WO1993015678A1 - Osteosynthesis implant assembly and fitting device - Google Patents

Osteosynthesis implant assembly and fitting device Download PDF

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Publication number
WO1993015678A1
WO1993015678A1 PCT/FR1993/000095 FR9300095W WO9315678A1 WO 1993015678 A1 WO1993015678 A1 WO 1993015678A1 FR 9300095 W FR9300095 W FR 9300095W WO 9315678 A1 WO9315678 A1 WO 9315678A1
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WO
WIPO (PCT)
Prior art keywords
assembly
sleeve
viewfinder
plate
series
Prior art date
Application number
PCT/FR1993/000095
Other languages
French (fr)
Inventor
Jean Marie Hardy
Original Assignee
Jean Marie Hardy
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Jean Marie Hardy filed Critical Jean Marie Hardy
Priority to JP5513819A priority Critical patent/JPH06509490A/en
Publication of WO1993015678A1 publication Critical patent/WO1993015678A1/en

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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
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1721—Guides or aligning means for drills, mills, pins or wires for applying pins along or parallel to the axis of the femoral neck
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A61F2002/30339—Double cones, i.e. connecting element having two conical connections, one at each of its opposite ends
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • A61F2002/30616—Sets comprising a plurality of prosthetic parts of different sizes or orientations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3625—Necks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3652—Connections of necks to shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

Definitions

  • the invention relates more particularly to the reduction and fixation of fractures of the upper end of the femur, without excluding other bone ends.
  • osteosynthesis solutions can be considered. Mention may be made, for example, of pins, nails and plates arranged to receive a cephalic screw.
  • the invention relates more particularly, the plates
  • these plates have a shaped support portion to be fixed at the level of the diaphysis of the bone.
  • the upper end of the support part has a hollow hollow sleeve, also known as a barrel. This barrel is oriented angularly with respect to the support part and receives the cephalic screw.
  • the barrel and the support part constitute a monobloc element.
  • connection between the two constituent parts is likely to be embedded in the upper end of the femur, causing a fracture.
  • the object of the invention is to remedy these drawbacks in a simple, safe, efficient and rational manner.
  • the problem which the invention proposes to solve is to design a set of implants which is particularly suitable for 35 osteosynthesis of the femur bone to significantly reduce the stock, while respecting precisely the major axis of the cervix.
  • the assembly comprises in combination, in a modular and interchangeable manner:
  • the end of the plate has angularly, a centering surface shaped to receive with locking capacity in translation and in rotation, a coupling sleeve .
  • the centering surface is constituted by a conical bore cooperating with a complementary conical surface, formed at one of the ends of the sleeve.
  • either the conical bearing is formed in coaxial alignment with the body of the sleeve.
  • a lug appears in overflow at the level of the connection part between the conical bearing surface and the body of the sleeve. , to cooperate with arrangements formed at the end of the centering surface.
  • the arrangements consist of two diametrically opposite notches.
  • the cephalic screw must be placed in the middle of the neck, along its long axis, which, in general, makes an angle of 130 ° with the diaphysis. It is therefore the cephalic screw which gives place to the barrel and consequently to the support plate.
  • a spindle which acts as a guide and which is oriented by a viewfinder, most often held manually.
  • An image intensifier is used to try to determine this axis.
  • the viewfinder allows you to push in the spindle at the angle it gives.
  • Holding the viewfinder in your hand is not very precise. If the aiming is carried out incorrectly, that is to say when the aiming angle does not exactly correspond to the angle formed between the barrel and the support plate, the latter cannot be applied against the diaphysis femoral. Yes despite everything, we want to apply the plate to the diaphysis, the barrel is subjected to a reaction force which acts in a harmful way on the fracture site.
  • a device which comprises a viewfinder equipped with an angularly orientable block, arranged to receive according to different positions, an aiming pin to determine the axis of the neck, said viewfinder being held in position by a spacer device cooperating with the faces of the bone and the soft parts.
  • the viewfinder comprises a base on which is mounted with the ability to move in translation and adjust in position, a support receiving the orientable block mounted with the ability to adjust the angle on two profiled arms. in an arc.
  • Another problem which the invention proposes to solve is to keep the viewfinder in place, while having both hands free.
  • the spacer device has two gripping arms coupled to a support member cooperating with the viewfinder, the faces of the bone and the soft parts, said legs acting by elasticity on said member being held in the locking position with the organ by an adjustable angular locking system.
  • Figure 1 is a perspective view showing the main elements of the prosthetic assembly according to the invention.
  • Figure 2 is a sectional view showing the reduction of a trochanteric fracture using the prosthetic assembly.
  • Figure 3 is a sectional view showing the different angular orientations of the sleeves relative to the plate.
  • Figure 4 is a cross-sectional view taken along line 4.4 of Figure 2.
  • Figure 5 is a perspective view showing the main elements of the delivery device.
  • Figure 6 shows the use of the device for aiming the long axis.
  • Figure 7 is a cross-sectional view taken along line 7.7 of Figure 6.
  • the prosthetic assembly according to the invention comprises a series of support plates (1), a series of coupling sleeves (2), and a series of cephalic screws (3).
  • Each of the support plates (1) has, in a known manner, a series of holes (1a) for fixing it at the level of the femoral shaft.
  • the cross section of the plate (1) is very slightly concave to adapt to the anatomical shape of the femur.
  • the upper end of the plate (1) has angularly, a centering surface (1b).
  • This litter (1b) is shaped to allow coupling in a removable manner, sleeves (2), with locking capacity in translation and in rotation.
  • the centering surface (1b) has a through conical bore (1 b1) cooperating with a complementary conical surface (2a) formed at one end of the sleeve corresponding (2).
  • This assembly by cones (1 b1) (2a) ensures the locking in translation of the sleeve (2) relative to the plate (1).
  • the coupling sleeve (2) is executed in different dimensions and is arranged to be oriented in different angular positions, relative to the centering surface
  • the conical centering surface (2a) is either formed in coaxial alignment with the body (2b) of the sleeve (2), or angularly offset relative to the body ( Figures 1 and 3).
  • the angulation between the bearing surface (2a) and the body (2b) can be 3 °, 6 ° and 10 °.
  • the angulation between the centering surface (1 b) and the plate (1) is of the order of 130 °, corresponding to the anatomical angle between the major axis of the neck and the external side of the femur.
  • each of said sleeves (2) has a lug ( 2c) intended to cooperate with arrangements formed at the end of said centering surface (1b).
  • the cephalic screws (3) are produced in a perfectly known manner -, Q, with a threaded head (3a) and a rod (3b) mounted to slide freely in the bore (2d) of the corresponding sleeve (2) and of the centering surface (1b), the bore of which opens into the support plate (1a).
  • the rod (3b) is locked in rotation by means of flats (3b1) cooperating with flats formed in the bore (2d) of the sleeve (2).
  • a device which essentially comprises a viewfinder (4) and a spacer device (5).
  • the viewfinder (4) comprises a base (4a) on which is mounted with capacity for movement in translation and for position adjustment, a support (4b).
  • the support (4b) is mounted to slide freely in the base (4a) by a dovetail system, while a screw (6), engaged in a lumen of said support, ensures the locking in translation .
  • an orientable block (4c) On the support (4b) is mounted an orientable block (4c) arranged to receive at different positions, an aiming rod (7) to determine the axis of the neck.
  • the block (4c) is articulated at the end of the support (4b) and cooperates with two arms profiled in an arc (4d) while being angularly blocked therein in a corresponding lumen, by means of a system 5 quote.
  • the block (4c) has a series of holes (4c1) arranged in alignment, but offset angularly relative to the perpendicular plane passing through the major axis of the viewfinder.
  • the holes (4c1) are offset by + 5 °, + 10 °, - 5 °, - 10 °.
  • the spacer (5) has two gripping branches (5a) and
  • the member (5c) has a cross section in the shape of an inverted U to cover the cross section of the viewfinder (4), in particular of the support (4b) by presenting two wings (5c1) and
  • each of the wings has, overflowing their internal faces, pins (5c3) intended to grip the bone.
  • the 5 branches (5a) and (5b) act by elasticity on the member (5c), in particular on the vertical wings (5c1) and (5c2) of this member.
  • the retractor (5) is slid into the open position on the faces of the bone between the latter and the soft parts.
  • a bearing action on the branches (5a) (5b) has the effect of bringing the wings (5c1) (5c2) by elasticity thereby ensuring the 5 securing the viewfinder (4) on the bone.
  • the system (8) (9) maintains the position.
  • the viewfinder (4) is placed on the bone, being held there by the retractor (5).
  • the orientable block (4c) is adjusted to the desired angulation (generally 130 ° thus corresponding to the cervico-diaphyseal angle).
  • a pin is placed in the hole (O) of the block, while an image intensifier makes it possible to check whether the point of penetration of the pin is correct. If it is too high, the base is moved back relative to the support.
  • the spindle After having correctly determined the penetration orifice, the spindle is pushed in, following it to the amplifier. If the front axis is not perfect, we change the angulation of the blade holder and we then know the new anguiation. After checking the spindle from the front, the amplifier checks the profile position. If the spindle is not strictly in the axis of the neck, it is removed and placed at + 5 or - 5 ° in ( fe orientable block. Since the plane of the spindle is stationary, any aiming of + 10 ° to - 10 ° is necessarily perfect on the face.

Abstract

An osteosynthesis implant assembly, particularly for the end of the femur, comprises a modifiable, interchangeable combination of: a series of support plates (1) shaped for fixing to the shaft of the femur; a series of coupling sleeves (2) of different lengths and angular position, capable of being secured to the top end of the plate; a series of cephalic screws (3) freely engaging in the sleeves (2) from the top end of the plate.

Description

ENSEMBLE D' IMPLANTS D'OSTEOSYNTHESE ET SON DISPOSITIF DE POSE OSTEOSYNTHESIS IMPLANT ASSEMBLY AND ITS DELIVERY DEVICE
5 L'invention concerne plus particulièrement, la réduction et la fixation des fractures de l'extrémité supérieure du fémur, sans pour cela exclure d'autres extrémités osseuses.The invention relates more particularly to the reduction and fixation of fractures of the upper end of the femur, without excluding other bone ends.
Généralement, on distingue quatre grands types de fractures,Generally, there are four main types of fractures,
, Qà savoir :, Q namely:
- les fractures cervicales vraies entre la tête et le col du fémur,- true cervical fractures between the head and the neck of the femur,
- les fractures basi-cervicales entre le col du fémur et le massif trochantérien,- basi-cervical fractures between the neck of the femur and the trochanteric massif,
- les fractures cervico-trochantériennes dans le massif trochantérien,- cervico-trochanteric fractures in the trochanteric massif,
- les fractures sous-trochantériennes en dessous du massif trochantérien.- sub-trochanteric fractures below the trochanteric massif.
20 En fonction du type de fractures, différentes solutions d'ostéosynthèses peuvent être envisagées. On peut citer par exemple, des broches, des clous et des plaques agencées pour recevoir une vis céphalique. L'invention concerne plus particulièrement, les plaques20 Depending on the type of fracture, different osteosynthesis solutions can be considered. Mention may be made, for example, of pins, nails and plates arranged to receive a cephalic screw. The invention relates more particularly, the plates
25d'appui recevant une vis céphalique.25 support receiving a cephalic screw.
Généralement, ces plaques présentent une partie d'appui conformée pour être fixée au niveau de la diaphyse de l'os. L'extrémité supérieure de la partie d'appui présente un manchon creux débouchant, connu également sous le nom de canon. Ce canon est orienté 30 angulairement par rapport à la partie d'appui et reçoit la vis céphalique. Le canon et la partie d'appui constituent un élément monobloc.Generally, these plates have a shaped support portion to be fixed at the level of the diaphysis of the bone. The upper end of the support part has a hollow hollow sleeve, also known as a barrel. This barrel is oriented angularly with respect to the support part and receives the cephalic screw. The barrel and the support part constitute a monobloc element.
Pour tenir compte des différentes morphologies et des différents types de fractures, il est nécessaire de prévoir différentes 35 longueurs de vis et différents ensembles plaque - canon, avec différentes longueurs du canon et différentes orientations angulaires de ce canon par rapport à la plaque. Il est donc nécessaire d'avoir un stock important pour tenter d'avoir des ensembles plaque - canon, susceptibles de s'adapter le plus possible, à l'angle cervico-diaphysaire.To take into account the different morphologies and different types of fractures, it is necessary to provide for different 35 screw lengths and different plate - barrel assemblies, with different barrel lengths and different angular orientations of this barrel relative to the plate. It is therefore necessary to have a large stock to try to have plate - barrel assemblies, capable of adapting as much as possible, to the cervico-diaphyseal angle.
On connaît également des implants d'ostéosynthèse de l'extrémité du fémur, où le canon et la partie d'appui ne constitue pas unAlso known are osteosynthesis implants of the end of the femur, where the barrel and the support part does not constitute a
_. -.élément monobloc mais sont réalisés en plusieurs parties distinctes. On peut citer par exemple, la demande de brevet WO-A-8804161 qui enseigne un ensemble en deux parties distinctes, à savoir une partie rectiligne d'appui au niveau de la diaphyse fémorale et une partie coudée destinée à recevoir un vis céphalique. Cette solution n'est pas satisfaisante, étant donné que l'on retrouve le même problème que pour un ensemble où le canon et la partie d'appui sont monobloc. En effet, dans cette solution, il n'y a pas de possibilité de modification de l'angle col - diaphyse. Les même inconvénients se retrouvent dans le brevet US_. -.one-piece element but are made in several separate parts. We can cite for example, patent application WO-A-8804161 which teaches an assembly in two distinct parts, namely a straight support part at the level of the femoral shaft and a bent part intended to receive a cephalic screw. This solution is not satisfactory, since we find the same problem as for an assembly where the barrel and the support part are in one piece. Indeed, in this solution, there is no possibility of modification of the angle col - diaphysis. The same drawbacks are found in the US patent
20438762, où de plus, la liaison entre les deux parties constitutives est susceptible de s'encastrer dans l'extrémité supérieure du fémur, en entraînant une fracture.20438762, where moreover, the connection between the two constituent parts is likely to be embedded in the upper end of the femur, causing a fracture.
25 II apparaît donc qu'avec ces autres solutions, il n'est pas possible de corriger une mauvaise pause de la vis céphalique, compte- tenu des différentes angulations nécessaires.It therefore appears that with these other solutions, it is not possible to correct a bad break in the cephalic screw, given the different angulations required.
L'invention s'est fixée pour but de remédier à ces 30 inconvénients, de manière simple, sûre efficace et rationnelle.The object of the invention is to remedy these drawbacks in a simple, safe, efficient and rational manner.
Le problème que se propose de résoudre l'invention est de concevoir un ensemble d'implants particulièrement adapté pour 35 l'ostéosynthèse de l'os du fémur permettant de diminuer de manière importante le stock, tout en respectant de manière précise, le grand axe du col.The problem which the invention proposes to solve is to design a set of implants which is particularly suitable for 35 osteosynthesis of the femur bone to significantly reduce the stock, while respecting precisely the major axis of the cervix.
Un tel problème est résolu en ce que l'ensemble comprend en combinaison, d'une manière modulable et interchangeable :Such a problem is solved in that the assembly comprises in combination, in a modular and interchangeable manner:
- une série de plaques d'appui conformées pour être fixées au niveau de la diaphyse fémorale,- a series of support plates shaped to be fixed at the level of the femoral shaft,
- une série de manchons d'accouplement de longueur et d'orientation angulaire différente, aptes à être rendus solidaires de l'extrémité supérieure de la plaque,- a series of coupling sleeves of different length and angular orientation, capable of being made integral with the upper end of the plate,
- une série de vis céphaliques engagées librement dans les manchons à partir de l'extrémité supérieure de la plaque.- a series of cephalic screws freely engaged in the sleeves from the upper end of the plate.
Pour résoudre le problème posé de pouvoir accoupler la plaque d'appui à différents types de manchons, l'extrémité de la plaque présente angulairement, une portée de centrage conformée pour recevoir avec capacité de blocage en translation et en rotation, un manchon d'accouplement.To solve the problem posed of being able to couple the support plate to different types of sleeves, the end of the plate has angularly, a centering surface shaped to receive with locking capacity in translation and in rotation, a coupling sleeve .
Pour résoudre le problème posé d'assurer l'accouplement entre la plaque et le manchon correspondant, la portée de centrage est Constituée par un alésage conique coopérant avec une portée conique complémentaire, formée à l'une des extrémités du manchon.To solve the problem posed of ensuring the coupling between the plate and the corresponding sleeve, the centering surface is constituted by a conical bore cooperating with a complementary conical surface, formed at one of the ends of the sleeve.
Pour résoudre le problème posé de respecter le grand axe du col et de tenir compte des éventuelles erreurs de visée, :To resolve the problem posed of respecting the long axis of the neck and taking account of possible aiming errors:
- soit la portée conique est formée en alignement coaxial avec le corps du manchon.- either the conical bearing is formed in coaxial alignment with the body of the sleeve.
- soit la portée conique est décalée angulairement, par rapport au corps du manchon.- either the conical bearing is angularly offset, relative to the body of the muff.
Pour résoudre le problème posé d'accoupler les manchons sur la portée correspondante de la plaque d'appui, afin d'obtenir différentes orientations angulaires, un ergot apparaît en débordement au niveau de la partie de raccordement entre la portée conique et le corps du manchon, pour coopérer avec des agencements formés en bout de la portée de centrage. Les agencements sont constitués par deux échancrures diamétralement opposées.To solve the problem posed of coupling the sleeves on the corresponding bearing surface of the support plate, in order to obtain different angular orientations, a lug appears in overflow at the level of the connection part between the conical bearing surface and the body of the sleeve. , to cooperate with arrangements formed at the end of the centering surface. The arrangements consist of two diametrically opposite notches.
Le problème posé d'assurer le blocage angulaire de la vis céphalique dans le manchon correspondant accouplé à la plaque, est résolu en ce que l'alésage du manchon et le corps de la vis sont de section complémentaire présentant au moins un méplat longitudinal.The problem posed of ensuring the angular blocking of the cephalic screw in the corresponding sleeve coupled to the plate, is solved in that the bore of the sleeve and the body of the screw are of complementary section having at least one longitudinal flat.
Selon l'état de la technique cité , un autre problème apparaît au niveau de la pose de ces plaques. En effet, la vis céphalique doit être placée en plein milieu du col, selon son grand axe, qui, en général, fait un angle de 130° avec la diaphyse. C'est donc la vis céphalique qui donne la place au canon et par conséquent à la plaque d'appui. Pour déterminer le grand axe, on utilise une broche qui fait office de guide et qui est orientée par un viseur, tenu le plus souvent manuellement. Un amplificateur de brillance est utilisé pour tenter de déterminer cet axe. Le viseur permet d'enfoncer la broche selon l'angle qu'il donne.According to the cited state of the art, another problem appears at the level of the installation of these plates. Indeed, the cephalic screw must be placed in the middle of the neck, along its long axis, which, in general, makes an angle of 130 ° with the diaphysis. It is therefore the cephalic screw which gives place to the barrel and consequently to the support plate. To determine the major axis, a spindle is used which acts as a guide and which is oriented by a viewfinder, most often held manually. An image intensifier is used to try to determine this axis. The viewfinder allows you to push in the spindle at the angle it gives.
Le fait de tenir le viseur à la main n'est pas très précis. Si la visée est incorrectement effectuée, c'est-à-dire lorsque l'angle de la visée ne correspond pas exactement à l'angle formé entre le canon et la plaque d'appui, cette dernière ne peut s'appliquer contre la diaphyse fémorale. Si l'on veut malgré tout appliquer la plaque sur la diaphyse, le canon est soumis à une force de réaction qui agit de manière néfaste sur le foyer de fracture.Holding the viewfinder in your hand is not very precise. If the aiming is carried out incorrectly, that is to say when the aiming angle does not exactly correspond to the angle formed between the barrel and the support plate, the latter cannot be applied against the diaphysis femoral. Yes despite everything, we want to apply the plate to the diaphysis, the barrel is subjected to a reaction force which acts in a harmful way on the fracture site.
Un autre problème que se propose donc de résoudre l'invention est de mettre en place, dans des conditions optimum, l'ensemble prothétique, tel que défini selon l'invention, en respectant parfaitement, le grand axe du col. Pour résoudre un tel problème, il a été conçu et mis au point un dispositif qui comprend un viseur équipé d'un bloc orientable angulairement, agencé pour recevoir selon différentes positions, une broche de visée pour déterminer l'axe du col, ledit viseur étant maintenu en position par un appareil écarteur coopérant avec les faces de l'os et les parties molles.Another problem which the invention therefore proposes to solve is to set up, under optimum conditions, the prosthetic assembly, as defined according to the invention, while perfectly respecting the major axis of the neck. To solve such a problem, a device has been designed and developed which comprises a viewfinder equipped with an angularly orientable block, arranged to receive according to different positions, an aiming pin to determine the axis of the neck, said viewfinder being held in position by a spacer device cooperating with the faces of the bone and the soft parts.
Pour résoudre le problème posé de respecter le grand axe du col, le viseur comprend une embase sur laquelle est monté avec capacité de déplacement en translation et de réglage en position, un support recevant le bloc orientable monté avec capacité de réglage angulaire sur deux bras profilés en arc de cercle.To solve the problem of respecting the major axis of the neck, the viewfinder comprises a base on which is mounted with the ability to move in translation and adjust in position, a support receiving the orientable block mounted with the ability to adjust the angle on two profiled arms. in an arc.
Un autre problème que se propose de résoudre l'invention est de maintenir en place, le viseur, tout en ayant les deux mains libres.Another problem which the invention proposes to solve is to keep the viewfinder in place, while having both hands free.
Un tel problème est résolu en ce que l'appareil écarteur présente deux branches de préhension accouplées à un organe d'appui coopérant avec le viseur, les faces de l'os et les parties molles, Iesdites branches agissant par élasticité sur ledit organe en étant maintenues en position de blocage avec l'organe par un système de blocage angulaire réglable. L'invention est exposée, ci-après, plus en détail à l'aide des dessins annexés, dans lesquels :Such a problem is solved in that the spacer device has two gripping arms coupled to a support member cooperating with the viewfinder, the faces of the bone and the soft parts, said legs acting by elasticity on said member being held in the locking position with the organ by an adjustable angular locking system. The invention is set out below in more detail with the aid of the appended drawings, in which:
La figure 1 est une vue en perspective montrant les principaux éléments de l'ensemble prothétique selon l'invention.Figure 1 is a perspective view showing the main elements of the prosthetic assembly according to the invention.
La figure 2 est une vue en coupe, montrant la réduction d'une fracture trochantérienne au moyen de l'ensemble prothétique. La figure 3 est une vue en coupe montrant les différentes orientations angulaires des manchons par rapport à la plaque.Figure 2 is a sectional view showing the reduction of a trochanteric fracture using the prosthetic assembly. Figure 3 is a sectional view showing the different angular orientations of the sleeves relative to the plate.
La figure 4 est une vue en coupe transversale considérée selon la ligne 4.4 de la figure 2.Figure 4 is a cross-sectional view taken along line 4.4 of Figure 2.
La figure 5 est une vue en perspective montrant les principaux éléments du dispositif de pose.Figure 5 is a perspective view showing the main elements of the delivery device.
La figure 6 montre l'utilisation du dispositif pour la visée du grand axe.Figure 6 shows the use of the device for aiming the long axis.
La figure 7 est une vue en coupe transversale considérée selon la ligne 7.7 de la figure 6.Figure 7 is a cross-sectional view taken along line 7.7 of Figure 6.
Comme le montre la figure 1 , l'ensemble prothétique selon l'invention, comprend une série de plaques d'appui (1 ), une série de manchons d'accouplement (2), et une série de vis céphalique (3).As shown in FIG. 1, the prosthetic assembly according to the invention comprises a series of support plates (1), a series of coupling sleeves (2), and a series of cephalic screws (3).
Chacune des plaques d'appui (1) présente d'une manière connue, une série de trous (1a) pour sa fixation au niveau de la diaphyse fémorale. La section transversale de la plaque (1 ) est très légèrement concave pour s'adapter à la forme anatomique du fémur.Each of the support plates (1) has, in a known manner, a series of holes (1a) for fixing it at the level of the femoral shaft. The cross section of the plate (1) is very slightly concave to adapt to the anatomical shape of the femur.
Selon l'invention, l'extrémité supérieure de la plaque (1 ) présente angulairement, une portée de centrage (1b). Cette portée (1b) est conformée pour permettre l'accouplement d'une manière démontable, des manchons (2), avec capacité de blocage en translation et en rotation. Dans ce but, comme le montrent les figures 2, 3 et 4 notamment, la portée de centrage (1b) présente un alésage conique débouchant (1 b1 ) coopérant avec une portée conique complémentaire (2a) formée à l'une des extrémités du manchon correspondant (2). Cet assemblage par cônes (1 b1) (2a) permet d'assurer le blocage en translation du manchon (2) par rapport à la plaque (1).According to the invention, the upper end of the plate (1) has angularly, a centering surface (1b). This litter (1b) is shaped to allow coupling in a removable manner, sleeves (2), with locking capacity in translation and in rotation. For this purpose, as shown in Figures 2, 3 and 4 in particular, the centering surface (1b) has a through conical bore (1 b1) cooperating with a complementary conical surface (2a) formed at one end of the sleeve corresponding (2). This assembly by cones (1 b1) (2a) ensures the locking in translation of the sleeve (2) relative to the plate (1).
Comme le montre la figure 1 , le manchon d'accouplement (2) est exécuté selon différentes dimensions et est agencé pour être orienté selon différentes positions angulaires, par rapport à la portée de centrageAs shown in Figure 1, the coupling sleeve (2) is executed in different dimensions and is arranged to be oriented in different angular positions, relative to the centering surface
(1b) de la plaque (1). Dans ce but, la portée de centrage conique (2a) est, soit formée en alignement coaxial avec le corps (2b) du manchon (2), soit décalée angulairement par rapport au corps (figures 1 et 3).(1b) of the plate (1). For this purpose, the conical centering surface (2a) is either formed in coaxial alignment with the body (2b) of the sleeve (2), or angularly offset relative to the body (Figures 1 and 3).
A titre d'exemple indicatif, nullement limitatif, l'angulation entre la portée (2a) et le corps (2b), peut être de 3°, 6° et 10°. En ce qui Q;oncerne l'angulation entre la portée de centrage (1 b) et la plaque (1 ), cette dernière est de l'ordre de 130°, correspondant à l'angle anatomique entre le grand axe du col et la face externe du fémur.As an indicative example, in no way limiting, the angulation between the bearing surface (2a) and the body (2b) can be 3 °, 6 ° and 10 °. Regarding Q; the angulation between the centering surface (1 b) and the plate (1), the latter is of the order of 130 °, corresponding to the anatomical angle between the major axis of the neck and the external side of the femur.
Il est donc possible d'obtenir des angulations cervico- $iaphysaires variant de 120° (130° - 10°) à 140° (130° + 10°) (figure 3).It is therefore possible to obtain cervico-iaphyseal angulations varying from 120 ° (130 ° - 10 °) to 140 ° (130 ° + 10 °) (Figure 3).
Toujours en ayant pour objectif de diminuer le stock, tout en permettant l'accouplement en rotation des manchons par rapport la plaque (1), notamment par rapport à la portée de centrage (1b), chacun desdits manchons (2) présente un ergot (2c) destiné à coopérer avec des agencements formés en bout de ladite portée de centrage (1b). L'ergotStill having the objective of reducing the stock, while allowing the sleeves to rotate in rotation with respect to the plate (1), in particular with respect to the centering surface (1b), each of said sleeves (2) has a lug ( 2c) intended to cooperate with arrangements formed at the end of said centering surface (1b). Ergot
(2c) est formé en débordement au niveau de la partie de raccordement entre la portée conique (2a) et le corps du manchon (2). Cet ergot est 5 destiné à coopérer avec une des deux échancrures (1b2) (1 3) formées diamétralement en bout de la portée de centrage (1b).(2c) is formed in overflow at the connection part between the conical bearing (2a) and the body of the sleeve (2). This lug is 5 intended to cooperate with one of the two notches (1b2) (1 3) formed diametrically at the end of the centering surface (1b).
On conçoit donc qu'en fonction de l'angulation de la portée conique (2a) du manchon et de l'engagement de l'ergot (2c) dans l'une 5 ou l'autre des échancures, on obtiendra une anguiation au dessus ou en dessous du grand axe.It can therefore be seen that, as a function of the angulation of the conical bearing surface (2a) of the sleeve and of the engagement of the lug (2c) in one or the other of the notches, there will be an anguation above or below the major axis.
Les vis céphaliques (3) sont réalisées d'une manière -, Q parfaitement connue, avec une tête filetée (3a) et une tige (3b) montée à libre coulissement dans l'alésage (2d) du manchon correspondant (2) et de la portée de centrage (1 b), dont l'alésage débouche dans la plaque d'appui (1a). Le blocage en rotation de la tige (3b) s'effectue au moyen de méplats (3b1) coopérant avec des méplats formés dans l'alésage (2d) du manchon (2).The cephalic screws (3) are produced in a perfectly known manner -, Q, with a threaded head (3a) and a rod (3b) mounted to slide freely in the bore (2d) of the corresponding sleeve (2) and of the centering surface (1b), the bore of which opens into the support plate (1a). The rod (3b) is locked in rotation by means of flats (3b1) cooperating with flats formed in the bore (2d) of the sleeve (2).
Selon une autre caractéristique importante de l'invention, pour la mise en place de cet ensemble prothétique, on utilise un dispositif qui 20 comprend essentiellement un viseur (4) et un appareil écarteur (5).According to another important characteristic of the invention, for the installation of this prosthetic assembly, use is made of a device which essentially comprises a viewfinder (4) and a spacer device (5).
Comme le montre la figure 5, le viseur (4) comprend une embase (4a) sur laquelle est monté avec capacité de déplacement en 5 translation et de réglage en position, un support (4b). Par exemple, le support (4b) est monté à libre coulissement dans l'embase (4a) par un système en queue d'arronde, tandis qu'une vis (6), engagée dans une lumière dudit support, assure le blocage en translation.As shown in FIG. 5, the viewfinder (4) comprises a base (4a) on which is mounted with capacity for movement in translation and for position adjustment, a support (4b). For example, the support (4b) is mounted to slide freely in the base (4a) by a dovetail system, while a screw (6), engaged in a lumen of said support, ensures the locking in translation .
Sur le support (4b) est monté un bloc orientable (4c) agencé pour recevoir selon différentes positions, une tige de visée (7) pour déterminer l'axe du col. Le bloc (4c) est articulée en bout du support (4b) et coopère avec deux bras profilés en arc de cercle (4d) en y étant bloqué angulairement dans une lumière correspondante, au moyen d'un système 5 de vis. Le bloc (4c) présente une série de trous (4c1 ) disposés en alignement, mais décalés angulairement par rapport au plan perpendiculaire passant par le grand axe du viseur.On the support (4b) is mounted an orientable block (4c) arranged to receive at different positions, an aiming rod (7) to determine the axis of the neck. The block (4c) is articulated at the end of the support (4b) and cooperates with two arms profiled in an arc (4d) while being angularly blocked therein in a corresponding lumen, by means of a system 5 quote. The block (4c) has a series of holes (4c1) arranged in alignment, but offset angularly relative to the perpendicular plane passing through the major axis of the viewfinder.
A titre indicatif, les trous (4c1) sont décalés de + 5° , + 10° , - 5°, - 10°.As an indication, the holes (4c1) are offset by + 5 °, + 10 °, - 5 °, - 10 °.
L'écarteur (5) présente deux branches de préhension (5a) etThe spacer (5) has two gripping branches (5a) and
(5b) reliées à un organe d'appui (5c) conformé pour coopérer avec le Q viseur (4), les faces de l'os et les parties molles (figure 7). L'organe (5c) à une section transversale en forme de U renversé pour coiffer la section du viseur (4), notamment du support (4b) en présentant deux ailes (5c1) et(5b) connected to a support member (5c) shaped to cooperate with the viewfinder Q (4), the faces of the bone and the soft parts (FIG. 7). The member (5c) has a cross section in the shape of an inverted U to cover the cross section of the viewfinder (4), in particular of the support (4b) by presenting two wings (5c1) and
(5c2). Les extrémités de chacune des ailes présentent, en débordement de leurs faces internes, des pions (5c3) destinés à enserrer l'os. Les 5 branches (5a) et (5b) agissent par élasticité sur l'organe (5c), notamment sur les ailes verticales (5c1) et (5c2) de cet organe.(5v2). The ends of each of the wings have, overflowing their internal faces, pins (5c3) intended to grip the bone. The 5 branches (5a) and (5b) act by elasticity on the member (5c), in particular on the vertical wings (5c1) and (5c2) of this member.
Il apparaît donc, lorsque l'on saisit chacune des branches de 0 préhension de l'écarteur, en exerçant un effort dirigé vers le bas, le rapprochement concomitant des ailes (5c1) et (5c2) pour enserrer le viseur et la section de l'os. Le maintien en position d'écartement des deux branches (5a) et (5b) s'effectue par un système de blocage angulaire, par 5 exemple sous forme d'une lame ressort (8) coopérant avec une barre crantée (9). La lame ressort (8) est solidaire de la branche (5b), tandis que la barre crantée (9) est solidaire de l'autre branche (5a).It therefore appears, when entering each of the 0 gripping branches of the retractor, by exerting a downward force, the concomitant bringing together of the wings (5c1) and (5c2) to grip the viewfinder and the section of the 'bone. Maintaining the spacing position of the two branches (5a) and (5b) is effected by an angular locking system, for example in the form of a spring leaf (8) cooperating with a notched bar (9). The leaf spring (8) is integral with the branch (5b), while the notched bar (9) is integral with the other branch (5a).
Il convient d'analyser maintenant le fonctionnement du 0 dispositif pour la mise en place de l'ensemble prothétique. L'écarteur (5) est glissé en position ouverte sur les faces de l'os entre celui-ci et les parties molles. Une action d'appui sur les branches (5a) (5b) a pour effet de rapprocher par élasticité les ailes (5c1 ) (5c2) assurant ainsi la 5 solidarisation du viseur (4) sur l'os. Le système (8) (9) assure le maintien en position.It is now necessary to analyze the operation of the 0 device for the installation of the prosthetic assembly. The retractor (5) is slid into the open position on the faces of the bone between the latter and the soft parts. A bearing action on the branches (5a) (5b) has the effect of bringing the wings (5c1) (5c2) by elasticity thereby ensuring the 5 securing the viewfinder (4) on the bone. The system (8) (9) maintains the position.
Après avoir effectué l'incision, le viseur (4) est placé sur l'os, en y étant maintenu par l'écarteur (5). Le bloc orientable (4c) est réglé à l'angulation voulue (généralement 130° correspondant ainsi à l'angle cervico-diaphysaire). Une broche est placée dans le trou (O) du bloc, tandis qu'un amplificateur de brillance permet de vérifier si le point de ^pénétration de la broche est correct. S'il est trop haut, l'embase est reculée par rapport au support.After making the incision, the viewfinder (4) is placed on the bone, being held there by the retractor (5). The orientable block (4c) is adjusted to the desired angulation (generally 130 ° thus corresponding to the cervico-diaphyseal angle). A pin is placed in the hole (O) of the block, while an image intensifier makes it possible to check whether the point of penetration of the pin is correct. If it is too high, the base is moved back relative to the support.
Après avoir convenablement déterminé l'orifice de pénétration, on enfonce la broche, en la suivant à l'amplificateur. Si l'axe de face n'est pas parfait, on change l'angulation du porte lame et l'on connaît alors la nouvelle anguiation. Après avoir contrôlé la broche de face, l'amplificateur vérifie la position de profil. Si la broche n'est pas strictement dans l'axe du col, on l'enlève et on la place à + 5 ou - 5° dans (fe bloc orientable. Etant donné que le plan de la broche est immobile, toute visée de +10° à - 10° est forcément parfait au niveau de la face.After having correctly determined the penetration orifice, the spindle is pushed in, following it to the amplifier. If the front axis is not perfect, we change the angulation of the blade holder and we then know the new anguiation. After checking the spindle from the front, the amplifier checks the profile position. If the spindle is not strictly in the axis of the neck, it is removed and placed at + 5 or - 5 ° in ( fe orientable block. Since the plane of the spindle is stationary, any aiming of + 10 ° to - 10 ° is necessarily perfect on the face.
Les avantages ressortent bien de la description, en particulier on souligne et on rappelle : 5The advantages are clear from the description, in particular it is emphasized and recalled: 5
- La diminution du stock de pièces.- The decrease in the stock of parts.
- L'interchangeabilité des manchons d'accouplement pour orienter d'une manière précise la vis céphalique en fonction du grand axe.- Interchangeability of the coupling sleeves to precisely orient the cephalic screw according to the major axis.
- La simplicité et l'efficacité du dispositif pour la mise en place 0 de l'ensemble.- The simplicity and efficiency of the device for setting up 0 of the assembly.
35 35

Claims

R E V E N D I C A T I O N S R E V E N D I C A T I O N S
-1- Ensemble d'implants d'ostéosynthèse de l'extrémité supérieure du fémur notamment, caractérisé en ce qu'il comprend en combinaison, d'une manière modulable et interchangeable :-1- Set of osteosynthesis implants of the upper end of the femur in particular, characterized in that it comprises in combination, in a modular and interchangeable manner:
- une série de plaques d'appui (1) conformées pour être fixées au niveau de la diaphyse fémorale,- a series of support plates (1) shaped to be fixed at the level of the femoral shaft,
- une série de manchons d'accouplement (2) de longueur et d'orientation Q angulaire différentes, aptes à être rendus solidaires de l'extrémité supérieure de la plaque,- a series of coupling sleeves (2) of different angular length and orientation Q , capable of being made integral with the upper end of the plate,
- une série de vis céphaliques (3) engagées librement dans les manchons (2) à partir de l'extrémité supérieure de la plaque.- a series of cephalic screws (3) freely engaged in the sleeves (2) from the upper end of the plate.
55
-2- Ensemble selon la revendication 1 , caractérisé en ce que l'extrémité de la plaque (1) présente angulairement, une portée de centrage (1b) conformée pour recevoir avec capacité de blocage en translation et en rotation, un manchon d'accouplement (2). 0-2- The assembly of claim 1, characterized in that the end of the plate (1) has angularly, a centering surface (1b) shaped to receive with locking capacity in translation and in rotation, a coupling sleeve (2). 0
-3- Ensemble selon la revendication 2, caractérisé en ce que la portée de centrage (1b) est constituée par un alésage conique débouchant (1 b1) coopérant avec une portée conique complémentaire (2a), formée à l'une 5 des extrémités du manchon (2).-3- The assembly of claim 2, characterized in that the centering surface (1b) is constituted by a through conical bore (1 b1) cooperating with a complementary conical surface (2a), formed at one of the ends of the sleeve (2).
-4- Ensemble selon la revendication 3, caractérisé en ce que la portée conique (2a) est formée en alignement coaxial avec le- corps (2b) du manchon (2). 0-4- The assembly of claim 3, characterized in that the conical bearing (2a) is formed in coaxial alignment with the- body (2b) of the sleeve (2). 0
-5- Ensemble selon la revendication 3, caractérisé en ce que la portée conique (2a) est décalée angulairement, par rapport au corps (2b) du manchon (2). 5 -6- Ensemble selon la revendication 3, caractérisé en ce qu'un ergot (2c) apparaît en débordement au niveau de la partie de raccordement entre la portée conique (2a) et le corps (2b) du manchon (2), pour coopérer avec des agencements (1 b2) (1 b3) formés en bout de la portée de centrage (1b).-5- An assembly according to claim 3, characterized in that the conical surface (2a) is angularly offset, relative to the body (2b) of the sleeve (2). 5 -6- The assembly of claim 3, characterized in that a lug (2c) appears in overflow at the connection portion between the conical bearing (2a) and the body (2b) of the sleeve (2), to cooperate with arrangements (1 b2) (1 b3) formed at the end of the centering surface (1b).
-7- Ensemble selon la revendication 6, caractérisé en ce que les Q agencements (1 b2) (1 b3) sont constitués par deux échancrures diamétralement opposées.-7- The assembly of claim 6, characterized in that the Q arrangements (1 b2) (1 b3) are constituted by two diametrically opposite notches.
-8- Ensemble selon la revendication 3, caractérisé en ce que l'alésage (2d) du manchon (2) et le corps (3b) de la vis (3) sont de section complémentaire présentant au moins un méplat longitudinal pour assurer le blocage angulaire de la vis.-8- The assembly of claim 3, characterized in that the bore (2d) of the sleeve (2) and the body (3b) of the screw (3) are of complementary section having at least one longitudinal flat to ensure locking angular of the screw.
-9- Dispositif de pose de l'ensemble selon l'une quelconque des 0 revendications 1 à 8, caractérisé en ce qu'il comprend un viseur (4) équipé d'un bloc (4c) orientable angulairement, agencé pour recevoir selon différentes positions, une broche de visée (7) pour déterminer l'axe du col, ledit viseur (4) étant maintenu en position par un appareil écarteur (5) 5 coopérant avec les faces de l'os et les parties molles.-9- Device for installing the assembly according to any one of claims 0 to 8, characterized in that it comprises a viewfinder (4) equipped with a block (4c) angularly adjustable, arranged to receive according to different positions, an aiming pin (7) to determine the axis of the neck, said viewfinder (4) being held in position by a spacer device (5) 5 cooperating with the faces of the bone and the soft parts.
-10- Dispositif de pose de l'ensemble selon la revendication 9, caractérisé en ce que le viseur (4) comprend une embase (4a) sur laquelle est monté avec capacité de déplacement en translation et de réglage en position, un support (4b) recevant le bloc orientable (4c) monté avec capacité de réglage angulaire sur deux bras profilés en arc de cercle (4d).-10- Device for installing the assembly according to claim 9, characterized in that the viewfinder (4) comprises a base (4a) on which is mounted with capacity for displacement in translation and adjustment in position, a support (4b ) receiving the orientable block (4c) mounted with angular adjustment capacity on two arms profiled in an arc (4d).
-11- Dispositif de pose de l'ensemble selon la revendication 9, caractérisé 5 en ce que l'appareil écarteur (4) présente deux branches de préhension (5a) (5b) accouplées à un organe d'appui (5c) coopérant avec le viseur (4), les faces de l'os et les parties molles, Iesdites branches (5a) (5b) agissant notamment par élasticité sur ledit organe (5c) en étant maintenues en position de blocage avec l'organe (5c) par un système de blocage angulaire réglable (8) (9). -11- Device for installing the assembly according to claim 9, characterized 5 in that the spacer device (4) has two gripping branches (5a) (5b) coupled to a support member (5c) cooperating with the viewfinder (4), the faces of the bone and the soft parts, Said branches (5a) (5b) acting in particular by elasticity on said member (5c) while being held in the locking position with the member (5c) by an adjustable angular locking system (8) (9).
PCT/FR1993/000095 1992-02-05 1993-01-29 Osteosynthesis implant assembly and fitting device WO1993015678A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP5513819A JPH06509490A (en) 1992-02-05 1993-01-29 Osteopathic planting assemblies and fixtures

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR92/01529 1992-02-05
FR9201529A FR2686788A1 (en) 1992-02-05 1992-02-05 Set of osteosynthesis implants, especially for the end of the femur, and its fitting device

Publications (1)

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WO1993015678A1 true WO1993015678A1 (en) 1993-08-19

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EP (1) EP0578807A1 (en)
JP (1) JPH06509490A (en)
FR (1) FR2686788A1 (en)
WO (1) WO1993015678A1 (en)

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US11529176B2 (en) 2016-09-08 2022-12-20 DePuy Synthes Products, Inc. Variable angle bone plate
US10820930B2 (en) 2016-09-08 2020-11-03 DePuy Synthes Products, Inc. Variable angle bone plate
US10905476B2 (en) 2016-09-08 2021-02-02 DePuy Synthes Products, Inc. Variable angle bone plate
US10624686B2 (en) 2016-09-08 2020-04-21 DePuy Synthes Products, Inc. Variable angel bone plate
US11026727B2 (en) 2018-03-20 2021-06-08 DePuy Synthes Products, Inc. Bone plate with form-fitting variable-angle locking hole
US10772665B2 (en) 2018-03-29 2020-09-15 DePuy Synthes Products, Inc. Locking structures for affixing bone anchors to a bone plate, and related systems and methods
US11013541B2 (en) 2018-04-30 2021-05-25 DePuy Synthes Products, Inc. Threaded locking structures for affixing bone anchors to a bone plate, and related systems and methods
US10925651B2 (en) 2018-12-21 2021-02-23 DePuy Synthes Products, Inc. Implant having locking holes with collection cavity for shavings

Also Published As

Publication number Publication date
EP0578807A1 (en) 1994-01-19
FR2686788A1 (en) 1993-08-06
JPH06509490A (en) 1994-10-27

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