WO1987002572A1 - Flexible implants for stable flexible osteosynthesis of fractures of femur and tibia, respectively and working instrumentation - Google Patents
Flexible implants for stable flexible osteosynthesis of fractures of femur and tibia, respectively and working instrumentation Download PDFInfo
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- WO1987002572A1 WO1987002572A1 PCT/RO1986/000001 RO8600001W WO8702572A1 WO 1987002572 A1 WO1987002572 A1 WO 1987002572A1 RO 8600001 W RO8600001 W RO 8600001W WO 8702572 A1 WO8702572 A1 WO 8702572A1
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- WIPO (PCT)
- Prior art keywords
- rod
- long
- short
- instrument
- bone
- Prior art date
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- 239000007943 implant Substances 0.000 title claims abstract description 125
- 210000000689 upper leg Anatomy 0.000 title claims abstract description 31
- 210000002303 tibia Anatomy 0.000 title claims abstract description 18
- 210000002436 femur neck Anatomy 0.000 claims abstract description 32
- 230000000087 stabilizing effect Effects 0.000 claims abstract description 13
- 210000000527 greater trochanter Anatomy 0.000 claims abstract description 3
- 210000000988 bone and bone Anatomy 0.000 claims description 107
- 238000000605 extraction Methods 0.000 claims description 19
- 230000035515 penetration Effects 0.000 claims description 14
- 238000006073 displacement reaction Methods 0.000 claims description 8
- 230000009471 action Effects 0.000 claims description 7
- 230000001737 promoting effect Effects 0.000 claims description 5
- 239000012634 fragment Substances 0.000 claims description 4
- 230000001154 acute effect Effects 0.000 claims description 3
- 239000008280 blood Substances 0.000 claims description 3
- 210000004369 blood Anatomy 0.000 claims description 3
- 230000004048 modification Effects 0.000 claims description 3
- 238000012986 modification Methods 0.000 claims description 3
- 230000001954 sterilising effect Effects 0.000 claims description 3
- 238000004659 sterilization and disinfection Methods 0.000 claims description 3
- XOFYZVNMUHMLCC-ZPOLXVRWSA-N prednisone Chemical compound O=C1C=C[C@]2(C)[C@H]3C(=O)C[C@](C)([C@@](CC4)(O)C(=O)CO)[C@@H]4[C@@H]3CCC2=C1 XOFYZVNMUHMLCC-ZPOLXVRWSA-N 0.000 claims description 2
- 238000011084 recovery Methods 0.000 claims description 2
- 244000166490 Tetrameles nudiflora Species 0.000 claims 2
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- 239000005862 Whey Substances 0.000 claims 1
- 102000007544 Whey Proteins Human genes 0.000 claims 1
- 108010046377 Whey Proteins Proteins 0.000 claims 1
- 150000002500 ions Chemical group 0.000 claims 1
- 206010017076 Fracture Diseases 0.000 abstract description 44
- 208000010392 Bone Fractures Diseases 0.000 abstract description 25
- 206010016454 Femur fracture Diseases 0.000 abstract description 4
- 206010043827 tibia fracture Diseases 0.000 abstract description 4
- 238000010586 diagram Methods 0.000 description 21
- 230000008901 benefit Effects 0.000 description 5
- 230000001054 cortical effect Effects 0.000 description 5
- 210000003275 diaphysis Anatomy 0.000 description 5
- 230000006641 stabilisation Effects 0.000 description 3
- 208000003322 Coinfection Diseases 0.000 description 2
- 230000035876 healing Effects 0.000 description 2
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- 230000033001 locomotion Effects 0.000 description 2
- 230000000149 penetrating effect Effects 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 238000011105 stabilization Methods 0.000 description 2
- 238000003786 synthesis reaction Methods 0.000 description 2
- 241000272470 Circus Species 0.000 description 1
- 208000008924 Femoral Fractures Diseases 0.000 description 1
- 244000105017 Vicia sativa Species 0.000 description 1
- 230000003872 anastomosis Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000008859 change Effects 0.000 description 1
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- 238000010168 coupling process Methods 0.000 description 1
- 238000005859 coupling reaction Methods 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
- 208000020089 femoral neck fracture Diseases 0.000 description 1
- 210000002391 femur head Anatomy 0.000 description 1
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Classifications
-
- 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
- A61B17/72—Intramedullary pins, nails or other devices
- A61B17/7208—Flexible pins, e.g. ENDER pins
-
- 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
- A61B17/8863—Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
-
- 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
- A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
- A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/916—Tool for installing or removing orthopedic fastener
Definitions
- the present invention refers to flexible implants used in the s table flexible os teosynthesis of femoral neck and greater troohanter frao tares, of sub troohanterian, mediodiaphysary, saper- and intercondylian fraotures of femur and of diaphysary fractures of tibia, as well as to the working ins trumentation required for the introduction/extraction of the flexible implants in/from the bone.
- the object of the present invention consis ts in achieving estecsyntheses which s tabilize the fracture gaps, enabling the patient's recovery in a short period, under the conditions of making less injuring operations , with minimal blood losses and with the possibility of making them in all ages and of minimizing the premature and later local and general complications of the fractures.
- the theme solved by the present invention consis ts in achieving a mounting which stabilizes bo th the instable frac ture gaps and the extension of the principle of flexible os teosynthesis with the known biomechanical benefits for all fractures of femur and tibia diaphysis, the stability of the mountings in course of the time is ensured in case of short flexible implants by their fastening to the diaphysis with an orthopaedic screw, in case of long flexible implants, through the shape of the lower end which is locked in the hole for the introduction into the bone and being seated with the las t part on the edge bear the hole, the performing of the operation bo th in case of osteosynthesis with short flexible implants and with long flexible implants is easily made with the ins trumentation adapted to the implant shapes and to the needs of the operating times.
- the implants eliminate the disadvantages above mentioned by the fact that they are made of short rods, of which one is upper and the o ther one is lower, used in the osteosynthesis for femoral bone fracture as well as of a long rod, used as such or with ano ther long rod and with the short rods, in case of s tabilizing the fracture with double gap, these ones crossing the femur neck and every part of the femur placed under the greater trochanter or only with ano ther long rod for s tabilizing the diaphysary fractures of tibia and femur and , respectively, the super and intercondylian fractures of the femur, the short, upper rod being made up of an upper active part, having a shaped end, continued with an upper part, upward ourved, af ter which there follows a long s traight part, connected through a lower ourved part, downward directed , with a part inclined as agains t a horizontal direction,
- the long straight part having a lower, flat surface limited by an upper surface whose cross-sectional area has the shape of a truncated cone, with the small base placed toward the lower, flat surface, the lower shor.t rod having, in the long, downward curved part, a radius of curvature between 7 and lo cm, and the radii of curvature of the intermediary and, respectively, lower parts, inward and outward curved are equal to eaoh other and have values between 1/2 and 1/3 of the curvature radius, of the long, downward curved part, these radii being lower than the curvature radius of the upper, downward curved part, the plane in which there is placed the lug, the latter having a lower, flat surface limited by a truncated coneshaped area with the small base located toward the lower surface, forming with a horizontal plane an angle of 40 ...
- the long rod having the active, shaped end provided with an upper inclination up to 45° and a lower inclination up to 30° or with edges delimiting some faces converging to the longitudinal axis of the long rod.
- the instrumentation eliminates the above mentioned disadvantages since, in order to stabilize the fracture gaps, under the conditions of performing lass injuring operation, with minimal blood losses, for the introduction of the long rod through the hole made in the bone and of the mentioned lower, short rod through the hole made in the bone, there are used: an instrument formed of a short body, provided with an active end, with a frontal recess, delimited, at the lower side by a lower wall, in which it is made an elongated seat, communicat ing with a seat made in a vertical, wall, sidewisw delimiting the recess, the seat shapes being so selected as to enable the penetration of the lower, inward curved part of the long rod in the seat made in the wall, when a fragment of the long, straight part of the long rod penetrates in the elongated seat., and the upper, outward curved part of the respective rod is.
- a pierced hole being made in the body, its diameter being so selected as to enable the introduction of the long, straight part of the long rod through it, in view of correcting the curvature, reason for which it is also introduced through a pierced hole, made in the long body of an instrument for lifting the long rod in view of its extraction, from the bone, the body being ended, with an aotive, upward curved end, in which an upper recess is made being so shaped as to enable the penetration of the straight long part of the long rod, near the lower inward curved part of the long rod, the body having, opposite to the upper recess, a circular collar, connected through a shaped part with a short rod, in which a circular hole is made for the.
- an instrument being used in the hole made in the bone the instrument in question being made up of a body to which an anvil and a support are fastened, the anvil having a short, cylindrical part provided with a circular recess and the support has a threaded rod which may be introduced/extracted in/from a L-shaped channel communicating with the outside, made in a band in which there is also worked a longitudinal channel, ended with a circular part, having a dimension higher than that of an end delimit ing the recess at the top, so that it is possible to displace the anvil along the channel, when the band is placed in front of the recess, the fastening of the band being achieved by means of a nut threaded on the rod, the body having a straight part, to which the anvil and the support are fastened, delimited respectively by a short part inclined as against the longitudinal axis of the straight part and also by a part inclined in the same direction as the short part against
- a handle made up of an outside shaped body, provided with a longitudinal window, ended with a flared part, the window being made in a middle part of the body, continued with a posterior anvil and, respectively, an active end of cylindrical shape, in which it is made a longitudinal, cylindrical channel, continued with a recess delimited by a shaped wall communicating with the outside through a cylindrical seat, in a plane perpendicular to the plane in which there is placed the channel, the active end a cylindrical channel being made, its longitudinal axis being placed under the axis of the
- a recess having the same shape as the semi-circular recess being positioned in front of the jaw recess, by fastening the jaw by means of a nut; for. modifying the curvatures of the lower, downward curved and,-respectively, outward curved parts of the short, upper and, respec tiverly, lower, outward curved parts of the short, upper and, respectively, lower rods, and of the straight, long, part of the long rod, depending on the needs, due to the bone shape; in another constructive version, it contains an instrument made up of a sleeve with sidewise flared edges, jointed with a short bolt, with a U-shaped support, in which there are made a recess and, respectively, some marginal, longitudinal slits, separated from the recess, by a wall, a stopper being fastened to the support, the former coming into contact with the two short, posterior arms jointed in turn with a short bolt to two for
- the sleeve being possible to be closed with a plate, in which there are mounted thick bolts, which may penetrate through the holes from the long part and from the sleeve and, respectively, thin bolts which may penetrate in the holes near the fore end of the sleeve, the arms being provided, in order to achieve more accentuated curvatures of the long part, of the long rod, with upper recesses communicating with the outside, placed at the same level when the arms are brought in working position, in which it is introduced the rod, which is, in this position, located under the long part and.
- the sleeve by displacing downward the sleeve and implicitly the part, the rod being curved, the modification of the rod curvatures according to the bone shape being made by means of the sleeve and. bolts between which there are introduced the rods, as the case may be, by keeping the part in the working position, through the holes drilled in the arms in which a bolt is introduced, the bolt in question being mounted, when not working, in the holes made in the supports, in some lower ends of the arms, being introduced in slits; for transportation or sterilization requirements the sleevei together with the arms and, respectively, the long part, are rotating around the bolt, so as to bring them in the perimeter delimitad by the support, position in which they are located under the wall, and the sleeve is folded around the bolt, being locked in the support, the bolts being secured by nuts against loosening, and forpreventing the displacement of the component parts during the transport, namely the short arms and the part, two spacing parts are provided.
- - fig.1 a side view of a short, smooth, upper, flexible implant for the osteosynthesis of the femoral neck;
- - fig.2 a side view of a long, smooth, lower, flexible implant for the osteosynthesis of the femoral neck
- - fig.4 a side view of a long, flexible implant for the osteosynthesis of femur and tibia
- - fig.5 a view of the end of flexible implant for the osteosynthesis of femur and tibia, which remains in contact with the femoral corctical. shell;
- fig.10 a frontal view of the active end of the instrument shown in figure 8, in which the flexible implant shown in figuue 2 or figure.4 is introduced by hammering
- fig.11 a top view, of the active end of the instrument shown in figure 8, in which the flexible implant shown in figure 2 and figure 4 is introduced by hammering;
- FIG. 1 a side view of a working instrument for hammering a flexible implant shown in figure 1;
- - fig.26 a frontal view of the active end of the working instrument shown in figure 24
- - fig.27 a section through the instrument, after plane C-C, shown in figure 24;
- - fig.29 a partial section and side view of a working instrument for the final introduction of a flexible implant shown in figure 1;
- - fig.30 a top view of the instrument shown in figure 29;
- - fig.31 a view in plane of an active end of the working instrument. shown im figure 29, in contact with a flexible implant;
- - fig.35 a top view of the active end of the instrument shown in figure.34;
- - fig.36 a side view of a drill for drilling an initial hole in the bone;
- - fig,42 a side view and partial section of a working instrument for achieving an impact required, for extracting the flexible implant from the bone, by means of the instruments shown in figuees 22 and 34;
- - fig.43 a partial section add top view of an active end of the instrument shown in figure 42;
- - fig.44 a side view and partial section of a working instrumer for introducing an upper, smooth, short, flexible implant, in the bone, over a depth of 3...4 cm;
- - fig.45 a seotion after plane E-E, shown in figure 44, through the instrument;
- - fig.48 a frontal view of the active end of the instrument shown in figure 44, in contact with an upper, smooth, short, flexible implant transversally sectioned
- - fig.49 a side view of a working instrument for seizing and correcting the curvature of a flexible implant, shown in working position
- - fig.50 a transversal section after plane G-G, shown in figure 49, through the instrument
- - fig.51 a top view of the working instrument shown in figure 49, with partial sections
- - fig.60 a side view of a working instrument for stiffening the long implants in case of their initial hammering or whan grasping various instruments for their introduction or extraction in/from the multi-functional handle
- - fig.61 a top view of an active end of the working instrument shown in figure 60;
- - fig.67 a diagram of mounting short flexible implants combined with a. long flexible implant
- - fig.68 a diagram of mounting two long flexible implants spatially superposed in two points for the osteosynthesis of super and intercondylian, mediodiaphysary and subtrochantarian fractures of femur;
- - fig.70 a diagram of mounting from the bottom to the top two long flexible implants which are spatially superposed in two points, for the osteosynthesis of the tibia diaphysary fractures;
- - fig.72 a diagram of achieving the prevention of buckling the long. flexible implant when it is initially introduced in the bone
- - fig.73 a. diagram of introducing a long flexible implant in the bone, in the first phase, with guiding, by using a working instrument shown in figure 60;
- - fig.76 a diagram of.. mounting a long, flexible implant and of lifting it from the bone , 'by means of the working instrument shown in figure 16;
- - fig.77 a diagram of correcting the curvature of a long, flexible implant by means of the working instruments shown in figures 16, 18 and.62;
- the flexible implants aremade up of short rods, 1 and 2, of which one is upper and the other one is lower, used in the stable flexible osteosynthesis for the fractures of the femoral neck as well as of a long rod, 3, used with another long rod, 3, in the stable flexible osteosynthesis of thediiphysary fractures of tibia when their mounting is made from the bottom to the top, starting from the supermalleolar level on either side of tibia, achieving their spatial superpositi ⁇ n in two points, in the lower and upper parts of the medullary channel, or in the stable flexible osteosynthesis of the superintercondylian, diaphysary and sub troohanter ian fractures of femur, in which case, the mounting of rod 3 is made by introducing it in condyle or over condyle, inside or outside, achieving a spatial superposition in the lower and upper parts of the medullary channel; in case of the instable fractures of the greater troohanter, - plain
- the osteosynthesis is achieved by means of both rods, 1 and 2, together with one or both rods 3.
- Rod 1 is formed of an upper active part, a, with a shaped end, b, promoting the penetration and the directing, giving the possibility of choosing, when manoeuvring from the. outside, the line required for stabilizing the fraoture gap, continued with an upper part, c, upward curved, after which there follows a long, straight part, d, connected, through a lower part, e, downward curved, with its radius of curvature equal to that of part c, between 1 and 3 cm, to a part, f, inclined as against a horizontal direction, ended with a lug, g.
- the axis of part a is parallel to the axis. of part f and forms an angle of 40°...70° with, the axis of part d.
- the latter has a lower, flat surface h, delimited by an upper surface i, whose cross-seotion is. shaped as a truncated cone, with the small base placed toward the surface h.
- Rod 2 is formed with an upper, short, straight, active part,j, with a shaped end, k, promoting the penetration and the directing, giving the possibility of choosing, when manoeuvring from the outside, the line required for stabilizing the fracture centre, connected through an upper, downward curved port, 1, with, a long, downward, curved part, m, connected in turn, through intermediary and, respectively, lower parts, n and o, inward and outward curved, the radii of curvature having values lower than that of the curvature radius of part 1, with a part, p, inclined as against a horizontal direction, ended with a lug, q.
- the latter has a fla.t lower surface, r, delimited by an upper surface with a truncated cone cross-section, s, with the. small base toward surface r.
- the eurvature radius of part m is 7 ... 10 cm, and the curvature radii of parts n and o are 1/2 ... 1/3 (7 ... 10) cm.
- the plane in which lug q is placed forms an angle of 40°... 7o° with a horizontal plane.
- the axis. of part j also forms an angle of 40°... 70° with a horizontal plane.
- Rod 3 is made up of a long, straight part, t, ended with a shaped, active end, u, with an upper inclination to 45° and a lower inclination to 30°, which makes possible, when manoeuvring from the putside, to chose the line required for stabilizing the fracture gap, connected, through some lower and, respectively, upper parts, v and W, inward and outward curved, with curvature radii having values between 3 and 5 mm, with a flat, narrow part, x, and a widened, flat or inward curved end part, y, so dimensioned as to stop the complete penetration of rod 3 in a medullary channel, not shown in the figures.
- Part y is delimited by part x through steps z, inclined as against the longitudinal axis of rod, 3, forming with it an acute angle of 60°... 75°, symmetrically arranged as against the respective axis.
- Parts v and w are half-flattened and the width of part x is equal to those of parts v and w, with the diameter of part, t, respectively.
- the end u may have edges. a i , delimiting some faces converging to the longitudinal axis of rod, 3.
- the instrumentation is composed of tan instrument 4, for introducing rods 2 and 3, an instrumant 5 for final hammering of rod 3, an instrument 6, for final introduction or lifting of rod 3, in view of its extraction, an instrument 7, for lifting rod 3, in view of its extraction, on instrument 8 for achieving the adequate line of a hole b in a bone 9, tibia or femur, for the introduction of rod 3 according to a certain line, an instrument 11, for hammering rods 1 and 2 in view of their introducing in bone 9, an instrument 12, for the final introduction of rod 1,an, instrument 13 for modifying the curvature of the ends of rods 1 and 2, an instrument A, for guiding rod 3 when introducing it in bone 9, by hammering it, an instrument 14 for extracting parts v and w, belonging to rod 3 from bone 9, an instrument B for achieving an impact for extracting rods 1, 2 and 3 from the bone 9, an instrument C, for introducing rod 1, over a depth of 3...4 cm, an instrument D, for fasten
- Instrument 4 is made up of a short body c i , provided with an active end d i having a frontal recess e i , delimited at its bottom side by a lower wall f i , in which an elongated seat g i is made, communicating with a segt h i made in a vertical wall i i , sidewise delimiting the recess a i .
- the shapes of seats g i and h i are so selected as to enable the penetration of part v in seat h i , when a fragment of part t penetrates in seat g i , and part w is placed in recess e i .
- body c i has a circular collar j i connected through a shaped part k i with a short rod l i .
- a circular seat m i is provided in the latter.
- n i In the middle of body c i , there is made a pierced hole n i , with a diameter so selected as to enable the introduction of rod 3, through it.
- Instrument 5 is formed of a long body o i ended with a frontal recess p i , delimited at its bottom side by a wall qi and sidewise by a wall r i .
- a seat s i so dimensioned that, when a fragment of part t of rod 3 is introduced in it, its part v be in contact with wall r i , and part w be positioned outside the recess p i .
- body o i has a circular collar ti, connected through a shaped part u i with a short rod v i .
- a circular seat w i is provided in this one.
- a pierced hole x i In the centre of body c i , there is. made a pierced hole x i with a diameter so selected as to enable the introduction of rod r through it.
- Instrument 6 is formed of a long body y i with two inclined faces z i , ended with a frontal, active recess a ii , so dimensioned as to enable the contact between body y i and part v of rod 3, whan no ralative motion of body y i is possible in the transversal direction, as against rod 3.
- body y i has a circular collar b ii , connected through a shaped part c ii with a short rod d ii .
- a seat e ii is provided in the latter.
- a pierced hole, f ii In the centre of body y i there is made a pierced hole, f ii , with a diameter so selected as to enable the introduction of rod 3 through it.
- Instrument 7 is formed of a long body g ii ended with an active upward curved end h ii , in which there is made an upper recess i ii , so shaped as to enable the penetration of part t of rod 3, near part v.
- the body g ii Opposite to recess i i , the body g ii has a circular collar j ii connected through a shaped part k ii , with a sho ⁇ t rod l ii .
- a circu lar seat m ii is provided in the latter.
- a pierced hole n ii is made in the centre of body g ii , with a diameter so selected as to enable the introduction of rod 3 through it.
- Instrument 8 is made up of a body c ii provided respectively with a straight, posterior part p ii and a shaped, upward curved, fore part q ii , ended with a sharp end r ii , to which some cutting edges s ii of part q ii are converging. The edges s ii are parallel in the first half of part q ii , then they are converging to end r ii .
- Part p ii is connected through a circular collar t ii and a shaped part u ii with a short rod v ii provided with a circular seat w ii
- Instrument 10 is formed of a. long, thin body x ii ended with an active, hook-shaped, inward curved end y ii , so shaped as to enable the gripping of part.v belonging to rod 3 or the introduction of rod
- the body x ii is connected through a circular collar z ii and a shaped part a iii with a short rod b iii , provided with a circular seat c iii .
- Instrument 11 is made up of a body d provided with a posterior part e iii , inclined as against a horizontal plane, which is connected through a vertical part f iii with a fore, horizontal flat part g iii
- a semi-circular seat h iii is made in the latter, being so dimensioned as to be penetrated by lug g of rod 1.
- Part e iii is connected through a circular collar i iii and a shaped part j ii with a short rod k iii provided with a circular seat 1 iii .
- Instrument 12 is made up of a short body m iii , ended with a shaped end n iii , which is inclined, with an angle higher, than 90° as against the axis of body m iii , having a diameter higher than all the rest of body m iii , provided with a straight, frontal face o iii .
- n iii there is made an elongated seat p iii , delimited at its rear side by a wall q iii of semi-circular shape, so dimensioned that when introducing lug g in it, its part f remains outside.
- the body m iii is connected through a circular collar r iii and a shaped part s iii with a short rod t iii , provided with a circular seat u iii .
- Instrument 13 is formed of a body v iii , ended with a cylindershaped end w iii , having an external diameter higher than that of body v iii , in which there is made a seat x iii , open to the outside, sidewise placed, having the longitudinal axis perpendicular to the longitudinal axis of body v ii , in front of which there is a flat wall y iii .
- Body v iii is connected through a circular collar z iii and a shaped part a with a short rod b , provided with s circular seat c iv .
- Instrument A is made up of a long body 18, to which a jaw, 20 is fastened with a nut, 19.
- the body 18 has a long part d iv , connected through a circular collar e iv and a shaped part f iv with a short rod g iv , provided with a circular seat h iv Opposite to collar e iv , the body d is. ended with a jaw i iv provided over a frontal surface j iv with a semi-circular recess k iv , having the longitudinal axis parallel to that of part d iv .
- a short rod l iv autside threaded having the longitudinal axis placed in the extension of part d iv serving for guiding jaw 20, reason for which the latter, has a pierced hole m iv , through which rod l iv penetrates.
- Instrument 14 is made up of a thin, long body o iv , ended with an active, upward curved, widened end p iv , provided with two claws q iv so shaped as to enable the contact with the inclined steps z of the rod 3.
- the body c iv is delimited, through a circular collar r iv , by a handle s iv , provided with a longitudinally elongated window t iv .
- Instrument B is composed of an outside shaped handle 21, which is coupled, through a connecting piece 22, with a cylindrical, active end 23, axially provided in turn with a longitudinal channel u iv which communicates with the outside through a slit v iv inclined as against the longitudinal axis of handle 21 with on angle of 45°, the width of slit v iv being equal to 1/2 of the diameter of channel u iv , enabling the introduction of any of the bodies x iv and o iv from instruments lo and 14.
- the handle 21 is provided with a spherical seat w iv in which a sperical end x iv of part 22 penetrates, opposite to it being a short, outside threaded rod y iv , by means of which the joint with end 23 is made, reason for which a hole z iv is drilled in the joint.
- the pins 24 penetrating in rod y iv are introduced in the end.
- Instrument 15 shaped as a drill is well known and is used for making a hole with straight axis in bone 9.
- Instrument 16 is formed of a tail a v , provided with a longitudinally elongated window b v , placed near the rear, end o v of the tail a v .
- the latter forms a single piece with an active end d v , having. an intermediary part e v shaped as a truncated cone, delimited respectively by an upper cylindrical part f v and a lower, cylindrical part g v , the diameter of the latter being higher than the diameter part fv.
- the longitudinal axis of handle a v crosses the longitudinal axis of the active end d v , near part f v , in order to achieve Instrument 17 is made up.
- Instrument C is formed of a body 25 to which there are fastened an anvil 26 and a support 27.
- the anvil 26 has a short, cylindrical part l v , provided with a circular recess m v
- the support 27 has a threaded rod n which may be introduced/extracted in/from a L-shaped channel o v , communicating with the outside, made in a band 28.
- the body 25 has a straight part s v on which there ar9 fastened anvil 26 and support 27, delimited respectively, by a short part t v , inclined as against the longitudinal axis of part s v and by part u v , also inclined in the same direction as part t v , as against the same axis.
- Part u v is connected through a circular collar v v and o shaped part w v with a short rod x v , provided with, a circular seat y V o
- the anvil 26 has a straight, upper part z v connected with an inclined part a v , having the longitudinal axis parallel to that of the short par.t t v .
- the part a has an upper, inclined surface b parallel to the longitudinal axis of part u v .
- Band 28 is provided with a shaped, end part c vi , having the shape of a circle arc in transversal section which makes with the longitudinal axis of the straight part s v an angle smaller by 5°... 10° than the angle formed by the part t v with the same axis.
- Ins tr ument D is composed of a sleeve 30 wi th sidewise flared e dges , jointe d through a shor t bolt 31 wi th a U-shaped suppor t 32 in which there are made re spe c tively a recess d vi and some marginal, longitudinal slits e vi and f vi , se para ted, from the r ecess d v by a wall g vi .
- the la tte r are jointe d wi th a bolt 37 to suppor t 32 , in front of the recess d vi .
- To the bol t 37 there is also jointe d a long par t 38 , sidewise fla ttene d , in which there are made pierced holes h vi . along the longitudinal axis.
- the par t 38 has an exte rnal collar v vi , serving for Ii ting of the displacement of leeve 39 along it, as a result of the contact between collar i vi and a lower step j vi of the sleeve 39, which is sidewise cut so that it may come sidewise. into contact with part 38.
- sleeve 39 there are made some pierced holes k vi , having the same dimension and the some distance between them, as those of holes h vi . Except holes k vi , which are located along the longitudinal axis of sleeve 39, in the latter there are also disposed two holes m on either side of the longitudinal axis, near a fore, inclined end l vi .
- Sleeve 39 may be closed with a plate 4o in which there are mounted thick bolts 41, which may penetrate through holes h vi and k vi and thin bolts, which, may penetrate in holes m v ⁇ .
- bolts 41 and 42 it is possible to position one of rods 1 and 2 in view of modifying its curvature depending on the needs.
- a bolt 43 is introduced in the holes n vi made in the arms 34, the bolt in question being mounted, when not working, in the holes o vi made in the support 32 and the lower ends p vi of the arms 34 are introduced in slits e vi and f vi , in view of achieving a more accentuated curvature of rod 3, the arms 34 are provided with some upper recesses q vi which communicate with the outside, placed at the same level when the arms 34 are brought in the working position, in which rod 3 is introduced, which is placed in this position under part 38 and sleeve 39.
- the rod 3 is curved.
- the sleeve 39 is displaced along fart 38, the ends p vi of arms 34 are removed from slits e vi and f vi , which allows the folding of arms 34 with arms 34 and part 38 with sleeve 39 around bolt 37, so as to bring them in the perimeter delimited by support 32, a position in which they are placed under wall g vi , and sleeve 39 is folded around bolt 31, being locked in its support.
- the bolts 31, 35 end 37 are secured against loosening by means of nuts 44, 45 and 46.
- two spacing pieces 47 are also provided.
- Instrument E is composed of two arms 48 and 49, jointed through a bolt 50, provided with intermediary straight parts r vi and s vi , continued with horizontal, posterior parts t vi and u vi and fore parts v vi , and w vi , respectively, inclined as against a horizontal plane.
- the latter are connected with one of the shaped jaws 51 and . 52, following the external shape of the flexible rod 3, serving res pectively for fastening rod 3 in view of its guiding during the initial introduction in bone 9 and for seizing and manoeuvring the instruments 4, 5, 6, 7, 8, 10, 11, 12, 13, A and C for the introduction of extraction in and. from the multi-functional handle.
- Handle F is formed of an outside shaped body 53, provided with a longitudinal window x vi , ended with a flared part y vi , through which instrument 17 is introduced so as to change the position of body 53 around its longitudinal axis.
- the window x vi is made in a middle part z vi of the body 53, which is continued respectively with a posterior anvil a vii and an active, cylindrical end. b vii .
- a cylindrical, longitudinal channel c v ⁇ ii . is made in the latter and it is continued with ⁇ recess d vii delimited by a shaped wall e viii communicating with the outside through a cylindrical seat f viii .
- a lock 54 is located, being provided with a tzin, fore part, j vii and a thick, cylindrical, posterior part k vii , in which there are made two circular channels l vii and m v ⁇ shifted placid as against the transversal axis of channel c viii Part j vii is mounted under, the action of the force stored in a spring 55 which-is supported respectively on a shoulder n vii which limits the recess i vii and on a fore stopper 56, mounted in connection with lock 54, with the possibility of displacement in the recess i vii which allows to bring, as the case
- the posterior stopper 57 making a single piece with.lock 54 are placed in recess h vii with possibility of displacement.
- Channel g vii communicates with a channel c vii placed in the same plane with channel g vii . placed perpendicular to the latter, in which, there is disposed, under the action of a force stored in a spring, 58, a ball, 59, which, may penetrate, depending on the position of lock 54, in one of the channels 1 vii and m vii .
- the maintaining of the spring 58 in channel o vii is made by means of screw 60.
- a circular hole p vii is drilled in the latter, working first with a drill-shaped instrument 15, then continued with instrument 8, so that the end r ii reaches in the longitudinal axis of the medulliry channel, forming the line of rod 3 penetration in it.
- the introduction of rod 3 in the medullary channel through hole p vii is achieved by means of instrument 4, introduced in handle F.
- the buckling of rod 3 which may appear during the introduction, due to the resistance of bone 9 and of blows given to handle F, by means of instrument 16 is also prevented by guiding the rod with instrument A mounted in handle F or with instrument E.
- rod 2 can be rotated inside the medullary channel through the instrument 4 fastened in handle F in which instrument 17 is introduced.
- the last hammerings on the last part of introduction are made by means of instrument 5 mounted in contact with part y and then, for including part y in. bone 9, the instrument 5 is brought in contact with part w or, as the case may be, by means of instrument 17.
- the lower part y is brough in the medullary channel by means of instrument 6 fastened in handle F until. part y comes into contact with the external surface of the condyle.
- rod 3 is manually curved by means of instruments 6 and 7 for which it is introduced through holes f ii and n ii provided in them.
- the curving of rod 3 may be also made by means of instrument D by introducing rod 3 in recesses q vii made in arms 34 and by displacing downward sleeve 39 and, implicitly, part 38.
- the instrument 6 is introduced between part y of rod 3 and bone 9, so that its frontal recess a penetrates up to the part w of rod 3, creating thus the possibility that by hammering several times the handle F to which instrument 6 is fastened, parts v and w.
- the preparation of the introduction of rods 1 and 2 in bone 9 is made by modifying the curvatures of parts e and o according to the shape of bone 9, using sleeve 39, in which rod 1 or rod 2 are introduced, and the lug g or the lug q ar ⁇ included in part x iii of instrument 13 with which one actuates by means of the multi-functional handle F.
- sleeve 39 is fasten ed to arms 34 through bolt 43 so as to apply the effort required for the curvature modification.
- rod 1 in the neck q vii of bone 9 For the initial introduction of rod 1 in the neck q vii of bone 9, a hole r vii is drilled in bone 9, after which, by repeatedly hammering the anvil 26, belonging to instrument C, the rod 1 fastened in the latter is introduced by guiding through hole r vii .
- the introduction of rod 1 in the neck q vii is made by means of instrument 11, reason for which this one is assembled to handle F, on which blows are repeatedly applied with instrument 16, so that part o is directed to the inferior and internal side as against the femoral head, and the part d is directed to the superior and. external side as against the femoral head, so that rod 1 may come near and parallel to the upper edge s vii of the femoral neck q vii .
- a hole t vii is drilled in the bone, being located under hole r vii through which rod 2 is initially introduced by means of instrument 4, in which part n of rod 2 is placed, supported by handle F, in which one introduced instrument 17 for the final introduction of body 53 in part y vi , and by means of this instrument, one modifies, by rotation, the position as against the longitudinal axis, after which rod 2 is finally introduced in neck q vii by repeatedly applying blows on handle F to which instrument 4 is fastened, being in contact with rod 2.
- rod 2 has the part 1 placed in the lower side of the femoral head, the part m following a direction parallel and very near to an edge u vii of the femoral neck q vii
- rods 1 and 2 related to bone 9 are achieved by means of screws 61 and 62 fastened into bone 2, so that parts f and p of rods 1 and 2 come into direct contact with the cortical shell.
- the extraction of rods 1 and 2 from bone 9 is made by dismounting screws 61 and 62 and by fastening in turn rods 1 and 2, by means of instrument 10, which enables that by repeatedly applying blows with instrument B, the instrument lo should be removed away from bone 9, which has as a result the extraction of rods 1 and 2.
- rods 1, 2 and 3 in bone 9 For the introduction of rods 1, 2 and 3 in bone 9, proceed first to the introduction of one or both rods 3 in bone 9, up to part immediately over the fracture gap, then introduce rods 1 and 2, then continue the complete introduction of rods 1 and 2 or rod 3, the mounting stabilization being performed with screws 61 and 62 for rods 1 and 2 and by bringing part y of rod 3 in contact with the external surface of the femoral condyle.
- the implants and the instrumentation present the following advantage ss
- the flexible implants allow, through their structure enabling. their use in various groups of two, three and four, the osteosynthesis of all types of femur fractures and of some tibia fractures; - the upper and, respectively, lower short, flexible implants usad for the osteosynthesis of femoral neck fractures, enable through their configuration to improve the reduction of the fracture through, endoosseous taxis, do not damage the intraosseous vascular anastomoses minimizing the incidence of later necroses of the femoral head, their fastening with orthopaedic screws to the femur diaphysis achieves a mounting with maximal stability in course of the time, the flexible characteristics of the implant to which their divergently curved shape is associated, give them the possibility of working in a dynamic couple, alternatingly creating tensions of traction, compression, which promote the biologic processes of fracture healing by accelerating them;
- the mounted long, flexible implants which are spatially superposed in the lower and uppar parts of tha femur or tibia medullarychannel, have the advantage that, they cannot slip to the lower side due to the shape of. the implant ends, preventing the perforation of the tegument and the local secondary infection, or, to the bone inside both situations causing the damage of the mounting and the fracture loss of stabilization;
- the mounted long, flexible implants which are spatially superposed in the lower side of the medullary channel and parallel in the femoral neck have the advantage of stabilizing the instable fractures of the greater troohanter, the tensions which tend to displace the fracture being taken over through the implants and spread over tha two side faces of the femur lower side as well as the slipping toward the lower side, preventing the perforation of tha tegument and the local secondary infection;
Abstract
Flexible implants (1, 2, 3) for the stable flexible osteosynthesis of the femur and tibia fractures. In order to achieve osteosynthesis stabilizing the fracture gaps, they are made of short rods (1, 2), one upper and one lower, used in the osteosynthesis for the fracture of the femoral neck, as well as of a long rod (3), used as such or with another long rod (3) and with the short rods (1, 2) in case of stabilizing the double gap fractures crossing the femur neck and every part of the femur placed under the greater trochanter, or only with another long rod (3) for stabilizing the diaphysary fractures of tibia and femur. Working instrumentation required for achieving an efficient surgical operation in the stable flexible osteosynthesis by means of the flexible implants (1, 2, 3) are also disclosed.
Description
FLEXIBLE IMPLANTS FOR STABLE FLEXOBLE OSTEOSYNTHESIS OF FRACTURES OF FEMUR AND TIBIA, RES PECTIVELY AND WORKING
INSTRUMENTATION
The present invention refers to flexible implants used in the s table flexible os teosynthesis of femoral neck and greater troohanter frao tares, of sub troohanterian, mediodiaphysary, saper- and intercondylian fraotures of femur and of diaphysary fractures of tibia, as well as to the working ins trumentation required for the introduction/extraction of the flexible implants in/from the bone.
There are known flexible implants for the os teosynthesis of gaps of tibia diaphysary fracture and of femur super- intercondylian, mediodiaphysary and sub troohantarian fractures or of the ins table fractures of the greater troohanter, made up of a long, thin body provided with a long middle part, connected through a ourved part to short, fore and, respectively, posterior end parts, the posterior one being con tinued with a flattened part in which a window is made, as well as flexible implants for the os teosynthesis of the gaps of femoral neok fracture, which are made up of a body provided with a straight, long part connected through a curved part to a short end part, the straight part being continued with a flattened posterior part in which a window or a s tick-shaped part is provided.
The disadvantages of these implants consis t in the faot that the mounting finally ob tained by introducing more than two flexible implants in the bone, in view of s tabilising the gap of fracture is difficult to be achieved and is highly rigid, which uselessly prolong the surgery time, also creating, due to the rigidity, biomechanical conditions not promoting the fracture healing, and their fas tening in the bone does no t offer reliability in course of the time, since there is the possibility of their slipping, which may appear outside the bone, perforating thus the tegument, or in the medullary channel, a fact which leads to the loss of the frac ture gap stabilisation.
There are known ins trumentations for the introduc tion/extraction of a flexible implant in/ from the bone, containing an instrument for hammering a thin, long, flexible implant, made up of a body provided with an active end, having a plugged channel in which the flat teeed
part of the implant penetrates and in a middle sone of the body a pierced hole is made through which a rod is introduced, by means of which the implant position can be changed during the hammering (French patent No* 22376o9) , an ins trument for extracting the flattened part of the implant from the bone diaphysis cortical shell, In view ofcreating the possibility of its extraction from the bone, made up of an elongated body, provided with a key-shaped active end and a circular collar -provided end and a short flattened part between which there is a cylindrical part (Synthes) , an ins trument also used for lif ting the flattened part of the implant, formed of a body having an active flattened end , upward ourved (prospectus OEC-B76) , an instrument for making a hole in the bone for the introduc tion of the long flexible implant according to a certain line, made up of a body with a s traight part, delimited by fore and, respectively, pos terior parts, inolined as agains t the s traight part, the fore part being continued with an active end , upward curved, with four edges converging to the top, each edge being formed of two s traight parts making an ob tuse angle (prospectus OEC - B58) , an ins trument for the extraction of the long flexible implant from the bone, made up of a long body ended with a s tick-shaped end and a hendle, the stick-shaped end being located in the window made in the flattened part of the implant ( catallogue AESCULAP, page 42) , an instrument for hammering the implants in case of stabilizing the femoral neck gap of fracture, made up of a crankshaped body, ended with a lower, active end in which a plugged channel is made so as to aooomodate the flattened part of the implant, and in the middle zone of the body a rod is mounted for posi tioning during the implant hammering (French patent No.2237609) , an ins trument for modifying the curvature of the flexible implants , made up of a hand le to which a body is fas tened , this body being provided with two fixed jaws, inclined as against a horizontal plane, delimiting an opening in which the implant is introduced ( catallogue AESCULAP, page 27) , an ins trument for guiding the long flexible implant during the hammering made up of a long, cylindrical body, in which the long flexible implant is introduced , the body being provided with a threaded end which is fastened into the coupling of an anvil, to which a rod is mounted for positioning the implant during the hammering (French patent No.2237609), an ins trument for extraoting an implant from the bone, provided with stick -shaped rear end, formed respectively of a long body ended with a handle and of a plate-shaped, flattened part, upward curved, having an end part backward directed ( prospectus OEC, C2) , an ins trument for achieving an impact in view of extracting the flexible implant from
the bone, formed of a cylindrical body to which a tail is jointed by means of two bolts, so that one may avoid during the hammering the ris of seizing the body to the rod of the extraction instrument ( prospectus OEC-A59) , and an ins trument for fastening the implant, in view of its curving, made up of a suppor t to chioh a body is fastened in which a recess is made for mounting a fixed lower jaw, upward shaped , and a moving upper jaw supported by a rod actuated through an eccentric by a handle ( oatallogue AESCULAP, page 27) , an ins trument for creating the impact force, made up of a tail provided with a longitudinally elongated window to which it is fastened a cylindrical active end, finished with flat surfaoes, the tail fas tening to the end being made in the middle zone of the latter ( catallogue AESCULAP, page 27) , an ins trument for pushing a flexible implant into the bone, formed of a cylindrical body ended with an anvil and a cylindrical aotive end with the external diameter higher than that of the body rest, in which it is made a circular channel delimited by a s traight wall, in which there may be introduced respectively the flattened part of the implant and a multi-functional handle, formed of a tail to which there is fastened a body, in which a longitudinal channel is made, its fore part being delimited by a shaped wall, the channel communicating with a transversal channel in which a yoke-ended lock is mounted und er the action of the force Stored in a spring (catalogue SYNTHESIS) .
The disadvantages of these ins trumentations consist in the fact that the instruments for hammering a long, flexible implant, for removing away the flattened part of the implant from the bone diaphysis cor tical shell, for hammering the implants in the cases of s tabilizing the fracture gaps of the femoral neck, for guiding the long flexible implant, and , respectively, for pushing the implant into the bone canno t be used except under the conditions when the implant is ended with a flattened part or with a stick-shaped end, the instrument for curvature modifying does no t allow the proper fas tening of the implants, except in the middle zone, the instr ument provided with a plate-shaped part for the detachment from the bone canno t be used, except in case of the implant with one posterior end shaped as a stick, the ins trument for achieving the impact required for the extraction of the flexible implants from the bone is difficult to handle, since it does no t allow the ro tational mo tions of the tail, as agains t the body, the instrument for fastening the implant in view of its curving does no t allow its curving, except in the middle zone, the instrument for creating the force of impact requires the application of a relatively big effort when there are necessary impact forces of high va
lues, and the multi-functional handle does not allow to apply, by mean of it, forces with relatively high values to the ins truments fas tened to it and it canno t be positioned and kept in the desired position, except by hand.
The object of the present invention consis ts in achieving estecsyntheses which s tabilize the fracture gaps, enabling the patient's recovery in a short period, under the conditions of making less injuring operations , with minimal blood losses and with the possibility of making them in all ages and of minimizing the premature and later local and general complications of the fractures.
The theme solved by the present invention consis ts in achieving a mounting which stabilizes bo th the instable frac ture gaps and the extension of the principle of flexible os teosynthesis with the known biomechanical benefits for all fractures of femur and tibia diaphysis, the stability of the mountings in course of the time is ensured in case of short flexible implants by their fastening to the diaphysis with an orthopaedic screw, in case of long flexible implants, through the shape of the lower end which is locked in the hole for the introduction into the bone and being seated with the las t part on the edge bear the hole, the performing of the operation bo th in case of osteosynthesis with short flexible implants and with long flexible implants is easily made with the ins trumentation adapted to the implant shapes and to the needs of the operating times.
According to the present invention, the implants eliminate the disadvantages above mentioned by the fact that they are made of short rods, of which one is upper and the o ther one is lower, used in the osteosynthesis for femoral bone fracture as well as of a long rod, used as such or with ano ther long rod and with the short rods, in case of s tabilizing the fracture with double gap, these ones crossing the femur neck and every part of the femur placed under the greater trochanter or only with ano ther long rod for s tabilizing the diaphysary fractures of tibia and femur and , respectively, the super and intercondylian fractures of the femur, the short, upper rod being made up of an upper active part, having a shaped end, continued with an upper part, upward ourved, af ter which there follows a long s traight part, connected through a lower ourved part, downward directed , with a part inclined as agains t a horizontal direction, ended with a lug, the lower short rod being made up of an upper, short, straight active part, with a shaped end connected through an upper part, downward curved, with a long part, downward curved, connected in turn by means of an intermediary and, respectively, a lower part, inward and outward curved , with
a part incling as against the horizontal direction, ended with a lug, the long rod being formed of a long, straight part ended with a shaped and, promoting its penetration and directing in the bone, connected through lower and, respectively, upper parts, inward and outward ourved, to a flat, narrow part and to an end widened part, which is flat or inward curved, so dimensioned that it stops the complate penetration of the long rod in the medullary channel, the lower, short rod having in the lower curved part, downward directed, a radius of curvature equal to that of the upper part, upward curved, between 1 and 3 cm, and the axis of the upper active part is parallel to the axis of the part inclined as against a horizontal direction and forms with the axis of the long straight part an angle of 40... 70°, the long straight part having a lower, flat surface limited by an upper surface whose cross-sectional area has the shape of a truncated cone, with the small base placed toward the lower, flat surface, the lower shor.t rod having, in the long, downward curved part, a radius of curvature between 7 and lo cm, and the radii of curvature of the intermediary and, respectively, lower parts, inward and outward curved are equal to eaoh other and have values between 1/2 and 1/3 of the curvature radius, of the long, downward curved part, these radii being lower than the curvature radius of the upper, downward curved part, the plane in which there is placed the lug, the latter having a lower, flat surface limited by a truncated coneshaped area with the small base located toward the lower surface, forming with a horizontal plane an angle of 40 ... 70° and the axis of the upper, short, straight part forms with a horizontal plane an angle of 40° ...70°, the long rod having the active, shaped end provided with an upper inclination up to 45° and a lower inclination up to 30° or with edges delimiting some faces converging to the longitudinal axis of the long rod., the lower and, respectively, upper parts, inward and outward curved, having radii of curvature with values between 3 and 5 mm, and the end part is delimited by the flat narrow part, through some steps inclined as arainst the longitudinal axis of the rod, forming with this one an acute, angle of 60°... 75° symmetrically disposed as against the respective axis, the lower. and respectively, upper, inward and downward curved parts being halfflattened, the widths of these parts being equal to the width of the flat, narrow part and with the diameter of the long straight part, respectively.
In accordance with the present invention, the instrumentation eliminates the above mentioned disadvantages since, in order to
stabilize the fracture gaps, under the conditions of performing lass injuring operation, with minimal blood losses, for the introduction of the long rod through the hole made in the bone and of the mentioned lower, short rod through the hole made in the bone, there are used:an instrument formed of a short body, provided with an active end, with a frontal recess, delimited, at the lower side by a lower wall, in which it is made an elongated seat, communicat ing with a seat made in a vertical, wall, sidewisw delimiting the recess, the seat shapes being so selected as to enable the penetration of the lower, inward curved part of the long rod in the seat made in the wall, when a fragment of the long, straight part of the long rod penetrates in the elongated seat., and the upper, outward curved part of the respective rod is. placed in the frontal recess, opposite to which the body has a circular collar, connected, through a shaped part, with a short rod in which there is provided a central circular seat, a pierced hole being made in the body, its diameter being so selected as to enable the introduction of the long, straight part of the long rod through it, in view of correcting the curvature, reason for which it is also introduced through a pierced hole, made in the long body of an instrument for lifting the long rod in view of its extraction, from the bone, the body being ended, with an aotive, upward curved end, in which an upper recess is made being so shaped as to enable the penetration of the straight long part of the long rod, near the lower inward curved part of the long rod, the body having, opposite to the upper recess, a circular collar, connected through a shaped part with a short rod, in which a circular hole is made for the. initial introduction of the upper short rod over a depth of 3 ... 4 cm, an instrument being used in the hole made in the bone, the instrument in question being made up of a body to which an anvil and a support are fastened, the anvil having a short, cylindrical part provided with a circular recess and the support has a threaded rod which may be introduced/extracted in/from a L-shaped channel communicating with the outside, made in a band in which there is also worked a longitudinal channel, ended with a circular part, having a dimension higher than that of an end delimit ing the recess at the top, so that it is possible to displace the anvil along the channel, when the band is placed in front of the recess, the fastening of the band being achieved by means of a nut threaded on the rod, the body having a straight part, to which the anvil and the support are fastened, delimited respectively by a
short part inclined as against the longitudinal axis of the straight part and also by a part inclined in the same direction as the short part against this axis, the inclined part being connected, through a circular, collar and a shaped part, to a short rod, provided with a circular seat, the anvil having an upper, straight part connected with an inclined part with the longitudinal axis parallel to that of the short, port, provided with an upper, inclined surface, whose axis is parallel to the longitudinal axis of the inclined part, the bondbeing provided with an end, shaped part having the shape of a circle arc in cross-sectional area, which makes with the longitudinal axis of the straight part an angle lower by 5°...10° than the angle formed by the short part with the same axis, the final positioning of the upper, short rod in the neck being made by means of an instrument made up of a short body, ended with a shaped end, inclined with an angle higher than 90° as against the body axis, having a diameter higher than the rest of the body, provided with a straight frontal face, at the respective end, an elongated seat being made, delimited at the rear side by a semi-circular wall so dimensioned that, by introducing the lug of the upper short rod in it, its part inclined as against a horizontal direction remains outside, the body being connected, through a circular collar and a shaped part with a short rod provided with a circular seat, a handle being used for the introduction or the extraction of the short and, respectively, long rods in and from the bone, this handle enabling during the operation to fasten the instrument for introducing the short, the lower and, respectively, the long rods;an instrument for the final hammering of the long rod;an instrument for the final introduction or lifting of the long rod, in view of its extracting in/from the bone; an instrument for lifting the long rod, in view of its extraction; an instrument for achieving the adequate line of introducing the long rod in the bone 5 an instrument for extracting any of the short and, respectively long rods from the bone; an instrument for hammering the short rods in view of their introducing in the bone; an instrument for the final introduction of the upper short rod; an instrument for modifying the curvatures of the short rod ends; an instrument for detaching the long rod from the bone and, respectively an instrument for introducing the upper, short rod over a depth of 3 ... 4 cm, being possible to rotate the handle during the operation so as to position the long rod in the medullary channel or the lower, short rod in the neck, by means of an instrument formed of a long, cylindrical body ended with a posterior, and, respectively, a fore cylindrical collar, with a diameter lower than that of the collar, frontwise
provided with a shaped circular recess so as to enable the introduction of the lower short rod intermediary part or of lower, inward curved part of the long rod; a handle made up of an outside shaped body, provided with a longitudinal window, ended with a flared part, the window being made in a middle part of the body, continued with a posterior anvil and, respectively, an active end of cylindrical shape, in which it is made a longitudinal, cylindrical channel, continued with a recess delimited by a shaped wall communicating with the outside through a cylindrical seat, in a plane perpendicular to the plane in which there is placed the channel, the active end a cylindrical channel being made, its longitudinal axis being placed under the axis of the longitudinal channel, communicating with the outside through recesses and opposite located, the respective channel accomodating a lock provided with a fore, thin part and a posterior, thick, cylindrical part in which there are made two circular channels shifted as against the transversal axis of the channel, the fore part being mounted under the action of a force stored in a spring, which is supported respectively on a shoulder limiting the recess and also on a fore stopper, mounted in connection with the look, with the possibility of displacement in the recess, which allows to bring, as the case may be, the thin part in front of the channel from the recess where a posterior stopper is located having the possibility of displacing and with which the lock makes a single piece, the channel communicating, with another channel placed in the same plane as the other channel, perpendicular to the latter, in which, under the action of the force stored in a spring, a ball is placed, this ball penetrating depending on the lock position in one of the channel, the keeping of the spring in the channel being made by means of a screw, the rotation of the handle around the longitudinal axis depending on the. needs, when introducing the lower, short rod or the long rod in the bone, is made by means of the instrument for finally introducing the mentioned rods in the bone, which is placed in the flared part of the longitudinal window, all instruments which are handled by means of the handle having one of some collars connected through one of the shaped parts with one of the short rods, provided with one of the circular seats, which enables their locaking; for guiding the long rod during its initial introduction in the bone, in other constructive version, it contains an instrument fastened in the handle, formed of a long body, in which a jaw is fastened by means of a nut, the body having a long part connected through a circular collar and
a shaped part with a short rod, provided with a circular seat, opposite to the collar, the body being provided with a jaw provided on the frontal surface with a semi-circular recess, having the Iongitudinal axis parallel to that of the long part, the jaw being continued with a short rod, outside threaded, having the longitudinal axis in the extension of the long part which serves for guiding the jaw, reason for which the latter has a. pierced hole through which the rod. penetrates, a recess having the same shape as the semi-circular recess being positioned in front of the jaw recess, by fastening the jaw by means of a nut; for. modifying the curvatures of the lower, downward curved and,-respectively, outward curved parts of the short, upper and, respec tiverly, lower, outward curved parts of the short, upper and, respectively, lower rods, and of the straight, long, part of the long rod, depending on the needs, due to the bone shape; in another constructive version, it contains an instrument made up of a sleeve with sidewise flared edges, jointed with a short bolt, with a U-shaped support, in which there are made a recess and, respectively, some marginal, longitudinal slits, separated from the recess, by a wall, a stopper being fastened to the support, the former coming into contact with the two short, posterior arms jointed in turn with a short bolt to two fore short arms, the latter being boltjointed to the support, a long, sidewise flattened part being also bolt-jointed in front of the recess, pierced holes being drilled along the longitudinal axis of this part, which has an external, circular collar, used for limiting the displacement of a sleeve along it, as a result of the contact between the collar and a. lower edge of the sleeve, which is sidewise cut so that it may come in contact, sidewise, with the part, pieroed holes being drilled in the sleeve, having the same diameter and the same distance between them as those of the holes from the long part, beside the holes which are placed along the longitudinal axis of the sleeve, the latter having also hear a fore, inclined end, two holes located on either side of the longitudinal axis, the sleeve being possible to be closed with a plate, in which there are mounted thick bolts, which may penetrate through the holes from the long part and from the sleeve and, respectively, thin bolts which may penetrate in the holes near the fore end of the sleeve, the arms being provided, in order to achieve more accentuated curvatures of the long part, of the long rod, with upper recesses communicating with the outside, placed at the same level when the arms are brought in working position, in which it is
introduced the rod, which is, in this position, located under the long part and. the sleeve, by displacing downward the sleeve and implicitly the part, the rod being curved, the modification of the rod curvatures according to the bone shape being made by means of the sleeve and. bolts between which there are introduced the rods, as the case may be, by keeping the part in the working position, through the holes drilled in the arms in which a bolt is introduced, the bolt in question being mounted, when not working, in the holes made in the supports, in some lower ends of the arms, being introduced in slits; for transportation or sterilization requirements the sleevei together with the arms and, respectively, the long part, are rotating around the bolt, so as to bring them in the perimeter delimitad by the support, position in which they are located under the wall, and the sleeve is folded around the bolt, being locked in the support, the bolts being secured by nuts against loosening, and forpreventing the displacement of the component parts during the transport, namely the short arms and the part, two spacing parts are provided.
Examples are given below for the achievement of flexible implants and of the instrumentation, according to the present invention, related to fig.1 ... 88, which represent:
- fig.1, a side view of a short, smooth, upper, flexible implant for the osteosynthesis of the femoral neck;
- fig.2, a side view of a long, smooth, lower, flexible implant for the osteosynthesis of the femoral neck;
- fig.3, a view of the end of flexible implant shown in figure 1 which remains in contact with the femoral cortical shell;
- fig.4, a side view of a long, flexible implant for the osteosynthesis of femur and tibia;
- fig.5, a view of the end of flexible implant for the osteosynthesis of femur and tibia, which remains in contact with the femoral corctical. shell;
- fig.6, a section through the implant, after the plane A-A, represented, in figure 5;
- fig.7, a partial view of an impant for the osteosynthesis of femur and tibia achieved in another constructive version;
- figo8, a side view with partial section of a working instrument, for hammering flexible implants shown in figures 2 and 4;
- fig.9, a frontal view of the end of the instrument, shown in figure 8 which is introduced in a multi-functional handle;
- fig.10, a frontal view of the active end of the instrument shown in figure 8, in which the flexible implant shown in figuue 2
or figure.4 is introduced by hammering; fig.11, a top view, of the active end of the instrument shown in figure 8, in which the flexible implant shown in figure 2 and figure 4 is introduced by hammering;
- fig.12, a view with partial section of the active end of the instrument shown in figure 8, in contact with a flexible implant shown in figure 4;
- fig.13, a side view with partial section of a working instrum ment for the final hammering of a flexible implant, shown in figure 4
- fig.14, a top view of the active end of the instrument shown, in figure 13, coming into contact, when hammered, with the flexible implant shown in figure 4;
- fig.15, a view with section of the active end of the instrument shown in figure 13, in contact with a flexible implant shown in figure.4;
- fig.16, a side view of a working instrument with an active and for introducing or extracting in/from the bone the curvature placed near, the end to be hammered of a flexible implant shown in figure 4;
- fig.17, a top view with partial section of the working instrument shown in figure 16;
- fig.18, a side view of a working instrument initially used for extracting a flexible implant shown in figure 4;
- fig.19, a top view and partial section of a working instrument shown in figure 18;
- fig.20, a side view of a working instrument, curved and sharpen ed, with 4 edges, for achieving the directing of a certain line into the bone in view of introducing a flexible implant shown in figure 4;
- fig.21, a section after plane B-B shown in fig.20, through the working instrument for achieving the directing of a certain line in the bone;
- fig.22, a side view of a working instrument with the round and bent end of the active end, for extracting from the bone one of the flexible implants shown in figures 1, 2 and 4;
- fig.23, a partial top view of the round and bent end of the active end of the instrument shown in figure 22;
- fig.24, a side view of a working instrument for hammering a flexible implant shown in figure 1;
-.fig.25, a partial top view of the end for introducing in a multi-functional handle the working instrument shown in figure 24;
- fig.26, a frontal view of the active end of the working instrument shown in figure 24;
- fig.27, a section through the instrument, after plane C-C, shown in figure 24;
- fig.28, a partial section and view of an aotive end of the instrument for hammering a flexible implant, shown in figure 24, with. which it comes into contact;
- fig.29, a partial section and side view of a working instrument for the final introduction of a flexible implant shown in figure 1; - fig.30, a top view of the instrument shown in figure 29;
- fig.31, a view in plane of an active end of the working instrument. shown im figure 29, in contact with a flexible implant;
- fig.32, a partial section and side view of a working instrument for modifying the position of the end of one of the flexible implants shown in figures 1 and 2;
- fig.33, a transversal section, after plane D-D, shown in figure 32, through the instrument;
- fig.34, a partial section and side view of a working instrument for lifting from the metaphysis cortical shell the end of a flexible implant shown in figure 4;
- fig.35, a top view of the active end of the instrument shown in figure.34; - fig.36, a side view of a drill for drilling an initial hole in the bone;
- fig.37, a side view of a working instrument for creating the impact force required for the introduction of the flexible implant in the bone;
- fig.38, a partial section and side view of a working instrument for the rotation in the bone of one of the flexible implants shown in figures 2 and 4, by means of the working instrument shown in figure.8, fastened in a multi-functional handle;
- fig.39, a frontal view of the working instrument shown in figure 38;
- fig.40, a partial longitudinal section and view. of a working instrument used for guiding a long flexible implant during its introduction in the bone;
- fig.41, a transversal section,, after plane E-E, shown in figure 40, through the working instrument;
- fig,42, a side view and partial section of a working instrument for achieving an impact required, for extracting the flexible implant from the bone, by means of the instruments shown in figuees 22 and 34;
- fig.43, a partial section add top view of an active end of the instrument shown in figure 42;
- fig.44, a side view and partial section of a working instrumer for introducing an upper, smooth, short, flexible implant, in the bone, over a depth of 3...4 cm; - fig.45, a seotion after plane E-E, shown in figure 44, through the instrument;
- fig.46, a view of an end for fastening in the multi-functional handle of the instrument shown in figure 44;
- fig.47, a partial longitudinal section and view of an active end of the working instrument shown in figure 44, in contact with an upper, smooth, short flexible implant;
- fig.48, a frontal view of the active end of the instrument shown in figure 44, in contact with an upper, smooth, short, flexible implant transversally sectioned; - fig.49, a side view of a working instrument for seizing and correcting the curvature of a flexible implant, shown in working position;
- fig.50, a transversal section after plane G-G, shown in figure 49, through the instrument; - fig.51, a top view of the working instrument shown in figure 49, with partial sections;
- fig.52, an axonometric view of the instrument shown in figure 49; - fig.53, a partial, transversal section through the constructive, detail "G" shown in figure 51;
- fig.54, a section through the instrument after plane I-I shown in figure.51;
- fig.55, a transversal section after plane J-J, shown in figure 49 through the instrument;
- fig.56, a side view of a plate in which there are mounted bolts of the working instrument shown in figure 49;
- fig.57, a section after plane K-K shown in figure 49, through the instrument;
- fig.58, an axonometric view of the working instrument shown in figure.49;
- fig.59, a transversal section after plane L-L, shown in figure 58, through the instrument;
- fig.60, a side view of a working instrument for stiffening the long implants in case of their initial hammering or whan grasping various instruments for their introduction or extraction in/from the multi-functional handle;
- fig.61, a top view of an active end of the working instrument shown in figure 60;
- fig.62, a side view of a multi-functional handle designed to fasten various working instruments for the introduction of a flexible implant in the bone;
- fig.63, a partial longitudinal section and top view of the multi-functional handle;
- fig.64, a transversal section after plane M-M, shown in figure 63, through the multi-functional handle;
- fig.65, a frontal view of an active end of the multi-functional handle;
- fig.66, a diagram of mounting short flexible implants combine with. two long flexible implants;
- fig.67, a diagram of mounting short flexible implants combined with a. long flexible implant; - fig.68, a diagram of mounting two long flexible implants spatially superposed in two points for the osteosynthesis of super and intercondylian, mediodiaphysary and subtrochantarian fractures of femur;
- fig.69, a diagram of mounting two flexible implants which are spatially superposed in only one point for the osteosynthesis of the ins table fracture of the greater troohanter;
- fig.70, a diagram of mounting from the bottom to the top two long flexible implants which are spatially superposed in two points, for the osteosynthesis of the tibia diaphysary fractures;
- fig.71, a diagram of making a hole for the introduction of a long flexible implant in the bone;
- fig.72, a diagram of achieving the prevention of buckling the long. flexible implant when it is initially introduced in the bone; - fig.73, a. diagram of introducing a long flexible implant in the bone, in the first phase, with guiding, by using a working instrument shown in figure 60;
- fig.74, a diagram of correcting, by rotation, the line of a long, flexible implant in the bone, by means of working instruments shown in figures 8, 38 and 62;
- fig.75, a diagram of the final introduction of a long, flexible implant in the bone, by means of a working instrument, shown in figure 13;
- fig.76, a diagram of.. mounting a long, flexible implant and of lifting it from the bone , 'by means of the working instrument shown in figure 16;
- fig.77, a diagram of correcting the curvature of a long, flexible implant by means of the working instruments shown in figures 16, 18 and.62;
- fig.78, a view of the working instrument shown in figure 49, placed in. its working position, for curving a long flexible implant;
- fig, 79, a diagram of placing the working insiruments in view of extracting a long, flexible implant by means of the working instruments shown in figures 22 and 34;
- fig.80, a diagram of applying the impact force required for extracting a long, flexible implant by means of the working instruments shown in figures 22 and 42;
- fig.81, a view of the working instrument shown in figure 49, placed in working position, for modifying the curvature of the ends of short, flexible implants;
- fig.82, a diagram of initially introducing an upper, short, fleScible implant in the femoral neck, by means of the working instruments shown in figures 37, 44 and 62;
- fig.83, a diagram of intermediary introduction of an upper, flexible implant in the femoral neck by means of the working instruments in figures 24, 37 and 62;
- fig.84, a diagram of final introduction of an upper, short, flexible implant in the femoral neck, by means of the working instruments shown in figures 29, 37 and 62;
- fig.85, a diagram of introducing a lower, short, flexible implant in the femoral neck by means of the instruments shown in figures 8, 37 and 62;
- fig.86, a diagram of positioning a. lower, short, flexible implant in the femoral neok by means of the instruments shown in figures 8, 38, 62;
- fig.87, a diagram of final mounting of short, flexible implants in the bone;
- fig.88, a diagram of extracting short, flexible implants from the bone, by means of the working instruments shown in figures 22 and 42.
According to the present invention, the flexible implants aremade up of short rods, 1 and 2, of which one is upper and the other one is lower, used in the stable flexible osteosynthesis for the fractures of the femoral neck as well as of a long rod, 3, used with another long rod, 3, in the stable flexible osteosynthesis of thediiphysary fractures of tibia when their mounting is made from the bottom to the top, starting from the supermalleolar level on either
side of tibia, achieving their spatial superpositiόn in two points, in the lower and upper parts of the medullary channel, or in the stable flexible osteosynthesis of the superintercondylian, diaphysary and sub troohanter ian fractures of femur, in which case, the mounting of rod 3 is made by introducing it in condyle or over condyle, inside or outside, achieving a spatial superposition in the lower and upper parts of the medullary channel; in case of the instable fractures of the greater troohanter, - plain or comminuted, inter or per troohanter ian fractures -, the two rods are introduced over condyle, inside and outside, being spatially superposed in only one point, in the lower part of the medullary channel and parallel placed, in the femur neck and head.
In case of stabilizing fractures with double gap crossing the femur neok and every femoral part located under the greater troohanter, the osteosynthesis is achieved by means of both rods, 1 and 2, together with one or both rods 3.
Rod 1 is formed of an upper active part, a, with a shaped end, b, promoting the penetration and the directing, giving the possibility of choosing, when manoeuvring from the. outside, the line required for stabilizing the fraoture gap, continued with an upper part, c, upward curved, after which there follows a long, straight part, d, connected, through a lower part, e, downward curved, with its radius of curvature equal to that of part c, between 1 and 3 cm, to a part, f, inclined as against a horizontal direction, ended with a lug, g. The axis of part a is parallel to the axis. of part f and forms an angle of 40°...70° with, the axis of part d. The latter has a lower, flat surface h, delimited by an upper surface i, whose cross-seotion is. shaped as a truncated cone, with the small base placed toward the surface h.
Rod 2 is formed with an upper, short, straight, active part,j, with a shaped end, k, promoting the penetration and the directing, giving the possibility of choosing, when manoeuvring from the outside, the line required for stabilizing the fracture centre, connected through an upper, downward curved port, 1, with, a long, downward, curved part, m, connected in turn, through intermediary and, respectively, lower parts, n and o, inward and outward curved, the radii of curvature having values lower than that of the curvature radius of part 1, with a part, p, inclined as against a horizontal direction, ended with a lug, q. The latter has a fla.t lower surface, r, delimited by an upper surface with a truncated cone cross-section, s, with the. small base toward surface r.The eurvature radius of part m is 7 ... 10 cm, and the curvature radii of
parts n and o are 1/2 ... 1/3 (7 ... 10) cm. The plane in which lug q is placed forms an angle of 40°... 7o° with a horizontal plane. The axis. of part j also forms an angle of 40°... 70° with a horizontal plane.
Rod 3 is made up of a long, straight part, t, ended with a shaped, active end, u, with an upper inclination to 45° and a lower inclination to 30°, which makes possible, when manoeuvring from the putside, to chose the line required for stabilizing the fracture gap, connected, through some lower and, respectively, upper parts, v and W, inward and outward curved, with curvature radii having values between 3 and 5 mm, with a flat, narrow part, x, and a widened, flat or inward curved end part, y, so dimensioned as to stop the complete penetration of rod 3 in a medullary channel, not shown in the figures. Part y is delimited by part x through steps z, inclined as against the longitudinal axis of rod, 3, forming with it an acute angle of 60°... 75°, symmetrically arranged as against the respective axis. Parts v and w are half-flattened and the width of part x is equal to those of parts v and w, with the diameter of part, t, respectively. The end u may have edges. ai, delimiting some faces converging to the longitudinal axis of rod, 3.
According to the present invention, the instrumentation is composed of tan instrument 4, for introducing rods 2 and 3, an instrumant 5 for final hammering of rod 3, an instrument 6, for final introduction or lifting of rod 3, in view of its extraction, an instrument 7, for lifting rod 3, in view of its extraction, on instrument 8 for achieving the adequate line of a hole b in a bone 9, tibia or femur, for the introduction of rod 3 according to a certain line, an instrument 11, for hammering rods 1 and 2 in view of their introducing in bone 9, an instrument 12, for the final introduction of rod 1,an, instrument 13 for modifying the curvature of the ends of rods 1 and 2, an instrument A, for guiding rod 3 when introducing it in bone 9, by hammering it, an instrument 14 for extracting parts v and w, belonging to rod 3 from bone 9, an instrument B for achieving an impact for extracting rods 1, 2 and 3 from the bone 9, an instrument C, for introducing rod 1, over a depth of 3...4 cm, an instrument D, for fastening rods 1, 2 and 3 in view of their curving depending on the needs imposed by the locating of the fracture gaps, an instrument 15, drill-shaped, a working instrument 16 for creating the impact force necessary for the introduction of rods 1, 2 and 3 in bone 9, an instrument 17, for the final introduction of rods 2
and 3 in bone 9, an instrument E for stiffening long rods 3 during their initial introduction in bone 9 and, respectively for manoeuvring, instruments 4, 5, 6, 7, 8, 10, 11, 12, 13, A and B, in view of their introducing in a multi-functional handle, P, which can be rotated by means of instrument 17.
Instrument 4 is made up of a short body ci, provided with an active end di having a frontal recess ei , delimited at its bottom side by a lower wall fi, in which an elongated seat gi is made, communicating with a segt hi made in a vertical wall ii, sidewise delimiting the recess ai. The shapes of seats gi and hi are so selected as to enable the penetration of part v in seat hi, when a fragment of part t penetrates in seat gi, and part w is placed in recess ei.
Opposite to recess ei, body ci has a circular collar ji connected through a shaped part ki with a short rod li . A circular seat mi is provided in the latter. In the middle of body ci , there is made a pierced hole ni , with a diameter so selected as to enable the introduction of rod 3, through it.
Instrument 5 is formed of a long body oi ended with a frontal recess pi, delimited at its bottom side by a wall qi and sidewise by a wall ri. In the wall qi there is made a seat si so dimensioned that, when a fragment of part t of rod 3 is introduced in it, its part v be in contact with wall ri , and part w be positioned outside the recess pi. Opposite to recess pi, body oi has a circular collar ti, connected through a shaped part ui with a short rod vi. A circular seat wi is provided in this one. In the centre of body ci , there is. made a pierced hole xi with a diameter so selected as to enable the introduction of rod r through it.
Instrument 6 is formed of a long body yi with two inclined faces zi , ended with a frontal, active recess aii, so dimensioned as to enable the contact between body yi and part v of rod 3, whan no ralative motion of body yi is possible in the transversal direction, as against rod 3. Opposite to recess aii, body yi has a circular collar bii, connected through a shaped part cii with a short rod dii .
A seat eii is provided in the latter. In the centre of body yi there is made a pierced hole, fii, with a diameter so selected as to enable the introduction of rod 3 through it. Instrument 7 is formed of a long body gii ended with an active upward curved end hii, in which there is made an upper recess iii, so shaped as to enable the penetration of part t of rod 3, near part v. Opposite to recess iii, the body gii has a circular collar jii connected through a shaped part kii, with a shoϊt rod lii. A circu
lar seat mii is provided in the latter. In the centre of body g ii, there is made a pierced hole nii , with a diameter so selected as to enable the introduction of rod 3 through it.
Instrument 8 is made up of a body cii provided respectively with a straight, posterior part pii and a shaped, upward curved, fore part qii, ended with a sharp end rii , to which some cutting edges sii of part qii are converging. The edges sii are parallel in the first half of part qii , then they are converging to end rii .Part pii is connected through a circular collar tii and a shaped part uii with a short rod v ii provided with a circular seat wii, Instrument 10 is formed of a. long, thin body xii ended with an active, hook-shaped, inward curved end yii , so shaped as to enable the gripping of part.v belonging to rod 3 or the introduction of rod
1 or rod 2 in edge g. The body xii is connected through a circular collar zii and a shaped part aiii with a short rod biii, provided with a circular seat ciii .
Instrument 11 is made up of a body d provided with a posterior part eiii , inclined as against a horizontal plane, which is connected through a vertical part fiii with a fore, horizontal flat part giii A semi-circular seat hiii is made in the latter, being so dimensioned as to be penetrated by lug g of rod 1. Part eiii is connected through a circular collar iiii and a shaped part jii with a short rod kiii provided with a circular seat 1iii . Instrument 12 is made up of a short body miii, ended with a shaped end niii , which is inclined, with an angle higher, than 90° as against the axis of body miii, having a diameter higher than all the rest of body m iii , provided with a straight, frontal face oiii.
In the end niii there is made an elongated seat piii , delimited at its rear side by a wall qiii of semi-circular shape, so dimensioned that when introducing lug g in it, its part f remains outside. The body miii is connected through a circular collar riii and a shaped part siii with a short rod tiii , provided with a circular seat uiii. Instrument 13 is formed of a body v iii, ended with a cylindershaped end wiii , having an external diameter higher than that of body viii , in which there is made a seat xiii , open to the outside, sidewise placed, having the longitudinal axis perpendicular to the longitudinal axis of body vii , in front of which there is a flat wall yiii . Body viii is connected through a circular collar ziii and a shaped part a with a short rod b , provided with s circular seat civ.
Instrument A is made up of a long body 18, to which a jaw, 20 is fastened with a nut, 19. The body 18 has a long part div, connected through a circular collar eiv and a shaped part fiv with a short rod giv, provided with a circular seat hiv Opposite to collar eiv , the body d is. ended with a jaw iiv provided over a frontal surface jiv with a semi-circular recess kiv , having the longitudinal axis parallel to that of part div . In the extension of jaw iiv there is provided a short rod liv autside threaded, having the longitudinal axis placed in the extension of part div serving for guiding jaw 20, reason for which the latter, has a pierced hole miv , through which rod liv penetrates. By fastening jaw 20 with nut 19, in front of the recess kiv of jaw iiv there is positioned a recess niv , having the same shape as that of recess kiv from jaw iiv .
Instrument 14 is made up of a thin, long body oiv , ended with an active, upward curved, widened end piv , provided with two claws qiv so shaped as to enable the contact with the inclined steps z of the rod 3. The body civ is delimited, through a circular collar riv , by a handle siv , provided with a longitudinally elongated window tiv .
Instrument B is composed of an outside shaped handle 21, which is coupled, through a connecting piece 22, with a cylindrical, active end 23, axially provided in turn with a longitudinal channel uiv which communicates with the outside through a slit viv inclined as against the longitudinal axis of handle 21 with on angle of 45°, the width of slit viv being equal to 1/2 of the diameter of channel uiv , enabling the introduction of any of the bodies xiv and oiv from instruments lo and 14. The handle 21 is provided with a spherical seat wiv in which a sperical end xiv of part 22 penetrates, opposite to it being a short, outside threaded rod yiv , by means of which the joint with end 23 is made, reason for which a hole ziv is drilled in the joint. For ensuring the threaded joint between part 22 and end 23, the pins 24 penetrating in rod yiv are introduced in the end.
Instrument 15, shaped as a drill is well known and is used for making a hole with straight axis in bone 9.
Instrument 16 is formed of a tail av, provided with a longitudinally elongated window bv, placed near the rear, end ov of the tail av. The latter forms a single piece with an active end dv , having. an intermediary part ev shaped as a truncated cone, delimited respectively by an upper cylindrical part fv and a lower, cylindrical part gv, the diameter of the latter being higher than the diameter part fv. The longitudinal axis of handle av crosses the longitudinal axis of the active end dv, near part fv, in order to achieve
Instrument 17 is made up. of a long, cylindrical body hv, ended respectively with a posterior, cylindrical collar iv and a fore, cylindrical collar jv, having the external diameter lower than that, of collar iv, fron.tally provided with a circular recess kv, so shaped as. to enable the introduction of part n of rod 2 or of part v of rod 3.
Instrument C is formed of a body 25 to which there are fastened an anvil 26 and a support 27. The anvil 26 has a short, cylindrical part lv, provided with a circular recess mv, and the support 27 has a threaded rod n which may be introduced/extracted in/from a L-shaped channel ov, communicating with the outside, made in a band 28. In the latter, there is also worked a longitudinal channel pv, ended with a circular part qv, having a dimension higher than the end rv which delimits at the top side the recess mv, so that it is possible to displace the anvil 26 along the channel ov, when the band 28 is placed in front of the recess mv. The fastening of band 28 to the support 27 is made by means of nut 29 threaded on. rod nv. The body 25 has a straight part sv on which there ar9 fastened anvil 26 and support 27, delimited respectively, by a short part tv, inclined as against the longitudinal axis of part sv and by part uv, also inclined in the same direction as part tv, as against the same axis. Part uv is connected through a circular collar vv and o shaped part wv with a short rod xv, provided with, a circular seat yVo The anvil 26 has a straight, upper part zv connected with an inclined part av , having the longitudinal axis parallel to that of the short par.t tv.The part a has an upper, inclined surface b parallel to the longitudinal axis of part uv. Band 28 is provided with a shaped, end part cvi, having the shape of a circle arc in transversal section which makes with the longitudinal axis of the straight part sv an angle smaller by 5°... 10° than the angle formed by the part tv with the same axis.
Ins tr ument D is composed of a sleeve 30 wi th sidewise flared e dges , jointe d through a shor t bolt 31 wi th a U-shaped suppor t 32 in which there are made re spe c tively a recess dvi and some marginal, longitudinal slits evi and fvi , se para ted, from the r ecess dv by a wall gvi . To the suppor t 32 there is fas tened a s topper 33 wi th which two pos terior , shor t arms 33 may come into contac t , be ing join t e d in turn by means of a shor t bolt, 35 with two fore , shor t arms ,
36. The la tte r are jointe d wi th a bolt 37 to suppor t 32 , in front of the recess dvi . To the bol t 37 , there is also jointe d a long par t 38 , sidewise fla ttene d , in which there are made pierced holes hvi . along the longitudinal axis. The par t 38 has an exte rnal collar vvi ,
serving for Ii ting of the displacement of
leeve 39 along it, as a result of the contact between collar ivi and a lower step jvi of the sleeve 39, which is sidewise cut so that it may come sidewise. into contact with part 38. In the sleeve 39 there are made some pierced holes kvi, having the same dimension and the some distance between them, as those of holes hvi . Except holes kvi, which are located along the longitudinal axis of sleeve 39, in the latter there are also disposed two holes m on either side of the longitudinal axis, near a fore, inclined end lvi.
Sleeve 39 may be closed with a plate 4o in which there are mounted thick bolts 41, which may penetrate through holes hvi and kvi and thin bolts, which, may penetrate in holes mvι. By means of bolts 41 and 42, it is possible to position one of rods 1 and 2 in view of modifying its curvature depending on the needs. For maintaining part 38 in working position, a bolt 43 is introduced in the holes nvi made in the arms 34, the bolt in question being mounted, when not working, in the holes ovi made in the support 32 and the lower ends pvi of the arms 34 are introduced in slits evi and fvi, in view of achieving a more accentuated curvature of rod 3, the arms 34 are provided with some upper recesses qvi which communicate with the outside, placed at the same level when the arms 34 are brought in the working position, in which rod 3 is introduced, which is placed in this position under part 38 and sleeve 39. When removing bolt 43 and displacing upward sleeve 39 and implicitly part 38, the rod 3 is curved.
For requirements of transport and sterilization, the sleeve 39 is displaced along fart 38, the ends pvi of arms 34 are removed from slits evi and fvi , which allows the folding of arms 34 with arms 34 and part 38 with sleeve 39 around bolt 37, so as to bring them in the perimeter delimited by support 32, a position in which they are placed under wall gvi , and sleeve 39 is folded around bolt 31, being locked in its support.
The bolts 31, 35 end 37 are secured against loosening by means of nuts 44, 45 and 46. In order to prevent the displacement of the short arms 36 and part 38, during the transport, two spacing pieces 47 are also provided.
Instrument E is composed of two arms 48 and 49, jointed through a bolt 50, provided with intermediary straight parts rvi and svi, continued with horizontal, posterior parts tvi and uvi and fore parts vvi , and wvi , respectively, inclined as against a horizontal plane. The latter are connected with one of the shaped jaws 51 and . 52, following the external shape of the flexible rod 3, serving res
pectively for fastening rod 3 in view of its guiding during the initial introduction in bone 9 and for seizing and manoeuvring the instruments 4, 5, 6, 7, 8, 10, 11, 12, 13, A and C for the introduction of extraction in and. from the multi-functional handle.
Handle F is formed of an outside shaped body 53, provided with a longitudinal window xvi , ended with a flared part yvi , through which instrument 17 is introduced so as to change the position of body 53 around its longitudinal axis. The window xvi is made in a middle part zvi of the body 53, which is continued respectively with a posterior anvil avii and an active, cylindrical end. bvii . A cylindrical, longitudinal channel cvιii. is made in the latter and it is continued with α recess dvii delimited by a shaped wall eviii communicating with the outside through a cylindrical seat fviii. In a plane perpendicular to the plane in which there is placed channel cvii, at the end bvii there is made a cylindrical channel gvii, having the longitudinal axis placed below that of channel cvii. Channel gvii communicates with the outside through the recesses hvii and ivii , respectively, opposite place and in this channel, a lock 54 is located, being provided with a tzin, fore part, jvii and a thick, cylindrical, posterior part kvii , in which there are made two circular channels lvii and mvι shifted placid as against the transversal axis of channel cviii Part jvii is mounted under, the action of the force stored in a spring 55 which-is supported respectively on a shoulder nvii which limits the recess ivii and on a fore stopper 56, mounted in connection with lock 54, with the possibility of displacement in the recess ivii which allows to bring, as the case may be, the thin part in front of the channel cviii. The posterior stopper 57 making a single piece with.lock 54 are placed in recess hvii with possibility of displacement. Channel gvii communicates with a channel cvii placed in the same plane with channel gvii. placed perpendicular to the latter, in which, there is disposed, under the action of a force stored in a spring, 58, a ball, 59, which, may penetrate, depending on the position of lock 54, in one of the channels 1vii and mvii . The maintaining of the spring 58 in channel ovii is made by means of screw 60.
For introducing rods 3 in bone 9, a circular hole p vii is drilled in the latter, working first with a drill-shaped instrument 15, then continued with instrument 8, so that the end rii reaches in the longitudinal axis of the medulliry channel, forming the line of rod 3 penetration in it. The introduction of rod 3 in the medullary channel through hole pvii is achieved by means of instrument 4, introduced in handle F. The buckling of rod 3 which may appear during
the introduction, due to the resistance of bone 9 and of blows given to handle F, by means of instrument 16 is also prevented by guiding the rod with instrument A mounted in handle F or with instrument E. Depending on the needs, rod 2 can be rotated inside the medullary channel through the instrument 4 fastened in handle F in which instrument 17 is introduced.
For the final introduction of rod 3 in the bone 9 and for bringing part y of rod 3 in contact with the external surface of the condyle, the last hammerings on the last part of introduction are made by means of instrument 5 mounted in contact with part y and then, for including part y in. bone 9, the instrument 5 is brought in contact with part w or, as the case may be, by means of instrument 17.
At the end of the operation, in order to avoid an accidental side slipping, the lower part y is brough in the medullary channel by means of instrument 6 fastened in handle F until. part y comes into contact with the external surface of the condyle.
Depending on the needs, rod 3 is manually curved by means of instruments 6 and 7 for which it is introduced through holes fii and nii provided in them. The curving of rod 3 may be also made by means of instrument D by introducing rod 3 in recesses qvii made in arms 34 and by displacing downward sleeve 39 and, implicitly, part 38. After obtaining the fraoture consolidation, for extracting rods 3 of osteosynthesis from the medullary channel, the instrument 6 is introduced between part y of rod 3 and bone 9, so that its frontal recess a penetrates up to the part w of rod 3, creating thus the possibility that by hammering several times the handle F to which instrument 6 is fastened, parts v and w. should not be fastened anymore to bone 9, after which instrument 7 is in handle F, instead of handle 6, allowing through the tilting motion, the lifting of parts v and w at the surface of bone 9. From now on, part v is brought into contact with instrument 14 and, if necessary, the part v is brought into contact wit instrument 10, achieving by drawing, the extraction of rod 3 from bone 9. The total extraction of rod 3 from bone 9 is made by applying impact forces by means of instrument B on one of collars zii and riv of instruments 10 and 14. The preparation of the introduction of rods 1 and 2 in bone 9 is made by modifying the curvatures of parts e and o according to the shape of bone 9, using sleeve 39, in which rod 1 or rod 2 are introduced, and the lug g or the lug q arβ included in part xiii of instrument 13 with which one actuates by means of the multi-functional handle F. During the operation, sleeve 39 is fasten ed to arms 34 through bolt 43 so as to apply the effort required for the curvature modification.
For the initial introduction of rod 1 in the neck qvii of bone 9, a hole rvii is drilled in bone 9, after which, by repeatedly hammering the anvil 26, belonging to instrument C, the rod 1 fastened in the latter is introduced by guiding through hole rvii. The introduction of rod 1 in the neck qvii is made by means of instrument 11, reason for which this one is assembled to handle F, on which blows are repeatedly applied with instrument 16, so that part o is directed to the inferior and internal side as against the femoral head, and the part d is directed to the superior and. external side as against the femoral head, so that rod 1 may come near and parallel to the upper edge svii of the femoral neck qvii .
Then, a hole tvii is drilled in the bone, being located under hole rvii through which rod 2 is initially introduced by means of instrument 4, in which part n of rod 2 is placed, supported by handle F, in which one introduced instrument 17 for the final introduction of body 53 in part yvi , and by means of this instrument, one modifies, by rotation, the position as against the longitudinal axis, after which rod 2 is finally introduced in neck qvii by repeatedly applying blows on handle F to which instrument 4 is fastened, being in contact with rod 2. In the final position, rod 2 has the part 1 placed in the lower side of the femoral head, the part m following a direction parallel and very near to an edge uvii of the femoral neck q vii
The positioning of rods 1 and 2 related to bone 9 is achieved by means of screws 61 and 62 fastened into bone 2, so that parts f and p of rods 1 and 2 come into direct contact with the cortical shell.
The extraction of rods 1 and 2 from bone 9 is made by dismounting screws 61 and 62 and by fastening in turn rods 1 and 2, by means of instrument 10, which enables that by repeatedly applying blows with instrument B, the instrument lo should be removed away from bone 9, which has as a result the extraction of rods 1 and 2.
For the introduction of rods 1, 2 and 3 in bone 9, proceed first to the introduction of one or both rods 3 in bone 9, up to part immediately over the fracture gap, then introduce rods 1 and 2, then continue the complete introduction of rods 1 and 2 or rod 3, the mounting stabilization being performed with screws 61 and 62 for rods 1 and 2 and by bringing part y of rod 3 in contact with the external surface of the femoral condyle.
In accordance with the present invention, the implants and the instrumentation present the following advantage ss
- the flexible implants allow, through their structure enabling. their use in various groups of two, three and four, the osteosynthesis of all types of femur fractures and of some tibia fractures;
- the upper and, respectively, lower short, flexible implants usad for the osteosynthesis of femoral neck fractures, enable through their configuration to improve the reduction of the fracture through, endoosseous taxis, do not damage the intraosseous vascular anastomoses minimizing the incidence of later necroses of the femoral head, their fastening with orthopaedic screws to the femur diaphysis achieves a mounting with maximal stability in course of the time, the flexible characteristics of the implant to which their divergently curved shape is associated, give them the possibility of working in a dynamic couple, alternatingly creating tensions of traction, compression, which promote the biologic processes of fracture healing by accelerating them;
- the mounted long, flexible implants, which are spatially superposed in the lower and uppar parts of tha femur or tibia medullarychannel, have the advantage that, they cannot slip to the lower side due to the shape of. the implant ends, preventing the perforation of the tegument and the local secondary infection, or, to the bone inside both situations causing the damage of the mounting and the fracture loss of stabilization;
- the mounted long, flexible implants which are spatially superposed in the lower side of the medullary channel and parallel in the femoral neck have the advantage of stabilizing the instable fractures of the greater troohanter, the tensions which tend to displace the fracture being taken over through the implants and spread over tha two side faces of the femur lower side as well as the slipping toward the lower side, preventing the perforation of tha tegument and the local secondary infection;
- the combined use. of the short and long implants in the double gap fractures of the femoral neck of any other part of the femur have the advantage of preserving the flexibility of the mounting in the fracture areas and all over the bone line when performing fast surgical operations which are less, injuring for the patient;
- they enable simple and easy manoeuvres for the introduction/ extraction of the flexible implants from/ in the bone;
- they have a simple construction and a great reliability;
- they may be easily cleaned and sterilized and do not have areas of collecting organic remnants resulted during the operation;
- they may be handled with the same multi-functional handle;
- with a small number of instruments and relatively small dimensions, one ensures the achievement of the osteosynthesis of a wide fracture range;
- the handling, transpor t and pre para tion for opera tion may be made wi thout difficul ty.
C L A I M S
1.Flexible implants for the stable flexible osteosynthesis of thefemur and tibia fractures, which, under the conditions of the femoral fracture placing in the mediodiaphysary and femoral neck are, two of them, introduced through the medullary channel in the femur, condylian or overcondylien, outside or inside placed, both being so curved as to be superposed in the space in two points, in the lower and upper parts of the medullary channel,, another, one is introduced according to a direction parallel to the upper edge of the femoral neck coming in its immediate vicinity, and the last one is placed in the lower channel of the femoral neck, following a direction parallel and very hear to the edge of the femoral neck, under those of the femur fracture placing in the femoral neck and subtrochanterian zones, one is introduced through the medullary channel into the femur, condylian or overcondylian, outside or inside, having finally a curved shaped, another one is introduced, according to a direction parallel to the upper edge of the femoral neck, coming to its immediate vicihity, and the last one is placed in the lower quadrant of .the femoral neck, following a direction parallel and very near to the edge of the femoral neck, under those of femur fraoture placing in the mediodiaphysary, subtrochanterian, super and intercondylian zones, two of them are introduced through. the medullary channel into the femur, condylian or supercondylian, outside or inside, both being so curved as to finally superpose in the space in two paints, in tha lower and upper parts of the medullary channel and under those of the femur fracture placing only in the zone of the greater troohanter, two of the implants are introduced through. the medullary channel into the femur, condylian and supercondylian, outside or inside, both being so curved as to finally superpose spatially in the lower part, in only one point, after which they follow some parallel lines in the medullary channel, under those, of fraoture placing only in the zone of the femoral neck, one of them is introduced according to a direction parallel to the upper edge of the femoral neck coming in its vicinity, and another ona is placed in the lower quadrant of the femoral neck, following a direction parallel and very near to the edge of the femoral neck and finally under those of tibia fracture placing in the diaphysary areas, two of the implants are introduced
Claims
through the medullary channel. from, the bottom to the top, starting from the supermalleolar level, on either side of tibia, both being so curved as to be finally superposed in space, in two points, in the lower and upper parts of the medullary channel, c h a r a c t e r i ze d b y t h e f a c t t h a t, in order to achieve osteosyntheses stabilizing the fracture gaps, enabling the patients' recovery in a short period, they are made of short rods (1 and 2), one upper and one lower, used in the osteosynthesis for the fractures of the femoed neck, as well as of a long rod (3), used as such or with another long rod (30 and with tha short rods (1 and 2) in case of stabilizing the double gap fractures crossing the femur neck and every part of the femur placed under the greater trochanter, or only with another, long rod (3) for stabilizing the diaphysary fractures of tibia and femur and, respectively, the super and intercondylian fractures of femur, the upper short rod (1) being made up of an upper, active part (a) having a shaped end (b), continued with an upper, upward curved part (c), after which there follows a long, straight part (d), connected through a lower, curved part (e), downward directed, with a part (f), inclined as against a horizontal direction, ended with a lug (g), the lower short rod (2) being formed of an upper, short, straight active part (j) with a shaped end (k), connected through an upper, downward curved part (1) with a long, downward curved part (m), in turn connected by means of intermediary, and lower parts (n and o), inward and respectively outward connected, with a part (p) inclined as against a horizontal direction, ended with a lug (q), the long rod (3) being made up of a long, straight part (t), ended with a shaped end (u), promoting the penetration and the directing in the bone (9), connected through lower and upper parts, (v and w), inward and respectively outward curved, with a flat, narrow part (x) and a flat or inward-curved, widened end part (y), so dimensioned, that it stops, the complete penetration of the long rod (3) in. the medullary channel.
2. Implants according to. claim 1, c h a r a c t e r i z e d b y t h e f a c t that the upper, short. rod (1) has in its lower downward curved part (a) a radius of curvature which is equal to that of the upper, upward curved part (c) between 1 and 3 cm, and the axis of the upper active part (a) is parallel to the axis of the part ( j), inclined. as against a horizontal direction and forms with the axis of the long, straight part (d) an angle, of 40°...70°, the long, straight part (d) having a lower, flat surface (h) delimited by an upper surface with, the shape of a truncated cone in cross-rsection, with tha small base placed to the flat, lower surface (h).
3. Implants according to. claim 1, c h a r a c t e r i z e d b y t h e f a c t that the lower, short..rod (2) has in its long, downward curved part (m) a radius of curvature between 7 and 10 cm, and the radii of curvature of the intermediary and, respectively, lower, inward and, respectively, outward parts (n and o) are equal to each other and hava values between 1/2 - 1/3 of the curvatura radius of the long, downward curved part (m), these radii being lower than the curvature radius of the upper, downward curved part (1), the plane in which there is placed the lug (c), which has a flat, lower surface (r), delimited by a surface (s) with, the shape of a truncated cone and the small base placed toward the lower surface, (r), forming with a horizontal plane an angle of 40° ... 70°, and the axis of. the upper, short, straight,, active part (j) forms an angle of 40° ...70° with a horizontal plane.
4. Implants, according to olaim 1, c h a r a c t e r i z e d b y t h e f a c t that the long rod (3) has the active shaped end (u) provided with an upper inclination up to 45° and a lower inclination up to 30° or with some edges (ai ) delimiting some faces converging to the longitudinal axis of the long. rod (3), the lower and, respectively, upper parts (v and w), inward and, respectively outward curved, having curvature radii with values between 3 end 5 mm, and the end part (y) is delimited by the flat, narrow part (x), by some steps (z), inclined as against the longitudinal axis of. the long rod (3) forming with i.t an acute angle of 60° ...75°, symmetrically disposed as against the vertical axis, the lower and, respectively upper parts (v and w), inward and, respectively outward ourved being semi-flattened, the widths of these parts (v and w) being equal respectively to the width of the flat, narrow part (x) and to the diameter of the long, straight part (t).
5. Working instrumentation required for achieving an efficient surgical operation in the stable flexible osteosynthesis of the fractures of femoral neck, tha fractures of the greater troohanter, the subtrochanterian,. mediodiaphysary, super and intercondylian fractures of femur, as well as the diaphysary fractures of tibia, when the stabilizing of the fracture gap is achieved by means of flexible implants according to claims 1 ... 4, which include a drill-shaped instrument for making, in the bone, a hole, whose axis is perpendicular to the longitudinal axi3 of the bone, an instrument for achieving the adequate lines for tha introduction of a long rod in the bone, a working instrument for creating the impact force necessary for introducing any of the flexible rods in the bone, an instrument for stiffening the long rods when whey are initially introduced in the bone, an instrument for the final hammering of the long rod, an instrument for the final introduction or the lifting in view of withdrawal of the long rod in/from the bone, an instrument for hammering the short, upper and, respectively, lower rods, in view of their introduction in the bone, an instrument for changing the curvature, of the ends of the said short rods,, an instrument for extracting either the long rod or the short rods from the bone, an instrument for releasing the end parts of tha long rod from the. bone, an instrument for achieving an impact, in. view of extracting either the long rod or the short rods from the bone, c h a r a c t e r i z e d b y t h e f a c t t h a t in order, to stabilize the fracture gaps in the above said cases, when making less injuring surgical operation, with minimal, blood lossed, for introducing both the long rod (3) through the hole (Di) made inthe bone (9) and the said short, lower, rod (2), through another hole ( tvii) made in the bone (9), it is composed of an instrument (4) which is made up of a short body (ci ) provided with an active end (di) with a frontal recess (ei), delimited, at the bottom side by a lower wall (fi), in which there is made an elongated seat (gi) communicating with a seat (hi) made in a vertical wall (ii), sidewise delimiting the recess (ei ), the shapes of seats (gi and hi ) being so selected as to allow the penetration of the lower, inward curved part (v) of the long rod (3) in the seat (hi ) made in the wall (iii), when a fragment of the long, straight part (t) of the long rod (3) penetrates in the elongated seat (gi ), and the upper, outward curved part (w) of the respective rod (3) is placed in the frontal recess (ei ), opposite to which, the body (ci ) having a circular collar (ji ) connected, through a shaped part (ki ), with, a short rod (1i ), the latter being provided with a central circular seat, (mi ), a pierced hole (ni ) being made in the body (oi ), its diameter being so selected as to enable the introduction of. tha long, straight, part (t) of the long rod (3), through it, in view of correcting the curvature, for. which the rod (3) is also introduced through another pierced hole (nii ), drilled in a long body (gii ) of an instrument (7) for lifting the long rod (3) in view of extracting from the bone (9), the body (gii) being ended with an active, upward curved and (hii), in which an upper recess (iii ) is. made, being so shaped as to enable the penetration of the straight, long part (t) of the long rod (3), near the lower, inward curved part (v) of the long rod (3), opposite to the upper recess (iii), the body (gii ) having a circular collar ( jii), connected through a shaped part (kii) With a short rod (lii) in which there is made a circular hole (mii), for the initial introduction of the upper, short rod (1) over a depth of 3...4 cm, in the hole (rvii ) made in the bone (9), using, an instrument (C) composed of a body (25) to which there are fastened an anvil. (26) and a support (27), the anvil (26) having a short, cylindrical part (1vii ), provided with a circular recess (mv) and the support (27) has a threaded rod (nv), which may be respectively introduced/extracted in/from a L-shaped channel (ov), communicating with the outside, made in a band (28), in the latter being also made a longitudinal channel (pv), ended with a circular part (qv), having a dimension higher than that of an end (rv) delimiting at the top side the circular recess (mv) so that it is possible to displace the anvil (26) along the channel (pv), when band (20) is located in front of tha recess. (mv), the fastening of the band (28) to the support (27) being achieved by means of a nut (29) threaded on rod (nv), the body (25) having a straight part (sv) to which there are fastened the anvil (26) and the support (27), delimited by a shor part (tv), inclined as against the longitudinal, straight part (sv) and, respectively by a part (uv) also inclined in tha some direction as the short part ( tv), as against this axis, the inclined part (uv) being connected through a circular collar (vv) and a shaped part (wv) with a short rod (xv), provided with a circular seat (yv), the anvil
(26) having an upper, straight part (zv ), connected with an inclined part (avi ), with the longitudinal axis parallel to that of the short part (tv), provided with an upper, inclined surface (bvi ), parallel to the longirudinal axis of the inclined part (uv), the band (20) baing provided with a shaped end part (cvi ), having, in transversal section, the shape of a circle arc making with the longitudinal axis of the straight part (sv) and angle lower by 5 ... 10° than the angle formed by. the part ( tv) with the same axis, tha final positioning of the upper, short rod (1) in the neck (gvii) being made by means of an instrument (12), which is made up of a short, body (miii), ended with a shaped end (niii), inclined with an angle higher than 90° as against the axis of body (miii) and with a diameter higher than the rest of the body (miii ), provided with a straight, frontal face
(oiii), in the shaped end (niii) baing. made an elongated saat (piii), delimited at the bottom side by a semi-circular wall (giii) so dimensioned that, when introducing the lug (g) of the upper, short rod (1) in it, its part (f) inclined as against a horizontal direction remains outside, the body (miii) being connected through a circular collar (riii) and a shaped part (siii) with a short rod (tiii), provided with a circular seat (uiii), a handle (F) being used for the introduction or extraction of the. short and, respectively long rods (1, 2 and 3) in/from the bone (9), enabling during the operation, to fasten the instrument (4) for the introduction of the short, lower and respectively long rods (2 and 3), of an instrument (5) for the final hammering of the said long. rod, of an instrument (6) for the final introduction or for lifting in view of extracting tha long rod (3) in/from the bone (9), of an instrument (7) for lifting in view of extracting the long rod (3), of an instrument (7) for achieving the adequate line of introducing the long rod (3) in the bone (9), of an instrument, (lo) for extracting from the bone (9) any of the short and, respectively long rods (1, 2 and 3), of an instrument (11) for hammering the short rods (1 and 2), in view of their introducing in the bone (9), of an instrument (12). for the final introduction of the short, upper rod (1), of an instrument (13) for modifying the curvature of tha ends of short rods (1 and 2), of an instrument (14) for extracting the long rod (3) from the bone (9) and, respectively, of an instrument (C) for introducing the short, upper rod (1) over a depth of 3-4 cm, the handle (F) being able to be rotated during the operation for positioning the rod (3) in the medullary channel or the lower, short rod (2) in the neck (qvii), by means of an instrument (17), which is made up of a long, cylindrical body (h), ended respectively with a posterior, oylindrical collar (iv) and a fore, cylindrical collar (jv), having a diameter lower than that of collar (iv), frontally provided with a circular recess (kv), so shaped as to enable the introduction of the intermediary part (n) of the lower, short rod (2) or the lower, inward curved part (v) of the long rod (3).
6. Instrumantation, according, to claim 5, c h a r a c t e r i z e d b y t h e f a c t that the handle (F) is formed of an outside shaped body (52), provided with a longitudinal window (xvi) ended with a flared part (yvi), the window (xvi ) being made in a middle part (zvi) of the body (53), which is continued respectively with a posterior anvil (avi ) and an active, cylindrical end (bvi ) in which there is made a cylindrical,, longitudinal channel (cviii), continued with a recess (diii ) delimited by a shaped wall (evii) communicating with the outside through a cylindrical seat (fvii), in. a plane perpendicular to the plane in which there is placed channel (cvii ), in whose active end (bvii) there is made a cylindrical channel (gvii ), having the longitudinal axis placed under that of tha longitudinal channel (cvii ), communicating with the outside through recesses (hvii and-ivii ) opposed - placed, in which there is placed a lock (54), provided with a fore, thin part (jvii). and a thick, cylindrical, poster rior part (kvii ) in which there are made two circular channels (lvii and mvii ) shifted placed as against the transversal axis of the longitudinal, cylindrical channel (cvii ), the. fore part (jvii ) being mounted undar the action of the force s.tored in a spring (55), which is suppoerted respec tively.on a. shoulder (nvii ) limiting the recess (ivii) and on a fore stopper (56), mounted in connection with tha lock (54), having the possibility to. displace in the recess (ivii ), which enables to bring, as tha case may be, the thin part (jvix) in front of the cylindrical, longitudinal channel (cvii) in the other racess
(hiii) a posterior stopper (57) being placed, with the possibility to displace and forming a single piece with the lock. (54), the cylindrical channel (gvii ) communicating with a channel (evii ) placed in the same place with channel (gvii ) and perpendicular to the latter, in which, under the action of a force stored in a spring (58), a ball (59) is placed which may penetrate, depending on the position of lock (54), in one of the channels (1vii and mvii), the maintaining of the spring (58) in tha last said channel (ovii ) being achieved by means of a screw (60), the rotation of handle (F) around the longitudinal axis, depending on needs, when introducing the short, lower rod (2) or tha long rod (3) in the bona (9) being made by means of the said instrument (17), for the final introduction of the mantionad short rods (2 and.3) into the bone (9), reason for which it is introduced in the flared part (yvi) of the longitudinal window (xvi), all instruments (4, 5, 6, 7, 8, 10, 11, 12, 13, 14 and C), which are manoeuvred by means of handle (F), having. each one of the collars (ji, ti, bii jii, tii, zii, iiii, rii, ziii, riii and vv) , connected through one of the shaped parts (ki , ui , cii, kii, uii, aiii, jii,i siii, aiii, svi, and wv), with one of tha short-rods (Ii, vi, dii, lii, vii, biii,kiii, tiii, biv, tiv and xv), provided with one of the circular seats (m, w, aii, mii, wii, ciii, liii, uiii and yv) which enables their locking by means of lock (54).
7. Instrumentation according to claims 5 and 6 c h a r a c t e r i z e d b y t h e f a c t that for guiding the long rod (3) during its initial introduction in tha bona (9), in other constructive version, it includes an instrument (A), fastened in handle (F), made up of a long body (18), to which there is fastened a jaw (20), by means of a nut (19), the body (18) having a long part (dvi ), connected through a circular collar (eiv) and a. shaped part (fvi ) with a short rod (g iv), provided with a circular seat (biv ), opposed to the collar (aiv), the body (div) being provided with a jaw (iiv) provided on the frontal surface (jiv), with a semi-circular recess (k ) having the longitudinal axis parallel to that of the long part (div) in the extension of jaw (iiv ), a short rod. (liv) outside threaded, and a longitudinal axis in the extension of the long part (div ), serving for guiding the jaw (20), reason for which the latter has a pierced hole (miv ), through which the rod (e penetrates, a recess (niv ) having the same shape as the semi-ciroular recess (kiv ), being positioned, in front of the recess (kiv) of the jaw (iiv ), ba fastening jaw (20), reason for which the latter has a pierced hole (m iv), through which the rod (eiv ) penetrates, a recess (niv) having the same shape as the semi-circular recess (kiv ) being positioned in front of the recess (kiv ) of the jaw (iiv ), by fastening jaw (20) with nut (19).
8. Instrumentation according to claims 5, 6, and 7 c h a r a ct e r i z e d b y t h e f a c t that, for modifying the curvatures from the lower, downward curved and, respectively, lower, outward curved parts (e and o) of the short, upper and, respectively lower rods (1 and 2) and from the straight, long part (t) of the long rod (3), depending on the bone shape (9), in other constructive version, it includes an instrument (D), composed of a sleeve (30) with sidewise flared edges, jointed by moans of a short bolt (31) with a U-shnped support (32), in which there are made respectively a recess (dvi ) and some longitudinal, marginal slits (evi and fvi), separated from the recess (dvi ) by a wall (gvi), a stopper (33) being fastened to the support (32) and coming in contact with two posterior, short arms (34), jointed in turn by means of a short holt (35) with two fore, short arms (36), the latter boing jointed through a bolt (37) to the support (32), in front of the recess (dvi) being also jointed through .this bolt (37) a long, sidewise flattened part (38), in which there are made, along its longitudinal axis, some pierced holes (hvi), the long part (38) having an outer, circular collar (ivi ), serving for limiting the displacing of a sleeve (39), along it, as a result of the contact between the collar (ivi) and a lower step (jvi ) of the sleeve (39) which is sidewise cut out, so that it may come in contact sidewise with part (38) in the sleeve being (39) being made some pierced holes (kvi ) with the some diameter and the same distance between them as those of the othei holes (hvi ), except these latter said holes (kvi ) which are placed along the longitudinal axis of sleeve (39), in the latter being also provided two holes (mvi ) disposed on either side of the longitudinal axis, near a fore inclined end (1vi) the sleeve (39) being able to be closed with a plate (40), in which there are mounted thick bolts (41), which may penetrate through the holes (hvi and kvi ) and, respectively, thin bolts (42) which may pene trate in the two holes (mvi ), in view of achieving a more accentuated curvature of the Ions part (t) of the long rod (3), the posterior arms (34) being provided with sone upper recesses (qvi ), communicating with the outside, placed at the same level when the respective arms (34) are brought in working position, in which the long rod (3) is introduced, the respective rod in this position being placed under the long part (38) and the sleeve (39) and, implicitly, the part (38), the long rod being curved, the modification of the curvatures (e and o) of the short rod (1 and 2), according to the shape of the bone (9), being made by means of sleeve (39) and bolts (41, 42) between which there are introduced the short rods (1 and 2), as the case may be, with the maintaining of part (38) in working position, a bolt (43) being mounted when not working, in the holes (ovi), drilled in the support (32) and the lower ends (pvi) of the arms (34) being introduced in the slits (e and f) and finally, for transport and sterilization requirements, the sleeve (39) and the arms (34) and, respectively, the long part (38) are rotated around bolt (37), so as to bring them in the perimeter delimited by the support (32), position in which they are placed under the wall (gvi), the sleeve (39) being revolved around the bolt (31), being locked in the support (30), the bolta (31, 35 and 37) being secured against loosening nuts (44, 45 and 46), in order to prevent the displacement of the component parts during the transport, namely the short arms (36) and the part (38), two spacing pieces (47) being provided.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| BR8606956A BR8606956A (en) | 1985-11-05 | 1986-09-18 | FLEXIBLE IMPLANTS FOR STABLE FLEXIBLE OSTEOSYNTHESIS OF FEMUR AND TIBIA FRACTURES AND OPERATIONAL INSTRUMENTATION |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| RO120.633 | 1985-11-05 | ||
| RO120633A RO89820B1 (en) | 1985-11-05 | 1985-11-05 | Elastic implants for a stable elastic osteorrhaphy of femoral and tibial fractures, respectively, as well as corresponding instrumentation |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO1987002572A1 true WO1987002572A1 (en) | 1987-05-07 |
Family
ID=20118219
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/RO1986/000001 WO1987002572A1 (en) | 1985-11-05 | 1986-09-18 | Flexible implants for stable flexible osteosynthesis of fractures of femur and tibia, respectively and working instrumentation |
Country Status (7)
| Country | Link |
|---|---|
| US (2) | US5013314A (en) |
| EP (1) | EP0245287A1 (en) |
| CN (1) | CN86106939A (en) |
| BR (1) | BR8606956A (en) |
| DD (2) | DD284597A5 (en) |
| RO (1) | RO89820B1 (en) |
| WO (1) | WO1987002572A1 (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| FR2640491A1 (en) * | 1988-12-21 | 1990-06-22 | Bristol Myers Squibb Co | SURGICAL INSTRUMENT PUSH-ROD |
| EP0425472A1 (en) * | 1989-10-25 | 1991-05-02 | Hans Georg Dr. Ender | Bone nail and tool therefor |
| FR2657005A1 (en) * | 1990-01-15 | 1991-07-19 | Hardy Jean Marie | ENCLOSURE SYSTEM FOR THE TREATMENT OF FRACTURES, PARTICULARLY OF THE CERVICO-TROCHANTERIAN AND PERTROCHANTERIAL TYPE. |
| WO1991010407A1 (en) * | 1990-01-15 | 1991-07-25 | Hardy Jean Marie | Nailing system for treating fractures, particularly cervico-trochanterian and pertrochanterian fractures |
| US5113685A (en) * | 1991-01-28 | 1992-05-19 | Acromed Corporation | Apparatus for contouring spine plates and/or rods |
| FR2722545A1 (en) * | 1994-07-18 | 1996-01-19 | Advanced Technical Fabrication | Hook with undulations along its length for bone fracture repair |
| FR2722396A1 (en) * | 1994-07-18 | 1996-01-19 | Advanced Technical Fabrication | FIXING DEVICE FOR OSTEOSYNTHESIS |
| EP0693272A1 (en) * | 1994-07-18 | 1996-01-24 | Advanced Technical Fabrication | Fixing device for osteosynthesis |
| US6077271A (en) * | 1998-03-06 | 2000-06-20 | Acumed, Inc. | Bone plate vise |
| US10456180B2 (en) | 2002-07-22 | 2019-10-29 | Acumed Llc | Adjustable bone plates |
| US9308033B2 (en) | 2002-07-22 | 2016-04-12 | Acumed Llc | Adjustable bone plates |
| EP1765207A2 (en) * | 2004-06-11 | 2007-03-28 | Synthes GmbH | Intramedullary rod with spiraling flutes |
| EP1765207A4 (en) * | 2004-06-11 | 2009-03-25 | Synthes Gmbh | Intramedullary rod with spiraling flutes |
| EP2301459A1 (en) * | 2004-06-11 | 2011-03-30 | Synthes GmbH | Apparatus for internal fixation of a fracture |
| US11083504B2 (en) | 2008-10-10 | 2021-08-10 | Acumed Llc | Bone fixation system with opposed mounting portions |
| US9808297B2 (en) | 2008-10-10 | 2017-11-07 | Acute Innovations Llc | Bone fixation system with opposed mounting portions |
| US11911083B2 (en) | 2008-10-10 | 2024-02-27 | Acumed Llc | Bone fixation system with opposed mounting portions |
| US8568417B2 (en) | 2009-12-18 | 2013-10-29 | Charles River Engineering Solutions And Technologies, Llc | Articulating tool and methods of using |
| US9924986B2 (en) | 2009-12-18 | 2018-03-27 | Charles River Engineering Solutions And Technologies, Llc | Articulating tool and methods of using |
| US11033306B2 (en) | 2009-12-18 | 2021-06-15 | Charles River Engineering Solutions And Technologies, Llc | Articulating tool and methods of using |
| EP2555694A4 (en) * | 2010-04-05 | 2016-09-07 | Rp Medical Inc | Medical implant extraction device |
| US11039936B2 (en) | 2010-04-05 | 2021-06-22 | Rp Medical Inc. | Medical implant extraction device |
| US9775657B2 (en) | 2011-09-30 | 2017-10-03 | Acute Innovations Llc | Bone fixation system with opposed mounting portions |
| US9237910B2 (en) | 2012-01-26 | 2016-01-19 | Acute Innovations Llc | Clip for rib stabilization |
| US9452005B2 (en) | 2012-08-23 | 2016-09-27 | DePuy Synthes Products, Inc. | Bone fixation system |
| US10716606B2 (en) | 2012-08-23 | 2020-07-21 | DePuy Synthes Products, Inc. | Bone fixation system |
| US10772729B2 (en) | 2012-08-23 | 2020-09-15 | DePuy Synthes Products, Inc. | Bone implant |
| US10004603B2 (en) | 2012-08-23 | 2018-06-26 | DePuy Synthes Products, Inc. | Bone implant |
| US9861406B2 (en) | 2012-08-23 | 2018-01-09 | DePuy Synthes Products, Inc. | Bone fixation system |
| US9510876B2 (en) | 2012-08-23 | 2016-12-06 | DePuy Synthes Products, Inc. | Intramedullary fixation system |
| US10159515B2 (en) | 2014-07-03 | 2018-12-25 | Acumed Llc | Bone plate with movable joint |
| US9956015B2 (en) | 2014-07-03 | 2018-05-01 | Acumed Llc | Bone plate with movable joint |
Also Published As
| Publication number | Publication date |
|---|---|
| BR8606956A (en) | 1988-01-19 |
| CN86106939A (en) | 1987-08-26 |
| US4915092A (en) | 1990-04-10 |
| US5013314A (en) | 1991-05-07 |
| EP0245287A1 (en) | 1987-11-19 |
| RO89820B1 (en) | 2002-06-28 |
| DD284597A5 (en) | 1990-11-21 |
| DD279402A5 (en) | 1990-06-06 |
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