US2393831A - Bone splint - Google Patents

Description

"Jan. 29, 1946. f o. STADER 2,393,331

' BONE SPLINT Filed Dec. 29, 1942 Patented Jan. 29, 1946 UNITED STATES PATEN T OFFICE -BONE-SPLINT *Otto Stader, ArdmorefiPa.

(Application December 29, 1942; Serial No. 470,475

'2' Claims.

'LThisinvention relatesuto :new and useful improvements in bone splints and more particularly to splints for :effecting :the 1 reduction and fixation of fractures 'ofthe .os' calcis :or heel rbone.

'Fractures;.:of:thetos calcis are;difficult;properly ito .effect :reduction :and fixation chiefly" because of the strong upward pull:of the Achilles tendon which i tends :to "displace tthe :os calcis :fragment upwardand-also :because the :musclesandtendons underneath the foot tend: to fdisplace the frag- ..ment forward, these .tendencies :rcombining ato causea shorteningpf the. fractured os calcis.

Previousii'attempts:toi'treat fractures of -the .os

wcalcisl'havezallrecognized the importance of preventingcontraction ofzthe Achilles tendon in the l reduction of: such ifractures, and "the fact that counteracting restraint must :be -maintained Jthrou'ghout the :healing process. However, 'no ;particular1attention'l has tbeen'zpaid to the equally important problem of preventingwcontraction of 'the'plantar muscles'in "the sole of the. foot to prevent. shortening of 'theos :calcis.

.Prior toithapresent invention the practice .employed in.the:reduction and fixation of s calcis fractures generallymas'been as follows: A single pin ist'passedthrough thevlowernextremity of "the --tibia, and another. pin issimilarly passed through ..thetupperioutermost area of ltheos calcis. 'I'hese twoz-pins are .then secured tina suitable mechanical reduction :apparatus or; frame. After reducitiOl'i' of .the fracture-by thisaapparatus,1a plaster cast is applied and then itheuapparatusxis removed, the opposite-end portions of; said tpinsbein'g: embedded "in .the plaster cast.

..Certain substantial difliculties I and objections are'presentedbymthis"treatment of oscalcis fracztures. ..In thefirstiplace,.the: plaster. castis not a rigid structure; and following'its application and the embedding of the pin ends therein,:' disinte- *gration of the cast-occurs withthe result that the pins become" -'loosened"' in the cast; and it is impossible to maintain the degree of reduction of the fracture originally" obtained in the reduction frame. Secondly; with a plaster cast applied as aforesaid; ifit is notpossible in the first instance to obtain a satisfactory reduction, which is ithe "rule rather than theexception-in' fractures of'the 0s calcis, then ati each treatment that 'is :made

until a satisfactory reduction is obtained, the

plaster 'ca'st must beremoved and' the' entire reduction treatment repeated.

Furthermore, one of the most important considerations "attendant upon 7 the treatment of os calcisfractures is the desirability of'lmaintainlng adequate sub-astragaloid-joint space, in order to better 'insure thatthe ,patient mu be "free, from .pain. in this; jointxafter' the :os calcis fracture; has

completely healed. The conventional plaster cast "treatmentlofosl calcis fractureswislnot sufficiently strong Ito :prevent contraction of lthe Achilles tendon and maintain .this proper joint space or thernormal atuber-jointangle swhichiis an-angle normal-1y of about :40:formed .by the bisection of a'line: drawn :from the edge of zthe posterior subastragaloid: articulation anteriorly'to the anterior rim of the anterior subastragaloid articulation and a line drawn posteriorlyoventhe superior surface ofthe'tuberosity. 1ThiS tl1b61= joint angle has been'greatly distorted by .:the "fracture 'as the result of a shortening -of the Achilles tendon and plantar muscles therebyproducing subsequent deformity. Nor *does this treatmentrserve to prevent shortening of the-10s calcis through contractionof the plantar muscles.

.With theforegoing in mind,- the;principalobject of the present invention isto providean-0s calcis fracture reduction and fixation splint which effectively prevents contraction-of both the "Achilles tendon and; plantarmuscles andaf- .fords absolutezrigidity to the; fractured bone frag- .ments while' at the. same time; allowing-for necessary inspection and :secondary adjustments thereof during knitting.

Another object of the invention is to provide a .splint of the character set forth'which does=not require'fixation or immobilization of the'fracture by the usual plaster or ,otherrcast.

Another object of the present' invention; is to provide a. splint of 'the'itype ldescribed whichis sufilciently. strong to. prevent contraction of the Achilles; tendon, and plantar muscles and maintain the proper sub-astragaloid joint spacingand restoretuber-joint. vanglemduring healing ofjfractures of the oslcalcis.

. A- further. object of the invention .is to provide a splintlofitherstated character ,which is constructed and arranged, tocpermit positive lateral displacement with respect to; the. vertical canterior-lposterior planettoleffect completeanMomical correctionsof the os ,calcis .thereby..affording complete anatomicalreduction .of the fracture.

.A still, further objectuof ti-reinvention is. to

:provide. aisplint of the type described which .may ".be used in conjunction with a. conventional ,os

calcis clamp without interfering with application .anduse of such-a clamp.

..Ihese and other ,objectsofuthe inventionl-and 1 the variousf'features :and details of, the; construction andoperation .thereotare hereinafter, fully set forth and described, and shown in the accompanying drawing, in which: v

Figure l is a view in perspective of the lower leg and foot of a'person showing the splint of the present invention positioned for reduction and fixation-of a fracture of the s calcis or heel bone.

Figure 2 is a view in side elevation of the disclosure in Figure 1. V g

'gure 3 is an enlarged fragmentary view in section taken on line 3-, 3, Figure. 2;' and Figure 4 is an enlarged fragmentary view in 7 section taken on line 44, Figure 1. v Referring now more particularly to the draw-g ing, an os oalcis splint made according to the present inventioncomprises a pair of spindles or;

bars I, I which have the mal'orportion o f their length threaded as indicated-2x 2, 2, respectively.

' her I I may be fixedly secured in place upon the 1 spindles I by means of nuts or the like lllthread- Y ed on the threads 5 at the extremity of the These threads .2, 2 extend along each of the spindles I from one end thereof to an enlarged portion 3 'provided'or formed inwardly adjacent the opposite end of each spindle 1. Beyond this enlarged portion 3 each spindle I terminates in a reduced spindle portion 4 having threads 5 at the extremitythereofp The enlarged portion 3 of each spindle I provides a stop .or shoulder 6 adjacent the portion 4,fthe purpose of which will 7 be set' forth hereinaften'and, thesurface of said portion 3 is made hexagonal or similar shape to provide a nutelike portion to enable rotation of the. spindles by anysuitable means such as a wrench'or the like.

-. Upon the threadedportionsi of each of the spindles 'I is threadedasupport or block I and the construction and arrangement of these supports or blocks 1 and spindles I is such that, if the said supports 1 are held against rotation, the spindles, I maybe rotated to adjust said sup- I port I-axially with respect to said spindles. The supports may be positively locked in a predetermined position axially with respect to the spindles I by means of lock n uts 8 or the like threaded thereon. W

V V A s-shown in the drawing, each of the supports I isslotted as indicated at 9 to receive the lug or'like portion ID of a stud II. This lug portion In is provided with'a'suitably located aperture I2 therein through which freely extends a retaining screw or the like, I3 threaded into the supports I and passing through the slots 9, the construction and arrangement being such that said stud II may pivot within the slot 9 about said screw I3 relative to the supports 1 in a plane parallel to the axis of the associated spindle I.

-A pin bar or holder I4 is mounted at or adjacent its midpoint upon each stud I I and secured thereon by a nut orthe like I5 for rotation with said stud I I.

A pair of screws I6 are threaded in port I at opposite sides of the slots 9 therein and stud .II and thesescrews I6 extend in the direction of the pin'bars I4 and engage thefadjacent face thereof thereby making it possible by adjustment of said screws I5 to effect positive mechanicalad'justment of said pin bars I4 and suitable openings I8 to receive the respective portion 4 of the two spindles I. These openings I8 in the terminal portions of the yoke memher I! have their axes substantially perpendicular to theplane of said yoke member I? so that when the yoke member'is mounted on the portions 4 of the spindles I, as aforesaid, and in abutting relation against the shoulders -6 provided by the portions 4, the said yoke member I7 will reside in a plane substantially at-right angles to the plane of the two spindles. ,The, yoke memspindle portions 4. v

' A shown, each of the pin barsld, previously described, is provided with a plurality of bores 'o'r openings 20 which extend therethrough and are arranged to receive the end portions of .a skeletal pin or other bone-penetrating element -2I.' isimilarly, the terminal'end portions of the yoke member I! are each providedv with a bore or opening 22 which extends therethrough and are arranged to'receive the end portions of a like skeletal pin or other bone-penetrating element 23....The skeletal pins or elements 2I and 23' are each adapted'to penetrate orextend entirely through the flesh andbone: of the liinb with the end portions of said pins projecting from opposite sides of the limb andextendi through the correspondingly"positioned bores 20 and 22 in the pin bars" I4 and the terminal end portions of the yoke member II, respectively, as 7 shown in Figure 1 of the drawing. The pin bars I4 and the yoke member I! are each provided withsetscrews or the like 24 and 25, respectively, disposed normal to the axis of the bores 20 and 22, by means. of which the pins H and 23 may be locked or secured relative to the pin bars I4 andthe yoke II. a

The" pins 2| and 23'are provided withsharply tapered pointsior ends as lindicated'at 26 tofaeach supcilitate penetration into and through thabone and surrounding flesh." This is accomplished by forcing the pins through the flesh and bones at theseveral places shown in the drawing. The pins may be forced through the bone with comparatively easy effort: due to the sharply pointed ends 26 thereof merely Icy-applying :pressure axially of said pinsand at the'same'time rotating the same in alternately opposite directions in the manner of a hand drill. J e

For strength and rigidity the pins 2I and 23 employed are composed generally of metal such as, for example, stainless steel, and the 'like,'and

in the course of application and use of the splint,

it has been found that .the'contact of these metal pins with'the tissue and flesh through which inserted causes abio-chemica1 reaction to take 7 place which, sets up a galvanic-like current through the-pins, the flesh andtissue in which embedded, and the externally connected I4 and their supporting structure; a

This galvanic-like current manifests itself by an ammoniacal odor" definitely indicative of tissue (protein) breakdown, causes'alsoirritation of the adjacent bone structure; and attributes generally to the discomfort of the patient.

' Elimination of the occurrence of such a galvan- 10' current may e accomplished by electrically insulating r segregating eachpin from the others.

pin bars For example, this may be done, as; described in my United States Patent No. 2,251,209, either by constructingjthe pin' bars I 4 of suitable di-electric material such 1 as; for example, hard rubber,

eassure, 131 "tic er the lik -6r by inserting perture's dr'bores'fll and-22, s1eeve like 'tru'cture of suchadi electric "material in sneer indicated at 21 in'the drawing. "By h n arrangement each of the pins 2| "and U ctricany insulated from the others aind, r such' arrangement, "the occurrence of a "geivan ik e current is jentirely eliminatedtogenre with "the objectionable "manifestations tliereof. v 7

lying'th'e plinttheLsk'eletal pin 23 isin- In rt'edfthrougih'the"opening"22inpne 'end of the Re member II and then is passed entirely v 'theheelofthe foot so'as to'piercethe ac s "in. t e upper tri r arn r Th'e dther end f-of the *pinZB projecting frointhe ioppo'sitepideof the heel' is next passed through 'i'i g r i'in i :m e srie i i d'v iriember I1 a'ndthe pin is then se'curelylocked in the yoke member H by means of the lock nut's or scre'ws25.

The first of the skeletal pins 2| is now inserted through the tibia a short distance above the angle joint so as to roject laterally from opposite sides of the leg as shown in Figure 1 of the drawing. The pin bars I4 are next placed on the first inserted pin 2| with the ends of the latter passing through corresponding bores 20 in the respective pin bars I4. The second skeletal pin 2| is now inserted, in a manner similar'to that just described, with its projecting opposite end portions inserted through other corresponding bores 20 in said pin bars I4, the said pins 2| being locked or secured in the pin bars I4 by means of the set screws 24.

It is pointed out that the two skeletal pins 2| are passed through the tibia in such relative positions that when inserted they are substantially parallel to one another and reside substantially in the plane of the axis of the tibia. This latter is essential for it is important to the most advantageous use of the splint that the pin bars i4 when mounted on the pins 2| at opposite sides of the leg, have their long axis substantially parallel to the axis of the tibia so that accurate traction may be obtained.

With the pins 2| and pin bars I4 properly positioned, the bars or spindles I, I, each of which has threaded thereon a support I, are connected to the yoke member I! by inserting the portions 4 of said spindles through the openings I8 in the terminal end portions of said yoke member where they are secured by the nuts or like elements 19.

Finally, the studs II of the respective supports 1 on the bars or spindles I are inserted through the central opening in the pin bars I4 which are then secured on said studs II by means of the nuts or like elements I5, the said supports 1 being arranged posteriorly of the pin bars I4 with the screw elements I6 disposed for engagement of the anteriorly adjacent surface of said pin bars I4.

In reducing the fracture, the desired degree of traction against the pull or contraction of the tspm z assweat eri gsheds-spasma s esposterior plane.

tenor direction to its normal pdsition. When this adjustment has been fmade or durlri'gfth'e making thereof thes'pindles- I are rotated-to effect 'a relativeseparation of the 'yoke member H a'nd 'supportsr'l and provide the necessary countertraction against the pullofthe Achilles reason.

Too, it isnfot possible initiallyto obtain a-complete or final reduction of the fra'cturedue to extreme contraction of the Achilles tendon and plantar muscles, adjustments'm'aybe made from time to time until such a reduction has been made, anddifferenti'al adjustments of the spindlesl "relative-to one another also may beinade to effect lateral rotational displacement correction of the oscalcis with re spect' to the anteriorhe foregoing treatment --produces accurately fc 'iitrc l u traction againstfshortening {or (the Achilles-tendon and plantaif inuscle's to th'edegree required to restore-the normal tuber-joint angle reduction of the fracture that is positive and fixation thereof which is completely rigid and, in addition to the treatment of fractures of the os calcis, may be employed effectively in the treatment of other fractures in the general ankle joint area, including the lower tibia.

In the drawing and foregoing description of the present invention the pin bars I4 have been referred to and illustrated as provided with but one pair, or two, of the pin holes 20, but it will be obvious that these pin brackets may be provided with holes or openings for a greater number of pins as desired. The splint herein described may be applied in various ways and methods which must be determined by the practitioner or surgeon according to the particular case, although where the nature of the fracture permits, the methods of application and treatment herein set forth are preferred.

While a particular embodiment of the invention has been set forth and described, it is not intended that said invention shall be limited to such disclosure, but that changes and modifications may be made and incorporated therein within the scope of the claims.

I claim:

1. An os calcis fracture reduction-fixation splint comprising a substantially U-shaped heel yoke, a pin for connecting the opposite end portions of said heel yoke to the fractured bone, a pair of spaced pin bars respectively spaced from the end portions of the heel yoke, a pair of pins for connecting said pin bars to bone structure therebetween with the axes of said pins extending substantially parallel to the plane of the heel yoke and operable to prevent rotation of said pin bars relative to said bone structure, a pair of support members pivotally connected respectively to each of said pin bars and arranged for rotational movement in planes substantially at right angles to the axes of the pin bar pins, a pair of rigid elements connected respectively between each of the support members and the corresponding end portion of the heel is a yoke and securing the latter in spaced relation withrespect to the pin bars, said rigid elements being adjustable at will to position the heel yoke and its pin in variously spaced relation with respect to the pinbar pins, and means associated with the support members and cooperable with the associated pin bars to rotationally adjust the support members, rigid elements and heel yoke relative to the pin bars to' adjustably position said heel yoke pin laterally with respect to the axes ofthe pinbar pins;

yoke and operable to prevent rotation of said 2. An 05 calcis fracture reduction-fixation am n .pin bars relative to said bonestructure, a pair 7 'of spindles having-oneend thereof respectively mounted in the opposite end portions of said heel yoke and extending therefrom substantially at right angles to points adjacent said pin bars,

a support member threaded on each of said spinidles and pivotally connected to the adjacent pin 1 bar for rotational movement with respect thereto in aplane substantially at right angles to the axes of the pin bar pins, said spindles being rotatable at will" to position the heel yoke in variously spaced relation With respect to said support members and pin bars, and means associated v with the support members and mechanically ,co-

operable with the associated.- pin barspositively to rotationally adjust the support members, spindles and heel yoke relative to the pin bars to adjustably position and secure said heel yoke pin I laterally with respect to the axes of the pin bar o'r'ro STADER,

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