WO1995032675A1 - Osteosynthesis device comprising fixator inserts - Google Patents

Osteosynthesis device comprising fixator inserts Download PDF

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Publication number
WO1995032675A1
WO1995032675A1 PCT/FR1995/000711 FR9500711W WO9532675A1 WO 1995032675 A1 WO1995032675 A1 WO 1995032675A1 FR 9500711 W FR9500711 W FR 9500711W WO 9532675 A1 WO9532675 A1 WO 9532675A1
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WO
WIPO (PCT)
Prior art keywords
base
bone
cap
bars
screw
Prior art date
Application number
PCT/FR1995/000711
Other languages
French (fr)
Inventor
Pierre Barreau
Original Assignee
Pierre Barreau
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 Pierre Barreau filed Critical Pierre Barreau
Publication of WO1995032675A1 publication Critical patent/WO1995032675A1/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
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7011—Longitudinal element being non-straight, e.g. curved, angled or branched

Definitions

  • the present invention relates to an osteosynthesis device for veterinary applications but also for applications in human medicine, more particularly in pediatric surgery.
  • the practitioner is required to immobilize the bone ends relative to one another in order to allow the formation of a callus in good conditions.
  • Document FR-A-2 689 750 describes an anchoring element comprising a head which can be expanded and a device composed of anchoring elements of the screw type, connectors and rods.
  • the screw with radial expansion head is introduced into a pre-drilling in order to penetrate the bone until leaving the head alone protruding.
  • a connector comprises a base through at least a portion through which the rods in translation pass and a flange screwed on the base which blocks the rods relative to the base.
  • the connector includes a second hole in which the head of the screw is housed, a head which can then be expanded.
  • the assembly is carried out in the following way: -seat of the screws; -setting up of the bars through the bases of the connectors;
  • Document GB-A-2 178 323 also describes a device for fixing one or more bars, but more particularly applied to vertebral surgery.
  • This device comprises, as before, an anchoring screw to which is attached a base in two parts, one upper and the other lower, each provided with a through hole, allowing the mounting of the base on the screw .
  • the lower part of the base is keyed with a flat or a key to ensure anti-rotation of the base relative to the screw head.
  • the upper part of the base also includes anti-rotation means with respect to the lower part.
  • a nut / lock nut assembly ensures the blocking in axial translation of the base on the head after assembly and allows the upper part of the base to be clamped on the lower part in order to block the bars.
  • the problem posed concerns the anchoring of the fixing screws of the hoof in the cancellous bone of the sacrum. Therefore, the shoes are designed to be fixed using at least two screws, inclined with respect to each other, while the bar locking screw is located directly in contact with the bar. block in the hoof.
  • Each shoe must have a sufficient height, so that the bar locking screw screws with a sufficient number of threads, so that there is necessarily a significant bulk.
  • This very specific application leads to complex parts which are used only at the end of an assembly comprising other specific means of attachment to the other vertebrae.
  • Such shoes are only applicable to independent double bar assemblies, they are bulky, they can only be of a high cost price and do not solve the same problem as the present invention.
  • the device of this European application is totally unusable on the long bones of a small animal, for example in veterinary surgery.
  • the document FR-A-2 697 744 relates to a spinal instrumentation comprising at least two blocks each comprising two recesses provided for each receiving a bar. At the bottom of each recess forming a groove, there is provided at least one hole through which a bone fixing screw can pass.
  • the blocking is obtained by drawers mounted slidingly parallel to the bottom of each groove. Screws ensure the translational locking of these drawers by wedge effect. Tightening effects are obtained by slopes oriented so as to press the drawers against the bars.
  • Such blocks are of a complexity incompatible with the envisaged applications, both by the resulting bulk, by the number of parts required, or by the precision required for machining.
  • US-A-4 805 602 is to block a base on a bone and to ensure the clamping of a bar by an indirect clamping effect by means of a head.
  • This head comprises a threaded part which screws into a nut mounted free in rotation relative to the base but retained in translation by this base. Indeed, the head being grooved, it cannot rotate.
  • Such a device nevertheless remains too complex since it requires numerous machining operations, and the bearing surface on the bone is limited for too large a space due to the nut screwing onto an external thread formed on the base. Another problem also arises for practitioners when they have to reduce the fracture before it is immobilized.
  • the present invention therefore also relates to the ancillary device associated with the device according to the present invention.
  • the osteosynthesis device comprises coaptors attached to the bony ends of a fractured bone or vertebrae, two rigid connecting bars between said coaptors, and is characterized in that each coaptor comprises: a base, having a lower face and an upper face, each base being provided, on the one hand, for being fixed directly to the bone by at least one fixing screw, said lower face of each base being opposite, in contact and pressing on the cortex of the bone, and on the other hand, to receive each rigid connecting bar in a groove, formed on said upper face;
  • a bar blocking cap provided to come from its lower face in abutment on said bars, and - means for tightening the cap on the bars and means for fixing the base to the bone.
  • the means for tightening the cap comprise a thread formed in the base, a screw secured to the locking cap, the thread profile of which is conjugated with that of said thread and means for driving the cap in rotation relative to the base, such as flaps, and the means for fixing the base to the bone include two screws arranged through holes machined in the base.
  • the screw secured to the locking cap comprises a blind hole, coaxial with the longitudinal axis of the screw, opening at the free end of the screw, said hole being provided for receiving a pin, in particular for fixing 'a splice, said hole preferably being frustoconical and the spindle, cylindrical, to effect jamming.
  • the invention also includes variants in which the means for tightening the cap and the means for fixing the base to the bone are combined and unique and comprise a single screw whose head rests in a central hole in the cap and the body of which passes through the base through a hole for screwing into the bone, the cap comprising on its underside two grooves identical to the grooves made in the base. More particularly, the cap comprises a smooth guide pin, designed to cooperate with a counterbore made in the central hole made in the base.
  • One of the embodiments proposes a central hole tapped with the pitch of the thread of the single screw whose body is threaded over a sufficient length so as to tighten the cap on the bars and the base.
  • the underside of the base has a concave or convex radius of curvature and a value adapted to the profile of the bone in line with the location to which said base is attached.
  • each base there is also provided, on each base, a peripheral groove disposed between the upper and lower faces of the base and designed to receive the ends of a spacer and / or a compressor.
  • the device comprises, in addition to the coaptors and bars, a stiffener, comprising two upper and lower plates, the longitudinal edges of which are shaped into gutters to receive the bars, as well as means for clamping said plates one against the other.
  • the invention also includes a spacer or compressor comprising two branches, substantially parallel, one of them being slidingly mounted on an axis integral with the other branch with means for blocking in translation of this branch on the axis, and attachment members each comprising two annular sectors, substantially in X, oriented in a plane perpendicular to that which contains the branches.
  • FIG. 3 a view in longitudinal section along line 3-3 of FIG. 2
  • FIG. 4 a view of an assembly of the device according to the invention on a multiple fracture
  • FIG. 6 a view of a spacer according to the invention
  • FIG 1 there is shown the diaphyseal part 10 of a bone having a fracture 1 2, delimiting two bone ends 1 3 and 1 5.
  • the osteosynthesis device according to the invention as shown comprises two rigid bars 14 of circular section, four coaptors 1 6, the bars being oriented parallel to the longitudinal axis of the bone and the coaptors being distributed two on each side of the divide.
  • the rigid bars 14 are bars of biocompatible material, in this case stainless steel.
  • each co-sensor 1 6 is composed of a base 18 and a cap 20.
  • the base 1 8 is a disc which comprises a lower face 22, an upper face 24 and a flank 26.
  • the underside 22 is in contact with the cortex 28 of the bone on which said coaptor is attached.
  • the underside is concave in the transverse plane, the curvature being adapted to the diameter of the bone in the case of this long bone, but may be convex in the case of some specific bones.
  • the base comprises a central thread 30, opening out, oriented perpendicular to the faces and two holes 31 oriented parallel to the thread and arranged on either side of this thread according to a diameter, as can be seen in FIG. 3.
  • the upper face 24 comprises two grooves 32, of a diameter identical to that of the bars and of a depth less than half a diameter.
  • a groove 36 is formed in the sidewall 26 of the base, over the entire periphery.
  • the cap 20 is also a disc with a diameter identical to that of the base but with a smaller thickness.
  • It comprises a lower face 38, an upper face 40 and a sidewall 42.
  • the sidewall 42 includes flaps 44 intended to cooperate with a tightening key not shown but of known type, such as an eye wrench.
  • the upper face 40 is free.
  • the underside 38 includes a screw 46 machined with the cap.
  • This screw 46 has a diameter and a thread provided for cooperating with the central thread 30 of the base.
  • the screw further comprises a central bore 48, blind and opening at the end of the screw.
  • this bore 48 is slightly frustoconical.
  • FIG 2 there is shown in broken lines a spacer 49, as shown in Figures 6 and 7.
  • This spacer comprises two branches 50 and 52 and a connecting axis
  • This connecting axis 54 is integral with the first branch 50 while the second branch, provided with a hole 56, is slidably mounted on this axis.
  • the second branch 52 is movable in translation on this axis, substantially parallel to the first branch.
  • a thumb wheel 58 secured to the second branch ensures the removable blocking of this branch on the connecting axis 54.
  • gripping means 60 are provided in the form of handles 62.
  • the other end of each of these branches carries hooking members 64, which are annular sectors 66, oriented substantially perpendicular to the plane containing the branches.
  • the practitioner places at least one base 1 8 on each of the bone buttocks 1 3 and 1 5. For this, he positions the base so that the curvature matches the profile of the bone, in a suitable location and function of the fracture, location that the practitioner is able to determine.
  • the holes 31 of the base are aligned with a generator of the bone.
  • screws After drilling and tapping, he places screws in these holes and makes them penetrate by rotation into the cortex of the bone, the only one capable of mechanically retaining the base.
  • These screws are of known type and commonly used in surgery. They are made of biocompatible material such as stainless steel, and the thread is special for good grip in the bone material.
  • the anchor can be reinforced.
  • the practitioner chooses a screw of sufficient length to pass through the bone and enter the cortex at a diametrically opposite point of the bone.
  • the base With the two screws in place, the base is fixed to the bone. It does the same for the other base (s). In the case where the prior reduction of the fracture is necessary, the practitioner proceeds by using the bases thus fixed on either side of the fracture and the spacer 49.
  • the retractor according to the invention is again used but this time for the compression of the bone ends.
  • the gripping member can be produced in a variant with two additional sectors 65, associated in X. with the first sectors 66.
  • the locking of the wheel 58 allows compression to be maintained.
  • the number of coaptors, the dimensions of the discs and of the bars depend on the dimensions of the bone and these choices are part of the know-how of the practitioners.
  • FIG. 4 shows a device according to the invention for a particular application to a multiple fracture, which includes a sizing of dimensions sufficient for it to be attached, this is the use of the bore 48.
  • the cap has a screw part
  • the coaptor arranged in the central part above the sash is mounted on the bars 14 held by other coaptors forming bridging but it is not fixed on the sash.
  • pin 82 This allows pin 82 to be fixed through the splint, until it comes into the cortex of the bone.
  • the free end is provided to be fixed in the bore 48 reserved in the screw 46.
  • the end of the spindle being cylindrical, it locks in the frustoconical bore, the dimensions having been provided to obtain this wedging effect.
  • FIG. 5 there is shown a first alternative embodiment of a co-sensor 1 6.
  • the references are identical to those of the preceding figures but increased by 100, this for the elements common to the two embodiments.
  • the base 1 1 8 comprises grooves 1 32 and a peripheral groove 1 36 as well as a central bore 1 30.
  • the cap 1 20 comprises a central hole 1 21 and a guide pin 1 23, projecting under the lower face 1 38 opposite the upper face 1 24 of the base. Unlike the first embodiment, the cap includes grooves 125, similar to grooves 132.
  • the central hole 130 of the base is not tapped and includes a countersink 133 designed to receive the guide pin 1 23 which is also smooth without threading.
  • the holes 31 in the base of the first embodiment are eliminated in favor of a single screw which passes through the cap and the base and screws into the bone. Note that, in this case, the central screw simultaneously secures the base on the bone and the tightening of the cap on the base with the blocking of the connecting bars.
  • This variant is of a lower cost price because the machining is less numerous and its use can be reserved for common cases, the bone having to present a solid cortex.
  • holes may be provided allowing the fixing screws to pass through the bone with a diameter slightly greater than that of the body of the screw and with a milling greater than the dimensions of the screw head.
  • the practitioner can introduce and screw the screw at a variable angle of inclination, which in particular makes it possible to avoid opening into or passing through the medullary canal, by improving the fixation of the coaptors.
  • coaptors can be placed progressively with the bars in place, as soon as two of the coaptors are fixed on the bone.
  • the ends of the branches will be adapted so that the practitioner can rest on the different bases without being hindered by said spacers during the positioning of the bars and caps.
  • FIG. 5A a variant which is also very advantageous has been shown in the case, in particular, of fragile bones or suffering from certain diseases such as osteoporosis.
  • the anchoring may be insufficient to ensure the fixing of the co-sensor and the resumption of the clamping forces, there is provided a thread 231 in the base, at the pitch of the screw, screw which is itself threaded over a sufficient length.
  • the other elements remain unchanged with respect to FIG. 5 and bear identical references, increased by 1 00.
  • the tightening of the cap 220 on the base 21 8 can be very significant and independent of the penetration of the screw 221 in the bone, penetration which is carried out effortlessly, while maintaining the base pressed against the bone by its underside 222.
  • a stiffener can also be used
  • This stiffener is installed after mounting of the coaptors 1 6 and the bars 14. It comprises two rectangular plates 302 and 304 with a width substantially equal to the distance separating the bars. The edges longitudinal, the plates comprise gutters 306, shaped to receive the bars 14.
  • At least one hole 308, 31 0 is also provided, designed to receive a screw, the hole 310 being tapped.
  • the screw makes it possible to tighten the two plates one against the other, immobilizing the bars, in a complementary manner to the coaptors by stiffening the assembly.

Abstract

Osteosynthesis device comprising fixators (16) inserted in the bone ends (13, 15) of a fractured bone or vertebra, with two rigid rods (14) connecting said fixators. The invention is characterized in that each fixator comprises a seat element (18, 118, 218) having a lower face (22, 122, 222) and an upper face (24, 124, 224), each seat element being directly secured to the bone (10) by at least one anchoring screw, the lower face (22, 122, 222) of each seat element being opposite one another and resting on the cortical substance of the bone, and each rigid connecting rod (14) being inserted in a groove (32, 132, 232) formed in said upper face (24, 124, 224) of each seat element; a cap (20, 120, 220) for locking the rods (14), with the lower face (38, 138, 238) thereof coming into engagement with said rods (14); means for clamping said cap (20, 120, 220) to said rods (14) and means for securing said seat element (18, 118, 228) to the bone (10).

Description

DISPOSITIF D'OSTEOSYNTHESE A COAPTEURS RAPPORTES OSTEOSYNTHESIS DEVICE WITH ADDED SENSORS
La présente invention a pour objet un dispositif d'ostéosynthèse pour les applications vétérinaires mais aussi pour des applications à la médecine humaine, plus particulièrement à la chirurgie pédiatrique.The present invention relates to an osteosynthesis device for veterinary applications but also for applications in human medicine, more particularly in pediatric surgery.
Dans le cas d'une fracture simple ou multiple, le praticien est amené à immobiliser les abouts osseux les uns par rapport aux autres afin de permettre la formation d'un cal dans de bonnes conditions.In the case of a single or multiple fracture, the practitioner is required to immobilize the bone ends relative to one another in order to allow the formation of a callus in good conditions.
Seule une immobilisation efficace et peu traumatisante peut garantir un résultat satisfaisant.Only an effective immobilization with little trauma can guarantee a satisfactory result.
Il existe des systèmes, dits fixateurs externes, qui nécessitent des éléments mécaniques formant broches qui traversent les abouts osseux et dont la fixation est réalisée à l'extérieur du membre fracturé par des entretoises et des raidisseurs, réglables.There are systems, called external fixators, which require mechanical elements forming pins which pass through the osseous buttocks and the fixing of which is carried out outside of the fractured member by adjustable spacers and stiffeners.
La mise en saillie de certains éléments du système le rend encombrant. De plus, il se pose un problème de stabilisation de la fracture car les bases des raidisseurs sont éloignées du foyer de la fracture, eloignement préjudiciable à une immobilisation efficace. En outre, ces fixateurs externes ne sont pas adaptés pour toutes les indications et notamment pour les applications à des fractures du fémur.The protrusion of certain elements of the system makes it bulky. In addition, there is a problem of stabilization of the fracture because the bases of the stiffeners are far from the focal point of the fracture, distance detrimental to effective immobilization. In addition, these external fixators are not suitable for all indications and in particular for applications to fractures of the femur.
Le document FR-A-2 689 750 décrit un élément d'ancrage comprenant une tête pouvant être expansée et un dispositif composé d'éléments d'ancrage du type vis, des connecteurs et des tiges. La vis avec tête à expansion radiale est introduite dans un préperçage afin de pénétrer l'os jusqu'à laisser la tête seule en saillie.Document FR-A-2 689 750 describes an anchoring element comprising a head which can be expanded and a device composed of anchoring elements of the screw type, connectors and rods. The screw with radial expansion head is introduced into a pre-drilling in order to penetrate the bone until leaving the head alone protruding.
Un connecteur comprend un socle à travers au moins une partie duquel les tiges en translation passent et une bride vissée sur le socle qui bloque les tiges par rapport au socle.A connector comprises a base through at least a portion through which the rods in translation pass and a flange screwed on the base which blocks the rods relative to the base.
Le connecteur comprend un second trou dans lequel vient se loger la tête de la vis, tête qui peut ensuite être expansée.The connector includes a second hole in which the head of the screw is housed, a head which can then be expanded.
Ainsi, le montage s'effectue de la façon suivante : -mise en place des vis ; -mise en place des barres à travers les socles des connecteurs ;Thus, the assembly is carried out in the following way: -seat of the screws; -setting up of the bars through the bases of the connectors;
-montage de la bride ; -montage de chacun des socles sur les têtes de vis correspondantes ; -pré-expansion des têtes et pré-serrage des brides ; -expansion et serrage définitifs.-mounting of the flange; -mounting of each of the bases on the corresponding screw heads; - pre-expansion of the heads and pre-tightening of the flanges; -final expansion and tightening.
Le document GB-A-2 178 323 décrit aussi un dispositif de fixation d'une ou plusieurs barres, mais plus particulièrement appliqué à la chirurgie vertébrale.Document GB-A-2 178 323 also describes a device for fixing one or more bars, but more particularly applied to vertebral surgery.
Ce dispositif comprend, comme précédemment, une vis d'ancrage sur laquelle est rapportée une embase en deux parties, l'une supérieure et l'autre inférieure, munie chacune d'un trou traversant, permettant le montage de l'embase sur la vis.This device comprises, as before, an anchoring screw to which is attached a base in two parts, one upper and the other lower, each provided with a through hole, allowing the mounting of the base on the screw .
La partie inférieure de l'embase est clavetée avec un méplat ou une clavette afin d'assurer l'anti-rotation de l'embase par rapport à la tête de vis.The lower part of the base is keyed with a flat or a key to ensure anti-rotation of the base relative to the screw head.
La partie supérieure de l'embase comprend également des moyens d'anti- rotation par rapport à la partie inférieure.The upper part of the base also includes anti-rotation means with respect to the lower part.
Enfin, un ensemble écrou/contre-écrou assure le blocage en translation axiale de l'embase sur la tête après montage et permet le serrage de la partie supérieure de l'embase sur la partie inférieure afin de bloquer les barres.Finally, a nut / lock nut assembly ensures the blocking in axial translation of the base on the head after assembly and allows the upper part of the base to be clamped on the lower part in order to block the bars.
Ces deux parties sont, bien entendu, munies d'une gorge, orientées dans un plan perpendiculaire à l'axe de la vis et décentrées par rapport à cet axe. Les gorges sont munies de cannelures prévues pour coopérer avec des cannelures conjuguées portées par des barres de liaison disposées, de façon connue, entre les embases. Ce dispositif présente le même inconvénient principal que celui précédemment évoqué, à savoir : l'embase est supportée par la tête de vis qui forme ancrage sans que l'embase vienne en appui sur l'os.These two parts are, of course, provided with a groove, oriented in a plane perpendicular to the axis of the screw and off-center with respect to this axis. The grooves are provided with grooves intended to cooperate with conjugate grooves carried by connecting bars arranged, in known manner, between the bases. This device has the same main drawback as that mentioned above, namely: the base is supported by the screw head which forms an anchorage without the base coming to bear on the bone.
On remarque également que cet agencement a commencé à résoudre le problème des barres qui peuvent être mises en place sur toutes les parties inférieures des embases, par dessus, cette opération étant suivie d'un montage une à une des parties supérieures qui assurent le blocage des barres.We also note that this arrangement has started to solve the problem of the bars which can be put in place on all the lower parts of the bases, from above, this operation being followed by mounting one by one of the upper parts which ensure the blocking of the bars.
Néanmoins, les pièces restent d'un usinage complexe avec des profils délicats et un encombrement relativement important, ce qui rend également ce dispositif difficilement applicable dans les domaines de la chirurgie vétérinaire et pédiatrique. Il faut de plus, des résistances mécaniques suffisantes pour chacune des pièces, ce qui exclut des dimensionnements trop limités. Dans le cas des os longs, notamment, ce dispositif ne peut pas être appliqué car les écrou et contre-écrou prennent trop de place en hauteur. Il faut de plus, ancrer toutes les vis à leur place définitive avant le montage des barres.However, the parts remain complex machining with delicate profiles and a relatively large size, which also makes this device difficult to apply in the fields of veterinary and pediatric surgery. In addition, sufficient mechanical strengths are required for each of the parts, which precludes too limited sizing. In the case of long bones, in particular, this device cannot be applied because the nut and lock nut take up too much space in height. It is also necessary to anchor all the screws in their final place before mounting the bars.
Le document EP-A-0 441 688 décrit un sabot de prise sacrée qui est très spécifique du fait de son application spécifique.Document EP-A-0 441 688 describes a sacred catch shoe which is very specific due to its specific application.
Le problème posé concerne l'ancrage des vis de fixation du sabot dans l'os spongieux du sacrum. De ce fait, les sabots sont prévus pour être fixés à l'aide d'au moins deux vis, inclinées l'une par rapport à l'autre, tandis que la vis de blocage des barres se situe directement en contact avec la barre à bloquer dans le sabot.The problem posed concerns the anchoring of the fixing screws of the hoof in the cancellous bone of the sacrum. Therefore, the shoes are designed to be fixed using at least two screws, inclined with respect to each other, while the bar locking screw is located directly in contact with the bar. block in the hoof.
Il est en outre prévu des sabots droit et gauche pour cette application spécifique afin que chacun soit parfaitement adapté au profil de la partie du sacrum sur laquelle il est apposé et chaque sabot ne peut comprendre qu'une barre.Right and left hooves are also provided for this specific application so that each one is perfectly adapted to the profile of the part of the sacrum on which it is affixed and each hoof can only include one bar.
Chaque sabot doit avoir une hauteur suffisante, pour que la vis de blocage des barres visse avec un nombre suffisant de filets, si bien qu'il y a nécessairement un encombrement important. Cette application très spécifique conduit à des pièces complexes qui ne sont utilisées qu'en extrémité d'un montage comprenant d'autres moyens spécifiques de fixation sur les autres vertèbres. De tels sabots ne sont applicables qu'à des montages à double barres indépendantes, ils sont encombrants, ils ne peuvent qu'être d'un prix de revient élevé et ne résolvent pas le même problème que la présente invention.Each shoe must have a sufficient height, so that the bar locking screw screws with a sufficient number of threads, so that there is necessarily a significant bulk. This very specific application leads to complex parts which are used only at the end of an assembly comprising other specific means of attachment to the other vertebrae. Such shoes are only applicable to independent double bar assemblies, they are bulky, they can only be of a high cost price and do not solve the same problem as the present invention.
En effet, le dispositif de cette demande européenne est totalement inutilisable sur des os long d'un petit animal, par exemple en chirurgie vétérinaire.Indeed, the device of this European application is totally unusable on the long bones of a small animal, for example in veterinary surgery.
Le document FR-A-2 697 744, concerne une instrumentation rachidienne comprenant au moins deux blocs comportant chacun deux évidements prévus pour recevoir chacun une barre. Au fond de chaque évidement formant gorge, il est prévu au moins un trou à travers lequel peut passer une vis de fixation de l'os.The document FR-A-2 697 744 relates to a spinal instrumentation comprising at least two blocks each comprising two recesses provided for each receiving a bar. At the bottom of each recess forming a groove, there is provided at least one hole through which a bone fixing screw can pass.
Le blocage est obtenu par des tiroirs montés coulissants parallèlement au fond de chaque gorge. Des vis assurent le blocage en translation de ces tiroirs par effet de coin. Des effets de serrage sont obtenus par des pentes orientées en sorte de plaquer les tiroirs contre les barres. De tels blocs sont d'une complexité incompatible avec les applications envisagées, tant par l'encombrement qui en résulte, que par le nombre de pièces nécessaires, ou encore par la précision requise des usinages.The blocking is obtained by drawers mounted slidingly parallel to the bottom of each groove. Screws ensure the translational locking of these drawers by wedge effect. Tightening effects are obtained by slopes oriented so as to press the drawers against the bars. Such blocks are of a complexity incompatible with the envisaged applications, both by the resulting bulk, by the number of parts required, or by the precision required for machining.
En sus, si la barre n'est pas parfaitement conformée, il n'y a pas de possibilité de mettre en place les tiroirs et de bloquer les barres. Si le tiroir venait à être introduit de façon incomplète, les barres maintenues sur une faible longueur, conduiraient à un montage instable.In addition, if the bar is not perfectly shaped, there is no possibility of setting up the drawers and blocking the bars. If the drawer were to be introduced in an incomplete way, the bars kept on a short length, would lead to an unstable assembly.
Il est impossible d'envisager l'utilisation de telles pièces pour l'ostéosynthèse d'un fémur de chat ou d'un rachis de nouveau-né. Le dispositif US-A-4 805 602 a pour but de bloquer une embase sur un os et d'assurer le serrage d'une barre par un effet de serrage indirect au moyen d'une tête. Cette tête comprend une partie filetée qui visse dans un écrou monté libre en rotation par rapport à l'embase mais retenu en translation par cette embase. En effet, la tête étant rainurée, elle ne peut pas tourner. Un tel dispositif reste néanmoins trop complexe puisqu'il nécessite des usinages nombreux, et la surface d'appui sur l'os est restreinte pour un encombrement trop important dû à l'écrou vissant sur un filetage externe ménagé sur l'embase. Il se pose également un autre problème pour les praticiens lorsqu'ils sont amenés à réduire la fracture préalablement à son immobilisation.It is impossible to envisage the use of such parts for osteosynthesis of a cat femur or a newborn spine. The object of US-A-4 805 602 is to block a base on a bone and to ensure the clamping of a bar by an indirect clamping effect by means of a head. This head comprises a threaded part which screws into a nut mounted free in rotation relative to the base but retained in translation by this base. Indeed, the head being grooved, it cannot rotate. Such a device nevertheless remains too complex since it requires numerous machining operations, and the bearing surface on the bone is limited for too large a space due to the nut screwing onto an external thread formed on the base. Another problem also arises for practitioners when they have to reduce the fracture before it is immobilized.
Les instruments mis à leur disposition sont assez encombrants et spécifiques. Il s'agit d'un temps opératoire assez délicat et parfois difficile, qu'il faut faire suivre d'un temps de mise en place de l'appareillage d'immobilisation par les coapteurs.The instruments at their disposal are quite bulky and specific. This is a fairly delicate and sometimes difficult operating time, which must be followed by a time for setting up the immobilization equipment by the coaptors.
Cette réduction est bien souvent utile car on a remarqué qu'une compression adaptée des deux abouts osseux d'une fracture permet la formation d'un cal dans de meilleures conditions. La présente invention concerne donc également l'ancillaire associé au dispositif selon la présente invention.This reduction is very often useful because it has been observed that suitable compression of the two bony abutments of a fracture allows the formation of a callus in better conditions. The present invention therefore also relates to the ancillary device associated with the device according to the present invention.
Le brevet US-3 997 138 décrit un ancillaire du type de celui qui sera exposé dans la description qui va suivre, aux perfectionnements près, propres à l'ancillaire nécessaire pour la mise en place des coapteurs selon la présente invention.US Pat. No. 3,997,138 describes an ancillary of the type which will be set out in the description which follows, with the exception of improvements, specific to the ancillary necessary for the installation of the coaptors according to the present invention.
Certaines fractures du type multiple posent un autre problème car il faut traiter les fragments lorsqu'ils sont suffisamment gros de manière à opérer une reconstitution la plus complète possible de l'os.Certain fractures of the multiple type pose another problem since it is necessary to treat the fragments when they are sufficiently large so as to effect the most complete possible reconstruction of the bone.
C'est le but de l'invention de proposer un dispositif simple qui pallie les inconvénients des appareils de l'art antérieur, qui permet de traiter les différents types de fractures y compris les fractures de vertèbres, les luxations ou les instabilités, qui est interne, qui assure un très bon positionnement des abouts osseux et un excellent maintien en position avec une rigidité suffisante, qui permet la réduction préalable de la fracture de façon aisée en utilisant une partie des éléments du présent dispositif mais aussi une mise en compression si cela s'avère nécessaire, qui demande un ancillaire peu important, qui limite le traumatisme et qui trouve son application tant dans le domaine vétérinaire que dans le domaine de la médecine humaine aux dimensions et conformations près.It is the object of the invention to provide a simple device which overcomes the drawbacks of the devices of the prior art, which makes it possible to treat the various types of fractures including vertebral fractures, dislocations or instabilities, which is internal, which ensures very good positioning of the osseous buttocks and excellent retention in position with sufficient rigidity, which allows the prior reduction of the fracture in an easy manner using a part of the elements of the present device but also a compression if this proves necessary, which requires a small ancillary, which limits the trauma and which finds its application both in the veterinary field and in the field of human medicine within dimensions and conformations.
A cet effet, le dispositif d'ostéosynthèse comprend des coapteurs rapportés sur les abouts osseux d'un os fracturé ou de vertèbres, deux barres rigides de liaison entre lesdits coapteurs, et se caractérise en ce que chaque coapteur comprend : - une embase, ayant une face inférieure et une face supérieure, chaque embase étant prévue, d'une part pour être fixée directement sur l'os par au moins une vis de fixation, ladite face inférieure de chaque embase étant en vis à vis, au contact et en appui sur la corticale de l'os, et d'autre part, pour recevoir chaque barre rigide de liaison dans une rainure, ménagée sur ladite face supérieure ;To this end, the osteosynthesis device comprises coaptors attached to the bony ends of a fractured bone or vertebrae, two rigid connecting bars between said coaptors, and is characterized in that each coaptor comprises: a base, having a lower face and an upper face, each base being provided, on the one hand, for being fixed directly to the bone by at least one fixing screw, said lower face of each base being opposite, in contact and pressing on the cortex of the bone, and on the other hand, to receive each rigid connecting bar in a groove, formed on said upper face;
- un capuchon de blocage des barres prévu pour venir par sa face inférieure en appui sur lesdites barres, et - des moyens de serrage du capuchon sur les barres et des moyens de fixation de l'embase sur l'os.- A bar blocking cap provided to come from its lower face in abutment on said bars, and - means for tightening the cap on the bars and means for fixing the base to the bone.
Selon une caractéristique particulière, les moyens de serrage du capuchon, ce capuchon ayant une face inférieure plane, comprennent un taraudage ménagé dans l'embase, une vis solidaire du capuchon de blocage, dont le profil du filetage est conjugué à celui dudit taraudage et des moyens d'entraînement en rotation du capuchon par rapport à l'embase, tels que des pans, et les moyens de fixation de l'embase sur l'os comprennent deux vis disposées à travers des trous usinés dans l'embase.According to a particular characteristic, the means for tightening the cap, this cap having a flat lower face, comprise a thread formed in the base, a screw secured to the locking cap, the thread profile of which is conjugated with that of said thread and means for driving the cap in rotation relative to the base, such as flaps, and the means for fixing the base to the bone include two screws arranged through holes machined in the base.
Selon un perfectionnement, la vis solidaire du capuchon de blocage comprend un trou borgne, coaxial à l'axe longitudinal de la vis, débouchant à l'extrémité libre de la vis, ledit trou étant prévu pour recevoir une broche, notamment pour la fixation d'une esquille, ledit trou étant de préférence tronconique et la broche, cylindrique, pour assurer en effet de coincement.According to an improvement, the screw secured to the locking cap comprises a blind hole, coaxial with the longitudinal axis of the screw, opening at the free end of the screw, said hole being provided for receiving a pin, in particular for fixing 'a splice, said hole preferably being frustoconical and the spindle, cylindrical, to effect jamming.
L'invention comprend aussi des variantes dans lesquelles les moyens de serrage du capuchon et les moyens de fixation de l'embase sur l'os sont confondus et uniques et comprennent une seule vis dont la tête prend appui dans un trou central ménagé dans le capuchon et dont le corps traverse l'embase à travers un trou pour visser dans l'os, le capuchon comprenant sur sa face inférieure deux rainures identiques aux rainures ménagées dans l'embase. Plus particulièrement, le capuchon comprend un pion de guidage lisse, prévu pour coopérer avec un lamage ménagé dans le trou central ménagé dans l'embase. Un des modes de réalisation propose un trou central taraudé au pas du filetage de la vis unique dont le corps est fileté sur une longueur suffisante en sorte de serrer le capuchon sur les barres et l'embase.The invention also includes variants in which the means for tightening the cap and the means for fixing the base to the bone are combined and unique and comprise a single screw whose head rests in a central hole in the cap and the body of which passes through the base through a hole for screwing into the bone, the cap comprising on its underside two grooves identical to the grooves made in the base. More particularly, the cap comprises a smooth guide pin, designed to cooperate with a counterbore made in the central hole made in the base. One of the embodiments proposes a central hole tapped with the pitch of the thread of the single screw whose body is threaded over a sufficient length so as to tighten the cap on the bars and the base.
Une caractéristique importante de l'invention est que la face inférieure de l'embase a un rayon de courbure concave ou convexe et d' une valeur adaptée au profil de l'os au droit de l'emplacement sur lequel est rapportée ladite embase.An important characteristic of the invention is that the underside of the base has a concave or convex radius of curvature and a value adapted to the profile of the bone in line with the location to which said base is attached.
Il est en outre prévu, sur chaque embase, une gorge périphérique disposée entre les faces supérieures et inférieures de l'embase et prévue pour recevoir les extrémités d'un écarteur et/ou d'un compresseur.There is also provided, on each base, a peripheral groove disposed between the upper and lower faces of the base and designed to receive the ends of a spacer and / or a compressor.
En complément, le dispositif comprend, en plus des coapteurs et des barres, un rigidificateur, comportant deux plaques supérieure et inférieure, dont les bords longitudinaux sont conformés en gouttières pour recevoir les barres, ainsi que des moyens de serrage desdites plaques l'une contre l'autre. L'invention comprend aussi un écarteur ou compresseur comportant deux branches, sensiblement parallèles, l' une d'entre elles étant montée coulissante sur un axe solidaire de l'autre branche avec des moyens de blocage en translation de cette branche sur l'axe, et des organes d'accrochage comprenant chacun deux secteurs annulaires, sensiblement en X, orientés dans un plan perpendiculaire à celui qui contient les branches.In addition, the device comprises, in addition to the coaptors and bars, a stiffener, comprising two upper and lower plates, the longitudinal edges of which are shaped into gutters to receive the bars, as well as means for clamping said plates one against the other. The invention also includes a spacer or compressor comprising two branches, substantially parallel, one of them being slidingly mounted on an axis integral with the other branch with means for blocking in translation of this branch on the axis, and attachment members each comprising two annular sectors, substantially in X, oriented in a plane perpendicular to that which contains the branches.
Le dispositif de la présente invention est décrit ci-après de façon à en faire apprécier tout l'intérêt et à en faire ressortir tous les avantages, ceci en regard de dessins annexés relatifs à trois modes de réalisation, dessins sur lesquels les figures suivantes représentent : - Figure 1 , une vue en perspective d'un os long fracturé équipé du dispositif d'ostéosynthèse selon l'invention,The device of the present invention is described below so as to make it appreciate all the interest and to highlight all the advantages, this with regard to the accompanying drawings relating to three embodiments, drawings in which the following figures represent : - Figure 1, a perspective view of a long fractured bone equipped with the osteosynthesis device according to the invention,
- Figure 2, une vue en coupe transversale suivant la ligne 2-2 de la figure 1 ,- Figure 2, a cross-sectional view along line 2-2 of Figure 1,
- Figure 3, une vue en coupe longitudinale suivant la ligne 3-3 de la figure 2,FIG. 3, a view in longitudinal section along line 3-3 of FIG. 2,
- Figure 4, une vue d'un montage du dispositif selon l'invention sur une fracture multiple,FIG. 4, a view of an assembly of the device according to the invention on a multiple fracture,
- Figure 5, une vue d'une variante de réalisation des coapteurs, - Figure 5A, une vue d'une variante de réalisation avec un taraudage dans l'embase,- Figure 5, a view of an alternative embodiment of the coaptors, - Figure 5A, a view of an alternative embodiment with a thread in the base,
- Figure 6, une vue d'un écarteur selon l'invention,FIG. 6, a view of a spacer according to the invention,
- Figure 7, une vue en coupe suivant la ligne 7-7 de la figure 6, - Figure 8, une vue en coupe détaillée d'une variante de l'organe d'accrochage d'un écarteur/ compresseur, et- Figure 7, a sectional view along line 7-7 of Figure 6, - Figure 8, a detailed sectional view of a variant of the attachment member of a spacer / compressor, and
- Figure 9, une vue d'un rigidificateur faisant l'objet d'un perfectionnement de l'invention.- Figure 9, a view of a stiffener subject to an improvement of the invention.
Sur la figure 1 , on a représenté la partie diaphysaire 10 d'un os comportant une fracture 1 2, délimitant deux abouts osseux 1 3 et 1 5.In Figure 1, there is shown the diaphyseal part 10 of a bone having a fracture 1 2, delimiting two bone ends 1 3 and 1 5.
Le dispositif d'ostéosynthèse selon l'invention tel que représenté comprend deux barres 14 rigides à section circulaire, quatre coapteurs 1 6, les barres étant orientées parallèlement à l'axe longitudinal de l'os et les coapteurs étant répartis deux de chaque côté de la fracture. Les barres rigides 14 sont des barres en matériau biocompatible, en l'occurrence de l'acier inoxydable.The osteosynthesis device according to the invention as shown comprises two rigid bars 14 of circular section, four coaptors 1 6, the bars being oriented parallel to the longitudinal axis of the bone and the coaptors being distributed two on each side of the divide. The rigid bars 14 are bars of biocompatible material, in this case stainless steel.
Ainsi que cela est montré sur la figure 2, chaque coapteur 1 6 est composé d'une embase 18 et d'un capuchon 20.As shown in FIG. 2, each co-sensor 1 6 is composed of a base 18 and a cap 20.
L'embase 1 8 est un disque qui comprend une face inférieure 22, une face supérieure 24 et un flanc 26.The base 1 8 is a disc which comprises a lower face 22, an upper face 24 and a flank 26.
La face inférieure 22 est en contact avec la corticale 28 de l'os sur lequel est rapporté ledit coapteur.The underside 22 is in contact with the cortex 28 of the bone on which said coaptor is attached.
Dans le but d'assurer une bonne assise à l'embase, la face inférieure est concave dans le plan transversal, la courbure étant adaptée au diamètre de l'os dans le cas de cet os long, mais pouvant être convexe dans le cas de certains os spécifiques.In order to ensure a good seat at the base, the underside is concave in the transverse plane, the curvature being adapted to the diameter of the bone in the case of this long bone, but may be convex in the case of some specific bones.
L'embase comprend un taraudage central 30, débouchant, orienté perpendiculairement aux faces et deux trous 31 orientés parallèlement au taraudage et disposés de part et d'autre de ce taraudage suivant un diamètre, comme cela est visible sur la figure 3.The base comprises a central thread 30, opening out, oriented perpendicular to the faces and two holes 31 oriented parallel to the thread and arranged on either side of this thread according to a diameter, as can be seen in FIG. 3.
Ce diamètre est confondu avec la génératrice médiane de la face inférieure concave. La face supérieure 24 comprend deux rainures 32, d 'un diamètre identique à celui des barres et d ' une profondeur inférieure à un demi diamètre.This diameter coincides with the median generatrix of the concave underside. The upper face 24 comprises two grooves 32, of a diameter identical to that of the bars and of a depth less than half a diameter.
Une gorge 36 est ménagée dans le flanc 26 de l'embase, sur toute la périphérie. Le capuchon 20 est également un disque avec un diamètre identique à celui de l'embase mais avec une épaisseur plus faible.A groove 36 is formed in the sidewall 26 of the base, over the entire periphery. The cap 20 is also a disc with a diameter identical to that of the base but with a smaller thickness.
Il comprend une face inférieure 38, une face supérieure 40 et un flanc 42.It comprises a lower face 38, an upper face 40 and a sidewall 42.
Le flanc 42 comprend des pans 44 prévus pour coopérer avec une clé de serrage non représentée mais de type connu, tel qu'une clé à oeil. La face supérieure 40 est libre.The sidewall 42 includes flaps 44 intended to cooperate with a tightening key not shown but of known type, such as an eye wrench. The upper face 40 is free.
La face inférieure 38 comprend une vis 46 venue d' usinage avec le capuchon.The underside 38 includes a screw 46 machined with the cap.
Cette vis 46 a un diamètre et un filetage prévus pour coopérer avec le taraudage central 30 de l'embase. La vis comporte de plus un alésage 48, central, borgne et débouchant à l'extrémité de la vis.This screw 46 has a diameter and a thread provided for cooperating with the central thread 30 of the base. The screw further comprises a central bore 48, blind and opening at the end of the screw.
Plus particulièrement cet alésage 48 est légèrement tronconique.More particularly, this bore 48 is slightly frustoconical.
Sur la figure 2, on a représenté en trait discontinu un écarteur 49, tel qu'il est présenté sur les figures 6 et 7. Cet écarteur comprend deux branches 50 et 52 ainsi qu' un axe de liaisonIn Figure 2, there is shown in broken lines a spacer 49, as shown in Figures 6 and 7. This spacer comprises two branches 50 and 52 and a connecting axis
54.54.
Cet axe de liaison 54 est solidaire de la première branche 50 tandis que la seconde branche, munie d'un trou 56, est montée coulissante sur cet axe.This connecting axis 54 is integral with the first branch 50 while the second branch, provided with a hole 56, is slidably mounted on this axis.
La seconde branche 52 est mobile en translation sur cet axe, sensiblement parallèlement à la première branche.The second branch 52 is movable in translation on this axis, substantially parallel to the first branch.
Une molette 58 solidaire de la seconde branche assure le blocage amovible de cette branche sur l'axe de liaison 54.A thumb wheel 58 secured to the second branch ensures the removable blocking of this branch on the connecting axis 54.
A l'une des extrémités de chacune des branches, il est prévu des moyens de préhension 60 sous forme de poignées 62. L'autre extrémité de chacune de ces branches portent des organes d'accrochage 64, qui sont des secteurs annulaires 66, orientés sensiblement perpendiculairement au plan contenant les branches. La mise en oeuvre du dispositif selon l'invention est indiquée ci-après, à l'aide des figures 1 à 4 et en complément les figures 6 et 7.At one end of each of the branches, gripping means 60 are provided in the form of handles 62. The other end of each of these branches carries hooking members 64, which are annular sectors 66, oriented substantially perpendicular to the plane containing the branches. The implementation of the device according to the invention is indicated below, with the aid of FIGS. 1 to 4 and in addition to FIGS. 6 and 7.
Le praticien place au moins une embase 1 8 sur chacun des abouts osseux 1 3 et 1 5. Pour cela, il positionne l'embase pour que la courbure épouse le profil de l'os, en un endroit adapté et fonction de la fracture, endroit que le praticien est apte à déterminer.The practitioner places at least one base 1 8 on each of the bone buttocks 1 3 and 1 5. For this, he positions the base so that the curvature matches the profile of the bone, in a suitable location and function of the fracture, location that the practitioner is able to determine.
Les trous 31 de l'embase sont alignés avec une génératrice de l'os.The holes 31 of the base are aligned with a generator of the bone.
Après perçage et taraudage, il place des vis dans ces trous et les fait pénétrer par rotation dans la corticale de l'os, seule à même de retenir mécaniquement l'embase. Ces vis sont de type connu et couramment utilisées en chirurgie. Elles sont en matériau biocompatible tel que l' inox, et le filetage est particulier pour bien accrocher dans la matière osseuse.After drilling and tapping, he places screws in these holes and makes them penetrate by rotation into the cortex of the bone, the only one capable of mechanically retaining the base. These screws are of known type and commonly used in surgery. They are made of biocompatible material such as stainless steel, and the thread is special for good grip in the bone material.
Si cela est nécessaire, l'ancrage peut être renforcé. Dans ce cas, le praticien choisit une vis d'une longueur suffisante pour traverser l'os et pénétrer dans la corticale en un point diamétralement opposé de l'os.If necessary, the anchor can be reinforced. In this case, the practitioner chooses a screw of sufficient length to pass through the bone and enter the cortex at a diametrically opposite point of the bone.
Les deux vis étant mises en place, l'embase est fixée sur l'os. Il procède de même pour la ou les autres embases. Dans le cas où la réduction préalable de la fracture est nécessaire, le praticien y procède en utilisant les embases ainsi fixées de part et d'autre de la fracture et Pécarteur 49.With the two screws in place, the base is fixed to the bone. It does the same for the other base (s). In the case where the prior reduction of the fracture is necessary, the practitioner proceeds by using the bases thus fixed on either side of the fracture and the spacer 49.
En effet, il suffit de positionner les secteurs 66 dans les gorges de deux coapteurs distincts et d'écarter les branches en translation relative. La molette 58 permet de bloquer l'écarteur en position ouverte durant la phase d'alignement.Indeed, it suffices to position the sectors 66 in the grooves of two separate coaptors and to separate the branches in relative translation. The wheel 58 makes it possible to block the retractor in the open position during the alignment phase.
Ensuite, il suffit de dévisser la molette pour que les abouts osseux se rapprochent.Then, just unscrew the wheel so that the bone ends come closer.
Néanmoins, dans certains cas, il peut être utile de comprimer les deux abouts après alignement, ou tout au moins de les maintenir dans cette position.However, in some cases, it may be useful to compress the two ends after alignment, or at least to keep them in this position.
L'écarteur selon l'invention est de nouveau utilisé mais cette fois pour la mise en compression des abouts osseux. En effet ainsi que cela est représenté sur la figure 8, l'organe de préhension peut être réalisé selon une variante avec deux secteurs supplémentaires 65, associés en X. avec les premiers secteurs 66.The retractor according to the invention is again used but this time for the compression of the bone ends. In fact, as shown in FIG. 8, the gripping member can be produced in a variant with two additional sectors 65, associated in X. with the first sectors 66.
Il suffit de réutiliser les embases, plus particulièrement les deux embases disposées de part et d'autre de la fracture avec les secteurs 65 et de resserrer les branches.It suffices to reuse the bases, more particularly the two bases arranged on either side of the fracture with the sectors 65 and to tighten the branches.
Le blocage de la molette 58 permet un maintien en compression.The locking of the wheel 58 allows compression to be maintained.
Dès la fin de ces opérations si elles se sont avérées nécessaires ou dès la mise en place de toutes les embases, le praticien dispose une première et une seconde barres de liaison 14 dans les rainures correspondantes 32.As soon as these operations have ended, if they have proved necessary, or as soon as all the bases have been fitted, the practitioner has first and second connecting bars 14 in the corresponding grooves 32.
Il place ensuite un premier capuchon 20 sur l'embase la plus appropriée en tournant à la main puis à la clé ce capuchon pour que la vis 46 pénètre et visse dans le taraudage 30 jusqu'à ce que la face inférieure 38 de ce capuchon vienne au contact des barres 14. II procède de la même façon en guidant les barres dans les rainures des autres embases.He then places a first cap 20 on the most appropriate base by turning by hand then with the key this cap so that the screw 46 penetrates and screws into the tapping 30 until the underside 38 of this cap comes in contact with the bars 14. It proceeds in the same way by guiding the bars in the grooves of the other bases.
Il suffit alors de serrer, ensuite, plus fermement les capuchons pour éviter tout glissement des barres dans les rainures et assurer un bon montage.It then suffices to tighten, then, more firmly the caps to prevent any sliding of the bars in the grooves and to ensure a good assembly.
Si le compresseur est toujours en place, il est retiré latéralement car on constate que les secteurs sont disposés à l'extrémité de prolongateurs, ce qui déporte les barres en dehors de la zone de travail et de mise en place des barres.If the compressor is still in place, it is removed laterally because it can be seen that the sectors are arranged at the end of the extenders, which offset the bars outside the work area and the positioning of the bars.
Le nombre de coapteurs, les dimensions des disques et des barres sont fonction des dimensions de l'os et ces choix font partie du savoir-faire des praticiens.The number of coaptors, the dimensions of the discs and of the bars depend on the dimensions of the bone and these choices are part of the know-how of the practitioners.
Sur la figure 4, on a représenté un dispositif selon l'invention pour une application particulière à une fracture multiple, qui comprend une esquille de dimensions suffisantes pour qu'elle soit rapportée, c'est là l'utilisation de l'alésage 48. Dans le cas où il n'y a pas d 'esquille, le capuchon présente une partie visFIG. 4 shows a device according to the invention for a particular application to a multiple fracture, which includes a sizing of dimensions sufficient for it to be attached, this is the use of the bore 48. In the case where there is no splint, the cap has a screw part
46 pleine, l'alésage 48 étant supprimé.46 full, the bore 48 being deleted.
Cette esquille est référencée 80 et la broche qui la soutient, 82. Les autres éléments identiques à ceux des figures précédentes portent les mêmes références que sur ces autres figures.This sketch is referenced 80 and the pin which supports it, 82. The other elements identical to those of the preceding figures bear the same references as in these other figures.
Dans ce cas, le coapteur, disposé dans la partie centrale au dessus de l'esquille est monté sur les barres 14 tenues par d 'autres coapteurs formant pontage mais il n'est pas fixé sur l'esquille.In this case, the coaptor, arranged in the central part above the sash is mounted on the bars 14 held by other coaptors forming bridging but it is not fixed on the sash.
Cela permet de fixer la broche 82 à travers l'éclat, jusqu'à venir dans la corticale de l'os.This allows pin 82 to be fixed through the splint, until it comes into the cortex of the bone.
L'extrémité libre est prévue pour se fixer dans l'alésage 48 réservé dans la vis 46. L'extrémité de la broche étant cylindrique, elle se bloque dans l'alésage tronconique, les dimensions ayant été prévues pour obtenir cet effet de coincement.The free end is provided to be fixed in the bore 48 reserved in the screw 46. The end of the spindle being cylindrical, it locks in the frustoconical bore, the dimensions having been provided to obtain this wedging effect.
Le praticien doit ensuite bloquer le capuchon de ce coapteur comme ceux des autres coapteurs à la fin de l'intervention. Sur la figure 5, on a représenté une première variante de réalisation d 'un coapteur 1 6.The practitioner must then lock the cap of this coaptor like those of other coaptors at the end of the intervention. In Figure 5, there is shown a first alternative embodiment of a co-sensor 1 6.
Les références sont identiques à celles des figures précédentes mais augmentées de 100, ceci pour les éléments communs aux deux modes de réalisation. L'embase 1 1 8 comprend des rainures 1 32 et une gorge périphérique 1 36 ainsi qu'un alésage central 1 30.The references are identical to those of the preceding figures but increased by 100, this for the elements common to the two embodiments. The base 1 1 8 comprises grooves 1 32 and a peripheral groove 1 36 as well as a central bore 1 30.
Le capuchon 1 20 comprend un trou central 1 21 et un pion de guidage 1 23, en saillie sous la face inférieure 1 38 en vis à vis de la face supérieure 1 24 de l'embase. Contrairement au premier mode de réalisation, le capuchon comprend des rainures 125, analogues aux rainures 132.The cap 1 20 comprises a central hole 1 21 and a guide pin 1 23, projecting under the lower face 1 38 opposite the upper face 1 24 of the base. Unlike the first embodiment, the cap includes grooves 125, similar to grooves 132.
Le trou central 130 de l'embase n'est pas taraudé et comprend un lamage 133 prévu pour recevoir le pion de guidage 1 23 qui est également lisse sans filetage. Les trous 31 dans l'embase du premier mode de réalisation sont supprimés au profit d'une vis unique qui passe à travers le capuchon et l'embase et visse dans l'os. On remarque que, dans ce cas, la vis centrale assure simultanément la fixation de l'embase sur l'os et le serrage du capuchon sur l'embase avec le blocage des barres de liaison.The central hole 130 of the base is not tapped and includes a countersink 133 designed to receive the guide pin 1 23 which is also smooth without threading. The holes 31 in the base of the first embodiment are eliminated in favor of a single screw which passes through the cap and the base and screws into the bone. Note that, in this case, the central screw simultaneously secures the base on the bone and the tightening of the cap on the base with the blocking of the connecting bars.
Cette variante est d'un prix de revient moins élevé car les usinages sont moins nombreux et son utilisation peut être réservée à des cas courants, l'os devant présenter une corticale solide.This variant is of a lower cost price because the machining is less numerous and its use can be reserved for common cases, the bone having to present a solid cortex.
Dans ce cas, on peut prévoir des trous permettant le passage des vis de fixation dans l'os avec un diamètre légèrement supérieur à celui du corps de la vis et avec un fraisage supérieur aux dimensions de la tête de vis. Ainsi le praticien peut introduire et visser la vis suivant un angle d 'inclinaison variable, ce qui permet d 'éviter notamment de déboucher dans ou de passer à travers le canal médullaire, en améliorant la fixation des coapteurs.In this case, holes may be provided allowing the fixing screws to pass through the bone with a diameter slightly greater than that of the body of the screw and with a milling greater than the dimensions of the screw head. Thus, the practitioner can introduce and screw the screw at a variable angle of inclination, which in particular makes it possible to avoid opening into or passing through the medullary canal, by improving the fixation of the coaptors.
On remarque que les coapteurs peuvent être placés au fur et à mesure avec les barres en place, dès que deux des coapteurs sont fixés sur l'os. En ce qui concerne l'écarteur, les extrémités des branches seront adaptées afin que le praticien puisse prendre appui sur les différentes embases sans être gêné par lesdits écarteurs lors de la mise en place des barres et des capuchons.It is noted that the coaptors can be placed progressively with the bars in place, as soon as two of the coaptors are fixed on the bone. With regard to the spacer, the ends of the branches will be adapted so that the practitioner can rest on the different bases without being hindered by said spacers during the positioning of the bars and caps.
Sur la figure 5A, on a fait figurer une variante également très intéressante dans le cas, notamment, d'os fragiles ou atteints de certaines maladies comme l'ostéoporose. En effet, dans ce cas, l'ancrage pouvant être insuffisant pour assurer la fixation du coapteur et la reprise des efforts de serrage, il est prévu un taraudage 231 dans l'embase, au pas de la vis, vis qui est elle-même filetée sur une longueur suffisante. Les autres éléments restent inchangés par rapport à la figure 5 et porte des références identiques, augmentées de 1 00. On comprend que le serrage du capuchon 220 sur l'embase 21 8 peut être très important et indépendant de la pénétration de la vis 221 dans l'os, pénétration qui s'effectue sans effort, tout en maintenant l'embase plaquée sur l'os par sa face inférieure 222. Dans certains cas particuliers, il peut aussi être utilisé un rigidificateurIn FIG. 5A, a variant which is also very advantageous has been shown in the case, in particular, of fragile bones or suffering from certain diseases such as osteoporosis. Indeed, in this case, the anchoring may be insufficient to ensure the fixing of the co-sensor and the resumption of the clamping forces, there is provided a thread 231 in the base, at the pitch of the screw, screw which is itself threaded over a sufficient length. The other elements remain unchanged with respect to FIG. 5 and bear identical references, increased by 1 00. It is understood that the tightening of the cap 220 on the base 21 8 can be very significant and independent of the penetration of the screw 221 in the bone, penetration which is carried out effortlessly, while maintaining the base pressed against the bone by its underside 222. In certain particular cases, a stiffener can also be used
300 représenté sur la figure 9. Ce rigidificateur est installé après montage des coapteurs 1 6 et des barres 14. Il comprend deux plaques rectangulaires 302 et 304 d'une largeur sensiblement égale à l'écart séparant les barres. Sur les bords longitudinaux, les piaques comprennent des gouttières 306, conformées pour recevoir les barres 14.300 shown in Figure 9. This stiffener is installed after mounting of the coaptors 1 6 and the bars 14. It comprises two rectangular plates 302 and 304 with a width substantially equal to the distance separating the bars. The edges longitudinal, the plates comprise gutters 306, shaped to receive the bars 14.
Il est également prévu au moins un trou 308, 31 0, prévu pour recevoir une vis, le trou 310 étant taraudé. La vis permet de serrer les deux plaques l'une contre l'autre, immobilisant les barres, de façon complémentaire aux coapteurs en rigidifiant le montage. At least one hole 308, 31 0 is also provided, designed to receive a screw, the hole 310 being tapped. The screw makes it possible to tighten the two plates one against the other, immobilizing the bars, in a complementary manner to the coaptors by stiffening the assembly.

Claims

R E V E N D I C A T I O N S
1 . Dispositif d'ostéosynthèse comprenant des coapteurs ( 1 6) rapportés sur les abouts osseux ( 1 3, 1 5) d'un os fracturé ou de vertèbres, deux barres rigides (14) de liaison entre lesdits coapteurs, caractérisé en ce que chaque coapteur comprend : - une embase ( 1 8, 1 1 8, 21 8), ayant une face inférieure (22, 1 22,1. Osteosynthesis device comprising coaptors (1 6) attached to the bone ends (1 3, 1 5) of a fractured bone or vertebrae, two rigid bars (14) connecting between said coaptors, characterized in that each coaptor includes: - a base (1 8, 1 1 8, 21 8), having a lower face (22, 1 22,
222) et une face supérieure (24, 1 24, 224), chaque embase étant prévue, d'une part pour être fixée directement sur l'os (10) par au moins une vis de fixation, ladite face inférieure (22, 1 22, 222) de chaque embase étant en vis à vis, au contact et en appui sur la corticale de l'os, et d'autre part, pour recevoir chaque barre rigide222) and an upper face (24, 1 24, 224), each base being provided, on the one hand, for being fixed directly to the bone (10) by at least one fixing screw, said lower face (22, 1 22, 222) of each base being opposite, in contact and bearing on the cortex of the bone, and on the other hand, to receive each rigid bar
(14) de liaison dans une rainure (32, 132, 232), ménagée sur ladite face supérieure (24, 1 24, 224) ;(14) connecting in a groove (32, 132, 232), formed on said upper face (24, 1 24, 224);
- un capuchon (20, 1 20, 220) de blocage des barres ( 14) prévu pour venir par sa face inférieure (38, 1 38, 238) en appui sur lesdites barres (14), eta cap (20, 1 20, 220) for blocking the bars (14) provided to come by its lower face (38, 1 38, 238) bearing on said bars (14), and
- des moyens de serrage du capuchon (20, 1 20, 220) sur les barres (14) et des moyens de fixation de l'embase (1 8, 1 1 8, 228) sur l'os (10).- Means for tightening the cap (20, 1 20, 220) on the bars (14) and means for fixing the base (1 8, 1 1 8, 228) on the bone (10).
2. Dispositif d'ostéosynthèse selon la revendication 1 , caractérisé en ce que les moyens de serrage du capuchon (20), ce capuchon ayant une face inférieure (38) plane, comprennent un taraudage (30) ménagé dans l'embase (18), une vis (46) solidaire du capuchon (20) de blocage, dont le profil du filetage est conjugué à celui dudit taraudage et des moyens d'entraînement en rotation du capuchon par rapport à l'embase (1 8), tels que des pans, et en ce que les moyens de fixation de l'embase sur l'os comprennent deux vis disposées à travers des trous (31 ) usinés dans l'embase.2. Osteosynthesis device according to claim 1, characterized in that the tightening means of the cap (20), this cap having a flat underside (38), comprise a thread (30) formed in the base (18) , a screw (46) integral with the locking cap (20), the thread profile of which is combined with that of said internal thread and means for driving the cap in rotation relative to the base (1 8), such as sides, and in that the means for fixing the base to the bone comprise two screws arranged through holes (31) machined in the base.
3. Dispositif d'ostéosynthèse selon la revendication 2, caractérisé en ce que la vis (46) solidaire du capuchon (20) de blocage comprend un trou borgne (48), coaxial à l'axe longitudinal de la vis, débouchant à l'extrémité libre de la vis (46), ledit trou (48) étant prévu pour recevoir une broche (82), notamment pour la fixation d'une esquille, ledit trou (48) étant de préférence tronconique et la broche, cylindrique, pour assurer en effet de coincement.3. Osteosynthesis device according to claim 2, characterized in that the screw (46) integral with the locking cap (20) comprises a blind hole (48), coaxial with the longitudinal axis of the screw, opening out at the free end of the screw (46), said hole (48) being designed to receive a pin (82), in particular for fixing a splint, said hole (48) preferably being frusto-conical and the spindle, cylindrical, to effect jamming.
4. Dispositif d'ostéosynthèse selon la revendication 1 , caractérisé en ce que les moyens de serrage du capuchon (1 20, 220) et les moyens de fixation de l'embase (1 18, 218) sur l'os sont confondus et uniques et comprennent une seule vis dont la tête prend appui dans un trou central (1 21 , 221 ) ménagé dans le capuchon (1 20, 220) et dont le corps traverse l'embase (1 1 8, 21 8) à travers un trou (130, 230) pour visser dans l'os (10), le capuchon (1 20, 220) comprenant sur sa face inférieure (138, 238) deux rainures (125, 225) identiques aux rainures (132, 232) ménagées dans l'embase.4. Osteosynthesis device according to claim 1, characterized in that the means for tightening the cap (120, 220) and the means for fixing the base (118, 218) on the bone are combined and unique. and include a single screw whose head is supported in a central hole (1 21, 221) formed in the cap (1 20, 220) and whose body passes through the base (1 1 8, 21 8) through a hole (130, 230) for screwing into the bone (10), the cap (120, 220) comprising on its underside (138, 238) two grooves (125, 225) identical to the grooves (132, 232) formed in the base.
5. Dispositif d'ostéosynthèse selon la revendication 4, caractérisé en ce que le capuchon (1 20, 220) comprend un pion de guidage (1 23, 223) lisse, prévu pour coopérer avec un lamage ( 133, 233) ménagé dans le trou central (130, 230) ménagé dans l'embase (1 1 8, 21 8). 5. Osteosynthesis device according to claim 4, characterized in that the cap (1 20, 220) comprises a guide pin (1 23, 223) smooth, intended to cooperate with a countersink (133, 233) formed in the central hole (130, 230) formed in the base (1 1 8, 21 8).
6. Dispositif d'ostéosynthèse selon la revendication 4 ou 5, caractérisé en ce que le trou central (230) est taraudé au pas du filetage de la vis unique dont le corps est fileté sur une longueur suffisante en sorte de serrer le capuchon (220) sur les barres (14) et l'embase '(218).6. Osteosynthesis device according to claim 4 or 5, characterized in that the central hole (230) is tapped with the thread of the single screw whose body is threaded over a sufficient length so as to tighten the cap (220 ) on the bars (14) and the base (218).
7. Dispositif d'ostéosynthèse selon l'une quelconque des revendications précédentes, caractérisé en ce que la face inférieure (22, 122, 222) de l'embase7. Osteosynthesis device according to any one of the preceding claims, characterized in that the lower face (22, 122, 222) of the base
(18, 1 1 8, 21 8) a un rayon de courbure concave ou convexe et d'une valeur adaptée au profil de l'os au droit de l'emplacement sur lequel est rapportée ladite embase (18, 1 18, 218).(18, 1 1 8, 21 8) has a concave or convex radius of curvature and of a value adapted to the profile of the bone in line with the location to which said base is attached (18, 1 18, 218) .
8. Dispositif d'ostéosynthèse selon l'une quelconque des revendications précédentes, caractérisé en ce que l'embase (18, 1 1 8, 218) comprend une gorge (36, 136, 236) périphérique disposée entre les faces supérieures (24, 124, 214) et inférieures (22, 122, 222) de l'embase (1 8, 1 1 8, 21 8) et prévue pour recevoir les extrémités d'un écarteur et/ou d'un compresseur (49).8. Osteosynthesis device according to any one of the preceding claims, characterized in that the base (18, 1 1 8, 218) comprises a peripheral groove (36, 136, 236) disposed between the upper faces (24, 124, 214) and lower (22, 122, 222) of the base (1 8, 1 1 8, 21 8) and designed to receive the ends of a spacer and / or of a compressor (49).
9. Dispositif d'ostéosynthèse selon l'une quelconque des revendications précédentes, caractérisé en ce qu'il comprend, en plus des coapteurs, et des barres, un rigidificateur (300), comportant deux plaques supérieure (302) et inférieure (304), dont les bords longitudinaux sont conformés en gouttières (306) pour recevoir les barres ( 14), ainsi que des moyens de serrage des dites plaques l'une contre l'autre.9. Osteosynthesis device according to any one of the preceding claims, characterized in that it comprises, in addition to the coaptors, and bars, a stiffener (300), comprising two upper (302) and lower (304) plates , whose longitudinal edges are shaped like gutters (306) to receive the bars (14), as well as means for clamping said plates one against the other.
10. Ecarteur ou compresseur pour la mise en oeuvre d'un dispositif comprenant des coapteurs (1 6) selon la revendication 8, caractérisé en ce qu'il comporte deux branches (50, 52), sensiblement parallèles, l'une (52) d'entre elles étant montée coulissante sur un axe (54) solidaire de l'autre branche (50) avec des moyens de blocage (58) en translation de cette branche sur l'axe, et des organes d'accrochage (64) comprenant chacun deux secteurs (65, 66) annulaires, sensiblement en X, orientés dans un plan perpendiculaire à celui qui contient les branches (50, 52). 10. Retractor or compressor for the implementation of a device comprising coaptors (1 6) according to claim 8, characterized in that it comprises two branches (50, 52), substantially parallel, one (52) of them being slidably mounted on an axis (54) integral with the other branch (50) with locking means (58) in translation of this branch on the axis, and hooking members (64) comprising each two annular sectors (65, 66), substantially in X, oriented in a plane perpendicular to that which contains the branches (50, 52).
PCT/FR1995/000711 1994-05-31 1995-05-31 Osteosynthesis device comprising fixator inserts WO1995032675A1 (en)

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FR94/06920 1994-05-31
FR9406920A FR2720262B1 (en) 1994-05-31 1994-05-31 Osteosynthesis device with added coaptors.

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US9358047B2 (en) 2011-07-15 2016-06-07 Globus Medical, Inc. Orthopedic fixation devices and methods of installation thereof
US9603635B2 (en) 2011-07-15 2017-03-28 Globus Medical, Inc Orthopedic fixation devices and methods of installation thereof
US11076887B2 (en) 2011-07-15 2021-08-03 Globus Medical, Inc. Orthopedic fixation devices and methods of installation thereof
US11172961B2 (en) 2011-07-15 2021-11-16 Globus Medical Inc. Orthopedic fixation devices and methods of installation thereof
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FR2720262A1 (en) 1995-12-01

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