ES2546991T3 - Orthopedic device to support and position a lower limb - Google Patents

Abstract

Orthopedic apparatus (1), to support and position a lower limb (7) of a patient in the course of an orthopedic surgery operation, the orthopedic apparatus (1) comprising: - fixing means (2) adapted to fix the apparatus orthopedic (1) to a surgical operating table; - a support (4) adapted to support the patient's foot (5.1); - a carriage (6) comprising first translation guiding means adapted to guide the support (4) in translation according to a longitudinal direction (X6) that is globally parallel to the mechanical axis (X7) of the lower member (7); - a joint (10) attached to the fixing means (2) and adapted to allow at least one pivot of the support (4) in a plane (P) globally parallel to the longitudinal direction (X6) and globally vertical when the apparatus Orthopedic (1) is in knee extension configuration of the lower limb; the orthopedic apparatus (1) being characterized in that it further comprises: - a slide (12) comprising a second means of translational guidance adapted to guide the carriage (6) in translation globally parallel to the longitudinal direction (X6), the second translation guide means being adapted to allow a translation according to discrete secondary positions spaced two by two by a secondary passage (P2); and - third translation guidance means adapted to guide the slide (12) in translation globally parallel to the longitudinal direction (X6), the third translation guidance means being adapted to allow translation according to discrete spaced tertiary positions two by two by a tertiary passage (P3), the tertiary passage (P3) being substantially superior to the secondary passage (P2).

Description

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DESCRIPTION

Orthopedic device to support and position a lower limb.

The present invention relates to an orthopedic apparatus for holding and positioning a lower limb of a patient in the course of an orthopedic surgery operation.

The present invention finds particularly application in the field of orthopedic repair surgery, in particular for the placement of hip prostheses.

US 5,645,079 A describes a prior art orthopedic apparatus for supporting and positioning a lower limb of a patient in the course of an orthopedic surgery operation. The patient is placed in a dorsal position on a surgical operating table. The orthopedic apparatus of US 5,645,079 A comprises means for fixing the orthopedic apparatus to the surgical operating table, a support for the patient's foot, a carriage to guide the support in translation along the mechanical axis of the lower limb of a patient and a joint to swing the support in a vertical plane.

It is necessary to adjust the position of such an orthopedic device to the length of the lower limb of each patient, in particular to place the hip in hyperextension. However, the orthopedic apparatus of US 5,645,079 A comprises a motor for regulating and adjusting the position of the orthopedic apparatus to the length of the lower limb.

However, such an engine performs a particularly slow translation movement to obtain the required accuracy. In addition, such an engine has a certain inertia that alters the positioning accuracy of the brace. On the other hand, the motors of US 5,645,079 A make the brace relatively heavy and bulky, and therefore difficult to use, transport and store.

In particular, the present invention is intended to solve, in whole or in part, the problems mentioned above.

For this purpose, the invention according to claim 1 is intended for an orthopedic apparatus for supporting and positioning a lower limb of a patient in the course of an orthopedic surgery operation, the orthopedic apparatus comprising:

-a fixation means adapted to fix the orthopedic device to a surgical operating table;

-a support adapted to support the patient's foot;

- a carriage comprising first means of translation guidance adapted to guide the support in translation according to a longitudinal direction that is globally parallel to the mechanical axis of the lower member;

-a joint attached to the fixing means and adapted to allow at least one pivot of the support in a plane globally parallel to the longitudinal and globally vertical direction when the orthopedic apparatus is in a knee extension configuration of the lower limb;

the orthopedic apparatus being characterized in that it further comprises:

- a slide comprising a second means of translation guidance adapted to guide the carriage in translation globally parallel to the longitudinal direction, the second means of guidance in translation being adapted to allow a translation according to discrete secondary positions spaced two in two by a secondary step; Y

-a third translation guidance means adapted to guide the sliding slide globally parallel to the longitudinal direction, the third translation guidance means being adapted to allow translation according to discrete tertiary positions spaced two by two in one step tertiary, the tertiary passage being substantially superior to the secondary passage.

In other words, an orthopedic apparatus according to the invention comprises three translation mechanisms parallel to a longitudinal direction, namely a very precise translation mechanism, for example of continuous variation, a precise and discrete translation mechanism and a movement mechanism. less precise translation to quickly "preposition" the brace according to the length of the lower limb of a patient.

Thus, an operator can quickly and accurately adjust the position of the brace to the length of the patient's lower limb, particularly when the hip is placed on hyperextension to improve the vision of the operative site.

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In the present application, the term "step" designates the separation between two consecutive consecutive positions that an operator can select. One step is preferably constant. Alternatively, the step may be variable.

In the present application, the term "mechanical axis of the lower limb" designates the rectilinear direction that joins the center of the femoral head to the center of the ankle. Thus, the mechanical axis of the lower limb of a patient is substantially vertical when the patient is standing.

In the present application, the term "hyperextension" designates a forced extension of the hip that is sufficient to allow an exposure of the femoral canal in order to position the femoral implant.

According to an embodiment of the invention, the slide and the third means of translational guidance are adapted to be mutually fitted in at least a part of their respective lengths.

In other words, the slide and the third guide means form a telescopic joint of the sliding type or sliding pivot.

Thus, the slide and the third means of translation guidance are mobile between a compact configuration, in which the slide and the third means of guidance in translation are mutually engaged, and an extended position in which the slide extends the third means of guided in translation. In compact configuration,

20 the orthopedic device facilitates its transport and storage in a reduced volume.

According to an embodiment of the invention, the third means of translation guidance are adapted to penetrate a housing defined by the slide.

25 In other words, the third means of translation guidance are embedded in the slide.

Thus, the cross section of the slide is greater than the cross section of the third means of translational guidance. Therefore, the mechanical resistance of the slide is relatively important, since the slide has a high moment of inertia.

According to a variant of the invention, the length of the slide is greater than or equal to the length of the third means of translational guidance.

In other words, the third means of translation guidance are fully fitted in the slide. 35 Thus, the volume occupied by the orthopedic apparatus in a compact configuration is minimized.

In the present application, the term "length" designates a dimension measured according to the longitudinal direction.

According to an embodiment of the invention, the third means of translation guidance comprise a profile that is unique and that is attached to the slide by complementarity of shapes.

In the present application, the term "single profile" indicates that the cross section of the profile is defined by a single surface. 45 Thus, said profile represents a relatively small volume and weight.

According to an embodiment of the invention, the profile is generally in the form of a circular base cylinder, the connection between the profile and the slide adapted to allow rotation of the slide with respect to the axis 50 of the cylinder.

Thus, said union between the profile and the slide allows precise spatial positioning of the lower limb of the patient.

According to an embodiment of the invention, each secondary passage is between 5 mm and 30 mm, preferably between 10 mm and 25 mm, and each tertiary passage is between 25 mm and 200 mm, preferably between 40 mm and 70 mm .

Thus, said secondary and tertiary steps allow the operator two levels of precision in the adjustment of the length 60 of the orthopedic apparatus: on the one hand, a rough but rapid prepositioning by the tertiary passage and then a more precise positioning by the secondary passage.

According to an embodiment of the invention, the second translation guide means have a plurality of secondary teeth which are arranged to define respectively the discrete secondary positions 65.

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Thus, said secondary teeth make it possible to define the secondary steps simply and without hindrance.

According to a variant of the invention, the secondary teeth are defined by the carriage instead of being defined by the second means of translation guidance.

According to an embodiment of the invention, the third means of translation guidance have a plurality of tertiary teeth which are arranged to define discrete tertiary positions respectively.

Thus, said tertiary teeth make it possible to define the tertiary steps simply and without hindrance.

According to a variant of the invention, the secondary teeth are defined by the slide instead of being defined by the third means of translation guidance.

According to an embodiment of the invention, the first translation guidance means are adapted to allow translation according to continuous primary positions.

Thus, an operator can very precisely adjust the position of the brace to the length of the patient's lower limb.

According to an embodiment of the invention, the support comprises a primary bearing and the first translation guide means comprise a threaded rod arranged in helical connection with the primary bearing.

Thus, said threaded rod allows a very precise adjustment to be carried out in a simple manner according to continuous primary positions.

According to an embodiment of the invention, the orthopedic apparatus further comprises a primary manual actuator to move the support in translation, a secondary manual actuator to move the carriage in translation and a tertiary manual actuator to move the slide in translation.

Thus, said manual actuators allow an operator to manually adjust the length of the brace. Such manual actuators have a very small volume and weight, which makes an orthopedic device according to the invention easy to transport and store.

According to a variant of the invention, the primary manual actuator is a handwheel adapted to perform the rotation of the threaded rod.

Thus, a steering wheel of this type allows an operator to easily and quickly rotate the threaded rod.

According to an embodiment of the invention, the secondary manual actuator comprises at least:

- a secondary stop member adapted to cooperate with each secondary teeth, the secondary moving stop member being between a stop position, in which the secondary stop member prevents the carriage from moving with respect to the slide, and a position of release, in which the car can be moved in translation relative to the slide;

-a secondary elastic recoil organ arranged to return the secondary stop member towards its stop position; Y

-a secondary release organ arranged to place the secondary stop member in its release position.

Thus, said secondary manual actuator has a normally locked position, which dispenses the operator from performing a specific action with a view to blocking the second means of translation guidance in translation.

According to an embodiment of the invention, the tertiary manual actuator comprises at least:

-a tertiary stop organ adapted to cooperate with each tertiary teeth, the mobile tertiary stop member being between a stop position, in which the tertiary stop member prevents the sliding of the slide with respect to the third guiding means in translation, and a release position, in which the slide can be moved in translation with respect to the third means of translation guidance;

- an elastic tertiary recoil member arranged to return the tertiary abutment member towards its abutment position; Y

-a tertiary release organ arranged to place the tertiary stop member in its position of

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release.

Thus, said tertiary manual actuator has a normally locked position, which dispenses the operator from carrying out a specific action with a view to blocking the third means of translation guidance in translation.

According to a variant of the invention, the orthopedic apparatus further comprises a shoe intended to receive a foot from the patient and the support comprises means for joining the shoe.

Thus, said shoe allows the patient's limb or lower to be installed on the orthopedic device.

According to an embodiment of the invention, the support comprises rotation means adapted to swing the foot of a patient in internal rotation and external rotation.

Thus, said means of rotation facilitate dislocation of the chain to allow cervicotomy of the femoral neck and then removal of the femoral head and exposure of the femoral canal, in order to position the femoral implant.

According to an embodiment of the invention, the orthopedic apparatus further comprises a crutch intended to rest on a floor when the lower limb of the patient rests on the orthopedic apparatus, the crutch being attached to the slide by means of an axis pivot joint. perpendicular to the longitudinal direction, the pivot joint being disposed on a distal part of the slide, preferably at the distal end of the slide.

Thus, said crutch allows transmitting to the ground the efforts exerted by the weight of the lower limb of the patient. Consequently, the components of the orthopedic apparatus withstand limited efforts, which requires a relatively small sizing.

The embodiment of the invention mentioned above can be claimed in the form of a claim independent of the modes and embodiments mentioned before and after.

According to a variant of the invention, the orthopedic apparatus further comprises at least one caster attached to the terminal portion of the crutch that is opposite the distal portion of the slide.

Thus, a user can easily transport the brace by rolling it on a floor.

According to a variant of the invention, the translation may be a curvilinear translation or a rotation with a relatively large radius of curvature, for example with respect to the length of the patient's lower limb. The radius of curvature must be selected so that the movement corresponds "globally" to a translation according to the longitudinal direction.

The embodiments and variants mentioned above can be considered in isolation or according to any technically permissible combination.

The present invention will be well understood and its advantages will also be highlighted in the light of the following description, given only by way of non-limiting example and made with reference to the attached drawings, in which:

- Figure 1 is a perspective view of an orthopedic apparatus according to the invention in a transport and storage configuration;

- Figure 2 is a perspective view of the orthopedic apparatus of Figure 1, seen from the side opposite to Figure 1;

Figure 3 is a perspective view, similar to Figure 2, of the orthopedic apparatus of Figure 1, in an intermediate configuration;

Figure 4 is a perspective view, according to an angle equivalent to that of Figure 3, of a part of the orthopedic apparatus of Figure 3, in the course of a positioning stage;

Figure 5 is a view, similar to Figure 4, of the part of the orthopedic apparatus of Figure 4, in the course of another positioning stage;

Figure 6 is a view, similar to Figure 3, of the orthopedic apparatus of Figure 3, in a knee extension configuration of a lower limb of a medium-sized patient;

Figure 7 is a view, similar to Figure 3, of the orthopedic apparatus of Figure 3, in a knee extension configuration of a lower limb of a large patient;

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Figure 8 is a perspective view, according to an angle equivalent to Figure 6, of the orthopedic apparatus of Figure 3, in a hyperextension configuration of a hip of a large patient;

Figure 9 is a view, similar to Figure 8, of the orthopedic apparatus of Figure 3, in a hyperextension configuration of a hip of a small patient;

Figure 10 is a perspective view truncated according to the plane X in Figure 2; Y

-Figure 11 is a section according to plane X in Figure 2.

Figures 1 and 2 illustrate an orthopedic apparatus 1 for holding and positioning a lower limb of a patient in the course of an orthopedic surgery operation. The patient is placed in a dorsal position on a surgical operating table.

The orthopedic apparatus 1 comprises fixing means 2 that are adapted to fix the orthopedic apparatus 1 to a surgical operating table. In the example of the figures, the fixing means 2 comprise a receptacle 2.1 having a prismatic shaped housing 2.2 with a square base. Housing 2.2 is adapted to receive a male body not shown that has a complementary shape to housing 2.2 and that is integral with the orthopedic table not shown. The fixing means 2 further comprise a key

2.3 which is adapted to penetrate a complementary hole of the male organ in order to lock the male organ in position in the housing 2.2.

The orthopedic apparatus 1 further comprises a support 4 that is adapted to support a 5.1 foot of a patient visible in Figure 6 or 7. The support 4 comprises a base 4.1 and a hook 4.2. As Figure 4 shows, the hook

4.2 is adapted to receive and retain a shoe 5.2, represented in dotted line strokes, into which the patient's foot 5.1 is inserted. Shoe 5.2 is intended to receive foot 5.1. The hook 4.2 forms a means of attachment to the shoe 5.2.

The support 4 further comprises rotation means 4.3 that are adapted to pivot the patient's foot 5.1 in internal rotation and external rotation, by pivoting the shoe 5.2. The directions of internal rotation and external rotation are symbolized in Figure 6 by arrows I.5.1 and E.5.1.

In addition, the orthopedic apparatus 1 comprises a carriage 6 comprising first means of translational guidance that are adapted to guide the support 4 in translation globally according to a longitudinal direction X6, which is globally parallel to the mechanical axis X7 of the lower member 7 of a patient.

The support 4 comprises a primary bearing 4.4 which is formed in this case by a nut mounted around the threaded rod 8. The first translation guide means essentially comprise a threaded rod 8 which is arranged in helical connection with the primary bearing 4.4. The threaded rod 8 is mounted free in rotation with respect to its axis X8 by means of rings 8.1 and 8.2 with polymer flanges, which are arranged in this case at the ends of the threaded rod 8. Alternatively, bearings can replace the rings 8.1 and 8.2.

The first translation guidance means are adapted to allow translation according to continuous primary positions along the X8 axis. The carriage 6 further comprises a primary manual actuator formed in this case by a handwheel 9. The handwheel 9 is adapted to perform the rotation of the threaded rod 8. The handwheel 9 is in this case integral with rotation to the threaded rod 8.

In service, when an operator exerts a manual rotation of the handwheel 9, the support 4 travels in translation parallel to the axis X8 of the threaded rod 8. The operator can thus simply make a very precise adjustment according to continuous primary positions along of the X8 axis, and, therefore, parallel to the longitudinal direction X6. For example, the operator can move the support 4 between an extreme position illustrated in Figure 4 and a middle position illustrated in Figure 5.

The orthopedic apparatus 1 further comprises a joint 10 that is attached to the fixing means 2 and that is adapted to allow a pivot of the support 4 in a plane P globally parallel to the longitudinal direction X6. In this case, the support 4 can pivot in rotation with respect to a pivot axis Y10. In the example of the figures, the plane P is globally vertical. In practice, most of the components of the orthopedic apparatus 1 pivot with the support 4.

In addition, as shown in the figure, the joint 10 is adapted to allow a pivot of the support 4 with respect to a substantially vertical axis Z10 in order to allow internal or external rotation of the lower member

7.

In addition, the orthopedic apparatus 1 comprises a slider 12 which carries a second guide means in

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translation adapted to guide the carriage 6 in translation globally parallel to the longitudinal direction X6. In the example of the figures, the second translation guide means comprise slide bearings 13.1 and 13.2 that are integral with the carriage 6. The slide bearings 13.1 and 13.2 can be formed, for example, by polymer bearings or bearings. of needles

The second translation guide means are adapted to allow a translation according to discrete secondary positions spaced two by two by a secondary passage P2 shown in Figure 6. As shown in Figures 4, 5 and 6, the second guide means in translation presents a plurality of secondary teeth 14 which are arranged to define respectively the discrete secondary positions. In other words, two secondary teeth 14 are separated by the secondary passage P2. In the example of the figures, the secondary step P2 is constant.

The orthopedic apparatus 1 further comprises a secondary manual actuator 16 for moving the carriage 4 in translation. As Figures 10 and 11 show, the secondary manual actuator 16 comprises a secondary stop member 16.1 that is adapted to cooperate with each secondary teeth 14. The secondary stop member

16.1 is contained in the slide bearing 13.1.

The secondary stop member 16.1 is movable between a stop position, in which the secondary stop member 16.1 prevents the translation of the carriage 4 with respect to the slide 12, and a release position, in which the carriage 4 can be moved in translation with respect to the slide 12. In other words, each secondary teeth 14 forms a stop means adapted to cooperate with the secondary stop member 16.1.

As Figure 11 shows, the secondary manual actuator 16 further comprises an elastic secondary recoil member 16.2 which is arranged to return the secondary stop member 16.1 to its stop position (Figure 10 or 11). In the example of Figures 10 and 11, the elastic secondary recoil member 16.2 is formed by a helical spring that works under compression. In addition, the secondary manual actuator 16 comprises a secondary release member, in this case a button, which is arranged to place the secondary stopper member 16.1 in its release position.

In service, an operator exerts traction on the button of the secondary manual actuator 16 in order to place the secondary stop member 16.1 in the release position. Next, the operator can slide the carriage 4 parallel to the longitudinal direction X6, moving the slide bearings 13.1 and 13.2 on the slide 12. After the operator has relaxed his traction on the button, the secondary elastic recoil member 16.2 returns the secondary stop member 16.1 to its stop position, in which the carriage 4 is integral in translation of the slide 12.

As Figure 3, 6 or 7 shows, the orthopedic apparatus 1 further comprises a crutch 18 which is intended to rest on the floor 3 when the lower limb 7 of the patient rests on the orthopedic apparatus 1. The crutch 18 is attached to the slide 12 by means of a pivot joint 20 of axis Y20 perpendicular to the longitudinal direction X6. The pivot joint 20 is disposed at the distal end of the slide 12.

The orthopedic apparatus 1 further comprises casters 22 which are attached to the terminal portion of the crutch 18 which is opposite the distal part of the slide 12. In other words, the casters 22 are arranged to rest on the floor 3 when the apparatus Orthopedic 1 is in service configuration or transport configuration.

In addition, the orthopedic apparatus 1 comprises third means of translation guidance that are adapted to guide the slide 12 in translation in a manner parallel to the longitudinal direction X6.

In the example of the figures, the third translation guide means comprise a profile 24 that is unique and that is connected to the slide 12 by complementarity of shapes. In this case, the profile 24 is globally in the form of a circular base cylinder and whose axis X24, visible in Figure 6, is substantially parallel to the longitudinal direction X6.

The joint between the profile and the slide is adapted to allow the rotation of the slide 12 with respect to the axis of the cylinder. In other words, the joint between the slide 12 and the profile 24 is a sliding pivot joint.

The slide 12 and the profile 24, which forms the third means of translational guidance, are adapted to be mutually fitted over almost the entire length L24 of the profile 24. Measured parallel to the longitudinal direction X6, the length L12 of the slide 12 is substantially equal to the length L24 of the profile 24. Typically, the length L12 and the length L24 can be approximately 800 mm. In other words, the third means of translational guidance are fully fitted in the slide 12. Thus, the volume occupied by the orthopedic apparatus 1 in a compact configuration (figures 1 and 2) is minimized, which facilitates its transport and storage.

As Figure 6 or 7 shows, it is profile 24 that is adapted to penetrate a housing 26 defined by the

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slide 12. In practice, the slide 12 has a hollow section defining the housing 26 in the form of a cylinder complementary to the profile 24 and whose axis X12, visible in Figure 6, is substantially parallel to the longitudinal direction X6. As Figures 4 and 5 show, the X12 axis is substantially collinear to the X24 axis.

5 Profile 24, which forms the third means of translation guidance, is adapted to allow translation according to discrete tertiary positions spaced two by two by a tertiary passage P3. To this end, the profile 24 has a plurality of tertiary teeth 28 which are arranged to define respectively the discrete tertiary positions.

10 In the example of the figures, the tertiary passage P3 is constant. In addition, the tertiary passage P3 is substantially greater than the secondary passage P2. In this case, each secondary passage P2 measures approximately 20 mm, while each tertiary passage P3 measures approximately 50 mm.

The orthopedic apparatus 1 further comprises a tertiary manual actuator 3 for moving the slider 12 in

15 translation. Like the secondary manual actuator 16, the tertiary manual actuator 32 comprises a tertiary stop member 32.1 which is adapted to cooperate with each tertiary teeth 28, as shown in Figures 10 and 11.

The tertiary stop member 32.1 is movable between a stop position, in which the tertiary stop member 32.1

20 prevents the translation of the slide 12 with respect to the profile 24, and a release position, in which the slide 12 can be moved in translation with respect to the profile 24. In other words, each tertiary teeth 28 forms a stopping means adapted to cooperate with the tertiary stop body 32.1.

The tertiary manual actuator 32 further comprises an elastic tertiary recoil member (for example, a

25 compression spring helical spring) which is arranged to return the tertiary stop member 32.1 towards its stop position. In addition, the tertiary manual actuator 32 comprises a tertiary release member, in this case a button, which is arranged to place the tertiary stopper member 32.1 in its release position.

In service, an operator exerts traction on the button of the tertiary manual actuator 32 in order to place

30 the tertiary stop member 32.1 in the release position. Then, the operator can slide the slider 12 parallel to the longitudinal direction X6. After the operator has relaxed his traction on the button, the tertiary recoil elastic member returns the tertiary stop member 32.1 to its stop position, in which the slide 12 is integral in translation to the profile 24.

35 Figures 8 and 9 respectively illustrate a position of hyperextension of a lower limb 7 of a large patient and a position of hyperextension of a lower limb 7 of a patient of small size.

In service, as the comparison between figures 7 and 8 shows, the pivoting of the support 4 is performed between:

40 -a knee extension position of the lower limb 7 (Figure 6 or 7), in which the longitudinal direction X6 is globally horizontal in the extension of the orthopedic table, and

- a position of hyperextension of the lower limb 7 (figure 8 or 9), in which the longitudinal direction extends obliquely from the fixing means 2 to the floor 3 on which the orthopedic apparatus 45 rests.

In the extension position illustrated in Figure 7, the angle between the slide 12 and the crutch 18 is approximately 90 degrees. In the hyperextension position illustrated in Figure 8, the angle between the slide 12 and the crutch 18 is approximately 230 degrees. When the lower member 7 is in the position of

50 hyperextension, the hip prosthesis can be placed on the patient.

Claims (15)

5 fifteen 25 35 Four. Five 55 65 1. Orthopedic apparatus (1), to support and position a lower limb (7) of a patient in the course of an orthopedic surgery operation, comprising the orthopedic apparatus (1): -a fixing means (2) adapted to fix the orthopedic device (1) to a surgical operating table; -a support (4) adapted to support the patient's foot (5.1); -a carriage (6) comprising first means of translation guidance adapted to guide the support (4) in translation according to a longitudinal direction (X6) that is globally parallel to the mechanical axis (X7) of the lower member (7); -a joint (10) attached to the fixing means (2) and adapted to allow at least one pivot of the support (4) in a plane (P) globally parallel to the longitudinal direction (X6) and globally vertical when the apparatus Orthopedic (1) is in knee extension configuration of the lower limb; the orthopedic apparatus (1) being characterized in that it further comprises: -a sliding (12) comprising a second means of translation guidance adapted to guide the carriage (6) in translation globally parallel to the longitudinal direction (X6), the second means of translation guidance being adapted to allow a translation according to discrete secondary positions spaced two by two by a secondary step (P2); Y - a third translation guide means adapted to guide the slide (12) in translation in a manner parallel to the longitudinal direction (X6), the third translation guide means being adapted to allow a translation according to discrete spaced tertiary positions of two by two by a tertiary passage (P3), the tertiary passage (P3) being substantially superior to the secondary passage (P2).

2.

Orthopedic apparatus (1) according to claim 1, wherein the slide (12) and the third means of translational guidance are adapted to be mutually fitted at least a part of their respective lengths (L12, L24).

3.

Orthopedic apparatus (1) according to claim 2, wherein the third means of translation guidance are adapted to penetrate a housing defined by the slide (12).

Four.

Orthopedic apparatus (1) according to one of the preceding claims, wherein the third means of translation guidance comprise a profile (24) that is unique and that is attached to the slide (12) by complementarity of shapes.

5.

Orthopedic apparatus (1) according to claim 4, wherein the profile (24) is globally in the form of a circular base cylinder, the joint between the profile and the slide (12) adapted to allow rotation of the slide

(12) with respect to the axis of the cylinder.

6.

Orthopedic apparatus (1) according to one of the preceding claims, wherein each secondary passage (P2) is between 5 mm and 30 mm, preferably between 10 mm and 25 mm, and wherein each tertiary passage (P3) is comprised between 25 mm and 200 mm, preferably between 40 mm and 70 mm.

7.

Orthopedic apparatus (1) according to one of the preceding claims, wherein the second means of translational guidance have a plurality of secondary teeth (14) which are arranged to define respectively the discrete secondary positions.

8.

Orthopedic apparatus (1) according to one of the preceding claims, wherein the third means of translational guidance have a plurality of tertiary teeth (28) which are arranged to define respectively discrete tertiary positions.

9.

Orthopedic apparatus (1) according to one of the preceding claims, wherein the first means of translation guidance are adapted to allow translation according to continuous primary positions.

10.

Orthopedic apparatus (1) according to claim 9, wherein the support (4) comprises a primary bearing (4.4), and wherein the first translation guiding means comprise a threaded rod (8) disposed in helical connection with the primary bearing (4.4).

eleven.

Orthopedic apparatus (1) according to one of the preceding claims, further comprising a primary manual actuator (9) for moving the support (4) in translation, a secondary manual actuator (16) for moving the carriage (6) in translation and a tertiary manual actuator (32) to move the slide (12) in

9 translation. 12. Orthopedic apparatus (1) according to claims 8 and 11, wherein the secondary manual actuator (16) comprises at least: - a secondary stop member (16.1) adapted to cooperate with each secondary teeth (14), the secondary stop member (16.1) being mobile between a stop position, in which the secondary stop member (16.1) prevents the translation of the carriage (6) with respect to the slide (12), and a release position, in which the carriage (6) can be moved in translation with respect to the slide (12); 10 -a secondary elastic recoil organ (16.2) arranged to return the secondary stop organ (16.1) towards its top position; Y - a secondary release member arranged so that the secondary stop member (16.1) is placed in its release position. 13. Orthopedic apparatus (1) according to claim 9 and according to claim 11 or 12, wherein the tertiary manual actuator (32) comprises at least: 20 -a tertiary stop body (32.1) adapted to cooperate with each tertiary teeth, the tertiary stop body (32.1) being mobile between a stop position, in which the tertiary stop body (32.1) prevents the translation of the slide (12) with respect to the third means of translation guidance, and a release position, in which the slide (12) can be moved in translation with respect to the third means of guidance in translation; 25 - an elastic tertiary recoil member arranged to return the tertiary stop member (32.1) to its stop position; Y - a tertiary release member arranged so that the tertiary stop member (32.1) is placed in its release position. 14. Orthopedic apparatus (1) according to one of the preceding claims, wherein the support (4) comprises rotating means (4.3) adapted to swing the foot (5.1) of a patient in internal rotation (I.5.1) and in external rotation (E.5.1). 35 15. Orthopedic apparatus (1) according to one of the preceding claims, further comprising a crutch (18) intended to rest on a floor (3) when the lower limb (7) of a patient rests on the orthopedic apparatus (1), the crutch (18) being attached to the slide (12) by means of a shaft pivot joint (20) (Y20) perpendicular to the longitudinal direction (X6), the pivot joint (20) being arranged in a distal part of the Slider (12), preferably at the distal end of the slider (12). 10