and the screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/1775—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the foot or ankle
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/1782—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hand or wrist
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8605—Heads, i.e. proximal ends projecting from bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8872—Instruments for putting said fixation devices against or away from the bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8875—Screwdrivers, spanners or wrenches
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B2017/681—Alignment, compression, or distraction mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
Definitions
- the present invention relates generally to orthopedic surgery, and more particularly to devices and methods for reduction of fractures and osteotomies by drawing bones together.
- U.S. Pat. No. 2,597,342 discloses the use of a compressible fastener for joining boards together.
- the Lang fastener includes a central loop portion and claw members that extend from diametrically opposed sides of the central loop.
- the loop is preferably a parallelogram.
- Each claw member has two claws.
- Each claw has downwardly turned ends with inwardly turned portions which are configured to penetrate and engage boards.
- the claw members are set astraddle adjacent board members.
- the central loop is then expanded outward to draw the opposing arms toward one another and thereby fasten the adjacent boards together.
- staple legs tend to splay outward during use in vivo, which may reduce the compressive force of the staple. Staples can pull out of the bones.
- the configuration of staples also reduces intra-operative choices. In order to accommodate varying inter-axis and leg length requirements, it is necessary to provide a wide array of staple sizes, which requires extra inventory.
- a staple conventionally has legs of the same length and diameter/cross-section, which may make the staple unsuitable for situations in which it is desirable to have a longer or larger leg on one side of the staple. Thus, even with a large inventory of staple sizes, intra-operative choices may be limited.
- U.S. Pat. No. 5,947,999 discloses a compressible bone staple that has a pair of wing members extending from opposing ends of the staple, each wing member having apertures therein for receiving a screw for fastening the clip member to a bio-organic tissue member.
- the '999 patent does not teach elimination of the downwardly depending leg portions of the staple.
- Groiso teaches away from elimination of the leg portions by noting “the aim of attaining a desired spacing between bone fragments could be obtained with connecting elements such as plates and screws, but these are much bulkier, require major surgical procedures for the placing thereof and the possibility of trauma is increased.”
- U.S. Pat. No. 5,947,999 (Col. 2, lines 55-59). Additionally, the '999 patent is direct toward connecting soft tissues (tendons and ligaments) to bone.
- U.S. Pat. No. 4,444,181 discloses a bone clip for repair of bones in vivo including a body having a slot in a central portion thereof and a pair of downwardly depending legs on either end of the body. After the clip is inserted in opposing bones, opposing bridges are compressed toward one another (rather than expanded) to shorten the clip and thereby draw the bones together.
- a surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners.
- the compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener.
- a pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to thereby form a compression opening between the fastener retaining portions.
- Each bridge member is preferably substantially V-shaped.
- the fasteners are sized and configured to pass through the fastener hole and retain the compression bracket on bones.
- the fasteners preferably have a lengthwise shaft sized to pass through the fastener hole and an upper retainer portion sized and configured to retain the fastener in the fastener hole.
- the fasteners are screws having a lower thread positioned to engage bone.
- the fasteners are pins.
- the compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings.
- the device is preferably provided with a means for selectively locking the fasteners in the fastener holes to maintain the fasteners in a substantially fixed relation with the fastener retaining portion.
- the fastener hole of the brace member may be substantially smooth.
- the shaft of at least one of the fasteners can be sized to provide play between the shaft and the fastener hole, such that the fastener can be selectively angled into bone during use of the device.
- FIG. 1 is a top view of one preferred embodiment of a compression brace of the invention, showing the brace in an uncompressed configuration.
- FIG. 2 is a top view of the compression brace of FIG. 1 , showing the brace in a compressed configuration and featuring a pair of screws disposed in the brace.
- FIG. 3 is a side cross-section of view taken along 3 - 3 of FIG. 1 .
- FIG. 4 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in an uncompressed configuration prior to reduction of the fracture.
- FIG. 5 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in a compressed configuration.
- FIG. 6 is a top view of a preferred embodiment of the compression brace of the invention, featuring an unthreaded fastener hole.
- FIG. 7 is a side cross-section view taken along 7 - 7 of FIG. 6 , and illustrating radial play of a screw within the unthreaded fastener hole.
- FIGS. 8A-C show views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end.
- FIG. 9 provides views of one preferred embodiment of the invention, featuring a plurality of clip members radiating from a shared fastener retaining portion.
- FIG. 10 provides views of one preferred embodiment of the invention, featuring a plurality of compression brackets joined end-to-end via shared fastener retaining portions, and including a branching compression bracket.
- FIG. 11 is a side view of a preferred embodiment of a screw type fastener for use in the invention.
- FIG. 12 is a side perspective view of a preferred embodiment of a pin-type fastener for use in the invention.
- FIG. 13 provides views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end via a shared fastener retaining portion.
- FIG. 14 provides views of one preferred embodiment of the invention.
- FIG. 15 provides views of one preferred embodiment of the invention.
- FIG. 16 provides views of one preferred embodiment of the invention.
- FIG. 17 provides views of one preferred embodiment of the invention.
- FIG. 18 provides views of one preferred embodiment of the invention.
- FIG. 19 provides views of one preferred embodiment of the invention.
- FIG. 20 is a perspective view of one embodiment of a drill guide instrument for use in installing the compression brackets of the invention.
- FIG. 21 provides perspective views of drivers for use with the drill guide instrument of FIG. 20 .
- FIG. 22 provides views of a snap-off screw for use with the compression brace of the invention.
- the invention is a surgical device for pressing and retaining adjacent bones 301 , 302 against one another, such as to reduce a fracture.
- the invention includes, generally, a compression brace 1 and fasteners 100 for securing the brace on bones 301 , 302 .
- compression of the brace 1 presses the adjacent bone fragments 301 , 302 together.
- the compression brace 1 has at least two fastener retaining portions 10 .
- Each fastener retaining portion 10 has a fastener hole or bore 20 therethrough for receiving a fastener 100 .
- a thread 22 is provided in the fastener hole 20 .
- the brace 1 can be considered to have a tissue or osteo side 2 , which sits against the bones during use, and an opposing side or outer surface 3 .
- the fastener retaining portion 10 preferably has a counterbore 30 formed in the outer surface 3 .
- the counterbore 30 is preferably substantially in axial alignment with the fastener hole 20 .
- the counterbore 30 is preferably spherical.
- the counterbore 30 is sized and configured to provide countersinking of an upper retainer portion 150 of a fastener 100 in the fastener retaining portion 10 of the compression brace 1 .
- a pair of bridge members 50 A, 50 B are positioned between the fastener retaining portions 10 .
- the bridge members 50 A, 50 B preferably extend directly from the fastener retaining portions 10 , but may be spaced from one or both of the fastener retaining portions, such as by a shared extension portion disposed between the bridge members 50 A, 50 B and fastener retainer portions 10 .
- the bridge members 50 A, 50 B are spaced apart from one another to form a compression opening 70 between the fastener retaining portions 10 .
- the bridge members 50 A, 50 B and the compression opening 70 are used to compress the fastener retaining portions 10 and fasteners 100 toward one another, in a manner described in further detail below.
- the bridge members 50 A, 50 B are substantially V-shaped.
- the V-shape is preferably formed by generally linear portions 51 , 52 , which normally join one another at an obtuse angle when the brace 10 is in an uncompressed configuration.
- central portions of the bridge members 50 A, 50 B expand outward, thus drawing or compressing the fastener retaining portions 10 toward one another.
- FIG. 2 demonstrates the configuration of the compression brace of FIG. 1 after it has been compressed a selected amount. Note that in FIG.
- the compression brace 1 has contracted generally along its lengthwise axis, while the opposing bridge members 50 A, 50 B have expanded in directions generally transverse to the lengthwise axis.
- the bridge members 50 A, 50 B can be pinched toward one another. Pinching will tend to force the fastener retaining portions 10 apart, particularly when using a V-shaped opening, which can be useful for certain surgical applications, such as distractions.
- the compression brace 1 can be used both for compression and distraction, as well as to provide for fine-tuning of bone gap sizes and compressive forces. Pinching can also be used to force the fastener retaining portions 10 toward one another, resulting in compression.
- Bridge members 50 A, 50 B may alternatively have curved, arcuate, straight, or other deformable configurations, provided that bridges 50 A, 50 B are configured to form a deformable compression opening 70 .
- the bridge members 50 A, 50 B are shortened and form a tighter angle along the compression opening 70 .
- FIG. 6 also shows an embodiment in which a chamfer is formed along the upper edge of the compression brace 1 .
- fasteners 100 are used to secure the bracket 1 to adjacent bones 301 , 302 .
- Each fastener 100 is sized and configured to pass through a fastener hole 20 and to retain the compression bracket 1 on bones 301 , 302 .
- Fasteners 100 of differing diameter can be used. For example, if angulation of the fastener 100 is desired, a smaller diameter may be used.
- the fasteners 100 may be locking or non-locking.
- each fastener 100 has a lengthwise shaft 110 sized to pass through at least one of the fastener holes 20 , and an upper retainer portion 150 sized and configured to retain the fastener 100 in the fastener hole 20 .
- the retainer portion 150 is preferably a circumferential head of the type used in conventional screws.
- the head 150 is preferably provided with a self-retaining drive mechanism, such as press-fit drive slots 155 .
- the fastener 100 is preferably a screw 100 , in which case the shaft 110 is provided with a lower thread 112 that is positioned to engage bone.
- the lower thread 112 is preferably self-tapping and self-drilling in bone.
- a cutting means 115 is preferably provided on or adjacent the tip of the screw 100 . Cutting means are well known to those of skill in the art of surgical screws.
- an alternative preferred fastener 100 is a pin 100 .
- the pin 100 shown in FIG. 12 has an enlarged head or fastener retainer portion 150 configured to retain the pin 100 in the fastener retainer member 10 .
- the shaft 110 of the pin 100 preferably has a substantially smooth outer surface.
- an upper thread 120 is provided on the shaft 110 adjacent the head of the fastener 100 for use in engaging the internal thread 22 in the fastener hole 20 .
- the upper thread 120 of the fastener 100 and the internal thread 22 of the compression brace 1 serve to maintain the fastener 100 in a substantially fixed relation to the fastener retaining portion 10 .
- an upper thread 120 has maintained the fasteners 100 in a substantially perpendicular relation to the fastener retainer portion 10 .
- the fasteners 100 have maintained a substantially fixed relation even after the compression bracket 1 has been compressed to draw the bones 301 , 302 together.
- a substantially fixed relationship can also be obtained by providing a snug-fit screw head appropriately sized to the fastener hole 20 and counterbore 30 .
- the pins of the staples tend to splay outward significantly during use in vivo, decreasing the compressive strength of the staples.
- the invention may be provided with a means 130 for selectively locking the fastener 100 in the fastener hole 20 .
- the locking means 130 is provided by forming the upper thread 120 from double-lead threads 132 , 133 .
- the double-lead threads 132 , 133 provide selective locking of the fastener 100 in the fastener hole 20 via locking interaction with the single internal thread 22 of the fastener hole 20 .
- One advantage of a double-lead type of locking means 130 is that the threads can be configured such that the compression bracket 1 can be reused, for example if it becomes necessary to remove and replace or reposition the original fastener 100 .
- Other locking means include mismatched threads.
- the surgical device may be configured such that there is play between the fastener 100 and the fastener retaining portion 10 .
- the fastener hole 20 of the brace member is substantially smooth, i.e. unthreaded.
- the shaft 110 of the fastener 100 is sized to provide play between the shaft 100 and the fastener hole 20 . As indicated in FIG. 7 , this configuration allows the fastener 100 to be selectively angled into bone during use of the device.
- Snap-off screws such as the type shown in FIG. 22
- the snap-off surgical screw shown in FIG. 22B is similar to the screws described above in that it has a head 150 , an upper threaded part 120 providing a locking thread 130 distal to the head, and a bore thread 112 distal to the locking thread 130 .
- a shaft extension 160 extends above the poly-axial head for use in rotating and driving the screw.
- the shaft extension 160 is axially aligned with the screw 100 .
- a distal end of the shaft extension 160 is fixedly connected to the head 150 of the screw by a narrow shaft 161 . After the screw 100 is inserted, the shaft 160 is broken off of the screw 100 at the point of the narrow shaft 161 .
- FIGS. 14-17 provide views of various embodiments of compression brackets 1 of the invention.
- the bracket shown in FIGS. 14A-14C has an elongated compression opening 70 .
- FIGS. 15A-15C show a compression bracket 1 having a spaced apart bridge members 50 A, 50 B, such that the opposing ends of the bridge members 50 A, 50 B are not directly adjacent one another.
- FIGS. 16A-16C show a compression bracket 1 having spaced apart bridge members 50 A, 50 B. Additionally, the spaced apart bridge members 50 A, 50 B of FIG. 16 are straight, and thus lack the V-shaped configuration of other embodiments.
- the bracket shown in FIGS. 17A-17C has a straight and generally narrow compression opening 70 , but is provided with diametrically opposed distal curved portions for use in engaging the bridge members 50 A, 50 B during spreading of the compression opening 70 .
- FIGS. 18A-18C show yet another embodiment in which the opposing bridge, and hence the compression opening 70 , are eliminated in favor of a single bridge 50 .
- the single bridge 50 can be bent in order to draw the opposing fastener retaining portions 10 together.
- the embodiment shown in FIGS. 18A-18C can be provided with the various threaded and unthreaded variations described above.
- FIGS. 19A-19D show an embodiment that combines the features of prior art surgical staples with the advantages provided by the compression bracket 1 of the present invention.
- the combined staple-compression bracket includes opposing bridge members 50 A, 50 B and a fastener retaining portion 10 having the configuration and characteristics described above.
- the opposing end of the device is provided with a downwardly depending leg 200 .
- the downwardly depending leg 200 is preferably provided with means for securing the leg 200 in bone, such as the proximal 201 and distal 202 teeth or serrations shown in FIG. 19C .
- the compression bracket 1 can include a plurality of fastener retaining portions 10 and a plurality of compression openings 70 .
- a pair of compression brackets are joined end-to-end in a unitary or unibody compression bracket structure.
- FIGS. 13A-C show an end-to-end configuration in which bridge members 50 A, 50 B are joined by a shared fastener retaining portion 10 .
- FIGS. 9A-9C a plurality of bridge members 50 A, 50 B radiate from a shared fastener retaining portion 10 .
- FIGS. 9A-9C a plurality of bridge members 50 A, 50 B radiate from a shared fastener retaining portion 10 .
- FIG. 10 also includes a compression bracket that branches off from the main chain via a shared fastener retaining portion 10 .
- Multi-part compression brackets can also be configured to include adjacent compression openings that are not separated by a fastener retaining member 20 .
- Multi-compression brackets such as those shown in FIGS. 8-10 are particularly suited for fixation or distraction of multi-part fractures, such as when a bone fractures into more than two fragments.
- the multi-compression bracket embodiments shown in FIGS. 8-10 are merely exemplary preferred embodiments of the invention, and are intended to provide those with skill in the art with the building blocks necessary to configure a wide variety of multi-compression bracket configurations, all of which would fall within the scope of the invention.
- compression braces 1 can be provided with a combination of threaded and unthreaded holes. Such a configuration could be used, for example, in situations where it is desirable to provide a perpendicularly locked fastener on one end of the brace 1 , while providing selective angulation of the fastener 100 on the opposing end of the brace.
- the compression brace 1 is used primarily for fixation of arthrodeses and osteotomies.
- the compression brace 1 can also be used in place of conventional plates, such as cuboid plates, hind or mid-foot plates, or calcaneal plates.
- the compression brace 1 is used as follows. After preparation of the surgical site, the compression brace 1 is placed on adjacent bones 301 , 302 such that one of the fastener holes is on the first bone or bone fragment 301 and one of the fastener holes 302 is on the second bone or bone fragment (see FIG. 4 ).
- the first and second bones 301 , 302 may of course be fragments or segments of the same bone, i.e. after fracture.
- the compression brace 1 is secured on the first bone 301 by inserting a fastener 100 through one of the fastener holes 20 and into the first bone 301 .
- the compression brace 1 is secured to the second bone 302 by inserting a fastener 100 through one of the fastener holes 20 and into the second bone.
- the bridge members 50 A, 50 B of the compression brace 1 are then spread apart to draw the fasteners 100 and the bones 301 , 302 toward one another.
- sufficient force can be applied to press adjacent bones 301 , 302 against one another to substantially eliminate a gap 300 between the bones 301 , 302 .
- sufficient force can be applied to move the bones 301 , 302 toward one another a selected distance, but without removing the gap 300 .
- more than one compression brace 1 can be used to fix the fracture.
- a multi-compression bracket such as the embodiments shown in FIGS. 8-10 can be used to fix the various bone fragments.
- holes are drilled into the bones 301 , 302 through the fastener holes 20 , and the fasteners 100 are then installed in the drilled holes. Pre-drilling is unnecessary if self-drilling fasteners 100 are used.
- the compression bracket 1 can also be used as a distraction plate, such as for opening osteotomies (e.g. HTO or spine distraction).
- a distraction plate such as for opening osteotomies (e.g. HTO or spine distraction).
- FIG. 20 shows a preferred drill guide instrument 300 for use in installing the compression braces 1 .
- the drill guide 300 includes a handle or mounting arm 310 having an extension portion 312 .
- a stationary guide base 318 is fixedly mounted on an upper end of the extension portion 312 .
- an adjustable guide base 328 is slidably and adjustably engaged to the stationary guide base 318 via an adjustment member 320 having a lengthwise opening 321 therethrough.
- a locking means 312 is provided for selectively locking the adjustable guide base 328 relative to the stationary guide base 318 .
- the locking means is a ring 330 threaded on the extension portion 312 .
- a first drill guide 301 is fixedly mounted on the stationary guide base 318
- a second drill guide 302 is fixedly mounted on the adjustable guide base 328 .
- the drill guides 301 , 302 are preferably removable from the drill guide instrument in order to accommodate selected sizes and configurations of fasteners 100 and compression braces 1 .
- a distal end of the drill guide 301 , 302 is provided with a counter bore having a side slot 304 therethrough for accommodating a compression brace 1 , in the manner shown in FIG. 20 .
- each drill guide 301 , 302 has a lengthwise cylindrical sleeve (not shown) passing therethrough.
- the sleeves are sized to receive and provide rotational guidance to driver components such as drill bit 380 (preferred embodiment shown in FIG. 21A ) or a screwdriver 390 (preferred embodiment shown in FIG. 21B ).
- the driver components 380 , 390 have a cylindrical shaft portion 384 sized to permit guided rotation within the drill guides 301 , 302 .
- a stop 386 is provided on the shaft 384 .
- the stop 386 is sized and positioned to abut against the drill guide 301 , 302 , the guide base 318 , 328 or another selected portion of the drill guide instrument 300 to prevent over drilling.
- the drive components 380 , 390 are provided with a conventional 388 mount on an upper end for selective engagement with a drive means, in a manner known to those of skill in the art.
- the drill bit driver component 380 is provided with a drill bit 381 .
- the screw driver component 390 is provided with a screw driver head 391 configured to match the fasteners 100 .
- Various sizes and types of drill bits 381 and screwdrivers 391 can be used with the drill guide instrument 300 , depending on intra-operative conditions.
- a tamping driver (not shown) can be provided for inserting pins 100 with the drill guide instrumentation 300 .
- the drill guide instrument 300 can be adjusted to the size of a selected compression brace 1 simply by sliding the second drill guide 302 relative to the first drill guide 301 until a suitable position is reached, and then locking the second drill guide 302 in place via the locking means 330 .
- the drill guide instrument 300 aligns the axes of the driver components 380 , 390 with those of the fastener holes 20 , which enables precise drilling or threading of fastener screws 100 .
- Spreading of the bridge members 50 A, 50 B is preferably accomplished using a spreader, such as the type shown in FIG. 10 of U.S. Pat. No. 5,660,188 (Groiso). If crimping of the bridge members 50 A, 50 B is desired, pliers can be used.
- the device and method can be used to join, fix and maintain bones in various procedures, including: LisFranc arthrodesis; mono or bi-cortical osteotomies in the forefoot; first metatarsophalangeal arthrodesis; Akin osteotomy; midfoot and hindfoot arthrodeses or osteotomies; fixation of osteotomies for hallux valgus treatment (Scarf and Chevron); and arthrodeses of the metatarsocuneiform joint to reposition and stabilize the metatarsus primus varus; carpal bone fusion; wrist fusion; elbow fracture; and metacarpal fractures.
- the compression brace 1 and fasteners 100 are preferably made of suitable biocompatible materials having sufficient mechanical strength and elasticity for the desired applications of the invention 1 .
- suitable materials include medical grade titanium alloys, medical grade stainless steel, and cobalt chrome.
- a memory metal, such as nitinol, can be incorporated into the invention.
- Suitable non-metallic biocompatible materials can also be used.
- the brace 1 or fasteners 100 can be made of a suitable bio-absorbable material, such that the components are eventually absorbed by the body after healing of the bone parts.
- bone as used herein includes whole bones as well as bone fragments (i.e. the two or more fragments of a particular bone that remain after the bone has been fractured, either completely or incompletely).
Abstract
A surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener, such as a screw or pin. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to form a compression opening. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings. In some embodiments, the fasteners are maintained in a substantially fixed relation with the fastener retaining portion. The brace is installed on adjacent bones such that a fastener engages each bone. The compression opening is spread apart to draw the fasteners toward one another, and thereby compress the adjacent bones together.
Description
- This application is a continuation of U.S. patent application Ser. No. 10/940,396, which was filed on Sep. 14, 2004, the entirety of which is herein incorporated by reference.
- Not applicable.
- Not applicable.
- The present invention relates generally to orthopedic surgery, and more particularly to devices and methods for reduction of fractures and osteotomies by drawing bones together.
- U.S. Pat. No. 2,597,342 (Lang) discloses the use of a compressible fastener for joining boards together. The Lang fastener includes a central loop portion and claw members that extend from diametrically opposed sides of the central loop. The loop is preferably a parallelogram. Each claw member has two claws. Each claw has downwardly turned ends with inwardly turned portions which are configured to penetrate and engage boards. In operation, the claw members are set astraddle adjacent board members. The central loop is then expanded outward to draw the opposing arms toward one another and thereby fasten the adjacent boards together.
- The earliest use of a compression opening in a surgical application appears to be U.S. Pat. No. 4,887,601 (Richards). Richards discloses an adjustable surgical staple having a slotted spine and downwardly depending legs on opposing ends of the spine. The legs are bent toward or away from the spine. However, a straight leg embodiment is discussed with reference to
FIGS. 7 and 8 . The Richards staple appears to have been intended for use in ophthalmic surgery. - The use of a compressible bone staples for fracture reduction is disclosed in U.S. Pat. Nos. 5,449,359 (Groiso); 5,660,188 (Groiso); 5,853,414 (Groiso); 5,947,999 (Groiso); and 5,993,476 (Groiso) (collectively, “the Groiso patents”). However, the Groiso patents, which are incorporated herein by reference, disclose the use of staples having downwardly depending legs for engaging adjacent bones. The Groiso compression bone staples suffer from several drawbacks. Staples having opposing spaced-apart bridges can be difficult and therefore expensive to manufacture. See e.g. U.S. Pat. No. 5,947,999 (Col. 1, lines 48-52). Positioning holes in the bones such that they align with the legs of the staple can be challenging, and typically requires specialized instrumentation. Additionally, staple legs tend to splay outward during use in vivo, which may reduce the compressive force of the staple. Staples can pull out of the bones. The configuration of staples also reduces intra-operative choices. In order to accommodate varying inter-axis and leg length requirements, it is necessary to provide a wide array of staple sizes, which requires extra inventory. A staple conventionally has legs of the same length and diameter/cross-section, which may make the staple unsuitable for situations in which it is desirable to have a longer or larger leg on one side of the staple. Thus, even with a large inventory of staple sizes, intra-operative choices may be limited.
- One of the Groiso patents, U.S. Pat. No. 5,947,999, discloses a compressible bone staple that has a pair of wing members extending from opposing ends of the staple, each wing member having apertures therein for receiving a screw for fastening the clip member to a bio-organic tissue member. However, the '999 patent does not teach elimination of the downwardly depending leg portions of the staple. In fact, Groiso teaches away from elimination of the leg portions by noting “the aim of attaining a desired spacing between bone fragments could be obtained with connecting elements such as plates and screws, but these are much bulkier, require major surgical procedures for the placing thereof and the possibility of trauma is increased.” U.S. Pat. No. 5,947,999 (Col. 2, lines 55-59). Additionally, the '999 patent is direct toward connecting soft tissues (tendons and ligaments) to bone.
- U.S. Pat. No. 4,444,181 (Wevers et al.) discloses a bone clip for repair of bones in vivo including a body having a slot in a central portion thereof and a pair of downwardly depending legs on either end of the body. After the clip is inserted in opposing bones, opposing bridges are compressed toward one another (rather than expanded) to shorten the clip and thereby draw the bones together.
- The use of bone screws and bone plates to reduce fractures is well known in the art. However, as far as the applicant is aware, no attempt has been made to provide a brace and screw combination that has the ability to pull bone fragments together in the efficient and highly effective manner described herein. There is thus a need for a surgical device having the following characteristics and advantages over the prior art.
- It is an object of the invention to provide an improved means of compressing adjacent bones together in surgical applications.
- It is an object of the invention to provide a substitute for surgical compression staples that has superior anchorage in bone.
- It is an object of the invention to increase intra-operative choices by allowing a surgeon to select desired lengths and diameters of fasteners.
- It is an object of the invention to reduce inventory by allowing a surgeon to mix and match between braces and fasteners.
- The foregoing objects and advantages are achieved by providing a surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to thereby form a compression opening between the fastener retaining portions. Each bridge member is preferably substantially V-shaped. The fasteners are sized and configured to pass through the fastener hole and retain the compression bracket on bones. The fasteners preferably have a lengthwise shaft sized to pass through the fastener hole and an upper retainer portion sized and configured to retain the fastener in the fastener hole. In one embodiment, the fasteners are screws having a lower thread positioned to engage bone. In an alternative embodiment, the fasteners are pins. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings.
- The device is preferably provided with a means for selectively locking the fasteners in the fastener holes to maintain the fasteners in a substantially fixed relation with the fastener retaining portion. Alternatively, the fastener hole of the brace member may be substantially smooth. The shaft of at least one of the fasteners can be sized to provide play between the shaft and the fastener hole, such that the fastener can be selectively angled into bone during use of the device.
- The foregoing and other objects, features, aspects and advantages of the invention will become more apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.
-
FIG. 1 is a top view of one preferred embodiment of a compression brace of the invention, showing the brace in an uncompressed configuration. -
FIG. 2 is a top view of the compression brace ofFIG. 1 , showing the brace in a compressed configuration and featuring a pair of screws disposed in the brace. -
FIG. 3 is a side cross-section of view taken along 3-3 ofFIG. 1 . -
FIG. 4 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in an uncompressed configuration prior to reduction of the fracture. -
FIG. 5 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in a compressed configuration. -
FIG. 6 is a top view of a preferred embodiment of the compression brace of the invention, featuring an unthreaded fastener hole. -
FIG. 7 is a side cross-section view taken along 7-7 ofFIG. 6 , and illustrating radial play of a screw within the unthreaded fastener hole. -
FIGS. 8A-C show views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end. -
FIG. 9 provides views of one preferred embodiment of the invention, featuring a plurality of clip members radiating from a shared fastener retaining portion. -
FIG. 10 provides views of one preferred embodiment of the invention, featuring a plurality of compression brackets joined end-to-end via shared fastener retaining portions, and including a branching compression bracket. -
FIG. 11 is a side view of a preferred embodiment of a screw type fastener for use in the invention. -
FIG. 12 is a side perspective view of a preferred embodiment of a pin-type fastener for use in the invention. -
FIG. 13 provides views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end via a shared fastener retaining portion. -
FIG. 14 provides views of one preferred embodiment of the invention. -
FIG. 15 provides views of one preferred embodiment of the invention. -
FIG. 16 provides views of one preferred embodiment of the invention. -
FIG. 17 provides views of one preferred embodiment of the invention. -
FIG. 18 provides views of one preferred embodiment of the invention. -
FIG. 19 provides views of one preferred embodiment of the invention. -
FIG. 20 is a perspective view of one embodiment of a drill guide instrument for use in installing the compression brackets of the invention. -
FIG. 21 provides perspective views of drivers for use with the drill guide instrument ofFIG. 20 . -
FIG. 22 provides views of a snap-off screw for use with the compression brace of the invention. - In the following detailed description of the preferred embodiments, reference is made to the accompanying drawings which form a part hereof, and in which are shown by way of illustration specific embodiments in which the invention may be practiced. It is to be understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present invention.
- As shown in
FIGS. 4 and 5 , the invention is a surgical device for pressing and retainingadjacent bones FIG. 4 , the invention includes, generally, acompression brace 1 andfasteners 100 for securing the brace onbones FIG. 5 , compression of thebrace 1 presses the adjacent bone fragments 301, 302 together. - As shown in
FIG. 1 , in a preferred embodiment thecompression brace 1 has at least twofastener retaining portions 10. Eachfastener retaining portion 10 has a fastener hole or bore 20 therethrough for receiving afastener 100. In a preferred embodiment shown inFIG. 3 , athread 22 is provided in thefastener hole 20. As indicated in the side view ofFIG. 3 , thebrace 1 can be considered to have a tissue orosteo side 2, which sits against the bones during use, and an opposing side orouter surface 3. As shown inFIG. 3 , thefastener retaining portion 10 preferably has acounterbore 30 formed in theouter surface 3. Thecounterbore 30 is preferably substantially in axial alignment with thefastener hole 20. Thecounterbore 30 is preferably spherical. Thecounterbore 30 is sized and configured to provide countersinking of anupper retainer portion 150 of afastener 100 in thefastener retaining portion 10 of thecompression brace 1. - A pair of
bridge members fastener retaining portions 10. Thebridge members fastener retaining portions 10, but may be spaced from one or both of the fastener retaining portions, such as by a shared extension portion disposed between thebridge members fastener retainer portions 10. Thebridge members fastener retaining portions 10. Thebridge members fastener retaining portions 10 andfasteners 100 toward one another, in a manner described in further detail below. - In the preferred embodiment shown in
FIG. 1 , thebridge members linear portions brace 10 is in an uncompressed configuration. When opposing expansion forces are applied to thebridges FIG. 1 , central portions of thebridge members fastener retaining portions 10 toward one another.FIG. 2 demonstrates the configuration of the compression brace ofFIG. 1 after it has been compressed a selected amount. Note that inFIG. 2 , thecompression brace 1 has contracted generally along its lengthwise axis, while the opposingbridge members bridge members fastener retaining portions 10 apart, particularly when using a V-shaped opening, which can be useful for certain surgical applications, such as distractions. In this manner, thecompression brace 1 can be used both for compression and distraction, as well as to provide for fine-tuning of bone gap sizes and compressive forces. Pinching can also be used to force thefastener retaining portions 10 toward one another, resulting in compression. -
Bridge members bridges FIG. 6 , thebridge members FIG. 6 also shows an embodiment in which a chamfer is formed along the upper edge of thecompression brace 1. - As shown in
FIG. 4 ,fasteners 100 are used to secure thebracket 1 toadjacent bones fastener 100 is sized and configured to pass through afastener hole 20 and to retain thecompression bracket 1 onbones Fasteners 100 of differing diameter can be used. For example, if angulation of thefastener 100 is desired, a smaller diameter may be used. Thefasteners 100 may be locking or non-locking. In a preferred embodiment shown inFIG. 11 , eachfastener 100 has alengthwise shaft 110 sized to pass through at least one of the fastener holes 20, and anupper retainer portion 150 sized and configured to retain thefastener 100 in thefastener hole 20. As shown inFIG. 11 , theretainer portion 150 is preferably a circumferential head of the type used in conventional screws. Thehead 150 is preferably provided with a self-retaining drive mechanism, such as press-fit drive slots 155. - As shown in
FIG. 11 , thefastener 100 is preferably ascrew 100, in which case theshaft 110 is provided with alower thread 112 that is positioned to engage bone. Thelower thread 112 is preferably self-tapping and self-drilling in bone. To facilitate tapping of thelower thread 112 into bone, a cutting means 115 is preferably provided on or adjacent the tip of thescrew 100. Cutting means are well known to those of skill in the art of surgical screws. - As shown in
FIG. 12 , an alternativepreferred fastener 100 is apin 100. Thepin 100 shown inFIG. 12 has an enlarged head orfastener retainer portion 150 configured to retain thepin 100 in thefastener retainer member 10. Theshaft 110 of thepin 100 preferably has a substantially smooth outer surface. - In a preferred embodiment shown in
FIG. 11 , anupper thread 120 is provided on theshaft 110 adjacent the head of thefastener 100 for use in engaging theinternal thread 22 in thefastener hole 20. In a preferred embodiment, theupper thread 120 of thefastener 100 and theinternal thread 22 of thecompression brace 1 serve to maintain thefastener 100 in a substantially fixed relation to thefastener retaining portion 10. For example, inFIG. 5 , anupper thread 120 has maintained thefasteners 100 in a substantially perpendicular relation to thefastener retainer portion 10. In the preferred embodiment ofFIG. 5 , thefasteners 100 have maintained a substantially fixed relation even after thecompression bracket 1 has been compressed to draw thebones fastener hole 20 andcounterbore 30. In the prior art uni-body compression staples disclosed in the Groiso patents, the pins of the staples tend to splay outward significantly during use in vivo, decreasing the compressive strength of the staples. - The invention may be provided with a
means 130 for selectively locking thefastener 100 in thefastener hole 20. In the preferred embodiment shown inFIG. 11 , the locking means 130 is provided by forming theupper thread 120 from double-lead threads lead threads fastener 100 in thefastener hole 20 via locking interaction with the singleinternal thread 22 of thefastener hole 20. One advantage of a double-lead type of locking means 130 is that the threads can be configured such that thecompression bracket 1 can be reused, for example if it becomes necessary to remove and replace or reposition theoriginal fastener 100. Other locking means include mismatched threads. - As shown in
FIG. 7 , the surgical device may be configured such that there is play between thefastener 100 and thefastener retaining portion 10. In the preferred embodiment shown inFIG. 7 , thefastener hole 20 of the brace member is substantially smooth, i.e. unthreaded. Additionally, theshaft 110 of thefastener 100 is sized to provide play between theshaft 100 and thefastener hole 20. As indicated inFIG. 7 , this configuration allows thefastener 100 to be selectively angled into bone during use of the device. - Snap-off screws, such as the type shown in
FIG. 22 , can be used asfasteners 100. The snap-off surgical screw shown inFIG. 22B is similar to the screws described above in that it has ahead 150, an upper threadedpart 120 providing alocking thread 130 distal to the head, and abore thread 112 distal to the lockingthread 130. Additionally, ashaft extension 160 extends above the poly-axial head for use in rotating and driving the screw. Theshaft extension 160 is axially aligned with thescrew 100. A distal end of theshaft extension 160 is fixedly connected to thehead 150 of the screw by anarrow shaft 161. After thescrew 100 is inserted, theshaft 160 is broken off of thescrew 100 at the point of thenarrow shaft 161. -
FIGS. 14-17 provide views of various embodiments ofcompression brackets 1 of the invention. The bracket shown inFIGS. 14A-14C has an elongated compression opening 70.FIGS. 15A-15C show acompression bracket 1 having a spaced apartbridge members bridge members FIGS. 16A-16C show acompression bracket 1 having spaced apartbridge members bridge members FIG. 16 are straight, and thus lack the V-shaped configuration of other embodiments. The configuration ofFIG. 16 is particularly adapted for situations in which it may be desirable to obtain compression by bending thebridge members bridges FIGS. 17A-17C has a straight and generally narrow compression opening 70, but is provided with diametrically opposed distal curved portions for use in engaging thebridge members -
FIGS. 18A-18C show yet another embodiment in which the opposing bridge, and hence the compression opening 70, are eliminated in favor of asingle bridge 50. Thesingle bridge 50 can be bent in order to draw the opposingfastener retaining portions 10 together. Otherwise, the embodiment shown inFIGS. 18A-18C can be provided with the various threaded and unthreaded variations described above. -
FIGS. 19A-19D show an embodiment that combines the features of prior art surgical staples with the advantages provided by thecompression bracket 1 of the present invention. As shown inFIG. 19A , the combined staple-compression bracket includes opposingbridge members fastener retaining portion 10 having the configuration and characteristics described above. However, the opposing end of the device is provided with a downwardly dependingleg 200. The downwardly dependingleg 200 is preferably provided with means for securing theleg 200 in bone, such as the proximal 201 and distal 202 teeth or serrations shown inFIG. 19C . - As shown in
FIGS. 8-10 and 13, thecompression bracket 1 can include a plurality offastener retaining portions 10 and a plurality of compression openings 70. In the embodiment shown inFIGS. 8A-8C , a pair of compression brackets are joined end-to-end in a unitary or unibody compression bracket structure.FIGS. 13A-C show an end-to-end configuration in whichbridge members fastener retaining portion 10. InFIGS. 9A-9C , a plurality ofbridge members fastener retaining portion 10. In FIGS. 10A-10C, a plurality ofcompression brackets 1 are joined end-to-end via sharedfastener retaining portions 10.FIG. 10 also includes a compression bracket that branches off from the main chain via a sharedfastener retaining portion 10. Multi-part compression brackets can also be configured to include adjacent compression openings that are not separated by afastener retaining member 20. Multi-compression brackets such as those shown inFIGS. 8-10 are particularly suited for fixation or distraction of multi-part fractures, such as when a bone fractures into more than two fragments. The multi-compression bracket embodiments shown inFIGS. 8-10 are merely exemplary preferred embodiments of the invention, and are intended to provide those with skill in the art with the building blocks necessary to configure a wide variety of multi-compression bracket configurations, all of which would fall within the scope of the invention. - One of the advantages of the invention over the prior art is that it enables a surgeon to intra-operatively select various combinations of brace and fastener sizes and configurations to accommodate the operative condition of a particular surgical site, thus providing greater options while decreasing staple inventory. To further enhance options, compression braces 1 can be provided with a combination of threaded and unthreaded holes. Such a configuration could be used, for example, in situations where it is desirable to provide a perpendicularly locked fastener on one end of the
brace 1, while providing selective angulation of thefastener 100 on the opposing end of the brace. The same effect can be obtained by selecting afastener 100 sized to permit angulation through a relatively larger threadedhole 20, such that the threads of thehole 20 do not substantially impinge on the selected degree of angulation. Similarly, a combination of locking and non-locking threads can be used. - The
compression brace 1 is used primarily for fixation of arthrodeses and osteotomies. Thecompression brace 1 can also be used in place of conventional plates, such as cuboid plates, hind or mid-foot plates, or calcaneal plates. - In operation, the
compression brace 1 is used as follows. After preparation of the surgical site, thecompression brace 1 is placed onadjacent bones bone fragment 301 and one of the fastener holes 302 is on the second bone or bone fragment (seeFIG. 4 ). The first andsecond bones compression brace 1 is secured on thefirst bone 301 by inserting afastener 100 through one of the fastener holes 20 and into thefirst bone 301. Thecompression brace 1 is secured to thesecond bone 302 by inserting afastener 100 through one of the fastener holes 20 and into the second bone. Thebridge members compression brace 1 are then spread apart to draw thefasteners 100 and thebones bridge members adjacent bones gap 300 between thebones bones gap 300. With fractures having more than two bone fragments, more than onecompression brace 1 can be used to fix the fracture. Alternatively, a multi-compression bracket such as the embodiments shown inFIGS. 8-10 can be used to fix the various bone fragments. In one embodiment of the method, holes are drilled into thebones fasteners 100 are then installed in the drilled holes. Pre-drilling is unnecessary if self-drilling fasteners 100 are used. - The
compression bracket 1 can also be used as a distraction plate, such as for opening osteotomies (e.g. HTO or spine distraction). By applying a force to bridgemembers fasteners 100 apart. Thedevice 1 can be used to open a space to allow insertion of a spacer, and then used to close the space in order to sandwich the spacer between adjacent bones. - The
compression bracket 1 can be installed with or without specialized instrumentation.FIG. 20 shows a preferreddrill guide instrument 300 for use in installing the compression braces 1. Thedrill guide 300 includes a handle or mountingarm 310 having anextension portion 312. Astationary guide base 318 is fixedly mounted on an upper end of theextension portion 312. As shown inFIG. 20 , anadjustable guide base 328 is slidably and adjustably engaged to thestationary guide base 318 via anadjustment member 320 having alengthwise opening 321 therethrough. A locking means 312 is provided for selectively locking theadjustable guide base 328 relative to thestationary guide base 318. In the embodiment shown inFIG. 20 , the locking means is aring 330 threaded on theextension portion 312. - A
first drill guide 301 is fixedly mounted on thestationary guide base 318, while asecond drill guide 302 is fixedly mounted on theadjustable guide base 328. The drill guides 301, 302 are preferably removable from the drill guide instrument in order to accommodate selected sizes and configurations offasteners 100 and compression braces 1. A distal end of thedrill guide side slot 304 therethrough for accommodating acompression brace 1, in the manner shown inFIG. 20 . - As indicated in
FIG. 20 , eachdrill guide FIG. 20 , the sleeves are sized to receive and provide rotational guidance to driver components such as drill bit 380 (preferred embodiment shown inFIG. 21A ) or a screwdriver 390 (preferred embodiment shown inFIG. 21B ). As shown inFIGS. 21A and 21B , thedriver components cylindrical shaft portion 384 sized to permit guided rotation within the drill guides 301, 302. Astop 386 is provided on theshaft 384. Thestop 386 is sized and positioned to abut against thedrill guide guide base drill guide instrument 300 to prevent over drilling. Thedrive components FIG. 21A , the drillbit driver component 380 is provided with adrill bit 381. As shown inFIG. 21B , thescrew driver component 390 is provided with ascrew driver head 391 configured to match thefasteners 100. Various sizes and types ofdrill bits 381 andscrewdrivers 391 can be used with thedrill guide instrument 300, depending on intra-operative conditions. A tamping driver (not shown) can be provided for insertingpins 100 with thedrill guide instrumentation 300. - As indicated in
FIG. 20 , thedrill guide instrument 300 can be adjusted to the size of a selectedcompression brace 1 simply by sliding thesecond drill guide 302 relative to thefirst drill guide 301 until a suitable position is reached, and then locking thesecond drill guide 302 in place via the locking means 330. Thedrill guide instrument 300 aligns the axes of thedriver components - Spreading of the
bridge members bridge members - The device and method can be used to join, fix and maintain bones in various procedures, including: LisFranc arthrodesis; mono or bi-cortical osteotomies in the forefoot; first metatarsophalangeal arthrodesis; Akin osteotomy; midfoot and hindfoot arthrodeses or osteotomies; fixation of osteotomies for hallux valgus treatment (Scarf and Chevron); and arthrodeses of the metatarsocuneiform joint to reposition and stabilize the metatarsus primus varus; carpal bone fusion; wrist fusion; elbow fracture; and metacarpal fractures.
- The
compression brace 1 andfasteners 100 are preferably made of suitable biocompatible materials having sufficient mechanical strength and elasticity for the desired applications of theinvention 1. Suitable materials include medical grade titanium alloys, medical grade stainless steel, and cobalt chrome. A memory metal, such as nitinol, can be incorporated into the invention. Suitable non-metallic biocompatible materials can also be used. Further, thebrace 1 orfasteners 100 can be made of a suitable bio-absorbable material, such that the components are eventually absorbed by the body after healing of the bone parts. - Unless the context indicates otherwise, the term “bone” as used herein includes whole bones as well as bone fragments (i.e. the two or more fragments of a particular bone that remain after the bone has been fractured, either completely or incompletely).
- Although the present invention has been described in terms of specific embodiments, it is anticipated that alterations and modifications thereof will no doubt become apparent to those skilled in the art. It is therefore intended that the following claims be interpreted as covering all alterations and modifications that fall within the true spirit and scope of the invention.
Claims (20)
1. A surgical device, in combination, comprising:
a compression brace having an outer side and a substantially planar osteo side, the osteo side disposed opposite the outer side, the compression brace including
first and second fastener retainers, each of the first and second fastener retainers defining a threaded opening, and
first and second bridge members disposed between the first and second fastener retainers and defining a first compression opening; and
first and second fasteners sized and configured to be received within the threaded openings defined by the first and second fastener retainers, each of the first and second fasteners including an elongate shaft extending from the head, the elongate shafts including a first threaded portion disposed adjacent to the head, the first threaded portion including threads sized and configured to engage the threaded openings defined by the first and second fastener retainers,
wherein the first and second bridge members are formed from a memory metal and are configured to be deformed such that a width of the first compression opening is adjusted to provide compression or distraction to adjacent bone segments when the compression brace is secured to the adjacent bone segments.
2. The surgical device of claim 1 , wherein the first and second bridge members are spaced apart from one another in a substantially unbiased relationship.
3. The surgical device of claim 1 , wherein the first and second fasteners include a second threaded portion along the elongate shaft, the second threaded portion sized and configured to engage bone.
4. The surgical device of claim 4 , wherein the first and second fasteners include a cutting means disposed at end opposite the head.
5. The surgical device claim 1 , wherein the first threaded portion of the first and second fasteners includes double lead threads.
6. The surgical device of claim 1 , wherein the compression brace includes:
a third fastener retainer, and
third and fourth bridge members disposed between the second and third fastener retainers and defining a second compression opening, the third and fourth bridge members formed from a memory metal.
7. The surgical device of claim 6 , wherein the compression brace includes:
a fourth fastener retainer, and
fifth and sixth bridge members disposed between the second and fourth fastener retainers, the fifth and sixth bridge members formed from a memory metal and defining a third compression opening.
8. A method of installing a surgical device, comprising:
inserting a first elongate shaft of a first fastener into a first threaded opening defined by a first fastener retainer of a compression brace, the compression brace including
a second fastener retainer defining a second threaded opening defined by the second threaded opening, and
first and second bridge members disposed between the first and second fastener retainers and defining a first compression opening having a width, the first and second bridge members formed from a memory metal;
engaging a first threaded portion of the first elongate shaft with the threads of the first threaded opening to secure the first fastener to the compression brace and to a first bone segment; inserting a second elongate shaft of a second fastener into the second threaded opening of the compression brace;
engaging a second threaded portion of the second elongate shaft with the threads of the second threaded opening to secure the second fastener to the compression brace and to a second bone segment; and
deforming at least one of the first and second bridge members to adjust the width of the width of the first compression opening thereby providing one of distraction or compression to the first and second bone segments.
9. The method of claim 8 , wherein the first and second bridge members are configured to maintain a width of the first compression opening after being deformed.
10. The method of claim 8 , wherein the first fastener includes a third threaded portion along the first elongate shaft configured to engage bone.
11. The method of claim 10 , wherein the second fastener includes a fourth threaded portion along the second elongate shaft configured to engage bone.
12. The method of claim 8 , wherein the first and second threaded portions include double lead threads.
13. The method of claim 8 , wherein the compression brace includes an outer side and a substantially planar osteo side disposed opposite the outer side.
14. A compression brace, comprising:
a first fastener retaining portion defining a first threaded opening and including a first countersink that is axially aligned with an axis defined by the first threaded opening, the first countersink inwardly extending from an outer side of the compression brace;
a second fastener retaining portion defining a second threaded opening and including a second countersink that is axially aligned with an axis defined by the second threaded opening, the second countersink inwardly extending from the outer side of the compression brace;
a first bridge member extending from the first fastener retaining portion to the second fastener retaining portion; and
a second bridge member extending from the first fastener retaining portion to the second fastener retaining portion,
wherein the first and second bridge members are formed from a memory metal and define a first compression opening therebetween, the first and second bridge members configured to be deformed to adjust a width of the first compression opening thereby providing one of a compression or distraction force to adjacent bone segments when the compression brace is secured to the adjacent bone segments.
15. The compression brace of claim 14 , wherein the first threaded opening is configured to receive a first fastener including a first head and a first elongate shaft extending from the first head, the first elongate shaft having a first threaded portion adjacent to the first head.
16. The compression brace of claim 15 , wherein the second threaded opening is configured to receive a second fastener including a second head and a second elongate shaft extending from the second head, the second elongate shaft having a second threaded portion adjacent to the second head.
17. The compression brace of claim 16 , wherein the first and second threaded portions are double lead threads configured to respectively lock the first and second fasteners in the first and second threaded openings.
18. The compression brace of claim 14 , wherein the compression brace includes a substantially planar osteo side disposed opposite the outer side.
19. The compression brace of claim 14 , wherein the first and second bridge members are substantially parallel each other and include diametrically opposed distal curved portions.
20. The compression brace of claim 14 , further comprising:
a third fastener retaining portion defining a third threaded opening and including a third countersink that is axially aligned with an axis defined by the third threaded opening, the third countersink inwardly extending from the outer side of the compression brace, the third fastener opening disposed adjacent to the first fastener retaining portion;
a fourth fastener retaining portion defining a fourth threaded opening and including a fourth countersink that is axially aligned with an axis defined by the fourth threaded opening, the fourth countersink inwardly extending from the outer side of the compression brace;
a third bridge member extending from the third fastener retaining portion to the fourth fastener retaining portion; and
a fourth bridge member extending from the third fastener retaining portion to the fourth fastener retaining portion,
wherein the third and fourth bridge members are formed from a memory metal and define a second compression opening therebetween, the third and fourth bridge members configured to be deformed to adjust a width of the second compression opening thereby providing one of a compression or distraction force to adjacent bone segments when the compression brace is secured to the adjacent bone segments.
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US14/329,429 US20150012004A1 (en) | 2004-09-14 | 2014-07-11 | Compression brace |
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US11/060,965 US8221478B2 (en) | 2004-09-14 | 2005-02-18 | Snap-off surgical screw |
US12/582,210 US20100036430A1 (en) | 2004-09-14 | 2009-10-20 | Compression brace |
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US14/172,547 Division US20140316470A1 (en) | 2004-09-14 | 2014-02-04 | Compression brace |
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US12/582,210 Abandoned US20100036430A1 (en) | 2004-09-14 | 2009-10-20 | Compression brace |
US14/172,547 Abandoned US20140316470A1 (en) | 2004-09-14 | 2014-02-04 | Compression brace |
US14/329,429 Abandoned US20150012004A1 (en) | 2004-09-14 | 2014-07-11 | Compression brace |
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US11/060,965 Active 2030-01-19 US8221478B2 (en) | 2004-09-14 | 2005-02-18 | Snap-off surgical screw |
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US14/329,429 Abandoned US20150012004A1 (en) | 2004-09-14 | 2014-07-11 | Compression brace |
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WO (1) | WO2006031692A2 (en) |
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Also Published As
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US20060081553A1 (en) | 2006-04-20 |
US20140316470A1 (en) | 2014-10-23 |
WO2006031692A3 (en) | 2006-06-29 |
WO2006031692A2 (en) | 2006-03-23 |
US20060058796A1 (en) | 2006-03-16 |
US8221478B2 (en) | 2012-07-17 |
US20150012004A1 (en) | 2015-01-08 |
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