WO2007054591A1 - Delta-shaped device for the treatment of trochanteric and subtrochanteric fractures of the femur - Google Patents

Delta-shaped device for the treatment of trochanteric and subtrochanteric fractures of the femur Download PDF

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Publication number
WO2007054591A1
WO2007054591A1 PCT/ES2006/000590 ES2006000590W WO2007054591A1 WO 2007054591 A1 WO2007054591 A1 WO 2007054591A1 ES 2006000590 W ES2006000590 W ES 2006000590W WO 2007054591 A1 WO2007054591 A1 WO 2007054591A1
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WO
WIPO (PCT)
Prior art keywords
strut
anchoring element
delta
nail
delta device
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PCT/ES2006/000590
Other languages
Spanish (es)
French (fr)
Inventor
Carlos Enrique Morales Berenguer
Original Assignee
Morales Berenguer Carlos Enriq
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Publication date
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Publication of WO2007054591A1 publication Critical patent/WO2007054591A1/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
    • A61B17/74—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
    • A61B17/72—Intramedullary pins, nails or other devices

Definitions

  • Delta device for the treatment of trochanteric and subtrochanteric fractures of the femur.
  • the present invention refers to a delta device for the surgical treatment of proximal femur fractures (trochanteric and subtrochanteric).
  • Cephalomedular nails are intramedullary devices that are inserted through the piriformis fossa of the femur or the tip of the greater trochanter and carry an anchor that can be one or two screws or a sheet that are fixed, through the neck of the femur, inside of the femoral head.
  • an anchor can be one or two screws or a sheet that are fixed, through the neck of the femur, inside of the femoral head.
  • they have one or two locking screws to prevent both the collapse of the fracture and the rotations of the bone that would lead to prevent its healing.
  • Patent ES 2 214 071 T3 discloses an intramedullary nail of this kind.
  • fixed angle plates are devices with a similar anchor (screw or blade inside the femoral neck), and instead of going inside the femoral canal, they are anchored with screws to the external cortex thereof.
  • Subtrochanteric femur fractures. Sims SH these plates are collected and described.
  • cephalomedular nails with respect to the latter, is that they can be inserted through small incisions and that being inside the canal they are closer to the mechanical axis of the leg, presenting a biomechanical advantage over the plates, further away of said axis and therefore suffering greater tensions. Plaques have the disadvantage of requiring large incisions, with greater soft tissue injury.
  • the proximal region of the femur is an area subject to a lot of biomechanical stress, since it is an angled area that supports very large forces (during walking it becomes 5-7 times the body weight).
  • the most important area for the stability of the proximal femur is the post-lantern cortex, in the vicinity of the lesser trochanter, because it is the area closest to the mechanical axis of the leg.
  • This area supports the greater loads of the whole body, and when it is fractured, if the anatomy is not restored so that it can support loads, a lot of tension is produced in it, tension that tends to displace the fracture in varus, that is, decreasing the angle between the neck of the femur and the diaphysis, with eventual ruptures of the implants or pseudoarthrosis of the fracture.
  • the support of the fractured leg is sometimes forbidden for weeks after surgery, in order to avoid these complications.
  • the object of the invention is to create a cephalomedular nail supported by a strut that configures the delta device and guarantees the possibility of immediately loading weight on the limb in the inter-trochanteric and subtrochanteric femur fractures, placing the implant through small incisions.
  • the object of this invention is to create a delta device that does not have the disadvantages described above with respect to cephalomedular nails and plates.
  • SUBSTITUTE SHEET (RULE 26) incision and damage to soft tissue that needs to be implanted, since it is placed in the outer pam of the femur.
  • cephalomedular nails Another disadvantage with respect to cephalomedular nails is that it is a system of static osteosynthesis, that is, it does not allow sliding of the sheet inserted in the femoral neck over the implant body, and thereby prevents compression between the fragments of bone that do allow dynamic systems.
  • the invention described and claimed here is intended to increase the rigidity of the assemblies in the same way as the RAB device did, but with greater biomechanical advantage, because it is intramedullary, and, above all, avoiding the large incisions not exempt from complications required by surgery. with plates allowing the patient to carry weight on the leg in the immediate postoperative period, avoiding complications arising from prolonged incarnation in elderly patients.
  • a static (more rigid and without interfragmentary compression) or dynamic assembly (allowing controlled compression between bone fragments) can be obtained.
  • the nail will have a hole in its interior similar to the one it has for the proximal anchoring element, which will house and orient the strut towards a point where it will converge with the anchoring element, thus closing a delta mount, much larger stability, which will replace the defect of the cortical critique posterointerna.
  • Said assembly will foreseeably have an angle of between 40 and 80 ° between the proximal stabilizing element and the nail, and 20-40 ° between the strut and the nail.
  • the anchoring element will have a bed to house the strut, towards which it will converge, so that the strut will be locked at this point. Depending on the configuration of this bed it will be possible to slide the anchoring element over the strut (dynamic system) or not (static system).
  • the anchor element will be constructed as a dynamic element.
  • This slide will allow the bone fragment that includes the femoral neck to slide a few millimeters (depending on the size of the carved bed), and with that it will impact the fragment of the main bone, thereby favoring interfragmentary compression, which is key to a favor the consolidation of the fracture.
  • more loads will be transmitted to the bone system, thus unloading the device.
  • the bed of the anchoring element for the strut will be of the right size to house the strut and with this this slip will not be allowed, thereby obtaining a static system.
  • Figure 1 represents a cross-section of the delta device disassembled according to the invention together with the anchoring element, the strut and the locking bolts.
  • Figure 2 represents the delta device with its assembled parts.
  • Figure 3 represents a front view of the anchoring element and on its lower face shows the bed that will house the strut.
  • Figure 4 represents a bottom view of the anchoring element where the bed that will house the strut is shown.
  • Figure 5 represents the strut with the anchor thread for the intramedullary nail.
  • Figure 6 represents a 90 degree rotated view of the intramedullary nail depicted in Figure 1 where the four holes and the stopper are appreciated. closing.
  • Figure ' 7 is a perspective representation of the delta device assembled and implanted in the femur. , •
  • Figure 8 is a representation of the delta device where the different distance from the point of application of the force to the nail is shown in the case that the strut was not present as in conventional intramedullary nails (Ll) 5 and said distance with the introduction of the strut (L2). This difference in distances affects the lever arm exerted on the proximal anchoring element in the same proportion, so that the resistance of this assembly is proportionally greater.
  • Figures 9, 10 represent the different design possibilities of the bed of the anchoring element that houses the strut. In figure 9 the strut is locked thereby configuring a static system. In figure 10 there is a certain margin of sliding of the anchoring element on the strut, a dynamic system being configured.
  • the delta device (1) object of the present invention comprises:
  • SUBSTITUTE SHEET (RULE 26) - An intramedullary nail (2) suitable for insertion into the medullary canal of the femur.
  • An anchoring element (7) of the intramedullary nail (2) in the head of the femur is an anchoring element (7) of the intramedullary nail (2) in the head of the femur.
  • Figure 2 shows how the elements listed in the preceding paragraph close a delta device (1), object of the present invention.
  • the intramedullary nail (2) has a conical distal end (3), suitable to facilitate the insertion of said nail into the medullary canal.
  • a drill 13
  • ovoid section which will house the dynamic locking bolt (15).
  • another hole (12) of circular section intended to house the static locking bolt (14).
  • a first hole, oblong section (6) intended to house the anchoring element (7), and below it a second hole (9) with a carved thread, in which will insert and screw the strut (10).
  • the proximal end of the nail (4) serves to anchor in it the instruments for inserting the device into the patient, and at the end of the intervention said hole will be obliterated by means of a closure plug (5).
  • the anchoring element (7) is a structure that has a bed (8) on its lower face to receive the end of the strut (10).
  • the strut (10) will serve to close the delta assembly, transfer the load of the anchoring element (7) to the intramedullary nail (2), reducing the lever arm that supports the anchoring element, as shown in Figure 8
  • the strut is fixed to the nail by means of a thread existing at its end (11), being screwed to the wrought thread existing in the hole (9) prepared for the strut.

Abstract

The invention relates to a delta-shaped device for the treatment of trochanteric and subtrochanteric fractures of the femur. The invention comprises a cephalomedullary nail which is supported by a crosspiece forming the delta-shaped device. The cephalomedullary nail includes a crosspiece which supports a proximal locking element which is inserted into the neck of the femur, thereby enabling the load to be partially removed from the locking element and transferred to the nail. The nail is equipped with a socket which locks the crosspiece and directs same towards a recess in the proximal anchoring element. Proximal femur fractures require resistant stable implants and the inventive device is designed to offer good stability and resistance. Different configurations of the anchoring element can be used such as to render the device dynamic or static.

Description

DESCRIPCIÓN DESCRIPTION
Dispositivo en delta para el tratamiento de las fracturas trocantéricas y subtrocantéricas del fémur.Delta device for the treatment of trochanteric and subtrochanteric fractures of the femur.
Objeto de la invenciónObject of the invention
La presente invención hace referencia a un dispositivo en delta para el tratamiento quirúrgico de las fracturas proximales de fémur (trocantéricas y subtrocantéricas).The present invention refers to a delta device for the surgical treatment of proximal femur fractures (trochanteric and subtrochanteric).
Antecedentes de la invenciónBackground of the invention
Tal como es conocido, el tratamiento quirúrgico actual de las fracturas trocantéricas y ; subtrocantéricas de fémur se basa fundamentalmente en dos técnicas: Los clavos cefalomedulares y las placas de ángulo fijo. Los clavos cefalomedulares son dispositivos intramedulares que se insertan por la fosa piriforme del fémur o por la punta del trocánter mayor y llevan un anclaje que puede ser uno o dos tornillos o una lámina que se fijan, a través del cuello del fémur, en el interior de la cabeza femoral. Distalmente, es decir, en la parte inferior, llevan uno o dos tornillos de bloqueo para impedir tanto el colapso de la fractura como las rotaciones del hueso que llevarían a impedir la curación del mismo.As is known, the current surgical treatment of trochanteric fractures and; Subtrochanteric femur is fundamentally based on two techniques: Cephalomedular nails and fixed angle plates. Cephalomedular nails are intramedullary devices that are inserted through the piriformis fossa of the femur or the tip of the greater trochanter and carry an anchor that can be one or two screws or a sheet that are fixed, through the neck of the femur, inside of the femoral head. Distantly, that is, in the lower part, they have one or two locking screws to prevent both the collapse of the fracture and the rotations of the bone that would lead to prevent its healing.
La Patente ES 2 214 071 T3 divulga un clavo intramedular de esta clase. Por otro lado, las placas de ángulo fijo son dispositivos con un anclaje similar (tornillo o lámina en el interior del cuello femoral), y que en lugar de ir por dentro del canal femoral van anclados con tornillos a la cortical externa del mismo. En este sentido, en el artículo: Orthop Clin North Am. 2002 Enero; Volumen 33 (1): páginas 113-126, viii. Subtrochanteric fémur fractures. Sims SH, se recogen y se describen estas placas. La ventaja de los clavos cefalomedulares respecto de estas últimas, es que se pueden insertar a través de pequeñas incisiones y que al estar dentro del canal se encuentran más cerca del eje mecánico de la pierna, presentando una ventaja biomecánica frente a las placas, más alejadas de dicho eje y por tanto sufriendo mayores tensiones. Las placas presentan la desventaja de precisar grandes incisiones, con mayor lesión de los tejidos blandos.Patent ES 2 214 071 T3 discloses an intramedullary nail of this kind. On the other hand, fixed angle plates are devices with a similar anchor (screw or blade inside the femoral neck), and instead of going inside the femoral canal, they are anchored with screws to the external cortex thereof. In this regard, in the article: Orthop Clin North Am. 2002 January; Volume 33 (1): pages 113-126, viii. Subtrochanteric femur fractures. Sims SH, these plates are collected and described. The advantage of the cephalomedular nails with respect to the latter, is that they can be inserted through small incisions and that being inside the canal they are closer to the mechanical axis of the leg, presenting a biomechanical advantage over the plates, further away of said axis and therefore suffering greater tensions. Plaques have the disadvantage of requiring large incisions, with greater soft tissue injury.
HOJA DE SUSTITUCIÓN (REGLA 26) Por otra parte, la región proximal del fémur es una zona sometida a mucho estrés biomecánico, por tratarse de una zona angulada que soporta fuerzas muy grandes (durante la deambulación llegan a ser de 5-7 veces el peso corporal). La zona más importante para la estabilidad del fémur proximal es la cortical posterointerna, en las inmediaciones del trocánter menor, por tratarse de la zona más cercana al eje mecánico de la pierna. Esta zona soporta las cargas mayores de todo el cuerpo, y cuando está fracturada, si no se restaura la anatomía para que pueda soportar cargas, se produce mucha tensión en ella, tensión que tiende a desplazar la fractura en varo, es decir, disminuyendo el ángulo existente entre el cuello del fémur y la diáfisis, con eventuales roturas de los implantes o pseudoartrosis de la fractura. De este modo, cuando hay afectación de esta zona en ocasiones se tiende a prohibir el apoyo de la pierna fracturada durante semanas tras la cirugía, a fin de evitar estas complicaciones. Esto obliga, a los pacientes, frecuentemente ancianos a permanecer en cama o silla de ruedas, pudiendo iniciar una cadena de complicaciones (tromboembolismos, úlceras por presión, infecciones respiratorias, desorientación y demencia) que puede llegar a acabar con su vida.SUBSTITUTE SHEET (RULE 26) On the other hand, the proximal region of the femur is an area subject to a lot of biomechanical stress, since it is an angled area that supports very large forces (during walking it becomes 5-7 times the body weight). The most important area for the stability of the proximal femur is the post-lantern cortex, in the vicinity of the lesser trochanter, because it is the area closest to the mechanical axis of the leg. This area supports the greater loads of the whole body, and when it is fractured, if the anatomy is not restored so that it can support loads, a lot of tension is produced in it, tension that tends to displace the fracture in varus, that is, decreasing the angle between the neck of the femur and the diaphysis, with eventual ruptures of the implants or pseudoarthrosis of the fracture. Thus, when there is involvement in this area, the support of the fractured leg is sometimes forbidden for weeks after surgery, in order to avoid these complications. This forces patients, often elderly, to stay in bed or wheelchair, being able to initiate a chain of complications (thromboembolisms, pressure ulcers, respiratory infections, disorientation and dementia) that can end their life.
Es en este punto donde la invención viene a aportar su contribución. El objeto de la invención es crear un clavo cefalomedular soportado por un puntal que configura el dispositivo en delta y que garantiza la posibilidad de cargar inmediatamente peso sobre la extremidad en las fracturas intertrocantéricas y subtrocantéricas de fémur, colocando el implante a través de pequeñas incisiones.It is at this point that the invention comes to contribute. The object of the invention is to create a cephalomedular nail supported by a strut that configures the delta device and guarantees the possibility of immediately loading weight on the limb in the inter-trochanteric and subtrochanteric femur fractures, placing the implant through small incisions.
Así las cosas, el objeto de esta invención es la de crear un dispositivo en delta que no presenta las desventajas anteriormente descritas respecto de los clavos cefalomedulares y las placas.Thus, the object of this invention is to create a delta device that does not have the disadvantages described above with respect to cephalomedular nails and plates.
En el artículo científico de Baixauli, Francisco MD; Vicent, Vicente MD; Baixauli, Emilio MD; Serra, Vicente MD; Sanchez-Alepuz, Eduardo MD; Gómez, Victor MD; Martos, Francisco MD, titulado "A Reinforced Rigid Fixation Device for Unstable Intertrochanteric Fractures" de la revista de Clinical Orthopaedics & Related Research, Volumen 361 : paginas 205-215, de Abril de 1999, se describe una placa-lámina llamada RAB que lleva un puntal que soporta la lámina, de manera que hace las veces de la cortical interna del fémur, aportando mucha más resistencia y permitiendo la carga inmediata de peso sobre esa extremidad. El inconveniente de esta placa es la granIn the scientific article by Baixauli, Francisco MD; Vicent, Vicente MD; Baixauli, Emilio MD; Serra, Vicente MD; Sanchez-Alepuz, Eduardo MD; Gomez, Victor MD; Martos, Francisco MD, entitled "A Reinforced Rigid Fixation Device for Unstable Intertrochanteric Fractures" from the journal of Clinical Orthopedics & Related Research, Volume 361: pages 205-215, of April 1999, describes a plate-sheet called RAB that bears a strut that supports the lamina, so that it acts as the internal cortex of the femur, providing much more resistance and allowing immediate weight loading on that limb. The drawback of this plate is the great
HOJA DE SUSTITUCIÓN (REGLA 26) incisión y daño a las partes blandas que precisa para ser implantada, ya que se coloca en la paite externa del fémur. Otra desventaja con respecto a los clavos cefalomedulares es que se trata de un sistema de osteosíntesis estático, es decir, no permite el deslizamiento de la lámina insertada en el cuello femoral sobre el cuerpo del implante, y con ello impide la compresión entre los fragmentos de hueso que sí permiten los sistemas dinámicos.SUBSTITUTE SHEET (RULE 26) incision and damage to soft tissue that needs to be implanted, since it is placed in the outer pam of the femur. Another disadvantage with respect to cephalomedular nails is that it is a system of static osteosynthesis, that is, it does not allow sliding of the sheet inserted in the femoral neck over the implant body, and thereby prevents compression between the fragments of bone that do allow dynamic systems.
Explicación de la invenciónExplanation of the invention.
La invención aquí descrita y reivindicada pretende aumentar la rigidez de los montajes del mismo modo que lo hizo el dispositivo RAB, pero con mayor ventaja biomecánica, por ser intramedular, y, sobre todo, evitando las grandes incisiones no exentas de complicaciones que requiere la cirugía con placas permitiendo al paciente cargar peso sobre la pierna en el postoperatorio inmediato, evitando las complicaciones derivadas del encarnamiento prolongado en pacientes mayores. Además, dependiendo de la configuración del elemento de anclaje se puede obtener un montaje estático (más rígido y sin compresión interfragmentaria) o dinámico (que permita la compresión controlada entre los fragmentos de hueso). Se trata de un clavo cefalomedular que contiene un puntal atornillado al clavo que va a buscar al interior de la cabeza al elemento de anclaje cerrando un dispositivo en delta, minimizando así las tensiones sobre la región proximal del clavo. Por tanto la contribución de esta invención radica en la incorporación de un soporte, que a modo de puntal ha de soportar el elemento de bloqueo proximal insertado en el cuello del fémur, permitiendo de este modo la descarga de este brazo y la transmisión de dicha carga al clavo. Dicho puntal irá enroscado en el clavo. El clavo tendrá un taladro en su interior similar al que tiene para el elemento de anclaje proximal, que albergará y orientará al puntal hacia un punto en el cual convergerá con el elemento de anclaje, cerrando de este modo un montaje en delta, de mucha mayor estabilidad, que suplirá el defecto de la crítica cortical posterointerna. Dicho montaje tendrá, previsiblemente, una angulación de entre 40 y 80° entre el elemento estabilizador proximal y el clavo, y de 20-40° entre el puntal y el clavo. El elemento de anclaje tendrá un lecho para albergar el puntal, hacia el cual convergerá el mismo, de modo que el puntal quedará bloqueado en este punto. Dependiendo de la configuración de este lecho será posible el deslizamiento del elemento de anclaje sobre el puntal (sistema dinámico) o no (sistema estático).The invention described and claimed here is intended to increase the rigidity of the assemblies in the same way as the RAB device did, but with greater biomechanical advantage, because it is intramedullary, and, above all, avoiding the large incisions not exempt from complications required by surgery. with plates allowing the patient to carry weight on the leg in the immediate postoperative period, avoiding complications arising from prolonged incarnation in elderly patients. In addition, depending on the configuration of the anchoring element, a static (more rigid and without interfragmentary compression) or dynamic assembly (allowing controlled compression between bone fragments) can be obtained. It is a cephalomedular nail that contains a strut screwed to the nail that will look inside the head for the anchoring element closing a delta device, thus minimizing tensions on the proximal region of the nail. Therefore the contribution of this invention lies in the incorporation of a support, which as a prop must support the proximal locking element inserted in the neck of the femur, thus allowing the discharge of this arm and the transmission of said load to the nail Said strut will be screwed into the nail. The nail will have a hole in its interior similar to the one it has for the proximal anchoring element, which will house and orient the strut towards a point where it will converge with the anchoring element, thus closing a delta mount, much larger stability, which will replace the defect of the cortical critique posterointerna. Said assembly will foreseeably have an angle of between 40 and 80 ° between the proximal stabilizing element and the nail, and 20-40 ° between the strut and the nail. The anchoring element will have a bed to house the strut, towards which it will converge, so that the strut will be locked at this point. Depending on the configuration of this bed it will be possible to slide the anchoring element over the strut (dynamic system) or not (static system).
HOJA DE SUSTITUCIÓN (REGLA 26) En un modo de realización de la invención se construirá el elemento de anclaje como elemento dinámico. Para conseguir este efecto no hay más que labrar un lecho alargado en la cara inferior del elemento de anclaje, de modo que exista la posibilidad de que el elemento de anclaje deslice sobre el puntal. Este deslizamiento permitirá que el fragmento de hueso que incluye el cuello femoral deslice unos determinados milímetros (dependiendo del tamaño del lecho labrado), y con ello se impactará contra el fragmento de hueso principal, favoreciendo con ello la compresión interfragmentaria, que es clave para una favorecer la consolidación de la fractura. Asimismo como consecuencia se transmitirán más cargas al sistema óseo descargando de esta manera el dispositivo. Para permitir este deslizamiento sin que exista rotación del elemento de anclaje es necesario que se bloquee de algún modo esta posibilidad de rotación, por ejemplo, construyendo el elemento de anclaje y el taladro para el mismo con una secςión oval, de modo que pueda deslizar pero no rotar sobre su eje. • ,SUBSTITUTE SHEET (RULE 26) In an embodiment of the invention the anchor element will be constructed as a dynamic element. In order to achieve this effect, it is only necessary to carve an elongated bed in the lower face of the anchoring element, so that there is a possibility that the anchoring element slides over the strut. This slide will allow the bone fragment that includes the femoral neck to slide a few millimeters (depending on the size of the carved bed), and with that it will impact the fragment of the main bone, thereby favoring interfragmentary compression, which is key to a favor the consolidation of the fracture. Likewise, as a consequence, more loads will be transmitted to the bone system, thus unloading the device. In order to allow this sliding without the rotation of the anchoring element, it is necessary that somehow this possibility of rotation be blocked, for example, by constructing the anchoring element and the hole for it with an oval section, so that it can slide but Do not rotate on its axis. •,
En otro modo de realización de la invención el lecho del elemento de anclaje para el puntal será del tamaño justo para albergar el puntal y con ello no se permitirá este deslizamiento, obteniéndose con ello un sistema estático.In another embodiment of the invention the bed of the anchoring element for the strut will be of the right size to house the strut and with this this slip will not be allowed, thereby obtaining a static system.
En cualquier caso, en la parte inferior del clavo habrá dos taladros para la inserción de sendos pernos de bloqueo, como los incluidos en los diseños actuales. Por otra parte, es posible que en la rosca labrada para el puntal pueda anclarse un mango que guíe un sistema para bloquear el clavo a nivel distal. Esto actualmente no se puede realizar, teniendo que llevarse a cabo mediante control radioscópico (con el consiguiente exceso de radiación para el paciente y sobre todo para los cirujanos, que sufren acumulación de radiación con cada procedimiento). El motivo por el que actualmente no se puede realizar es que hay demasiada distancia entre el punto de anclaje de la guía (en la parte más alta del clavo) y estos taladros, lo que hace que se pierda precisión y no se pueda embocar correctamente el tornillo en el taladro. La utilización de esta rosca labrada que quedaría aproximadamente en la mitad del clavo para anclar una guía de inserción de los tornillos quizá permitiría aumentar esta precisión, obviando la necesidad de emplear los rayos X.In any case, at the bottom of the nail there will be two holes for the insertion of two locking bolts, such as those included in the current designs. On the other hand, it is possible that a handle guiding a system to block the nail at the distal level can be anchored in the threaded thread for the strut. This cannot currently be done, having to be carried out by means of radioscopic control (with the consequent excess of radiation for the patient and especially for surgeons, who suffer accumulation of radiation with each procedure). The reason why it cannot currently be done is that there is too much distance between the anchor point of the guide (at the highest part of the nail) and these drills, which causes precision to be lost and not to correctly embed the screw in the drill. The use of this carved thread that would remain approximately in the middle of the nail to anchor a screw insertion guide could perhaps increase this precision, obviating the need to use X-rays.
Descripción de los dibujosDescription of the drawings
El objeto de esta invención se comprenderá mejor mediante la descripción de los dibujos adjuntos a la presente memoria descriptiva y un modo de realización de la misma:The object of this invention will be better understood by describing the drawings attached to the present specification and an embodiment thereof:
HOJA DE SUSTITUCIÓN (REGLA 26) La figura 1, representa un corte transversal del dispositivo en delta desmontado de acuerdo con la invención junto con el elemento de anclaje, el puntal y los pernos de bloqueo.SUBSTITUTE SHEET (RULE 26) Figure 1 represents a cross-section of the delta device disassembled according to the invention together with the anchoring element, the strut and the locking bolts.
La figura 2, representa el dispositivo en delta con sus piezas ensambladas. La figura 3, representa una vista frontal del elemento de anclaje y en su cara inferior muestra el lecho que albergará al puntal.Figure 2 represents the delta device with its assembled parts. Figure 3 represents a front view of the anchoring element and on its lower face shows the bed that will house the strut.
La figura 4, representa una vista inferior del elemento de anclaje donde se muestra el lecho que albergará al puntal. La figura 5, representa el puntal con la rosca de anclaje para el clavo intramedular. La figura 6, representa una vista girada 90 grados del clavo intramedular representado en la figura 1 donde se aprecian los cuatro taladros- y el tapón de. cierre. La figura '7,, es una representación en perspectiva del dispositivo en delta ensamblado e implantado en el fémur. , •Figure 4 represents a bottom view of the anchoring element where the bed that will house the strut is shown. Figure 5 represents the strut with the anchor thread for the intramedullary nail. Figure 6 represents a 90 degree rotated view of the intramedullary nail depicted in Figure 1 where the four holes and the stopper are appreciated. closing. Figure ' 7 ,, is a perspective representation of the delta device assembled and implanted in the femur. , •
La figura 8, es una representación del dispositivo en delta donde se muestra la diferente distancia del punto de aplicación de la fuerza al clavo en el caso de que no estuviera el puntal como ocurre en los clavos intramedulares convencionales (Ll)5 y dicha distancia con la introducción del puntal (L2). Esta diferencia de distancias afecta en la misma proporción al brazo de palanca ejercido sobre el elemento de anclaje proximal, por lo que la resistencia de este montaje es proporcionalmente superior. Las figuras 9, 10, representan las diferentes posibilidades de diseño del lecho del elemento de anclaje que alberga el puntal. En la figura 9 el puntal está bloqueado configurando con ello un sistema estático. En la figura 10 existe cierto margen de deslizamiento del elemento de anclaje sobre el puntal configurándose un sistema dinámico. Al cargar peso, representado por una flecha, sobre la extremidad se transmitirá esta fuerza al elemento de anclaje, y al quedar cierta distancia entre el final del lecho de anclaje y el extremo del puntal se podrá deslizar el elemento de anclaje (que no está bloqueado) sobre el puntal (que sí está fijo por su base, en su taladro). Este deslizamiento se aprecia en la figura 11.Figure 8 is a representation of the delta device where the different distance from the point of application of the force to the nail is shown in the case that the strut was not present as in conventional intramedullary nails (Ll) 5 and said distance with the introduction of the strut (L2). This difference in distances affects the lever arm exerted on the proximal anchoring element in the same proportion, so that the resistance of this assembly is proportionally greater. Figures 9, 10 represent the different design possibilities of the bed of the anchoring element that houses the strut. In figure 9 the strut is locked thereby configuring a static system. In figure 10 there is a certain margin of sliding of the anchoring element on the strut, a dynamic system being configured. When loading weight, represented by an arrow, this force will be transmitted to the anchoring element on the limb, and when there is a certain distance between the end of the anchoring bed and the end of the strut, the anchoring element (which is not blocked) can slide ) on the strut (which is fixed by its base, in its hole). This slip is seen in Figure 11.
Realización preferente de la invenciónPreferred Embodiment of the Invention
Tal como se aprecia en la figura 1 el dispositivo en delta (1) objeto de la presente invención comprende:As shown in Figure 1, the delta device (1) object of the present invention comprises:
HOJA DE SUSTITUCIÓN (REGLA 26) - Un clavo intramedular (2) adecuado para su inserción en el canal medular del fémur.SUBSTITUTE SHEET (RULE 26) - An intramedullary nail (2) suitable for insertion into the medullary canal of the femur.
Un elemento de anclaje (7) del clavo intramedular (2) en la cabeza del fémur.An anchoring element (7) of the intramedullary nail (2) in the head of the femur.
- Un puntal (10) que se albergará en el lecho receptor para el puntal (8) que se encuentra en la cara inferior del elemento de anclaje (7).- A strut (10) that will be housed in the receiving bed for the strut (8) that is located on the lower face of the anchoring element (7).
- Dos pernos de bloqueo (14), (15).- Two locking bolts (14), (15).
Del mismo modo, en la figura 2 se muestra como los elementos enumerados en el párrafo precedente cierran un dispositivo en delta (1), objeto de la presente invención.Similarly, Figure 2 shows how the elements listed in the preceding paragraph close a delta device (1), object of the present invention.
Se puede observar que el clavo intramedular (2) presenta un extremo distal cónico (3), apto para facilitar la inserción de dicho clavo en el canal medular. Proximal al mismo se encuentra- un taladro (13), de sección ovoidea, que albergará al perno de bloqueo dinámico (15). Por encima de este encontramos otro taladro (12) de sección circular, destinado a albergar al perno de bloqueo estático (14). En la parte superior del clavo se encuentra un primer taladro, de sección oblonga (6), destinado a albergar el elemento de anclaje (7), y por debajo del mismo un segundo taladro (9) con una rosca labrada, en el que se insertará y enroscará el puntal (10). El extremo proximal del clavo (4) sirve para anclar en el mismo el instrumental de inserción del dispositivo en el paciente, y al terminar la intervención dicho orificio será obliterado mediante un tapón de cierre (5). Por otra parte, el elemento de anclaje (7) es una estructura que presenta en su cara inferior un lecho (8) para acoger el extremo del puntal (10).It can be seen that the intramedullary nail (2) has a conical distal end (3), suitable to facilitate the insertion of said nail into the medullary canal. Near it is a drill (13), ovoid section, which will house the dynamic locking bolt (15). Above this we find another hole (12) of circular section, intended to house the static locking bolt (14). In the upper part of the nail is a first hole, oblong section (6), intended to house the anchoring element (7), and below it a second hole (9) with a carved thread, in which will insert and screw the strut (10). The proximal end of the nail (4) serves to anchor in it the instruments for inserting the device into the patient, and at the end of the intervention said hole will be obliterated by means of a closure plug (5). On the other hand, the anchoring element (7) is a structure that has a bed (8) on its lower face to receive the end of the strut (10).
El puntal (10) servirá para, cerrando el montaje en delta, transferir la carga del elemento de anclaje (7) al clavo intramedular (2), disminuyendo el brazo de palanca que soporta el elemento de anclaje, como se representa en la figura 8. El puntal queda fijo al clavo mediante una rosca existente en su extremo (11), atornillándose a la rosca labrada existente en el taladro (9) preparado para el puntal.The strut (10) will serve to close the delta assembly, transfer the load of the anchoring element (7) to the intramedullary nail (2), reducing the lever arm that supports the anchoring element, as shown in Figure 8 The strut is fixed to the nail by means of a thread existing at its end (11), being screwed to the wrought thread existing in the hole (9) prepared for the strut.
HOJA DE SUSTITUCIÓN (REGLA 26) SUBSTITUTE SHEET (RULE 26)

Claims

REIVINDICACIONES
1. Dispositivo en delta para el tratamiento de las fracturas de fémur, que comprende un clavo intramedular (2), un elemento de anclaje (7) y dos pernos de bloqueo (14¿ 15), en el cual el clavo intramedular (2) presenta un extremo distal (3) destinado a ser insertado en el canal medular, un extremo proximal (4), un tapón de cierre del extremo proximal (5), un taladro (6) de recepción del elemento de anclaje (7) situado en la parte proximal del clavo intramedular (2), un segundo taladro (12) situado próximo al extremo distal (3) destinado a albergar el perno de bloqueo estático (14) y un tercer taladro (13) distal al anterior (12) destinado a albergar el perno de bloqueo dinámico (15), caracterizado porque el clavo intramedular (2) presenta otro, taladro (9) situado distal al taladro receptor (6) del elemento de anclaje (7) y proximal . al segundo taladro (12), para recibir un puntal (10) que además contacta en un extremo con. el 'elemento de anclaje (7) en un lecho (8) receptor del puntal (10), cerrando así una unión triangular en delta (1) entre el puntal (10), el clavo intramedular (2) y el elemento de anclaje (7).1. Delta device for the treatment of femoral fractures, comprising an intramedullary nail (2), an anchoring element (7) and two locking bolts (14-15), in which the intramedullary nail (2) it has a distal end (3) intended to be inserted into the medullary canal, a proximal end (4), a closure plug for the proximal end (5), a hole (6) for receiving the anchoring element (7) located in the proximal part of the intramedullary nail (2), a second bore (12) located near the distal end (3) intended to house the static locking bolt (14) and a third bore (13) distal to the anterior (12) intended for housing the dynamic locking bolt (15), characterized in that the intramedullary nail (2) has another, hole (9) located distal to the receiving hole (6) of the anchoring element (7) and proximal. to the second hole (12), to receive a prop (10) that also contacts at one end with. the 'anchoring element (7) in a bed (8) receiving the stanchion (10), closing a triangular junction delta (1) between the strut (10), the intramedullary nail (2) and the anchor ( 7).
2. Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque el elemento de anclaje (7) es un tornillo2. Delta device according to claim 1, characterized in that the anchoring element (7) is a screw
3. Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque el elemento de anclaje (7) es una lámina. 3. Delta device according to Claim 1, characterized in that the anchoring element (7) is a sheet.
4. Dispositivo en delta de acuerdo con las Reivindicaciones 1 ó 3, caracterizado porque el lecho (8) que alberga el puntal (10) se ajusta al tamaño del extremo del puntal, configurando un sistema estático.4. Delta device according to claims 1 or 3, characterized in that the bed (8) housing the strut (10) is adjusted to the size of the end of the strut, configuring a static system.
5. Dispositivo en delta de acuerdo con las Reivindicaciones 1 ó 3, caracterizado porque el lecho (8) que alberga el puntal (10) está alargado en el sentido del eje mayor del elemento de anclaje (7), permitiendo el deslizamiento del elemento de anclaje (7) sobre el puntal (10), configurando así un sistema dinámico.5. Delta device according to claims 1 or 3, characterized in that the bed (8) housing the strut (10) is elongated in the direction of the major axis of the anchoring element (7), allowing the sliding of the element anchor (7) on the strut (10), thus configuring a dynamic system.
..
6. Dispositivo en delta de acuerdo , con las Reivindicaciones 1, 3 ó 5, caracterizado porque las secciones del elemento de anclaje (7) y del taladro (6) destinado para el mismo son ovales. 6. Delta device according to claims 1, 3 or 5, characterized in that the sections of the anchoring element (7) and the hole (6) intended for it are oval.
7. Dispositivo en delta- de acuerdo con las Reivindicaciones 1 a 6 caracterizado porque el puntal (10) soporta el elemento de anclaje (7).7. Delta device according to claims 1 to 6 characterized in that the strut (10) supports the anchoring element (7).
8. Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque el clavo intramedular (2) es cilindrico.8. Delta device according to Claim 1, characterized in that the intramedullary nail (2) is cylindrical.
HOJA DE SUSTITUCIÓN (REGLA 26) SUBSTITUTE SHEET (RULE 26)
9. Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque tanto la abertura, de entrada como la de salida de los taladros (6), (9) del clavo intramedular (2) está configurada por sendos orificios oblongos.9. Delta device according to claim 1, characterized in that both the opening, inlet and outlet of the holes (6), (9) of the intramedullary nail (2) is configured by two oblong holes.
10. Dispositivo en delta de acuerdo con las Reivindicaciones 1 ó 9, caracterizado porque el eje central del taladro (6) que alberga el elemento de anclaje (7) forma con el eje longitudinal del clavo un ángulo α comprendido entre 40° y 80°.10. Delta device according to claims 1 or 9, characterized in that the central axis of the borehole (6) housing the anchoring element (7) forms an angle α between 40 ° and 80 ° with the longitudinal axis of the nail .
11. Dispositivo en delta de acuerdo con la Reivindicación 1 ó 9, caracterizado porque el eje central del taladro (9) que alberga el puntal (10) forma con el eje longitudinal del clavo un ángulo β comprendido entre 20° y 40°. 11. Delta device according to claim 1 or 9, characterized in that the central axis of the borehole (9) housing the strut (10) forms an angle β between 20 ° and 40 ° with the longitudinal axis of the nail.
12. Dispositivo en delta de acuerdo con la Reivindicación 1, 9 ó 11, caracterizado porque el taladro (9) que alberga el, puntal (10) presenta una rosca labrada para la fijación del puntal (10) al clavo intramedular. (2). :s12. Delta device according to claim 1, 9 or 11, characterized in that the bore (9) housing the strut (10) has a threaded thread for fixing the strut (10) to the intramedullary nail. (2). : s
13; : Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque el taladro distal superior (12) destinado a albergar el perno de bloqueo estático (14) es circular y de un diámetro igual a dicho perno de bloqueo.13; : Delta device according to claim 1, characterized in that the upper distal bore (12) intended to house the static locking bolt (14) is circular and of a diameter equal to said locking bolt.
14. Dispositivo en delta de acuerdo con la Reivindicación 1, caracterizado porque el taladro distal inferior (13) destinado a albergar el perno de bloqueo dinámico14. Delta device according to Claim 1, characterized in that the lower distal bore (13) intended to house the dynamic locking bolt
(15) es ovoideo, y siendo su diámetro mayor, mayor que el diámetro del perno de bloqueo dinámico (15). (15) is ovoid, and its diameter being greater, greater than the diameter of the dynamic locking bolt (15).
15. Dispositivo en delta de acuerdo con la Reivindicación 1, 4 ó 5, caracterizado porque el puntal (10) presenta un extremo afilado que hará contacto con el elemento de anclaje (7) en el lecho receptor del puntal (8).15. Delta device according to claim 1, 4 or 5, characterized in that the strut (10) has a sharp end that will make contact with the anchoring element (7) in the strut receiving bed (8).
16. Dispositivo en delta de acuerdo con la Reivindicación 1, 12 ó 15, caracterizado porque en el otro extremo del puntal existe una rosca (11) para la fijación al clavo en el taladro correspondiente (9) del mismo paso de rosca que la de dicho taladro.16. Delta device according to claim 1, 12 or 15, characterized in that at the other end of the strut there is a thread (11) for fixing to the nail in the corresponding hole (9) of the same thread pitch as that of said drill.
HOJA DE SUSTITUCIÓN (REGLA 26) SUBSTITUTE SHEET (RULE 26)
PCT/ES2006/000590 2005-11-08 2006-10-24 Delta-shaped device for the treatment of trochanteric and subtrochanteric fractures of the femur WO2007054591A1 (en)

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ESP200502832 2005-11-08
ES200502832A ES2251888B1 (en) 2005-11-08 2005-11-08 DELTA DEVICE FOR THE TREATMENT OF TROCANTERIC AND SUBTOCANTERIC FRACTURES OF FEMUR.

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