US2454680A - Post-adjusting means for wire and nail directing apparatus - Google Patents

Description

M. F. STEPHENS POST-ADJUSTING MEANS FOR WIRE AND Nov. 23, 1948.

NAIL DIREGTING APPARATUS Filed Jan. 22, 1945 2 Sheets-Sheet-l I IIW H H I ,1 INVENTOR- j affxsic phens. 2.25.1 BY

W A TTORNEYS- Patented Nov. 23. 1 948 UNITED STATES 2,454,680 POST-ADJUSTING MEANSFORWIRE A NI) "NAIL DmEc'rINGnPPARA'r-Us Marion FdStephens, ;S.u1liyal Ap l c tionJanuan j 45 .Se ia N -*5 3.954

.4 Claims. My invention I relates to post-adjusting -means designed primarily for directing apparatus particularly adapted for precision technique *for intracapsula'r fracture of the hip but is not limited to such use.

In the extensive practice of hip-nailing, --there has been developedwhat is called the Smith- -Peterson technique. It comprises the insertion of aguiding pin or wire in the shaft of the femur, .the wire serving to guide a cannulatedvitallium Smith-Peterson nail inserted in such a manner -:thatit parallels'and is in contact with the-medial and anterior cortex of the neck of the femur. The guide, commonly called a Steinmann pin,is

usually about three-thirty-seconds of an inch -=:by ten inches and is removed from the bore of the nail afterthe latter has been'properly positionedin the'fracturedneck of the femur. The

Smith-Peterson nail for an adult is about five incheslong and has a diameter of five-thirty-secends of an inch although it is flanged and generally triangular in cross section. It extends through a hole drilled in the hard outer portion cfthe'femu'r, thehole extending in line with the center of theacetabulum at approximatelya 20 anterior angle. '-The=nails eX-tends'through the neck and preferablyinto thehea'd or ball-like -portion of'the hip joint, ndits function is'of course to re-enforce the head on the neck of the femur. For the best results, the nail must be nearly in the direct weight-bearing-line of {the joint and so positioned that-it receives the support of the dense corticle'boneon both sides of .the distal fragment. The insertion of both the guide pin-and the nail must be controlled at all A proposed apparatus for accurately placing .the guide wire or pin, and'hence the nail, in

proper position in the fractured bone, compre- .EhGHdS .a supporting and guiding means for the :guide .pin or wire, 'whichmeans includes a post vertically and rotatably adjustable inabearing, and it'is the objectof the present invention to provide a novel and advantageous means whereby an approximateadjustment of said post may first be made, and later when said approximate a'djustment has been checked by radiography, to permit making a fine adjustment to accurately position the guide pin or wire.

In the accompanying :drawings; Fi ure Lis e side elevation.

(c1.:i.-24s;arc1

Figs. 2, '3-"4-sand 5 afte -detail horizontal sec- -.-tional mew on the correspondingly numbered dines of 'F-ig'. i.

eager cam 7 are detail-vertical sectional -v-iews 5 (a rlines- 6 6 and I-A-lwof "-Fig. 4.

:Fig. 8'is" a detaihrear elevation as indicated by line- 8 8 -of -Fig. 1.

=F i-g. 9;is a *fragmentary vertical sectional view line 9-9 of Fig. -'8. "g.- 1 is a horizcntal sectional view on line 415-40 of "Fig. *1;

'Fi-g. 1 1 is an enlarged detail horizontal section en =line il l--'=l l .of =Fig. 12 1s a -fragmentary elevation of a por- 15 tion of the-sideopposite-that shown in Fig. 1.

Fig. I3 "is an enlargeddetail vertical section on r line l 3-'-=l 3 of "Fig; 4.

-1-4-is a fra gmentary enlarged view similar {to asportion of Fig.4, partly in section.

In -these figures in which'likereference charasters -=indicate corresponding parts, =20 denotes -g enerally-anupright supportrising from a-base'2l an'd carrying preferably at its top a transversely extendin g'uiding-"or dir-ecting member "22 for thepingfistilfiro 7 element whichis'tobe-sup- :pcftedandguided:initsiongitudmal;siidmg movement toward a predetermined point. Thesupport 'iflincludes a vertical pst 'ZS, the lower porition :of which acylindrical and mounted for :slidable and i dtatable movements in an upright tiibulai guide or hearing fl whichhas its lower '2end fixdinsthe center of the basem. The latter preferably square as shownin l ig. 10 and adjacent its {four corners-are leveling feet 25 in the 3'5 term of screws threaded through the base or -throughnuts= mountedtherein. To assist in lev- -;e1ing the base, spirit levels 25 inay'be set in the lcase-iiush-=with its upper surface at points be- "tWen 'ltSuGOmM-sf and center. 7

'iTh base 2*l is'to be-securedlcysuitable clamps n-(notshown) on' the top of an operating table or qthe alike after 'repe'r' "leveling and after proper positioning- 6f the insti umerit with respect to the Zpati'erit. iEhe body of-the patient is of course im- Lmobilize'd lby l the usual means associated with yfractureand-operating tables. When the table cor other-supportonwhichthe patient is held has not a suificient tp area to receive the 'base 2!, litymay beocnteq on any suitable support which "'50 .will ieperniit git to be 'p'iopeijly positioned both 'ileng thwise andlaterall-y' with respect "to the patients eddy.

" JIhelowerend of post '23 is supported on a ifollo'wer platen which is-vertically' adjustable in tl'ie' fixdd guidetube 2 4 and to center tlie pdst,

, tightening screw 39.

its lower extremity enters an upstanding annular flange 28 formed on the follower and having an inwardly and downwardly beveled edge as shown in Fig. 1.

While any suitable means may be provided for adjusting and securing the follower in order to vertically adjust and secure the post, I preferably form on the edge of the follower a laterally projecting arm 29 from which rises a rack bar 30. These parts are in a laterally projecting and longitudinally extending extension 3| formed on tube 24 as shown in Figs. 1 and, 2. Engageable with the rack through an opening in extension 3! is a pinion 3| fixed to the inner end of a shaft 32, the outer end of which has a hand-wheel 33. Shaft 32 is journaled in a bearing 34 projecting from extension 3| as shown in Fig. 2..

The upper end of tubular guide 24 is formed with two spaced vertical slits 35 to provide a spring finger 36, the upper portion of which is within a collar 3'! surrounding the upper portion of the tube 24. The collar has an upper inturned flange 38 to rest on the upper end of tube 24 and on its side is formed a lateral boss through which is threaded a clamping screw 39 adapted to enease the outer face of the spring finger 36. Within the upper portion of tube 24 and between it and the post 23 is a split bushing 40 substantially coextensive in length with the length or height of the collar as shown in Fig. 13, the longitudinal split in the bushing being spaced 90 from the axis of screw 39 as shown in Fig. 3. The bushing and the collar are held in their proper positions at the upper end of tube 24 by a bolt 4| which passes through these three parts. Bolt 4| has its head countersunk in the inner face of the bushing and a nut is threaded on its outer end. The bolt is located diametrically opposite screw 39 as shown in Fig. 3. It will be seen that on tightening the screw 39, the tube 24 will be frictionally locked to the bushing and the latter will be contracted around the post 23 so that the post will be clamped and secured against rotation in tube 24 and will also be held against upward sliding movement. When clamp screw 39 is loosened, post 23 may be rotated and it may be raised or lowered by turning hand-wheel 33.

By grasping and rotating post 23 an approximate adjustment of the pin guiding element 22 to an angular position in a horizontal direction may be made and that position then secured by It is desirable, however, to have a finer adjustment of element 22 in a horizontal direction, that is, about the vertical axis of post 23. To permit that being done, the cylindrical portion of the post is formed with a .plurality of key-ways or grooves 42 which receive keys 43 formed in the bore of a collar 44 surrounding post 23, the collar being thus slidably but nonrotatably mounted on the latter. Projecting radially from collar 44 is an arm 45, the upper edge of which curves downwardly and merges into a fiat segmental plate 46 formed at the outer end of the arm and having on its upper face a Vernier scale 41. The latter coacts with a scale 48 divided into 360 and arranged on the upper face of a track or ring 49. This ring is concentric with the axis of post 23 and is supported by three radial arms or spokes 59 whose inner ends are secured at to the top of collar 31. Rotatably mounted on post 23 and positioned between the hub 44 of the Vernier arm and arms 5| supporting the graduated ring 49, is the hub 52 of an adjusting and clamping arm 53. The latter is radially disposed as shown in Fig. 4 and its outer. end terminates .frictionally lock arm 53 to ring 49.

close to the inner edge of ring 49. Carried by the outer end of arm 53 is a vertically disposed clamping bolt 54, the fiat head 55 of which is slidably engaged with the lower side of an annular flange 59 formed on the inner edge of ring 49. This bolt 54 passes freely through a clamping sleeve 51 and has a milled-edge nut 58 engaged with its threaded upper end, as shown in Fig. 6. Sleeve 57 has a transverse threaded opening to one side of its bore to receive a slow motion adjusting screw 59, one end of which is secured by a ball and socket joint to one side face of the arm 45 as shown in Figs. 4 and 14. The lower end of sleeve 51 frictionally engages the upper face of ring 49 and of arm 53 so that when nut 58 is screwed down on bolt 54, said parts will be clamped between the head of the bolt and the sleeve to It will, therefore, be seen that when these parts are clamped together while screw 39 is loose, the rotation of slow motion screw 59 will cause arm 45 and hence post 23 to turn with respect to ring 49 and the verm'er scale 41 will move with respect to t e scale graduations 48, to thus obtain a fine angular adjustment of the pin guiding member 22 about the axis of post 23.

The angular adjustment in a vertical direction of the pin guiding member or element 22 is preferably obtained by the structure mounted on the upper part of post 23 and shown more particularly in Figs. 1, 8, 9, l1 and 12. The body portion of member 22 is preferably V-shaped in cross section as seen in Fig. 8 so that it is channeled or troughshaped to support and guide the pin, the latter being indicated in dotted lines in Fig. 8. About midway of the body portion of member 22 is an integral depending shank'or stem 60 having a transverse width equal to the width of the body and also having side faces which may be engaged by the arms of an inverted U-shaped spring clip 6!. The central or connecting portion of this clip extends across the groove or trough in the body of member 22 to hold or retain the pin therein, particularly when X-ray pictures are being made. The clip is of course readily engageable with and disengageable from said guiding member. The lower end of shank 60 is reduced in thickness as shown at 62 and this reduced portion is formed with a recess 63 shaped to fit a squared central portion of a shaft 64. A screw, pin or the like 65 fastens these .parts together.

Shaft 64 is mounted for oscillation at the top of post 23, the upper portion of which is square in cross section as seen in Fig. 5. The top of post 23 has a transverse recess'to receive the reduced lower end 62 of the stem or shank, the recess forming spaced bearing ears 66. The latter have circular bearing openings to receive cylindrical portions 6'! and 68 formed on shaft 64 beyond its squared central portion as shown in Fig. 11. At the outer side of the portion 61, the shaft is formed with another squared portion 69 which enters a square hole at the axis of a protractor Hi. The graduations H on the latter coact with a Vernier scale 12 arranged on a segmental plate 13 secured to a flat face of the squared upper portion of post '23, as shown in Figs. 8 and 12.

Mounted 0n the cylindrical bearing portion 68 of shaft 64 is a rotatably adjustable sleeve or hub 15 carrying a depending flat arm 16. A set screw 11 in a threaded boss on hub 15 is adapted to engage the portion 68 of shaft 64 to lock arm 16 for movement with the shaft. This clamping screw 11 permits of an approximate vertical angular adjustment of the pin guiding member 22 assent when the-lowerend of arm '16 is elamped between "fastened at its center-in a recess in the flat face of post 23 as. shown in Fig. 1. "When a finer adjustment of member 22 in a vertical direction is desired, the slow motion screws 18 are adjusted to move the arm 16 and hence, shaft 64 and protector relative to post 23. In this adjustment, the graduations TI on the protector are shifted relative to the fixed Vernier scale 12. The extremities 'of shaft 64 maybe threaded to receivea iihreaded cap screwi a l -at one endiandaa nut at the other end. to hold the parts-iassembled as shown in Fig, 11, i The cylindrical portion of post 23 isfprovi'd'ed with graduations .83 which-inlay be read in connection with the upper edge of hub or collar 44 so that the vertical adjustment of the pin guiding member 22 may be noted. The coacting scale graduations showing the horizontal and vertical angular adjustments of member 22 may also be noted so that such adjustments may be returned to at another time if necessary or desirable. When clamp screw 39 is loosened, the post 23 and all parts which it supports, may be removed from the. guide tube 24 to permit such parts to be sterilized.

The use and advantages of the apparatus to correctly position the guide pin in a fracture of the neck of the femur will be readily understood from the foregoing by a surgeon familiar with hipnailing and. the Smith-Peterson technique. Its use may, however, be briefly stated as follows: After the patient is secured in the proper position on the table, the instrument is leveled, properly positioned and then clamped to the table in the proper position relative to the fractured joint. The pin is placed in the guiding member 22 and held in place by the clip. Member 22 is then adjusted vertically to the proper height by turn ing hand-wheel 33. Approximate adjustments of member 22 as previously described, are then made to give the pin the proper angular disposition both horizontially and vertically. X-ray pictures in both vertical and horizontal planes are made to check the position of the pin with respect to the fractured bone. The finer adjustments may then be made and further X-rays are-taken to see that the pin is directed properly with respect to the fracture. made, the drill which cuts through the hard outer portion of the bonemay be guided by the member 22. The pin while in member 22 is slid or pushed along its trough or channel and is gradually pushed through the soft inner portion of the bone, X-ray pictures being taken from time to time to see that the pin is properly directed. After the pin has been properly positioned, the hole is reamed to the proper size for the Smith- Peterson nail which telescopes the pin. The guiding member 22 maybe used in guiding the reamer and the nail. When the nail is properly positioned, the pin is removed and the incision is closed.

The use of the apparatus will greatly shorten the time necessary for performing the operation and insure the accurate positioning of the pin and nail by a surgeon not particularly skilled in that class of operations. While the invention has been described as particularly Well adapted to the nailing of hip joints, it will be understood that it may be put to other uses.

To those skilled in the art, changes in or modifi- After the incision has been cationid'iirthe above aestnbeaiembmiimeritsf my invention will be suggested andmay be iiiad'e .-without departing from the inventive concept -thereoff. "Reference is, therefore-g to be had to the appended icl'a'ims to determine the scope of the presentinvention. 1 l

- Whatyisc'lai'iried'is':

i ilm" an apparatus"oftne -cl'assdescribed, a post, a bearing retatabi-y mountin said post, a track concentric with saidbea-ring means fixed-1y securing said track to Said bearing, one radial arm connected-with said post forrotation with the latterysaid onearmfiextending to said track, a second radial arm "circumferentially spaced from said one arm and having a hubrotatably surrounding saiii pestgmeansccnnectingthe two a forespii'ei armswh vtiiiie saicrpastis-b eiiigturned in saia beanng to an approximate desired position, and means for securing said second arm to said track after said post has been turned to said approximate position, said arm-connecting means including manually operable adjusting means for moving said one arm toward or from said secondarm after the latter has been secured to said track, to obtain a fine angular-adjustment of said post.

2. In an apparatus of the class described, a post, a bearing mounting said post for rotative and endwise adjustment, a track concentric with said bearing means fixedly securing said track to said bearing, one radial arm over said bearing and extending to said track, said one arm having a hub through which said post extends, said hub I being slidably connected with said post to rotate with the same and to permit endwise adjustment of said post in said hub, a second arm circumferentialy spaced from said one arm and having a hub through which said post extends slidably and rotatably, means connecting the two aforesaid arms with each other and effective to cause said second arm to move with said one arm while said post is being turned in said bearing to an approximate desired position, and means for securing said second arm to said track after said post has been turned to said approximate position,

said arm-connecting means including manually operable adjusting means for movin said one arm toward or from said second arm after the latter has been secured to said track, to obtain a fine angular adjustment of said post.

3. In an apparatus ofthe class described, a post, a bearing rotatably mounting said post, a track concentric with said bearing means fixedly securing said track to said bearing, one radial arm connected with said post for rotation with the latter, said one arm extending to said track, a second radial arm circumferentially spaced from said one arm and having a hub rotatably surrounding said post, a manually operable clamp carried by said second arm and engageable with said track to secure said second arm to said track when desired, said clamp inc uding a clamp member mounted on said second arm and turnable about an axis parallel with said post, an adjusting screw threaded through said clamp member at right angles to said axis, and means connecting said adjusting screw with said one arm, whereby prior to tightening said clamp, both of said arms may turn with said post when turning the latter in said bearing to an approximate desired position, and after tightening said clamp turning said adjusting screw will move said one arm with respect to said second arm, thereby turning said-t post. to obtain a-fine angular ad- .-justment of the latter.

4. In an apparatus of the class described, a post, a bearing rotatably mounting said post, a

track concentric with said bearing means fixedly having a head underlying said track, a sleeve upon said bolt and resting on the upper sideof said track, a nut on said bolt for moving said head and sleeve into clamping engagement with said track to lock said second arm to said .bearing after said post has been turned to a desired approximate adjustment, an adjusting screw threaded transversely through said sleeve at one side of said bolt, and means connecting said screw with said one arm, whereby said screw may be operated to move said one arm and obtain a fine adjustment of said Dost.

MARION F. STEPHENS.

REFERENCES CITED The following references are of record in the file of this patent:

V UNITED STATES PATENTS Number Name Date 2,148,692 Guinn Feb. 28, 1939 2,204,809 Miller et a1 June 18, 1940 2,226,708 Cleary Dec. 31, 1940 Lippincott Dec. 23, 1941

Images