WO2003030749A1 - Grooved centro-medullary nail and a method for the osteosynthesis of diaphyseal segments - Google Patents

Grooved centro-medullary nail and a method for the osteosynthesis of diaphyseal segments Download PDF

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Publication number
WO2003030749A1
WO2003030749A1 PCT/MX2001/000074 MX0100074W WO03030749A1 WO 2003030749 A1 WO2003030749 A1 WO 2003030749A1 MX 0100074 W MX0100074 W MX 0100074W WO 03030749 A1 WO03030749 A1 WO 03030749A1
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WO
WIPO (PCT)
Prior art keywords
nail
diaphyseal
medullary
osteosynthesis
grooved
Prior art date
Application number
PCT/MX2001/000074
Other languages
Spanish (es)
French (fr)
Inventor
Jorge P. Flores Davila
Original Assignee
Flores Davila Jorge P
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 Flores Davila Jorge P filed Critical Flores Davila Jorge P
Priority to PCT/MX2001/000074 priority Critical patent/WO2003030749A1/en
Publication of WO2003030749A1 publication Critical patent/WO2003030749A1/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
    • A61B17/72—Intramedullary pins, nails or other devices
    • 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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6441—Bilateral fixators, i.e. with both ends of pins or wires clamped
    • 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
    • A61B17/744—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 an intramedullary nail
    • 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
    • A61B17/68—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices

Definitions

  • the present invention relates to a device and method for the treatment of bone fractures of long bones and more particularly to a device and method for the treatment of intertrochanteric femoral bills.
  • Femoral fractures of the trochanteric region 2. Femoral fractures of the intracapsular area of the femoral neck, and 3. Diaphyseal femoral fractures.
  • femoral neck fractures As for femoral neck fractures, they are known to cause frequent aseptic necrosis or femoral head osteoarthritis. The treatment is often replacement by partial hip replacement. Diaphyseal fractures are primarily of traumatic etiology.
  • the methods applicable to intracapsular fractures are usually partial hip replacements.
  • FIG. 1 A and 1B illustrates a drilled and undrilled nail respectively.
  • pre-drilled or non-drilled nails consist in that (a) they cannot be used in multiple intertrochanteric fractures, and (b) they only provide good stability in the plane of the transverse fracture of the middle third.
  • FIG. 1C illustrates an osteosynthesis of a transverse fracture of the middle third using a nail of the prior art, the arrows indicate the movement that may exist in the fractured portions.
  • the holes that have been incorporated in the center-medullary drilled nails try to solve the problem of nail instability.
  • the holes of sayings Nails are designed to introduce proximal and distal screws and are intended to prevent the fractured bone from rotating on its own axis and moving in the axial direction.
  • the nails of the prior art are not able to approach the bones or provide or maintain controlled compression in the fractured portions where osteosynthesis is performed.
  • treatment methods consist of osteosynthesis with perforated plates of different designs such as flat plate 50 and angled plate 40 illustrated in FIG. 1D and 1 E.
  • an angled plate 40 (FIG. 1 E) is inserted into the femoral neck and the plate is applied to the femoral shaft. Said plates constitute a support when applying screws in the fractured portions.
  • the treatment of a trochanteric fracture using an angled plate of the prior art is illustrated in Figure 1F.
  • the angled plate method cannot be successfully applied to the case of multiple intertrochanteric fractures that are accompanied with multiple diaphyseal fractures of several femoral diaphyseal fragments or hip fractures plus diaphyseal fractures, because multiple fractures do not provide adequate support for perforated plates, difficulties that are nevertheless overcome with the method of the present invention.
  • Anatomical replacement 2. Avoid tissue injury
  • Another object of the invention is to provide an improved device and methods for the treatment of transverse fractures of the middle third.
  • This method will be applied in long bones with the possibility of access for the use of a grooved medullary center nail.
  • We will exemplify its application with the osteosynthesis of the femur, but as will be evident to a person skilled in the art, this can also be applied to other long bones.
  • FIG. 1A shows an undrilled nail of the prior art.
  • FIG. 1B shows a pre-drilled nail.
  • FIG. 1C illustrates an osteosynthesis of a transverse fracture of the middle third using nail 1 A of the prior art.
  • FIG. 1 D illustrates a front view of a straight monocortical compression plate and a side view thereof, of the prior art, which can be used in conjunction with the slotted nail of the present invention.
  • FIG. 1 It illustrates a front and side view of an angled plate of existing techniques, which can be used in conjunction with the slotted nail of the present invention.
  • FIG. 1 F illustrates an osteosynthesis of an intertrochanteric fracture using the angled plate of FIG. 1 E of the prior art.
  • FIG. 2 illustrates an epiphyse-diaphyseal grooved spinal center nail in accordance with the first embodiment of the present invention.
  • FIG. 3 illustrates a nail for diaphyseal-epiphyseal osteosynthesis, for use with angled plate according to a second embodiment of the present invention.
  • FIG. 4 illustrates a nail for diaphyseal osteosynthesis only. According to a third embodiment of the present invention.
  • FIG. 5 illustrates the GUIDE MECHANISM for the introduction of cortical screws into the grooved center-medullary nail in accordance with the present invention.
  • FIG. 6 illustrates an osteosynthesis of an intertrochanteric fracture with multiple femoral diaphyseal fragments using an angled plate.
  • FIG. 7 illustrates a diaphyseal osteosynthesis using a straight plate.
  • FIG. 8 illustrates a transverse diaphyseal osteosynthesis of the middle third using bi-cortical external compression means.
  • a device and method for performing surgery for the reduction of multiple trochanteric fractures with or without femoral diaphyseal multiple fragments is described.
  • the device comprises a slotted center-medullary nail 10 in accordance with any of the modalities described and whose application depends on the fracture and criteria of the physician.
  • the device for the treatment of fractures of the present invention is composed of the following elements: a) Slotted nail 11 diaphyseal of (FIG. 2), or b) Slotted nail 12 Femoral or diaphyseal-epiphyseal bread 2 pieces to add angled plate ( FIG. 3), or c) Slotted nail 13 diaphyseal medullary center only (FIG. 4).
  • the nail is also complemented with at least some of the following accessories: d) Proximal extension 18; e) Cortical and spongy screws 30; f) Angled plate 40; g) Straight plate 50; h) Controlled compression system 60; Y i) Center-medullary nail groove locator system 70.
  • the diaphyseal grooved medullary center nail 11 comprises a body 15 having a distal end 151 and a proximal end 152, said body 15 includes at least one groove 16, the groove 16 is intended to allow cortical screws 30 to pass through the diaphyseal grooved center-medullary nail 11.
  • the center-medullary nail 11 is composed of four slots, but as will be apparent to a person skilled in the art this number may vary.
  • the groove 16 of the medullary center nail may be free or contain a filler 161 of a soft material that does not oppose the passage of cortical screws 30. Alternatively, it may have a cover or cover 162 of a material that does not prevent the passage of screws. corticals 20. Both the filling 161 and the cover 162 are intended to prevent the growth of bone tissue inside the groove 16 which, over time, can prevent difficulty in its removal.
  • connection means 17 of the grooved center-medullary nail 11 with the impactor 71 are arranged, these are illustrated in FIG. 2 as threaded sections male 171 and female 172, placed in the grooved center-medullary nail 11 and impactor 71 respectively.
  • any mechanical type of connection can be used, for example, an insertion attachment means.
  • the impactor 71 is intended to provide an end to facilitate the introduction of the nail into the medullary canal, but also aims to serve as a guide for the introduction of the screws 30.
  • the latter objective is achieved with the locator system 70 of the groove of the center-medullary nail, described later.
  • the straight plate 50 by virtue of the holes it presents allows the possibility of placing screws 30 that cross the nail and allow osteosynthesis to be performed in the fractured segments.
  • the impactor 71 is intended to provide an end to facilitate the introduction of the nail into the medullary canal, but also aims to serve as a guide for the introduction of the screws 30. This latter objective is achieved with the locator system 70 of the center-medullary nail groove, which is described below. See FIG. 5.
  • the straight plate allows permanent compression to be applied to the fractured bone segments so that they narrow together and the osteosynthesis is more effective, in order to achieve direct or permanent consolidation. cousin without the presence of exotic callus. Even better results are obtained with the use of the controlled compression apparatus 60.
  • Slotted center-medullary nail 12 for diaphyseal-epiphyseal osteosynthesis of multiple intertrochanteric fractures with several femoral diaphyseal fragments or hip fractures plus diaphyseal fractures illustrated in FIG. 3, is similar to the diaphyseal grooved medullary center nail 11 of FIG. 2 but further comprises an extension 18, which is attachable with the center-medullary nail 12 by coupling means 17 '.
  • said coupling means 17 ' consist of the male threaded section 171 of the center-medullary nail 12 and the female threaded section 182 of the extension 18.
  • the male threaded section 181 of the extension can be coupled with the female threaded section 172 of the impactor 71 at the junction 17 ".
  • the coupling of the grooved center-medullary nail 12 and the extension 18 are intended to provide the nail with the necessary dimension to be able to penetrate the femoral distal diaphyseal segment, and allow removal of the extension 18 from the proximal femoral segment, so that it can be placed the angled plate in the free proximal trochanteric segment and in the femoral neck.
  • FIG. 6 illustrates the placement of the center-medullary nail of FIG. 2 and an angled plate 40 for osteosynthesis of an intertrochanteric fracture with multiple femoral diaphyseal fragments.
  • the extension 18 is removed to allow the application of the angled plate, accompanied by fastening with cortical and spongy screws 30 to fix the multiple fragments to their original position.
  • the rimmed extension 18 is then re-coupled, over the nail 12, and the nail is removed in accordance with the traditional methods, aided for better handling , mounting this segment on impactor 71.
  • the epiphyseal diaphyseal grooved center-medullary nail 12 is intended to:
  • Nail grooved spinal center for diaphyseal fractures 13 (FIG. 4), is prepared for the use of fractures of the shaft only, this reduction system can be applied with or without accompanying plate.
  • angled plate 40 has the characteristic of exhibiting a bend that defines an angle ⁇ of approximately 130 °.
  • the angled plate 40 is intended to provide reduction to the fragments resulting in the trochanteric fracture.
  • the angled plate 40 will have the help of the slotted femoral nail of the invention, to carry out the support function for the screws that perform the reduction of the diaphyseal fragments.
  • the angled plate 40 must be anchored in the fractured bone. Said anchorage is achieved by inserting one end into the femoral neck of the bone. Obviously, the above is only possible if the neck of the bone is substantially free of obstacles so that it can be inserted, which is why the extension 18 of the nail 12 illustrated in FIG. 3.
  • the nail 12 is grooved in nothing hinders the insertion of the angled plate and the screws, and because the extension 18 is removed from the trochanteric region of the bone, it also does not hamper the insertion of the angled plate 40
  • Monocortical external compression means comprise straight 50 and angled plates 40.
  • the straight plate 50 comprises a plate body 51, which has perforations 52 in which cortical and spongy screws 30 are introduced to hold the fractured segments.
  • the grooved medullary center nail of the present invention can be used in conjunction with the straight monocortical compression plate of Figure 1D, for the reduction of femoral fractures, although it is also possible to dispense with the plate and only hold the fragments only by means of the nail .
  • the plates 50 have as a basic function, to more solidly immobilize the union between the fractured parts, to allow the regeneration of the bone cells, Such regeneration or consolidation will allow the fractured parties to recover their consolidation.
  • the screws 30 are inserted into the oval holes 52 of the plate 50, and into the fractured cortical segments.
  • the screws are introduced with a certain inclination, so that when these screws are tightened, a compression force is generated between the fractured segments. It is estimated that the value of the compression force generated by the plate 50 is in a range of between 600 and 1 000 N (Newton).
  • Bicortical controlled compression means 60 can be applied to apply a pressure between the fractured segments. These controlled compression devices are widely described in the PCT / MX01 / 00050 international patent application cited as reference.
  • FIG. 8 illustrates the application of a transverse bone compression apparatus in combination with the slotted nail 10.
  • the controlled compression apparatus 60 comprises a grooved plate 61 at least two trans-bone nails 62 and a compression mechanism 63. Cortex screws 30 are inserted into holes 611 of plate 61 and screwed into the cortex of the first fractured segment. While screws 30 are also introduced into slot 612 and screwed into the second fractured segment.
  • two transosseous nails 62 are introduced, the position of these nails to perform interfragmentary compression depends on the doctor's vision according to the existing fractures.
  • the compression mechanism 63 shown in FIG. 8 as a pair of threaded sections and nuts, the transosseous nails 62 are brought closer together and thereby the fractured segments are also narrowed, that is to say a compression force is applied to the fractured segments.
  • the value of the generated pressure does not exceed 25 kN, so as not to exceed the modulus of elasticity and thereby avoid damage to the vitality of the fractured bone.
  • the applied force can cause an allowable deformation of up to 0.43 mm in patients of 20 years or less and of up to 0.21 mm in patients of 70 years.
  • Permissible deformation is an approximately linear function of age.
  • System 70 is illustrated in FIG. 5, said system consists of:
  • the edge 721 of the guide flag 72 is placed in the slit 711 of the compactor 71.
  • the second edge 722 is placed in the groove 731 of the guide rule 73 and inserted therein.
  • the grooved ruler 73 comprises at least one groove 732 which is coincident with the groove 16 of the grooved center-medullary nail 10. In this way, the surgeon can identify the position of the groove of the nail and introduce the osteosynthesis screws 30 through the grooves 16, which is preferably in the lateral part. Finally, IF THE IMPACTOR THAT WAS ADJUSTED UNTIL REACHING THE BUMPER, it will be possible to pass the spongy screws 30 on the hip and the cortex on the diaphysis, which will coincide with the groove of the grooved medullary center nail.
  • the access route of the grooved inside-medullary nail is lateral, using the same known technique already for the perforated or unperforated medullary center nail of the prior art.
  • This spinal center nail has a groove in the diaphyseal area only.
  • same method of application only cortical screws or the center medullary nail system plus or without controlled compression plate can be placed.
  • the plates and the nail should exert pressure only in the area surrounding the holes for the passage of screws, so as not to cause strong compression to the bone tissue that is between the plate and the medullary center nail, so it is essential to place plates with minimum screw pressure, which is achieved after adjusting these by loosening the same half turn.
  • the spinal center nail groove locator system can be used.

Abstract

The invention relates to a device that is used to perform surgery to reduce multiple femoral diaphyseal and intertrochanteric fractures, hip fractures and/or diaphyseal fractures. The inventive device comprises a grooved centro-medullary nail which is applied with or without an angular plate or with or without a diaphyseal plate. Said grooved centro-medullary nail comprises a body (15) consisting of at least one groove (16) which enables the positioning of the tightening screws (30). Moreover, said device comprises an extension piece (18) which can be connected to the nail (10) in order to increase the dimensions thereof and ensure that said nail can penetrate the medullary canal of the fractured bone. The aforementioned extension piece can be removed from the nail (10) once said nail been inserted sufficiently into the medullary cavity to enable the anchoring of the angular plate. Furthermore, said extension can be connected to the nail (10) once again in order to extract same from the medullary cavity. In addition, the inventive device comprises an angular plate which is used to support the fractured diaphyseal and epiphyseal portions.

Description

CLAVO CENTRO MEDULAR RANURADO Y MÉTODO PARA LA OSTEOSÍNTESIS DE SEGMENTOS DIAFISIARIOS.CLAVO CENTRAL MEDULAR RANURADO AND METHOD FOR OSTEOSYNTHESIS OF DIAPHYSICAL SEGMENTS.
CAMPO DE LA INVENCIÓN.FIELD OF THE INVENTION
La presente invención se refiere a un dispositivo y método para el tratamiento de fracturas óseas de huesos largos y más particularmente a un dispositivo y método para el tratamiento de facturas femorales intertrocantéricas.The present invention relates to a device and method for the treatment of bone fractures of long bones and more particularly to a device and method for the treatment of intertrochanteric femoral bills.
La descripción de la invención se ha realizado tomando como ejemplo de hueso largo al fémur.The description of the invention has been carried out taking as an example of long bone the femur.
ANTECEDENTES DE LA INVENCIÓN.BACKGROUND OF THE INVENTION
Para asuntos prácticos de esta invención se indica la siguiente clasificación anatómica de las fracturas femorales:For practical matters of this invention the following anatomical classification of femoral fractures is indicated:
1. Fracturas femorales de la región trocantérica, 2. Fracturas femorales de las de la zona intracapsular del cuello del fémur, y 3. Fracturas femorales diafisiarias.1. Femoral fractures of the trochanteric region, 2. Femoral fractures of the intracapsular area of the femoral neck, and 3. Diaphyseal femoral fractures.
Es comúnmente aceptado que los dos primeros tipos de fracturas ocurren en personas mayores de 60 años, con una relación mujeres-hombres 8:2, la causa principal es la osteoporosis. Otra causa común de estas fracturas es debido a traumatismos de diversa índole, además de otras causas menos frecuentes.It is commonly accepted that the first two types of fractures occur in people over 60, with a female-male 8: 2 ratio, the main cause is osteoporosis. Another common cause of these fractures is due to trauma of various kinds, in addition to other less frequent causes.
El pronóstico de estas fracturas depende de las condiciones de los tejidos, de la gravedad de las mismas, tipo de fracturas, localización, estabilidad de la reducción y otros parámetros. Además, se ha establecido que para obtener buenos resultados en las cirugías y buena consolidación, se requiere una adecuada irrigación sanguínea y condiciones biológicas de los tejidos para su reparación.The prognosis of these fractures depends on the conditions of the tissues, their severity, type of fractures, location, reduction stability and other parameters. In addition, it has been established that to obtain good results in surgeries and good consolidation, adequate blood irrigation and biological conditions of the tissues are required for repair.
Por lo que hace a las fracturas del cuello femoral, se sabe que estas causan necrosis aséptica frecuente o artrosis de la cabeza femoral. El tratamiento frecuentemente es reemplazo por prótesis parcial de cadera. Las fracturas diafisiarias son fundamentalmente de etiología traumática.As for femoral neck fractures, they are known to cause frequent aseptic necrosis or femoral head osteoarthritis. The treatment is often replacement by partial hip replacement. Diaphyseal fractures are primarily of traumatic etiology.
Los métodos aplicables a las fracturas ¡ntracapsulares son por lo general reemplazos parciales de cadera.The methods applicable to intracapsular fractures are usually partial hip replacements.
En las técnicas existentes se usan clavos medulares cuándo existen fracturas de hueso debido a fuerzas de cizallamiento que rompen el hueso por su sección transversal en tercio medio (fractura transversa de tercio medio), que es la indicación más propia para la colocación de clavos macizos no barrenados o barrenados,In existing techniques spinal nails are used when there are bone fractures due to shear forces that break the bone by its cross section in the middle third (transverse fracture of the middle third), which is the most appropriate indication for the placement of solid nails. drilled or drilled,
Dichos clavos medulares de las técnicas existentes se introducen en la cavidad medular por medio de rimado del hueso fracturado. En la FIG. 1 A y 1B se ilustra un clavo barrenado y no barrenado respectivamente.Said spinal nails of the existing techniques are introduced into the medullary canal by means of rhyming of the fractured bone. In FIG. 1 A and 1B illustrates a drilled and undrilled nail respectively.
Las desventajas asociadas al empleo de los clavos barrenados o no barrenados de la técnica previa consisten en que (a) no pueden ser usados en fracturas múltiples intertrocantéricas, y (b) solo proporcionan buena estabilidad en el plano de la fractura transversa de tercio medio.The disadvantages associated with the use of pre-drilled or non-drilled nails consist in that (a) they cannot be used in multiple intertrochanteric fractures, and (b) they only provide good stability in the plane of the transverse fracture of the middle third.
Debido a que el clavo es un soporte interno del hueso fracturado, es incapaz de servir para reducir segmentos fracturados intertrocantéricos corticales. Pues estos debido a que no tienen contacto con el clavo, no mantienen una sujeción adecuada para la osteosíntesis. Por otra parte, en el caso de la osteosíntesis de la fractura transversa de tercio medio, los huesos pueden desplazarse en la dirección del eje del clavo. Este efecto es adverso a la osteosíntesis. La literatura reconoce que una osteosíntesis será efectiva si la separación entre los segmentos fracturados es menor a 0.5 cm máximo ya que una separación entre los segmentos de 0.5 cm conduce a un retardo de consolidación de por lo menos un año y se considera que fracturas con separaciones mayores no pueden ser consolidadas. En la FIG. 1C se ¡lustra una osteosíntesis de una fractura transversa de tercio medio empleando un clavo de la técnica previa, las flechas indican el movimiento que puede existir en las porciones fracturadas.Because the nail is an internal support of the fractured bone, it is incapable of reducing cortical intertrochanteric fractured segments. Because these because they have no contact with the nail, they do not maintain an adequate support for osteosynthesis. On the other hand, in the case of osteosynthesis of the transverse fracture of the middle third, the bones can move in the direction of the nail axis. This effect is adverse to osteosynthesis. The literature recognizes that an osteosynthesis will be effective if the separation between the fractured segments is less than 0.5 cm maximum since a separation between the 0.5 cm segments leads to a consolidation delay of at least one year and it is considered that fractures with separations Older cannot be consolidated. In FIG. 1C illustrates an osteosynthesis of a transverse fracture of the middle third using a nail of the prior art, the arrows indicate the movement that may exist in the fractured portions.
Los orificios que se han incorporado en los clavos centro-medulares barrenados tratan de solucionar el problema de inestabilidad de los clavos. Lo orificios de dichos clavos están diseñados para introducir tornillos proximales y distales y tienen por objeto evitar que el hueso fracturado gire sobre su propio eje y se desplacen en la dirección axial. Sin embargo, los clavos de la técnica previa no son capaces de acercar a los huesos ni proporcionar ni mantener una compresión controlada en las porciones fracturadas donde se realiza la osteosíntesis.The holes that have been incorporated in the center-medullary drilled nails try to solve the problem of nail instability. The holes of sayings Nails are designed to introduce proximal and distal screws and are intended to prevent the fractured bone from rotating on its own axis and moving in the axial direction. However, the nails of the prior art are not able to approach the bones or provide or maintain controlled compression in the fractured portions where osteosynthesis is performed.
En cuanto a las fracturas trocantéricas, los métodos de tratamiento consisten en osteosíntesis con placas perforadas de diferentes diseños como la placa plana 50 y la placa angulada 40 que se ilustran en las FIG. 1D y 1 E. En el método de la técnica previa, una placa angulada 40, (FIG. 1 E) se introduce en el cuello femoral y la placa se aplica a la diáfisis femoral. Dichas placas constituyen un soporte al aplicar tornillos en las porciones fracturadas. En la figura 1F se ilustra el tratamiento de una fractura trocantérica utilizando una placa angulada de la técnica previa.As for trochanteric fractures, treatment methods consist of osteosynthesis with perforated plates of different designs such as flat plate 50 and angled plate 40 illustrated in FIG. 1D and 1 E. In the prior art method, an angled plate 40, (FIG. 1 E) is inserted into the femoral neck and the plate is applied to the femoral shaft. Said plates constitute a support when applying screws in the fractured portions. The treatment of a trochanteric fracture using an angled plate of the prior art is illustrated in Figure 1F.
El método de la placa angulada, sin embargo, no puede aplicarse con éxito al caso de las fracturas múltiples intertrocantéricas que se acompañan con fracturas diafisiarias múltiples de varios fragmentos diafisiarios femorales ó fracturas de cadera más fracturas diafisiarias, debido a que las múltiples fracturas no proporcionan un soporte adecuado a las placas perforadas, dificultades que sin embargo se superan con el método de la presente invención.The angled plate method, however, cannot be successfully applied to the case of multiple intertrochanteric fractures that are accompanied with multiple diaphyseal fractures of several femoral diaphyseal fragments or hip fractures plus diaphyseal fractures, because multiple fractures do not provide adequate support for perforated plates, difficulties that are nevertheless overcome with the method of the present invention.
Hasta ahora no se ha combinado el empleo de un clavo medular con placas anguladas, en virtud de que tal combinación de hecho no es posible, pues el clavo obstaculizaría la inserción de la placa en el cuello femoral y el mismo clavo además obstaculizaría la colocación de los tornillos 30 que se fijan a la placa , puesto que los tornillos no podrían atravesar el mismo.Until now, the use of a spinal nail with angled plates has not been combined, because such a combination is in fact not possible, since the nail would impede the insertion of the plate into the femoral neck and the same nail would also hamper the placement of the screws 30 that are fixed to the plate, since the screws could not pass through it.
Hasta ahora con la técnica anterior, es difícil de resolver el problema de la fractura intertrocantérica con fragmentos múltiples diafisiarios femorales ó fracturas de cadera más fracturas diafisiarias. Lo anterior como consecuencia de que la placa angulada de 130° que se emplea para proporcionar un reducción y estabilidad, no es fácilmente manejable y no cuenta con el apoyo que proporciona el clavo centro- medular ranurado de la presente invención, mediante el cual y aprovechando la ranura podemos fijar los fragmentos para la reducción de fracturas múltiples diafisiarias femorales. Se considera que las condiciones deseables para una osteosíntesis adecuada son las siguientes:Until now with the prior art, it is difficult to solve the problem of intertrochanteric fracture with multiple femoral diaphyseal fragments or hip fractures plus diaphyseal fractures. The foregoing as a result of the 130 ° angled plate that is used to provide a reduction and stability, is not easily manageable and does not have the support provided by the grooved center-medullary nail of the present invention, by which and taking advantage The groove can fix the fragments for the reduction of multiple fractures of the femoral diaphyseal. The desirable conditions for adequate osteosynthesis are considered to be the following:
1. Reposición anatómica 2. Evitar lesión tisular1. Anatomical replacement 2. Avoid tissue injury
3. Movilización temprana3. Early mobilization
4. Fijación estable4. Stable fixation
En la cirugía de cadera estable, hay 50% menos mortandad en relación a tratamientos conservadores no quirúrgicos.In stable hip surgery, there is 50% less mortality in relation to non-surgical conservative treatments.
Con la presente invención es posible reducir una fractura con mayor facilidad, menos tiempo y con mejores resultados, ya que el clavo propuesto permite como acabamos de mencionar, un buen apoyo para realizar la reducción de fracturas óseas.With the present invention it is possible to reduce a fracture with greater ease, less time and with better results, since the proposed nail allows, as we have just mentioned, a good support for reducing bone fractures.
Es por lo tanto un objeto de la invención proporcionar un dispositivo y método para el tratamiento de algunos casos de fracturas intertrocantérica con fragmentos múltiples diafisiarios femorales ó fracturas de cadera más fracturas diafisiarias.It is therefore an object of the invention to provide a device and method for the treatment of some cases of intertrochanteric fractures with multiple femoral diaphyseal fragments or hip fractures plus diaphyseal fractures.
Otro objeto de la invención es proporcionar un dispositivo y métodos mejorados para el tratamiento de fracturas transversas de tercio medio.Another object of the invention is to provide an improved device and methods for the treatment of transverse fractures of the middle third.
DESCRIPCIÓN DE LA INVENCIÓN.DESCRIPTION OF THE INVENTION
Se aplicará este método en huesos largos con posibilidad de acceso para el uso de un clavo centro medular ranurado. Ejemplificaremos su aplicación con la osteosíntesis de fémur, pero como será evidente a un técnico en la materia este puede también aplicarse a otros huesos largos.This method will be applied in long bones with the possibility of access for the use of a grooved medullary center nail. We will exemplify its application with the osteosynthesis of the femur, but as will be evident to a person skilled in the art, this can also be applied to other long bones.
Se propone un nuevo método y dispositivo que consiste en un CLAVO CENTROMEDULAR RANURADO 10, CON O SIN PLACAS AGREGADAS AL MISMO. De esta forma para la aplicación tenemos las siguientes MODALIDADES DE INVENCIÓN: 1. Aplicación de clavo centro medular 11 ranurado para cadera y diáfisis (FIG.A new method and device is proposed consisting of a SLOTED CENTROMEDULAR NAIL 10, WITH OR WITHOUT PLATES ADDED TO IT. In this way for the application we have the following INVENTION MODES: 1. Application of splined spinal center nail 11 for hip and shaft (FIG.
2)two)
2. Clavo ranurado 12 de dos componentes para osteosíntesis, con placa angulada mediante el retiro del segmento 18 (FIG. 3).2. Two-component grooved nail 12 for osteosynthesis, with angled plate by removing segment 18 (FIG. 3).
3. Clavo ranurado 13 diafisiario únicamente, con o sin placa recta (FIG. 4).3. Slotted nail 13 diaphyseal only, with or without straight plate (FIG. 4).
BREVE DESCRIPCIÓN DE LAS FIGURAS.BRIEF DESCRIPTION OF THE FIGURES.
La FIG. 1A muestra un clavo no barrenado de la técnica previa.FIG. 1A shows an undrilled nail of the prior art.
La FIG. 1B muestra un clavo barrenado de la técnica previa.FIG. 1B shows a pre-drilled nail.
La FIG. 1C ilustra una osteosíntesis de una fractura transversa de tercio medio empleando el clavo 1 A de la técnica previa.FIG. 1C illustrates an osteosynthesis of a transverse fracture of the middle third using nail 1 A of the prior art.
La FIG. 1 D ¡lustra una vista frontal de una placa recta de compresión monocortical y una vista lateral de la misma, de la técnica previa, que se puede emplear en conjunto con el clavo ranurado de la presente invención.FIG. 1 D illustrates a front view of a straight monocortical compression plate and a side view thereof, of the prior art, which can be used in conjunction with the slotted nail of the present invention.
La FIG. 1 E ¡lustra una vista frontal y lateral de una placa angulada de las técnicas existentes, que se puede emplear en conjunto con el clavo ranurado de la presente invención.FIG. 1 It illustrates a front and side view of an angled plate of existing techniques, which can be used in conjunction with the slotted nail of the present invention.
La FIG. 1 F ilustra una osteosíntesis de una fractura intertrocantérica empleando la placa angulada de la FIG. 1 E de la técnica previa.FIG. 1 F illustrates an osteosynthesis of an intertrochanteric fracture using the angled plate of FIG. 1 E of the prior art.
La FIG. 2 ilustra un clavo centro medular ranurado epífiso-diáfisiario de conformidad con la primer modalidad de la presente invención.FIG. 2 illustrates an epiphyse-diaphyseal grooved spinal center nail in accordance with the first embodiment of the present invention.
La FIG. 3 ilustra un clavo para osteosíntesis diáfiso - epífisiarias, para uso con placa angulada conforme a una segunda modalidad de la presente invención.FIG. 3 illustrates a nail for diaphyseal-epiphyseal osteosynthesis, for use with angled plate according to a second embodiment of the present invention.
La FIG. 4 ilustra un clavo para osteosíntesis diafisiaria únicamente. Conforme a una tercer modalidad de la presente invención. La FIG. 5 ¡lustra el MECANISMO GUÍA para la introducción de tornillos corticales en el clavo centro-medular ranurado de conformidad con la presente invención.FIG. 4 illustrates a nail for diaphyseal osteosynthesis only. According to a third embodiment of the present invention. FIG. 5 illustrates the GUIDE MECHANISM for the introduction of cortical screws into the grooved center-medullary nail in accordance with the present invention.
La FIG. 6 ilustra una osteosíntesis de una fractura intertrocantérica con fragmentos múltiples diafisiarios femorales empleando además una placa angulada.FIG. 6 illustrates an osteosynthesis of an intertrochanteric fracture with multiple femoral diaphyseal fragments using an angled plate.
La FIG.7 ilustra una osteosíntesis diafisiaria empleando además una placa recta.FIG. 7 illustrates a diaphyseal osteosynthesis using a straight plate.
La FIG. 8 ilustra una osteosíntesis diafisiaria transversa de tercio medio empleando medios de compresión externa bi-cortical.FIG. 8 illustrates a transverse diaphyseal osteosynthesis of the middle third using bi-cortical external compression means.
DESCRIPCIÓN DETALLADA DE LA INVENCIÓN.DETAILED DESCRIPTION OF THE INVENTION.
Se describe un dispositivo y método para llevar a cabo cirugía para la reducción de fracturas múltiples trocantéricas con o sin fragmentos múltiples diafisiarios femorales.A device and method for performing surgery for the reduction of multiple trochanteric fractures with or without femoral diaphyseal multiple fragments is described.
El dispositivo comprende un clavo centro-medular ranurado 10 de conformidad con cualquiera de las modalidades que se describen y cuya aplicación depende de la fractura y criterio del médico.The device comprises a slotted center-medullary nail 10 in accordance with any of the modalities described and whose application depends on the fracture and criteria of the physician.
El dispositivo para el tratamiento de fracturas de la presente invención se compone de los siguientes elementos: a) Clavo ranurado 11 diafisiario de (FIG. 2), ó b) Clavo ranurado 12 Pan femoral o diafiso-epifisiario 2 piezas para añadir placa angulada (FIG. 3), ó c) Clavo ranurado 13 centro medular diafisiario únicamente (FIG. 4).The device for the treatment of fractures of the present invention is composed of the following elements: a) Slotted nail 11 diaphyseal of (FIG. 2), or b) Slotted nail 12 Femoral or diaphyseal-epiphyseal bread 2 pieces to add angled plate ( FIG. 3), or c) Slotted nail 13 diaphyseal medullary center only (FIG. 4).
El clavo además se complementa por lo menos con algunos de los siguientes accesorios: d) Extensión proximal 18; e) Tornillos corticales y esponjosos 30; f) Placa angulada 40; g) Placa recta 50; h) Sistema de compresión controlada 60; y i) Sistema localizador de la ranura del clavo centro-medular 70.The nail is also complemented with at least some of the following accessories: d) Proximal extension 18; e) Cortical and spongy screws 30; f) Angled plate 40; g) Straight plate 50; h) Controlled compression system 60; Y i) Center-medullary nail groove locator system 70.
Clavo centro medular ranurado diafisiario (11 ).Nail diaphyseal grooved spinal center (11).
Con referencia a la FIG. 2, el clavo centro medular ranurado diafisiario 11 comprende un cuerpo 15 que tiene un extremo distal 151 y un extremo próximal 152, dicho cuerpo 15 incluye al menos una ranura 16, la ranura 16 tiene por objeto permitir que tornillos corticales 30 pasen a través del clavo centro-medular ranurado diafisiario 11. En la FIG. 2 el clavo centro-medular 11 se compone de cuatro ranuras, pero como será evidente a un técnico en la materia este número puede variar. La ranura 16 del clavo centro medular puede estar libre o contener un relleno 161 de un material suave que no se oponga al paso de los tornillos corticales 30. alternativamente puede poseer una tapa o cubierta 162 de un material que no evite el paso de los tornillos corticales 20. Tanto el relleno 161 como la tapa 162 tienen por objeto impedir el crecimiento de tejido óseo al interior de la ranura 16 que con el tiempo pueda evitar dificultad en su extracción.With reference to FIG. 2, the diaphyseal grooved medullary center nail 11 comprises a body 15 having a distal end 151 and a proximal end 152, said body 15 includes at least one groove 16, the groove 16 is intended to allow cortical screws 30 to pass through the diaphyseal grooved center-medullary nail 11. In FIG. 2 the center-medullary nail 11 is composed of four slots, but as will be apparent to a person skilled in the art this number may vary. The groove 16 of the medullary center nail may be free or contain a filler 161 of a soft material that does not oppose the passage of cortical screws 30. Alternatively, it may have a cover or cover 162 of a material that does not prevent the passage of screws. corticals 20. Both the filling 161 and the cover 162 are intended to prevent the growth of bone tissue inside the groove 16 which, over time, can prevent difficulty in its removal.
En el extremo próximal 152 se disponen medios de unión 17 del clavo centro- medular ranurado 11 con el impactador 71 , estos se ilustran en la FIG. 2 como secciones roscadas macho 171 y hembra 172, colocadas en el clavo centro-medular ranurado 11 y el impactador 71 respectivamente. Sin embargo como será evidente a un técnico en la materia pude emplearse cualquier tipo mecánico de unión por ejemplo un medio de unión de inserción.At the proximal end 152, connection means 17 of the grooved center-medullary nail 11 with the impactor 71 are arranged, these are illustrated in FIG. 2 as threaded sections male 171 and female 172, placed in the grooved center-medullary nail 11 and impactor 71 respectively. However, as will be apparent to a person skilled in the art, any mechanical type of connection can be used, for example, an insertion attachment means.
El impactador 71 tiene por objeto proporcionar un extremo para facilitar la introducción del clavo en la cavidad medular, pero también tiene por objeto servir como guía para la introducción de los tornillos 30. Este último objetivo se consigue con el sistema localizador 70 de la ranura del clavo centro-medular, que se describe más adelante.The impactor 71 is intended to provide an end to facilitate the introduction of the nail into the medullary canal, but also aims to serve as a guide for the introduction of the screws 30. The latter objective is achieved with the locator system 70 of the groove of the center-medullary nail, described later.
Con el clavo centro medular ranurado 11 es posible colocar una placa recta 50. La placa recta 50 en virtud de los orificios que presenta permiten la posibilidad de colocar tornillos 30 que atraviesan el clavo y permiten que en los segmentos fracturados se realice la osteosíntesis. El impactador 71 tiene por objeto proporcionar un extremo para facilitar la introducción del clavo en la cavidad medular, pero también tiene por objeto servir como guía para la introducción de los tornillos 30. Este último objetivo se consigue con el sistema localizador 70 de la ranura del clavo centro-medular, que se describe más adelante. Ver FIG. 5.With the grooved medullary center nail 11 it is possible to place a straight plate 50. The straight plate 50 by virtue of the holes it presents allows the possibility of placing screws 30 that cross the nail and allow osteosynthesis to be performed in the fractured segments. The impactor 71 is intended to provide an end to facilitate the introduction of the nail into the medullary canal, but also aims to serve as a guide for the introduction of the screws 30. This latter objective is achieved with the locator system 70 of the center-medullary nail groove, which is described below. See FIG. 5.
Además, en el caso de fracturas diafisiaria transversa de tercio medio, la placa recta permite aplicar una compresión permanente a los segmentos óseos fracturados para que estos se estrechen entre si y la osteosíntesis sea más efectiva, de modo de conseguir la consolidación directa o per-prima sin presencia de callo exostico. Aún mejores resultados se obtienen con la utilización del aparato de compresión controlada 60.In addition, in the case of transverse diaphyseal fractures of the middle third, the straight plate allows permanent compression to be applied to the fractured bone segments so that they narrow together and the osteosynthesis is more effective, in order to achieve direct or permanent consolidation. cousin without the presence of exotic callus. Even better results are obtained with the use of the controlled compression apparatus 60.
Clavo centro medular ranurado -epifiso diafisiario (12).Nail grooved spinal center - diaphyseal effusion (12).
El clavo centro-medular ranurado 12 para osteosíntesis diafiso-epifisirias de fracturas múltiples intertrocantéricas con varios fragmentos diafisiarios femorales ó fracturas de cadera más fracturas diafisiarias ¡lustrado en la FIG. 3, es similar al clavo centro medular ranurado diafisiario 11 de la FIG. 2 pero comprende además una extensión 18, que es acoplable con el clavo centro-medular 12 por medios de acoplamiento 17'. En la FIG. 3, dichos medios de acoplamiento 17' consisten de la sección roscada macho 171 del clavo centro-medular 12 y la sección roscada hembra 182 de la extensión 18.Slotted center-medullary nail 12 for diaphyseal-epiphyseal osteosynthesis of multiple intertrochanteric fractures with several femoral diaphyseal fragments or hip fractures plus diaphyseal fractures illustrated in FIG. 3, is similar to the diaphyseal grooved medullary center nail 11 of FIG. 2 but further comprises an extension 18, which is attachable with the center-medullary nail 12 by coupling means 17 '. In FIG. 3, said coupling means 17 'consist of the male threaded section 171 of the center-medullary nail 12 and the female threaded section 182 of the extension 18.
A su vez la sección roscada macho 181 de la extensión puede acoplarse con la sección roscada hembra 172 del impactador 71 en la unión 17".In turn, the male threaded section 181 of the extension can be coupled with the female threaded section 172 of the impactor 71 at the junction 17 ".
El acoplamiento del clavo centro-medular ranurado 12 y la extensión 18 tienen por objeto proporcionar al clavo la dimensión necesaria para poder penetrar en el segmento diafisiario distal femoral, y permitir el retiro de la extensión 18 del segmento proximal femoral, para que pueda ser colocada la placa angulada en el segmento trocantérico proximal libre y en el cuello femoral.The coupling of the grooved center-medullary nail 12 and the extension 18 are intended to provide the nail with the necessary dimension to be able to penetrate the femoral distal diaphyseal segment, and allow removal of the extension 18 from the proximal femoral segment, so that it can be placed the angled plate in the free proximal trochanteric segment and in the femoral neck.
En la FIG. 6 se ilustra la colocación del clavo centro-medular de la FIG. 2 y una placa angulada 40 para la osteosíntesis de una fractura intertrocantérica con fragmentos múltiples diafisiarios femorales.In FIG. 6 illustrates the placement of the center-medullary nail of FIG. 2 and an angled plate 40 for osteosynthesis of an intertrochanteric fracture with multiple femoral diaphyseal fragments.
Como ya se ha indicado, en los clavos centro-medulares de la técnica previa generalmente el extremo del clavo sobresale del trocánter del hueso fracturado. En el método de la presente invención, la extensión 18 se retira para permitir la aplicación de la placa angulada, acompañada de sujeción con tornillos 30 corticales y esponjosos para fijar los fragmentos múltiples a su posición original.As already indicated, in the center-medullary nails of the prior art generally the end of the nail protrudes from the trochanter of the fractured bone. In In the method of the present invention, the extension 18 is removed to allow the application of the angled plate, accompanied by fastening with cortical and spongy screws 30 to fix the multiple fragments to their original position.
Cuando la rehabilitación ha ocurrido y se desea extraer el clavo de la cavidad medular, se procede a acoplar nuevamente la extensión 18 previo rimado, sobre el clavo 12, y se procede a extraer el clavo en conformidad con los métodos tradicionales, ayudados para mejor manejo, montando este segmento en el impactador 71.When the rehabilitation has occurred and it is desired to remove the nail from the medullary canal, the rimmed extension 18 is then re-coupled, over the nail 12, and the nail is removed in accordance with the traditional methods, aided for better handling , mounting this segment on impactor 71.
El clavo centro-medular ranurado diafisiario epifisiario 12 tiene por objeto:The epiphyseal diaphyseal grooved center-medullary nail 12 is intended to:
• Facilitar la reducción de fragmentos en fracturas multifragmentadas al tener un apoyo para los fragmentos que se sostienen en el clavo centromedular y se fijan con tornillos de cortical, cumpliendo con ello con las premisas de una buena y más sencilla osteosíntesis.• Facilitate the reduction of fragments in multifragmented fractures by having a support for the fragments that are held in the centromedular nail and fixed with cortex screws, thereby complying with the premises of a good and simple osteosynthesis.
• Permitir que la placa angulada 40 diseñada para fracturas multifragmentadas se coloque sin interferir en su funcionamiento, al retiro de la extensión 18. No hay interferencia en la colocación de los tornillos corticales y esponjosos, ya que estos pueden atravesar el clavo centro-medular ranurado diafisiario epifisiario 12 , aún en caso de placas anguladas largas.• Allow the angled plate 40 designed for multifragmented fractures to be placed without interfering with its operation, upon removal of the extension 18. There is no interference in the placement of cortical and spongy screws, as these can pass through the grooved center-medullary nail epiphyseal diaphyseal 12, even in the case of long angled plates.
Se puede también bajo los mismos parámetros usar los clavos para fracturas diafiso epifisiarias con o sin placas rectas.It is also possible to use the nails for epiphyseal fractures with or without straight plates under the same parameters.
Clavo centro medular ranurado diafisiario (13).Nail diaphyseal grooved spinal center (13).
Clavo centro medular ranurado para fracturas diafisiarias 13 (FIG. 4), está preparado para el uso de fracturas de la diáfisis únicamente, pudiendo aplicarse este sistema de reducción con o sin placa acompañante.Nail grooved spinal center for diaphyseal fractures 13 (FIG. 4), is prepared for the use of fractures of the shaft only, this reduction system can be applied with or without accompanying plate.
Placas angulada.Angled plates
Estos son elementos del estado de la técnica tradicional, consiste en placas que poseen perforaciones ovaladas (42, 52) como se ilustra en las FIGS. 1D y 1E, pero la placa angulada 40 tiene la característica de exhibir un doblez que define un ángulo θ de aproximadamente 130°. La placa angulada 40 tiene como objetivo proporcionar reducción a los fragmentos en que resulta la fractura trocantérica.These are elements of the state of the art, consisting of plates that have oval perforations (42, 52) as illustrated in FIGS. 1D and 1E, but the angled plate 40 has the characteristic of exhibiting a bend that defines an angle θ of approximately 130 °. The angled plate 40 is intended to provide reduction to the fragments resulting in the trochanteric fracture.
Es difícil corregir una fractura del tipo que exhibe fragmentos múltiples diafisiarios femorales solo con la placa angulada 40. De conformidad con la presente invención, la placa angulada 40 tendrá la ayuda del clavo femoral ranurado de la invención, para llevar a cabo la función de soporte para los tornillos que realizan la reducción de los fragmentos diafisiarios. La placa angulada 40 debe anclarse en el hueso fracturado. Dicho anclaje se consigue insertando un extremo en el cuello femoral del hueso. Evidentemente, lo anterior solo es posible si el cuello del hueso se encuentra substancialmente libre de obstáculos para que pueda insertarse, razón por la cuál se necesita retirar la extensión 18 del clavo 12 ilustrado en la FIG. 3.It is difficult to correct a fracture of the type that exhibits multiple femoral diaphyseal fragments only with the angled plate 40. In accordance with the present invention, the angled plate 40 will have the help of the slotted femoral nail of the invention, to carry out the support function for the screws that perform the reduction of the diaphyseal fragments. The angled plate 40 must be anchored in the fractured bone. Said anchorage is achieved by inserting one end into the femoral neck of the bone. Obviously, the above is only possible if the neck of the bone is substantially free of obstacles so that it can be inserted, which is why the extension 18 of the nail 12 illustrated in FIG. 3.
En la presente invención, debido a que el clavo 12 es ranurado en nada obstaculiza la inserción de la placa angulada y los tornillos, y debido a que la extensión 18 se remueve de la región trocantérica del hueso, tampoco obstaculiza la inserción de la placa angulada 40.In the present invention, because the nail 12 is grooved in nothing hinders the insertion of the angled plate and the screws, and because the extension 18 is removed from the trochanteric region of the bone, it also does not hamper the insertion of the angled plate 40
Medios de compresión externa mono y bicorticales:Mono and bicortical external compression means:
a) Compresores monocorticales.a) Monocortical compressors.
Los medios de compresión externa monocorticales comprenden las placas rectas 50 y anguladas 40. Con referencia a la FIG. 1 D la placa recta 50 comprende un cuerpo 51 de placa, que posee perforaciones 52 en las que se introducen tornillos 30 corticales y esponjosos para sujetar los segmentos fracturados.Monocortical external compression means comprise straight 50 and angled plates 40. With reference to FIG. 1 D the straight plate 50 comprises a plate body 51, which has perforations 52 in which cortical and spongy screws 30 are introduced to hold the fractured segments.
El clavo centro medular ranurado de la presente invención puede emplearse en conjunto con la placa recta de compresión monocortical de la figura 1D, para la reducción de fracturas femorales, aunque también es posible prescindir de la placa y solamente sujetar los fragmentos únicamente por medio del clavo.The grooved medullary center nail of the present invention can be used in conjunction with the straight monocortical compression plate of Figure 1D, for the reduction of femoral fractures, although it is also possible to dispense with the plate and only hold the fragments only by means of the nail .
Las placas 50 tienen como función básica, inmovilizar más sólidamente la unión entre las partes fracturadas, para permitir la regeneración de las células óseas, Dicha regeneración o consolidación permitirá que las partes fracturadas recuperen su consolidación.The plates 50 have as a basic function, to more solidly immobilize the union between the fractured parts, to allow the regeneration of the bone cells, Such regeneration or consolidation will allow the fractured parties to recover their consolidation.
Los tornillos 30 se introducen en los orificios ovalados 52 de la placa 50, y en los segmentos corticales fracturados. Los tornillos se introducen con una cierta inclinación, de modo que al apretarse dichos tornillos se genera una fuerza de compresión entre los segmentos fracturados, Se estima que el valor de la fuerza de compresión que genera la placa 50 se encuentra en un rango de entre 600 y 1 ,000 N (Newton).The screws 30 are inserted into the oval holes 52 of the plate 50, and into the fractured cortical segments. The screws are introduced with a certain inclination, so that when these screws are tightened, a compression force is generated between the fractured segments. It is estimated that the value of the compression force generated by the plate 50 is in a range of between 600 and 1 000 N (Newton).
B) Compresores bicorticales de compresión controlada.B) Bicortical compressors with controlled compression.
Puede aplicarse medios de compresión controlada bicorticales 60 para aplicar una presión entre los segmentos fracturados. Estos dispositivos compresión controlada se describen ampliamente en la solicitud de patente internacional PCT PCT/MX01/00050 que se cita como referencia.Bicortical controlled compression means 60 can be applied to apply a pressure between the fractured segments. These controlled compression devices are widely described in the PCT / MX01 / 00050 international patent application cited as reference.
En la FIG. 8 se ilustra la aplicación de una aparato de compresión controlada trans- óseo en combinación con el clavo ranurado 10. El aparato de compresión controlada 60 comprende una placa ranurada 61 por lo menos dos clavos trans-óseo 62 y un mecanismo de compresión 63. Los tornillos de cortical 30 se introducen en los orificios 611 de la placa 61 y se atornillan en la cortical del primer segmento fracturado. Mientras que también se introducen tornillos 30 en la ranura 612 y se atornillan en el segundo segmento fracturado. Conforme a la FIG. 8, además se introducen dos clavos transóseos 62, la posición de estos clavos para realizar compresión interfragmentaria depende de la visión del médico según las fracturas existentes. Cuando se acciona el mecanismo de compresión 63, representado en la FIG. 8 como un par de secciones roscadas y tuercas, se hace que los clavos transóseos 62 se acerquen y con ello se hace que los segmentos fracturados también se estrechen, es decir se aplica una fuerza de compresión en los segmentos fracturados.In FIG. 8 illustrates the application of a transverse bone compression apparatus in combination with the slotted nail 10. The controlled compression apparatus 60 comprises a grooved plate 61 at least two trans-bone nails 62 and a compression mechanism 63. Cortex screws 30 are inserted into holes 611 of plate 61 and screwed into the cortex of the first fractured segment. While screws 30 are also introduced into slot 612 and screwed into the second fractured segment. According to FIG. 8, in addition two transosseous nails 62 are introduced, the position of these nails to perform interfragmentary compression depends on the doctor's vision according to the existing fractures. When the compression mechanism 63, shown in FIG. 8 as a pair of threaded sections and nuts, the transosseous nails 62 are brought closer together and thereby the fractured segments are also narrowed, that is to say a compression force is applied to the fractured segments.
Como será evidente a un técnico en la materia, pueden emplearse otros tipos de aparatos de compresión existentes en el mercado ortopédico.As will be apparent to a person skilled in the art, other types of compression devices existing in the orthopedic market can be used.
En el sistema de compresión controlada puede generar una carga ilimitada, sin embargo se recomienda que el valor de la presión generada no exceda de 25 kN, para no exceder el modulo de elasticidad y evitar con ello el daño a la vitalidad del hueso fracturado.In the controlled compression system it can generate an unlimited load, however it is recommended that the value of the generated pressure does not exceed 25 kN, so as not to exceed the modulus of elasticity and thereby avoid damage to the vitality of the fractured bone.
Se ha encontrado que la fuerza aplicada puede provocar una deformación permisible de hasta 0.43 mm en pacientes de 20 años o menos y de hasta 0.21 mm en pacientes de 70 años. La deformación permisible es una función aproximadamente lineal de la edad.It has been found that the applied force can cause an allowable deformation of up to 0.43 mm in patients of 20 years or less and of up to 0.21 mm in patients of 70 years. Permissible deformation is an approximately linear function of age.
La colocación del clavo centro-medular ranurado 10 y los medios de compresión permite obtener una condición en donde los segmentos fracturados se encuentran en una posición estable con unión sólida de los fragmentos que resulta en una CONSOLIDACIÓN DIRECTA O PERPRIMA,The placement of the grooved center-medullary nail 10 and the compression means allows to obtain a condition where the fractured segments are in a stable position with solid junction of the fragments resulting in a DIRECT OR PERPRIMATE CONSOLIDATION,
Sistema localizador de la ranura del clavo centro medular.Medullary center nail groove locator system.
El sistema 70 se ilustra en la FIG. 5, dichos sistema consta de:System 70 is illustrated in FIG. 5, said system consists of:
A) Un impactador ranurado 71 ;A) A grooved impactor 71;
B) Bandera guía 72; yB) Guide flag 72; Y
C) Regla ranurada 73 para localizar la ranura del clavo centro medular ranurado.C) Grooved rule 73 to locate the groove of the grooved medullary center nail.
Una vez colocado el clavo centro medular ranurado, por el método convencional para lo cuál es cómodo hacerlo con el impactador 71 , se coloca el borde 721 de la bandera guía 72 en la hendidura 711 de ¡mpactador 71.Once the grooved medullary center nail is placed, by the conventional method for which it is convenient to do so with the impactor 71, the edge 721 of the guide flag 72 is placed in the slit 711 of the compactor 71.
Se coloca el segundo borde 722 en la hendidura 731 de la regla guía 73 y se introduce en la misma. La regla ranurada 73 comprende al menos una ranura 732 que es coincidente con la ranura 16 del clavo centro-medular ranurado 10. De esta manera, el cirujano puede identificar la posición de la ranura del clavo e introducir los tornillos 30 de osteosíntesis a través de las ranuras 16, que se halla preferentemente en la parte lateral. Finalmente, SI EL IMPACTADOR QUE FUE AJUSTADO HASTA LLEGAR A SU TOPE, será posible hacer pasar los tornillos 30 de esponjosa en cadera y de cortical en diáfisis, mismos que coincidirán con la ranura del clavo centro medular ranurado.The second edge 722 is placed in the groove 731 of the guide rule 73 and inserted therein. The grooved ruler 73 comprises at least one groove 732 which is coincident with the groove 16 of the grooved center-medullary nail 10. In this way, the surgeon can identify the position of the groove of the nail and introduce the osteosynthesis screws 30 through the grooves 16, which is preferably in the lateral part. Finally, IF THE IMPACTOR THAT WAS ADJUSTED UNTIL REACHING THE BUMPER, it will be possible to pass the spongy screws 30 on the hip and the cortex on the diaphysis, which will coincide with the groove of the grooved medullary center nail.
MÉTODO. Hay diferentes métodos, que están sujetas al criterio del ortopedista por el tipo de la fractura a resolver.METHOD. There are different methods, which are subject to the orthopedist's criteria by the type of fracture to be resolved.
La vía de acceso del clavo dentro-medular ranurado es lateral, empleándose para ello la misma técnica conocida ya para clavo centro medular perforado o no perforado de la técnica previa.The access route of the grooved inside-medullary nail is lateral, using the same known technique already for the perforated or unperforated medullary center nail of the prior art.
1. Para introducción del clavo pandiafisiario ó metafiso-diafisiario sin placa angulada:1. For introduction of the pandiaphyseal or diaphyseal metaphyseal nail without angled plate:
A) Introduzca una broca delgada al segmento proximal, desde la porción distal del segmento proximal, hasta salir por la zona trocantérea; aumentar el diámetro de la broca 0.5 mm cada vez, hasta conseguir pasar el clavo escogido para la osteosíntesis según estudio radiográfico de acuerdo a método convencional. Luego introducir el clavo al segmento fracturario distal.A) Insert a thin drill bit into the proximal segment, from the distal portion of the proximal segment, to exit through the trochanter area; Increase the diameter of the drill 0.5 mm at a time, until the nail chosen for osteosynthesis can be passed according to a radiographic study according to a conventional method. Then introduce the nail to the distal fracture segment.
B) Reducción y fijación de las fracturas con tornillos o con placa diafisiaria y tornillos, a través de la ranura del clavo centro medular.B) Reduction and fixation of fractures with screws or with diaphyseal plate and screws, through the groove of the medullary center nail.
C) Si hay fractura diafisiaria y metafisiaria se valorará la viabilidad de este método con clavo. Al igual si nos referimos a las fracturas supracondileas femorales en las que se usan placas de 90°C) If there is a diaphyseal and metaphyseal fracture, the viability of this method with nail will be assessed. Like if we refer to supracondylar femoral fractures in which 90 ° plates are used
Aplicación de clavo diafisiario con o sin placa recta.Diaphyseal nail application with or without straight plate.
Este clavo centro medular presenta ranura en la zona diafisiaria únicamente. Mismo método de aplicación, se puede colocar solamente tornillos corticales o el sistema de clavo centro medular más placa de compresión controlada o sin ella. Las placas y el clavo deben ejercer presión únicamente en la zona circundante a los orificios para el paso de tornillos, para no causar fuerte compresión al tejido óseo que está entre la placa y el clavo centro medular, por lo cuál es indispensable la colocación de placas con presión mínima de los tornillos, que se consigue después de ajustados estos aflojando los mismos media vuelta.This spinal center nail has a groove in the diaphyseal area only. Same method of application, only cortical screws or the center medullary nail system plus or without controlled compression plate can be placed. The plates and the nail should exert pressure only in the area surrounding the holes for the passage of screws, so as not to cause strong compression to the bone tissue that is between the plate and the medullary center nail, so it is essential to place plates with minimum screw pressure, which is achieved after adjusting these by loosening the same half turn.
Aplicación de clavo centro medular más placa angulada de 130°: A) Aplicación del clavo 12 de 2 piezas FIG. 3, mismo método de aplicación. Retiro de la extensión proximal (18), colocación de la placa angulada.Application of spinal center nail plus angled plate of 130 °: A) Application of nail 12 of 2 pieces FIG. 3, same application method. Removal of the proximal extension (18), placement of the angled plate.
B) En todos los casos descritos para introducir los tornillos de reducción fragmentaria, puede emplearse el sistema localizador de la ranura del clavo centro medular.B) In all the cases described to introduce the fragmentary reduction screws, the spinal center nail groove locator system can be used.
De esta forma se consigue tener un soporte para ir armando los múltiples fragmentos a reducir y sujetarlos mediante tornillos de contención. Lo cual resulta de gran utilidad por el soporte gue proporciona el clavo a los fragmentos para poder fijarlos. In this way it is possible to have a support to assemble the multiple fragments to be reduced and fasten them by means of retaining screws. Which is very useful for the support that provides the nail to the fragments to be able to fix them.

Claims

REIVINDICACIONES. CLAIMS.
1. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios que comprende: un clavo centro medular ranurado 10 y tornillos de cortical 30, caracterizado porque el clavo centro medular 10 posee un cuerpo 15 que incluye por lo menos una ranura 16 que permiten que tornillos de cortical 30 pasen a través del mismo para fijar los elementos diafisiarios múltiples con objeto de consolidar el hueso fracturado.A device for carrying out surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments comprising: a grooved medullary center nail 10 and cortex screws 30, characterized in that the medullary center nail 10 has a body 15 that It includes at least one groove 16 that allows cortex screws 30 to pass through it to fix the multiple diaphyseal elements in order to consolidate the fractured bone.
2. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios en conformidad con la reivindicación 1 en donde dicho dispositivo además comprende: (a) una extensión 18, que es acoplable con el clavo 10, que tiene por objeto proporcionar al clavo la dimensión necesaria para poder penetrar en el canal medular del hueso fracturado, removerse del clavo 10 cuando éste se ha introducido suficientemente en la cavidad medular para permitir el anclaje de la placa angulada y volver a acoplarse al clavo 10 para extraerlo de la cavidad medular; y (b) una placa angulada para soportar las porciones epifisiarias y diafisiarias proximales fracturados.2. A device for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments in accordance with claim 1 wherein said device further comprises: (a) an extension 18, which is attachable with the nail 10 , which is intended to provide the nail with the necessary dimension to be able to penetrate the medullary canal of the fractured bone, remove it from the nail 10 when it has been sufficiently inserted into the medullary canal to allow anchoring of the angled plate and reattach to the nail 10 to extract it from the medullary canal; and (b) an angled plate to support the fractured proximal epiphyseal and diaphyseal portions.
3. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios en conformidad con las reivindicaciones 1 o 2, que además comprende una placa plana 50 para sujetar los fragmentos diafisiarios.3. A device for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments in accordance with claims 1 or 2, which further comprises a flat plate 50 to hold the diaphyseal fragments.
4. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios en conformidad con las reivindicaciones 1 o 2, que además comprende un sistema de compresión controlada 60 para aplicar una fuerza que estreche los espacios existentes entre los segmentos diafisiarios.4. A device for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments in accordance with claims 1 or 2, which further comprises a controlled compression system 60 to apply a force that narrows the existing spaces between the diaphyseal segments.
5. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios en conformidad con la reivindicación 4 en donde el sistema de compresión comprende una placa ranurada 61 y por lo menos un clavo transóseo 62 y un mecanismo de compresión 63.5. A device for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments in accordance with claim 4 wherein the system of Compression comprises a grooved plate 61 and at least one transverse nail 62 and a compression mechanism 63.
6. Un dispositivo para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios en conformidad con las reivindicaciones 1 o 2, que además comprende un sistema localizador de la ranura del clavo centro-medular ranurado. Dicho sistema comprende: (A) Un impactador ranurado 71 , (B) Bandera guía 72, y (C) Regla ranurada 73 para localizar la ranura del clavo centro medular ranurado.6. A device for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments in accordance with claims 1 or 2, which further comprises a slotted center-medullary nail groove locator system. Said system comprises: (A) A grooved impactor 71, (B) Guide flag 72, and (C) Grooved ruler 73 to locate the groove of the grooved medullary center nail.
7. Clavo centro medular ranurado para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios que comprende un cuerpo 15 que incluye por lo menos una ranura 16.7. Nail slotted spinal center to perform surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments comprising a body 15 that includes at least one groove 16.
8. Clavo centro medular ranurado para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios de conformidad con la reivindicación 7 comprende además un materia de relleno o tapas de un material suave que no impida el paso de tornillos corticales a través de la ranura.8. Slotted spinal center nail for performing surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments according to claim 7 further comprises a filling material or caps of a soft material that does not prevent the passage of screws cortical through the groove.
9. Clavo centro medular ranurado para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios de conformidad con la reivindicación 7 que además comprende una extensión 18 que tiene por objeto proporcionar al clavo la dimensión necesaria para poder penetrar en el canal medular del hueso fracturado, removerse del clavo 10 cuando éste se ha introducido suficientemente en la cavidad medular y volver a acoplarse al clavo 10 para extraerlo de dicha cavidad medular.9. Nail grooved spinal center to perform surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments according to claim 7 which further comprises an extension 18 which is intended to provide the nail with the dimension necessary to penetrate in the medullary canal of the fractured bone, remove it from the nail 10 when it has been sufficiently inserted into the medullary canal and reattach it to the nail 10 to remove it from said medullary canal.
10. Clavo centro medular ranurado para llevar a cabo cirugía para la reducción de fracturas múltiples intertrocantéricas y osteosíntesis de segmentos diafisiarios y epifisiarios de conformidad con la reivindicación 7 que además comprende un sistema localizador de la ranura del clavo centro-medular ranurado. Dicho sistema comprende: (A) Un impactador ranurado 71 , (B) Bandera guía 72, y (C)10. Slotted medullary center nail to perform surgery for the reduction of multiple intertrochanteric fractures and osteosynthesis of diaphyseal and epiphyseal segments according to claim 7 which further comprises a slotted center-medullary nail groove locator system. Said system comprises: (A) A slotted impactor 71, (B) Guide flag 72, and (C)
Regla ranurada 73 para localizar la ranura del clavo centro medular ranurado. Grooved rule 73 to locate the groove of the grooved medullary center nail.
PCT/MX2001/000074 2001-10-12 2001-10-12 Grooved centro-medullary nail and a method for the osteosynthesis of diaphyseal segments WO2003030749A1 (en)

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