[go: up one dir, main page]

WO2000067653A1 - Dispositif universel de compression de la hanche - Google Patents

Dispositif universel de compression de la hanche Download PDF

Info

Publication number
WO2000067653A1
WO2000067653A1 PCT/IL2000/000269 IL0000269W WO0067653A1 WO 2000067653 A1 WO2000067653 A1 WO 2000067653A1 IL 0000269 W IL0000269 W IL 0000269W WO 0067653 A1 WO0067653 A1 WO 0067653A1
Authority
WO
WIPO (PCT)
Prior art keywords
plate portion
femur
fixating
screw
upper plate
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/IL2000/000269
Other languages
English (en)
Inventor
Ahi-Izil Izilov
Gennady Nickelshpur
Zeev Aharonson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Sinai Medical Technologies Ltd
Original Assignee
Sinai Medical Technologies Ltd
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
Priority claimed from IL12990399A external-priority patent/IL129903A0/xx
Application filed by Sinai Medical Technologies Ltd filed Critical Sinai Medical Technologies Ltd
Priority to AU46072/00A priority Critical patent/AU4607200A/en
Priority to IL14642400A priority patent/IL146424A0/xx
Publication of WO2000067653A1 publication Critical patent/WO2000067653A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1668—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the upper femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A61B17/861—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A61B17/8877—Screwdrivers, spanners or wrenches characterised by the cross-section of the driver bit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip

Definitions

  • the present invention relates to a device for fixating a fractured femur by holding together in compression the fractured portions of the femur.
  • the present invention relates to a universal fixating device that may be adapted to take account of anatomical as well as physiological differences between a range of patients.
  • the general anatomical regions of interest of the femur (1) include the capest or femur head (2), collum or femur neck (3), the Trochanter major (4), Trochanter minor (5), Undertrochanter area (6), Cortical layer (7) and Diafiz (8).
  • proximal refers to a direction towards and into the patient body
  • distal refers to a direction generally away from the patient body.
  • the femur may be divided for easy reference into a proximal area and distal area.
  • femur neck fractures may be divided into medial fractures and lateral fractures.
  • Medial fractures include subcapital fractures (9), transcervical fractures (10) and basal fractures (11).
  • Lateral fractures include transtrochanter fractures (12), intertrochanter fractures (13) and undertrochanter fractures (14).
  • femur neck fractures are of great social importance, especially in geriatrics, such fractures occurring more commonly with the elderly than with other age groups.
  • Such fractures are often caused, particularly after age 70, by a relatively light trauma, non-coordinated movements, sharp turns, walking, going upstairs, lifting and carrying heavy loads, as due to semle osteoporosis characteristic of elderly people, wherein the bones become more brittle and fragile.
  • femur neck fractures, especially subcapital fractures often knit badly, so that for elderly people they often become a fatal injury.
  • the compression screw system includes an extension provided for being nonrotatably fixed to a lag screw that is to be anchored to the head of a femur or other bone in a manner so as to allow compression to be applied to a fracture.
  • the extension extends outward of the bone when attached to the lag screw is anchored to the bone to allow a compression plate to be easily positioned thereof.
  • the cross section of the extension is substantially the same as the cross section of the lag screw to allow the compression plate to be easily and quickly passed onto the lag screw from the extension once the compression plate has been positioned on the extension.
  • the Richards system has a number of drawbacks, as follows: a) the bone tissue of the femur head is drilled out over the whole duct length whereby bone tissue (trabeculae) and endosteum is essentially destroyed, and the blood supply which is already insufficient is affected; b) the design of the introduced rod and its madequately effective thread do not provide a stable compression connection of bone parts. At best bone fragments simply come in contact without a stable mutual fixation. Micromobility of bone fragments is as well possible, c) to position Richards system it is necessary to make a large cut in the femur muscular tissues to locate a compression plate. Thus, the Richards system is inadequate to the task of treating femur neck fractures, especially of subcapital fractures which simply do not knit in most cases.
  • An osteosynthesis device including a screw whose tip is pyramidal or conical and whose body is provided, at a distal end thereof, with an outside thread, wherein the head of the screw has a plurality of foldable small wings integral with the body and wherein the screw has a device for folding the small wings.
  • the device is useful particularly for fractures of the scaphoid, of the medial malleolus, Garden fractures 1 and 2 of the neck of the femur, pertrochanterian fractures of the femur, and generally, for fractures of small bones, and for putting in place hip or shoulder stops.
  • an osteosynthesis device for femur neck fractures comprises a rod with a buttress thread on one end and a hold-down nut on the other end of the rod having an internal thread.
  • tabs located in apertures formed in the rod on the side of the hold-down nut and a mechanism for operating the tabs.
  • the mechanism includes a screw disposed in the inner tread of the rod and engaging the tabs.
  • this device also has some drawbacks. It is not universal as its design does not allow for the differences in linear femur neck dimensions with different people, different cortical layer thickness in the undertrochanter femur area. Furthermore, the tabs are fixed axially with respect to the rod, and moreover do not enable the anchoring in the bone to be sufficiently secure. Therefore such a device must be manufactured individually for each patient or in series differing in dimensions according to anthropological parameters of different patients, so that the axial length of the rod, as well as the precise location of the tabs with respect thereto (and therefore to the optimal part of the bony tissue in which the tabs should be anchored) may be optimised for each patient.
  • the device of SU 938969 is unsuitable for treating some types of lateral fractures, such as undertrochanter fractures, and therefore unsuitable as a umversal hip compression device for all kinds of femur neck fractures.
  • An object of the present invention is to provide a universal and simple device for compression treatment of all kinds of femur neck fractures including medial fractures and including both subcapital fractures and lateral fractures, such as undertrochanter, intertrochanter and transtrochanter fractures.
  • Another object of the present invention is to provide a device for the fixation of femur fractures comprising means for reliably anchoring the device in the bone with all types of femur neck fractures.
  • Another object of the present invention is to provide a fixation device which reduces traumatization of a patient's bones and tissues during implantation of the device.
  • the present invention achieves these and other objects by providing a device for fixating a fractured femur in which thrust surfaces of a screw thread at the proximal end of a screw member together with a compression member to bring together in compression parts of the fractured femur.
  • An axially movable and settable antimigration device anchors the screw member in the bone where desired, increasing the versatility and universality of the device.
  • Extension members increase the effective axial length of the screw member to take account of anatomical differences between patients.
  • a two-part pressure plate is provided for use with any suitable screw member, in particular the fixating device of the present invention.
  • the two-part pressure or locking plate one part is adapted for mounting with respect to the screw member, and the other part is adapted for mounting to the femur, and is characterised in that the linear and/or angular relationship between the two parts may be adjusted as required, particularly in situ.
  • the present invention relates to a device for fixating a fractured femur, comprising :-
  • a proximal portion comprising a first cylindrical member having an external first screw thread adapted for distal compressive engagement with bony tissue in particular within the femur;
  • a distal portion comprising a second cylindrical member having an internal cavity and a substantially open distal end, and at least one lateral portal for enabling communication between said cavity and an outside of said second cylindrical member;
  • an antimigration device accommodated in said cavity and comprising at least one anchoring means having gripping means, said at least one anchoring means being selectively extendable m a substantially lateral direction such that said gripping means extends to said outside of said distal portion via a corresponding one of said at least one portal, said gripping means being adapted for anchoring said antimigration device within bony tissue when said gripping means is brought into compressive engagement therewith;
  • compression means releasably engageable with said distal portion of said screw member and selectively axially displaceable with respect thereto, said compression means having a proximal pressure face for selectively compressively engaging proximally with a distal end of said femur either directly or via any suitable washer interface such as a locking plate; and is characterised in that said antimigration device comprises axially movable fixation means for selectively setting and fixing the relative axial position of said gripping means with respect to said second cylindrical member.
  • said first cylindrical member is integrally joined to said second cylindrical member, and said first screw tliread comprises an external diameter substantially similar to an external diameter of said second cylindrical member.
  • said first cylindrical member comprises and axial lumen extending therethrough and having a proximal opening in said first cylindrical member and in communication with said cavity, said axial lumen and said cavity being of a size sufficient to enable a suitable alignment needle to be accommodated therein.
  • At least the proximal end of said first screw thread is self-taping with respect to bony tissue
  • said at least proximal end of said screw tliread comprises a plurality of circumferentially spaced radial slots to provide portions of said screw tliread in the form of blade-like elements separated by said radial slots, said blade like elements having leading edges adapted for tapmg into bony tissue.
  • said first screw thread comprises at least distal thread surfaces adapted for compressive engagement with bony tissue in response to a distal longitudinal force applied to said screw member.
  • the said distal thread surfaces of said first screw thread preferably comprise a distal tilt angle of between about 2° to about 4°.
  • said first screw thread further comprises proximal tliread surfaces having a proximal tilt angle of between about 30° to about 35°.
  • said proximal portion of said screw member comprises at least one longitudinal groove for facilitating transportation of bony tissue debris from the proximal end to the distal end of said first cylindrical member during implantation of said device.
  • said at least one portal is in the form of a longitudinal slit along the cylindrical wall of said second cylindrical member
  • said antimigration device comprises a proximally disposed ring, substantially coaxial with said second cylindrical member
  • said at least one anchoring means is in the form of a corresponding resilient arm cantilevered from said ring and extending substantially distally therefrom, said arm having a corresponding said at least one gripping means at the free distal end thereof, said antimigration device further comprising actuation means for reversibly extendmg said gripping means in a lateral direction .
  • the actuation means may comprise an axially movable thrust element having an external second screw thread complementary to and engaged with an internal third screw thread comprised at least in a distal portion of said cavity of said second cylindrical member, wherein a proximal end of said thrust element comprises a convex conical surface, said conical surface adapted to abut against and urge said free end of said at least one arm laterally outwards in response to an axial translation in the proximal direction by said thrust element.
  • the thrust element may comprise a substantially diametrical slot on the distal end thereof for engaging with an external complementary first tool so as to enable said thrust member to be axially displaced within said cavity by means of corresponding rotation of said first tool.
  • the gripping means may comprise an externally facing tab having at least one bone-engaging edge, preferably said bone-engaging edge being serrated.
  • said at least one arm is biased such that said tab does not significantly protrude from said corresponding at least one portal when said actuation means is disengaged from said anchoring means.
  • the axially movable fixation means for selectively setting and fixing the relative axial position of said gripping means with respect to said second cylindrical member may comprise a stub member engaged with and axially movable with respect to said ring member, said stub member having a proximal end for rotatably abutting against a proximal end of said cavity, and a distal end axially spaced from said engagement means.
  • the stub member may comprise an external fourth screw tliread complementary to and engaged with an internal fifth screw thread comprised in said second ring member, and the distal end of said stub member may also comprise a substantially diametrical slot for engaging with an external complementary second tool so as to enable said ring member to be axially displaced respect to said stub member by means of corresponding rotation of said second tool.
  • the said compression means comprises an axially movable first nut element having an internal sixth screw tliread complementary to and engaged with an external seventh screw thread comprised at least in a distal portion of said second cylindrical member, and a proximal end of said first nut element preferably comprises a rounded annular edge.
  • said first nut element comprises a pair of substantially diametrically opposed recesses on the distal end thereof for engaging with an external complementary third tool so as to enable said first nut element to be axially displaced within with respect to said screw member by means of corresponding rotation of said third tool.
  • the second cylindrical member comprises a pair of substantially diametrically opposed radial slots on the distal end thereof for engaging with an external complementary fourth tool so as to enable said screw member to be axially advanced into a femur by means of corresponding rotation of said fourth tool.
  • the preferred embodiment of the device optionally further comprises an axially engageable longitudinal extension member for effectively increasing the axial length of said screw member, wherein at least a proximal portion of said extension member comprises an external second screw thread complementary to and engaged with an internal third screw tliread comprised at least in a distal portion of said cavity of said second cylindrical member, and wherein said compression means is releasably engageable with a distal portion of said extension member and selectively axially displaceable with respect thereto.
  • Said extension member may be a tubular member having an external diameter substantially complementary to the internal diameter of said distal end of said screw member
  • the said compression means comprises an axially movable second nut element having an internal eighth screw thread complementary to and engaged with said external second screw thread comprised in a distal portion of said extension member, the proximal end of said second nut element preferably comprising a rounded annular edge.
  • said second nut element advantageously comprises a pan of substantially diametrically opposed recesses on the distal end thereof for engaging with an external complementary fifth tool so as to enable said second nut element to be axially displaced within with respect to said extension member by means of corresponding rotation of said fifth tool.
  • such an extension member preferably comprises a pair of substantially diametrically opposed radial slots on the distal end thereof for engaging with an external complementary sixth tool so as to enable said extension member to be axially displaced with respect to said screw member by means of corresponding rotation of said sixth tool.
  • said extension member may be a stepped tubular member having a proximal portion and a distal portion, wherein said proximal portion of said tubular member comprises an external diameter substantially complementary to the internal diameter of said distal end of said screw member, and wherein said distal portion of said tubular member comprises an external diameter substantially equal to the external diameter of said distal end of said screw member.
  • the compression means comprises an axially movable first nut element having an internal sixth screw tliread complementary to and engaged with an external seventh screw thread comprised in at least a distal portion of said extension member, the proximal end of said second nut element preferably comprising a rounded annular edge.
  • said first nut element may comprise a pair of substantially diametrically opposed recesses on the distal end thereof for engaging with an external complementary tliird tool so as to enable said first nut element to be axially displaced within with respect to said extension member by means of corresponding rotation of said third tool.
  • the extension member may comprise a pair of substantially diametrically opposed radial slots on the distal end thereof for engaging with an external complementary fourth tool so as to enable said extension member to be axially displaced with respect to said screw member by means of corresponding rotation of said fourth tool.
  • the present invention also relates to a pressure plate for securing a femur nail or screw to a femur, used in fixating a fractured femur. While being novel per se, the pressure plate of the present invention is particularly useful in conjunction with the fixating device of the present invention.
  • the pressure plate of the present invention is characterised in having an upper plate portion, a lower plate portion and adjusting means for adjusting at least one of the relative angular disposition and the relative linear displacement between said upper plate portion and said lower plate portion, and wherein said upper plate portion is adapted for rigid securement to said screw member (or to any suitable femur screw or nail) via said compression means, and wherein said lower plate portion is adapted for rigid securement with respect to a distal portion of the femur.
  • the lower plate portion preferably comprises a proximal surface having a profile complementary to a lower portion of said distal portion of the femur, and may be rigidly secured to said distal portion of said femur by at least one suitable screw via a corresponding at least one aperture comprised in said lower plate portion.
  • the upper plate portion preferably comprises a proximal surface having a profile complementary to an upper portion of said distal portion of the femur, and comprises a first aperture adapted for securingly engaging with a distal end of said device, and wherein said compression means compressively engages proximally with a distal end of said femur via said upper plate portion.
  • the said upper plate portion is adapted for securement to the distal end of the femur screw or nail in a similar manner, mutatis mutandis.
  • the pressure plate further comprises fixing means for fixing at least one of the relative angular disposition and the relative linear displacement between said upper plate portion and said lower plate portion.
  • said first aperture may have a flared distal entry complementary shaped to said rounded proximal annular edge.
  • the adjustment means comprises a liinge arrangement having a first liinge element comprised at an upper end of said lower plate portion and a cooperating second hinge element comprised in said upper plate portion intermediate an upper end and lower end of said upper plate portion, said upper end of said upper plate portion comprising said first aperture and said lower end of said upper plate portion comprising said fixing means.
  • the fixing means comprises a at least one screw device having a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded second aperture comprised in said lower end of said upper plate portion, said threaded portion having a proximal end rotatably engaged with said lower plate portion, and wherein said at least one screw device further comprises an actuating portion so as to enable said at least one screw device to be axially displaced with respect to said upper plate portion by suitable means.
  • the adjustment means comprises a linearly adjustable liinge arrangement having a first male hinge element comprised at an upper end of said lower plate portion and a cooperating second female hinge element comprised in said upper plate portion intermediate an upper end and lower end of said upper plate portion, said upper end of said upper plate portion comprising said first aperture and said lower end of said upper plate portion comprising said fixing means, wherein said female hinge element comprises a plurality of lateral apertures for selectively articulatingly engaging said male element in one of a corresponding plurality of relative linear relationships with respect to said lower plate portion via an articulating pin.
  • the fixing means comprises a at least one screw device having a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded second aperture comprised in said lower end of said upper plate portion, said threaded portion having a proxunal end for abutting against a distal surface of said lower plate portion, and wherein said at least one screw device further comprises an actuating portion so as to enable said at least one screw device to be axially displaced with respect to said upper plate portion by suitable means.
  • the adjustment means comprises a linearly adjustable liinge arrangement having a first male liinge element comprised at an upper end of said lower plate portion and a cooperating second female hinge element comprised in said upper plate portion intermediate an upper end and lower end of said upper plate portion, wherein said female hinge element comprises a plurality of lateral apertures for selectively articulatingly engaging said male element in one of a corresponding plurality of relative linear relationships with respect to said lower plate portion via an articulating pin, wherein said upper end of said upper plate portion comprises at least one said first aperture, and wherein said lower end of said upper plate portion comprises at least one said second aperture, said fixing means being associated with any one of said at least one second aperture.
  • the upper plate portion may be selectively engaged with respect to the said lower plate portion in one of a first or a second orientation corresponding to having said upper end or said lower end respectively, of said upper plate portion uppermost, wherein said at least one second apertures are substantially identical to said at least one first apertures, and wherein in said second orientation, one said second aperture is associated with said device and one said first aperture is associated with said fixing means.
  • the fixing means comprises a at least one screw device having a first threaded portion engaged with and adapted for axial displacement with respect to complementary threaded said second aperture comprised in said lower end or in said upper end of said upper plate portion, when said upper plate element is in said first or said second orientation, respectively, said threaded portion having a proximal end for abutting against a distal surface of said lower plate portion, and wherein said at least one screw device further comprises an actuating portion so as to enable said at least one screw device to be axially displaced with respect to said upper plate portion by suitable means.
  • said upper plate portion has a substantially S-shaped transverse cross-section.
  • the adjustment means is in the form of a curved lower end comprised in said upper plate portion, said slot having laterally disposed shoulders parallel thereto and cooperating with a male reaction block comprised an upper end of said lower plate portion, wherein said curved lower end and said block comprising suitable profiles such as to enable the area of contact between said lower end and said block to be adjusted such as to provide at least one of a range of relative angular dispositions and a range of relative linear displacements between said upper plate portion and said lower plate portion.
  • the fixing means comprises at least one screw device for clamping said upper plate portion to said lower plate portion, said at least one screw device having a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded tliird aperture comprised in said block of said lower plate portion, and wherein said at least one screw device further comprises a thrust surface for clamping contact with a distal surface of said lower portion, and an actuating portion so as to enable said at least one screw device to be axially displaced with respect to said lower plate portion by suitable means.
  • the fixing means preferably comprises two said screw devices disposed along the length of said block, and the slot preferably has an open lower end.
  • the present invention also relates to methods for fixating a fractured femur, using the device of the present invention, optionally with one or more extension members.
  • the present invention also relates to methods for fixating a fractured femur using the pressure plate of the present invention together with the device of the present invention, or alternatively with any other suitable femur screw or nail device. Description of Figures
  • Figure 1 shows in side elevational cross-sectional view, the general anatomical areas of interest of a human femur.
  • Figure 2 shows a preferred embodiment of the present invention:-Figure 2(a):- in side elevational partial cross-sectional view; Figure 2(b):- a variation of proximal end of the embodiment in side elevational partial cross-sectional view; Figure 2(c):- the embodiment of Figure 2(b) viewed along Q-Q; Figure 2(d):- the pressure plate of Figure 2(a) in perspective view; Figure 2(e): -a transverse perspective view of Figure 2(d) along A-A; Figure 2(f): -a transverse perspective view of Figure 2(d) along B-B.
  • Figure 3 shows in side elevational cross-sectional view one embodiment of an extension member.
  • Figure 4 shows in side elevational partial cross-sectional view, the embodiment of Figure 2 having a modified tip and comprising the extension member of Figure 3.
  • Figure 5 shows in side elevational cross-sectional view detail (II) of screw thread portion of the embodiment of Figure 4.
  • Figure 6 shows in side elevational partial cross-sectional view, the distal part of the embodiment of Figure 2 having a comprising an alternative extension member.
  • Figure 7 shows in perspective view a first embodiment of the locking plate according to the present invention.
  • Figure 8 shows in plan view the embodiment of Figure 7.
  • Figure 9 shows in side elevational cross-sectional view the upper plate portion of the embodiment of Figure 8 taken along C-C.
  • Figure 10 shows in perspective view the lower plate portion of the embodiment of Figure 7.
  • Figure 11 shows in cross-section the embodiment of Figure 8 taken along D-D.
  • Figure 12 shows m cross-section the embodiment of Figure 9 taken along E-E.
  • Figure 13 shows in perspective view a second embodiment of the locking plate according to the present invention.
  • Figure 14 shows in plan view the embodiment of Figure 13.
  • Figure 15 shows in side elevational cross-sectional view the upper plate portion of the embodiment of Figure 14 taken along F-F.
  • Figure 16 shows in perspective view the lower plate portion of the embodiment of Figure 13.
  • Figure 17 shows in cross-section the embodiment of Figure 14 taken along G-G.
  • Figure 18 shows in cross-section the embodiment of Figure 15 taken along H-H.
  • Figure 19 shows m perspective view a tliird embodiment of the locking plate according to the present invention.
  • Figure 20 shows in plan view the embodiment of Figure 19.
  • Figure 21 shows in side elevational cross-sectional view the upper plate portion of the embodiment of Figure 20 taken along J-J.
  • Figure 22 shows in side elevational cross-sectional view the upper plate portion of the embodiment of Figure 20.
  • Figure 23 shows in cross-section the embodiment of Figure 20 taken along K-K.
  • Figure 24 shows in cross-section the embodiment of Figure 20 taken along L-L.
  • Figure 25 shows in perspective view a fourth embodiment of the locking plate according to the present invention.
  • Figure 26 shows a rear view of the upper plate portion of the embodiment of Figure 25 in the direction (III).
  • Figure 27 shows in plan view the embodiment of Figure 25.
  • Figure 28 shows in side elevational cross-sectional view the upper plate portion of the embodiment of Figure 27 taken along M-M.
  • Figure 29 shows in perspective view the lower plate portion of the embodiment of Figure 25.
  • Figure 30 shows in cross-section the embodiment of Figure 27 taken along
  • Figure 31 shows in cross-section the embodiment of Figure 27 taken along O-O.
  • Figure 32 shows in side elevational partial cross-sectional view a first drill used for boring into the femur.
  • Figure 33 shows in side elevational partial cross-sectional view a second drill used for boring into the femur.
  • Figure 34 shows in side elevational view a tliird drill used for boring into the femur.
  • Figure 35 shows in side elevational partial cross-sectional view a screw holder engaged with the embodiment of Figure 2(a) having a lumen.
  • Figure 36 shows in side elevational partial cross-sectional view a proximal portion of the screw holder of Figure 35.
  • Figure 37 shows m side elevational partial cross-sectional view a special screw wrench engaged with the embodiment of Figure 2(a) having a lumen.
  • Figure 38 shows in cross-sectional view the embodiment of Figure 37 taken along C-C.
  • Figure 39 shows in side elevational partial cross-sectional view a proximal portion of the special screw wrench of Figure 37.
  • Figure 40 shows in side elevational partial cross-sectional view a nut holder engaged with the embodiment of Figure 2(a) having a lumen.
  • Figure 41 shows in side elevational partial cross-sectional view a proximal portion of the nut holder of Figure 40.
  • Figure 42 shows in side elevational partial cross-sectional view an all-purpose wrench.
  • Figure 43 shows in side elevational view an additional element for use in conjunction with the all-purpose wrench of Figure 42.
  • Figure 44 illustrates schematically the lumens required to be bored into the femur for implantation of the embodiments of Figures 1 to 6.
  • Figure 45 illustrates schematically a part of the implantation procedure for the embodiments of Figures 1 to 6 using the screw holder of Figures 35 and 36.
  • Figure 46 illustrates schematically a part of the implantation procedure for the embodiments of Figures 1 to 6 using the special screw wrench of Figures 37 to 39.
  • Figure 47 illustrates schematically the embodiments of Figures 1 to 6 implanted in the femur.
  • Figure 48 illustrates schematically the embodiments of Figures 1 to 6 implanted in the femur together with the pressure plate embodiment of Figures 7 to 12.
  • Figure 49 illustrates schematically the embodiments of Figures 1 to 6 implanted in the femur together with the pressure plate embodiment of Figures 13 to 18.
  • Figure 50 illustrates schematically the embodiments of Figures 1 to 6 implanted in the femur together with the pressure plate embodiment of Figures 19 to 24.
  • Figure 51 illustrates schematically the embodiments of Figures 1 to 6 implanted in the femur together with the pressure plate embodiment of Figures 25 to 31
  • distal refers to a direction away from the trunk or body of the patient
  • proximal refers to a direction towards the trunk or body of the patient.
  • the present invention relates to a device for fixating a fractured femur, in particular for holding in compression parts of a fractured femur neck.
  • Figures 2(a), 2(b) and 2(c) illustrate a preferred embodiment of the present invention.
  • the device designated by the numeral (200), comprises a screw member (20) and a compression means (210) releasably engageable with a distal portion of the screw member (20), and an axially settable antimigration device (300).
  • the screw member (20) comprises a proximal portion comprising a first cylindrical member (220) having a screw thread (31) along its outer surface.
  • the screw thread (31) is adapted for compressive engagement with bony tissue, particularly bony tissue within the femur, in response to a longitudinal force applied distally to the screw member (20), i.e., along the central longitudinal axis (230) thereof.
  • the screw thread (31 ) advantageously has a buttress-like transverse cross-sectional profile, in which the distally-facing thread surfaces (44) are approximately perpendicular to the longitudinal axis (230), while the proximally facing tliread surfaces (43) is at an acute angle to this axis (230).
  • the distal thread surfaces (44) comp ⁇ se a distal tilt angle ⁇ of between about 2° to about 4°
  • the proximal thread surfaces (43) comprise a proximal tilt angle ⁇ of between about 30° and about 35°, said tilt angles being measured from a radial line perpendicular to the axis (230).
  • This type of profile for the screw tliread (31) reduces resistance from the bony tissue when helically advancing the device (200) in the proximal direction, while at the same time maximising the axial thrust resistance in the distal direction.
  • the proximal end of the screw tliread (31) comprises a plurality of - in these figures, three - radial slots (235), thereby fo ⁇ ning the remaining portions of the screw tliread (31) separated by the slots (235) into blade-like elements (240) having radial leading edges (245).
  • Said leading edges (245) are particularly sharpened and are thus well suited to facilitate the self-taping action of the screw thread (31) into the bony tissue.
  • the ratio between the outer diameter and the inner diameter of the screw thread (31) is about 3:2.
  • the screw tliread (31) is integral with the said first cylindrical member (220).
  • At least a proximal portion, and preferably the whole length of the first cylindrical member (220) further comprises at least one or a plurality, and optimally two or three, longitudinal grooves (42).
  • the grooves (42) provide channels for bone debris formed during the tapping operation of the screw member (220) into the bone to be removed from the immediate vicinity of the screw thread (31) and thereby prevent premature clogging and jamming of the screw member (220), which could restrict advancement of the screw member (220) into the femur and/or cause deterioration of the fracture .
  • the said first cylindrical member (220) may be solid, having a conical tip (30), as illustrated in Figure 2(a).
  • the first cylindrical member (220) may comprises an axial lumen (29) extending therethrough and having an opening (40) in a truncated tip (30'), as illustrated in Figure 4.
  • This lumen (29) is of a diameter sufficient to enable a suitable alignment needle to be accommodated therein, as described hereinbelow.
  • the screw member (20) further comprises a distal portion comprising a second cylindrical member (260) having an internal cavity (35) and a substantially open distal end (250).
  • the second cylindrical member (260) is of a larger external diameter than the first cylindrical member (220), being typically approximately equal to the outer diameter of the screw thread (31). This geometry enables the first cylindrical member (220) to be proximally advanced into a distal part of the femur that is bored to accommodate the second cylindrical member (260).
  • the size of the screw tliread (31) is on the one hand maximised, while on the other hand providing stability and close fit of the second cylindrical member (260) within the bore provided for it at the distal end of the femur.
  • the said first cylindrical member (220) is integrally joined to the second cylindrical member (260).
  • the said second cylindrical member (260) also comprises a pair of substantially diametrically opposed radial slots (21) on the distal end thereof for engaging with an external complementary tool.
  • the slots (21) enable the screw member (20) to be axially advanced into the femur by means of engagement of this tool with the slots (21), and rotation of the tool, which causes the screw member (20) to rotate and for the screw thread (31 ) to engage and penetrate into the femur, as will be further described hereinbelow.
  • the cavity (35) is in communication with the lumen (29) when the latter is formed in said first cylindrical member, and the cavity (35) is of a size at least sufficient to enable said alignment needle to be accommodated therein.
  • the cavity (35) is much wider, and comprises a proximal wall (255) at the proximal end thereof, which may be in the form of a concave cone typically having truncated or pointed apex, depending on whether or not the first cylindrical member comprises a lumen (29), respectively.
  • the second cylindrical member (260) further comprises at least one lateral portal for enabling communication between the cavity (35) and the outside of the second cylindrical member (260).
  • at least one lateral portal for enabling communication between the cavity (35) and the outside of the second cylindrical member (260).
  • Typically about three such portals are provided, advantageously in the form of longitudinal slots (39) in the cylindrical wall (38) of the said second cylindrical member (260).
  • the compression means (210) are releasably engageable with a distal portion of the screw member (20) and is selectively axially displaceable with respect thereto. Further, the compression means (210) comprises a proximal pressure face (215) for engaging compressively, directly or indirectly, with a distal end of the femur.
  • the compression means (210) are axially advanced proximally along the distal end of the screw member (20)
  • the pressure face (215) and the distal tliread surfaces (44) of the screw thread (31) compressively bring together the fractured segments of the femur.
  • the compression means (210) is, in the embodiment of Figure 2(a), in the form of an axially movable first nut element (51) having an internal screw tliread (27) complementary to an external screw thread (34) comprised in at least a distal portion of the second cylindrical member (260).
  • the proximal end of the first nut element (51) comprises a rounded annular edge (52), and optionally further comprises a pair of diametrically opposed recesses (53) adapted for engagement with a special tool.
  • this special tool enables the first nut element (51) to be axially displaced with respect to the screw member (20) by means of a corresponding rotation of the tool.
  • Antimigration device (300) is accommodated in said cavity (35) and comprises at least one anchoring means having gripping means (320) for anchoring the device (200) in the femur once it has been positioned in place.
  • the anchoring means are selectively extendible in the lateral direction, as will be explained hereinbelow, from a neutral or datum position to an extended position.
  • the gripping means are typically enclosed within an envelope defined by the external surface of the second cylindrical member (260), and in the extended position the gripping means are extended through corresponding said portals, or slots (39) until the gripping means are brought into compressive engagement, substantially laterally, with bony tissue in the femur.
  • the antimigration device (300) represents an improvement over prior art devices, and is characterised in comprising axially movable fixation means (310) which enable a user to selectively set and fix the axial position of the gripping means (320) with respect to the second cylindrical member (260).
  • the fixation means (310) enables the user to choose precisely where the gripping means (320) should be situated axially with respect to the screw member (20), enabling the best choice of anchoring site within the femur to be chosen for each individual patient.
  • This versatility in choosing the location of the anchoring site tremendously widens the universal adaptability of the device (200), since the device (200) can be adapted for optimal effect with patients having different optimal anchoring sites.
  • the antimigration device (300) comprises a proximally disposed ring member (50) substantially coaxial with the axis (230) of the screw member (20).
  • the anchoring means are m the form of a plurality of resilient arms (47) cantilevered from the ring member (50) and extending distally therefrom, one arm (47) corresponding to and aligned with each said slot (39).
  • Each said arm (47) comprises a gripping means (320) at the free distal end thereof, the gripping means (320) being typically in the form of lateral externally facing tabs (22) accommodated within said corresponding slots (39) when the antimigration device (300) is in the datum unextended position.
  • the tabs (22) have a bone-engaging outer edge, which is preferably serrated for improving the traction properties of the gripping means (320) with respect to the bony tissue that it is anchored in.
  • the axially movable fixation means (310) comprises a cylindrical stub member (62) having an external screw thread complementary to an internal crew tliread of said ring member (50).
  • the stub member (62) also comprises a distal end having a substantially diametrical slot (63) for engaging with an external complementary special tool or appropriate screwdriver, for example, and a proximal end (32) for rotatingly abutting against proximal end wall (255) of cavity (35).
  • the stub (62) may be rotated via engagement of a tool with slot (63), while the stub (62) is pressed against end wall (255), enabling the ring member (50) to translate axially, thereby changing the relative axial position between the gripping means (320) and the screw member (20).
  • the antimigration device (300) further comprises actuation means for reversibly extending the gripping means (320) in a lateral direction.
  • the actuation means comprises an axially movable thrust element (64) accommodated in said cavity (35) and having an external screw thread (321) complementary to and engaged with an internal screw thread (322) comprised in at least a substantial distal portion of the second cylindrical member (260).
  • a proximal end of the thrust element (64) comprises a convex conical surface (65) which is abuts against the inner part of the free end of each arm (47), such that as the thrust element (64) is axially translated in the proximal direction, the diameter of the part of the conical surface (65) in contact with the arms (47) increases, urging the arms (47) laterally outwards.
  • the thrust element (64) may comprise a proximal arm-engaging leading end having any suitable profile, for example a body of revolution having a parabolic profile, in which at the proximal end of the travel range of the thrust element (64) more revolutions thereof are required than at the distal end to extend the arms (47), providing greater efficiency since the resistance of the bony tissue to the implantation of said tabs (22) generally increases with the depth of implantation.
  • the thrust element (64) comprises a substantially diametrical slot (66) in the distal end thereof for engaging with an external complementary special tool, or a suitable screwdriver for example, so as to enable the thrust member (64) to be axially displaced within the cavity (35) thereby.
  • the length of stub member (62) is such as to provide a substantial spacing between its distal end and the thrust member (64), such as to avoid contact between the stub member (62) and the thrust member (64) for their respective full ranges of axial travel.
  • the said arms (47) while resilient are biased such that the tabs (22) do not protrude from their corresponding slots (39) at the datum position of the antimigration device (300), i.e., when the thrust member (64) is disengaged from the arms (47).
  • the device (200) further optionally comprises at least one extension member (24) which is axially engageable with respect to the distal end of said screw member (20).
  • the extension member (24) effectively increases the axial length of the screw member (20), thereby enabling the basic screw member (20) to be used with patients having anatomically larger femurs than for other patients for whom the basic screw member (20) is appropriately sized, such a basic size being typically correlated to an average statistical value for patients.
  • two or more extensions members (24) may be adapted for engaging one with another in series with the screw member (24) to enhance the universality and versatility of the device (200).
  • the extension member (24) is typically essentially tubular, and at least a proximal portion thereof comprises an external screw thread (56) which is complementary to and engages with the internal screw tliread (322) comprised in the distal portion of the cavity (35).
  • the said compression means (210) are releasably engaged with and selectively axially displaceable with respect to a distal portion of the extension member (24), rather than with the second cylindrical member (260).
  • the compression means (210) are typically engaged with the most distal extension member (24).
  • the extension member (24) may be a non-stepped tubular extension member (24") having a mean external diameter substantially similar to the mean internal diameter of the distal end of the screw member (20).
  • the external diameter of the tubuar extension member (24") is complementary to the internal diameter of the second cylindrical member (260), taking into account the corresponding screw threads (56) and (322), respectively.
  • the compression means (210) comprises an axially movable second nut element (59), having an internal screw thread (256) which is complementary to and engages with the external screw thread (56) comprised in the distal portion of the tubular extension member (24").
  • the proximal end of the second nut element (59) comprises a rounded annular edge.
  • the second nut element (59) also comprises a pair of substantially diametrically opposed recesses (61) on the distal end thereof for engaging with a suitable external complementary tool.
  • the recesses (61) enable the second nut element (61) to axially displaced with respect to the screw member (20) by means of the engagement and rotation of such a tool with the second nut element (59).
  • the said tubular extension member (24") may optionally comprise a pair of substantially diametrically opposed radial slots (257) on the distal end thereof for engaging with an external complementary tool.
  • the slots (257) enable the screw member (20) to be axially advanced into the femur by means of engagement of this tool with the slots (257), and rotation of the tool, which causes the screw member (20) to rotate as a complete unit with the tubular extension member (24"), and for the screw thread (31) to engage and penetrate into the femur, as will be further described hereinbelow.
  • this tubular embodiment (24") of the extension member (24) is that it may be advanced into the said second cylindrical member (260) to any one of a range of depths, and therefore enables the total axial length of the device (200) to be finely tuned and thus matched to a particular patient having anatomical parameters within a predetermined range.
  • the extension member (24) may be in the form of a stepped extension member (24') having a proximal portion (258) and a distal portion (54).
  • the proximal portion (258) has an external diameter substantially complementary to the internal diameter of the distal end of the screw member (20), and comprises an external screw thread (56) complementary to and for engaging with internal screw thread (322) of the second cylindrical member (260).
  • the distal portion (54) comprises a larger external diameter, substantially equal to that of the distal end of the screw member (20), and also comprises a similar external screw tliread (57) to the external screw thread (34) on the distal end of the second cylindrical member (260).
  • the compression means (210) that may be used in conjunction with this embodiment (24') of the extension member (24) may be the same nut element (51) that is used with the basic screw member (200), mutatis mutandis.
  • this embodiment (24') of the extension member (24) is used with the screw member (20)
  • the stepped extension member (24') is screwed into the distal end of the second cylindrical member (260), typically until the proximally facing annular shoulder (259) between distal portion (54) and proximal portion (258) of the stepped extension member (24') abuts the distal end of the second cylindrical member (260).
  • the stepped tubular member (24') may also optionally comprise a pair of substantially diametrically opposed radial slots (58) on the distal end thereof for engaging with an external complementary tool.
  • said stepped extension member (24') may comprise an internal screw thread at least at the distal end thereof complementary to the external screw tliread (56) of another stepped or non-stepped extension member, hereby another extension member to be mounted distally thereto, and thus increase the effective length of the screw member (20).
  • the device (200) of the present invention may further optionally comprise a locking plate (400) for further securing the screw member (20) to the femur.
  • the locking plate (400) is of particular use when fixating lateral neck fractures, and is mounted to the outer distal surface of the femur, typically close to the under trochanter area (6) of the bone.
  • the locking plate (400) of the present invention is particularly characterised in comprising an upper plate portion (410) and a lower plate portion (420), and adjustment means (430) for adjusting the relative angular disposition and/or the relative linear displacement between the upper plate portion (410) and the lower plate portion (420).
  • the upper plate portion (410) is adapted for rigid securement to the screw member, typically via the compression means (210), while the lower plate portion (420) is adapted for rigid securement to a distal part of the femur.
  • the upper plate portion (410) advantageously comprises a proximal surface having a profile complementary to a upper portion of the distal part of the femur onto which the upper plate portion (410) abuts.
  • the lower plate portion (420) advantageously comprises a proximal surface having a profile complementary to a lower portion of the distal part of the femur onto which the lower plate portion (420) abuts.
  • the upper plate portion (410) comprises a first aperture (415) adapted for seemingly engaging with a distal end of the device (200), and said lower plate portion (420) may be rigidly secured to the distal portion of the femur by at least one, and preferably by as plurality of nails or wood screws, for example, via corresponding apertures (425) comprised in said lower plate portion (420).
  • the relative angular disposition between the upper plate portion (410) and the lower plate portion (420) may be fixed at any desired value, typically according to the geometry of the individual femur and the fractures contained therein by fixing means (500)
  • a first embodiment (67) of the pressure plate (400) comprises an upper plate portion (69) having profiled proximal surface (73), and a first aperture (70) adapted for engaging with the distal end of device (200).
  • aperture (70) is of a size to allow the distal end of device (200) to be threaded therethrough, if the device (200) is used without any extension member (24), or alternatively for the distal end of the extension member (24) to protrude therefrom, according to whether the stepped tubular extension member (24') or tubular extension member (24") is used with the device (200).
  • the aperture (70) has a concave rounded edge (71) complementary to the rounded annular edge (52) or (60), according to whether nut element (51) or nut element (59), respectively, is used as the compression means (210).
  • the pressure plate (400) also comprises a lower plate portion (68) having profiled proximal surface (72) and a plurality of apertures (70) for enabling nails or wood screws to secure the lower plate portion (70) to the femur.
  • the adjustment means (430) comprises a mechanically detachable hinge arrangement (450) having a first hinge element (451) comprised at the upper end of said lower plate portion (68), and a cooperating second liinge element (452) comprised in said upper plate portion (69) intermediate between the upper end and the lower end thereof.
  • a mechanically detachable hinge arrangement (450) having a first hinge element (451) comprised at the upper end of said lower plate portion (68), and a cooperating second liinge element (452) comprised in said upper plate portion (69) intermediate between the upper end and the lower end thereof.
  • said fixing means (500) comprise at least one screw device (75) having a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded second aperture comprised in said lower end of said upper plate portion (69).
  • the said threaded portion comprises a proximal end engaged with and capable or rotating with respect to said lower plate portion.
  • the said at least one screw device (75) further comprises an actuating portion (501) for enabling the screw device (75) to be rotated.
  • actuating portion (501) may be adapted for manually turning the same, or alternately may comprise means such as a diametrical slit or hexagonal pit, for example, for engaging with a suitable external tool so as to enable said screw device (75) to be axially displaced with respect to said upper plate portion (69) by means of corresponding rotation of said external tool.
  • a second embodiment (76) of the pressure plate (400) comprises an upper plate portion (78) having profiled proximal surface (82), and a first aperture (79) adapted for engaging with the distal end of device (200).
  • aperture (79) is of a size to allow the distal end of device (200) to be threaded therethrough, if the device (200) is used without any extension (24), or alternatively for the distal end of the extension member (24) to protrude therefrom, according to whether the stepped extension member (24') or tubular extension member (24" is used with the device (200).
  • the aperture (79) has a concave rounded edge (80) complementary to the rounded annular edge (52) or (60), according to whether nut element (51) or nut element (59), respectively, is used as the compression means (210).
  • the pressure plate (400) also comprises a lower plate portion (77) having profiled proximal surface (81) and a plurality of apertures (503) for enabling nails or wood screws to secure the lower plate portion (77) to the femur.
  • the adjustment means (430) comprises a mechanically detachable and linearly adjustable liinge arrangement having a first male liinge element (505) comprised at an upper end of said lower plate portion (77) and a cooperating second female liinge element (506) comprised in said upper plate portion (78), intermediate an upper end and lower end of said upper plate portion (78).
  • the female element (506) comprises a slot (85) for enabling the male element (505) to be engaged therein.
  • the upper end of said upper plate portion (78) comprises said first aperture (79), and said lower end of said upper plate portion (78) comprising said fixing means (500).
  • the said female liinge element comprises a plurality of lateral apertures (86) for selectively articulatingly engaging said male element (505) in one of a corresponding plurality of relative linear relationships with respect to said lower plate portion via an articulating pin.
  • both the relative linear and angular dispositions of the upper plate portion (78) may be adjusted with respect to the lower plate portion (77) by respectively engaging the male element (505) with one of the linear positions corresponding to apertures (86), and by rotating about the hinge formed at that portion with the articulating pin.
  • the fixing means (500) comprises a at least one screw device (84) having a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded second aperture comprised in said lower end of said upper plate portion (78).
  • the said threaded portion comprises a proximal end engaged with and capable or rotating with respect to said lower plate portion (77).
  • the said at least one screw device (84) further comprises an actuating portion (508) for enabling the screw device (75) to be rotated.
  • actuating portion (508) may be adapted for manually ttirning the same.
  • the actuating portion (508) may comprise means such as a diametrical slit, for example, for engaging with a suitable external tool so as to enable said screw device (84) to be axially displaced with respect to said upper plate portion (78) by means of corresponding rotation of said external tool.
  • a third embodiment (87) of the pressure plate (400) comprises an upper plate portion (89) having profiled proximal surface (93), and at least a first aperture (90) adapted for engaging with the distal end of device (200).
  • aperture (90) is of a size to allow the distal end of device (200) to be threaded therethrough, if the device (200) is used without any extension (24), or alternatively for the distal end of the extension member (24) to protrude therefrom, according to whether the stepped extension member (24') or tubular extension member (24") is used with the device (200).
  • the aperture (90) has a concave rounded edge (91) complementary to the rounded annular edge (52) or (60), according to whether nut element (51) or nut element (59), respectively, is used as the compression means (210).
  • the pressure plate (400) also comprises a lower plate portion (88) having profiled proximal surface (92) and a plurality of apertures (509) for enabling nails or wood screws to secure the lower plate portion (88) to the femur.
  • said adjustment means (430) comprises a linearly adjustable lunge arrangement having a first male hinge element in the form of two parallel distally extending plates (510) comprised at an upper end of said lower plate portion (88), and a cooperating second female liinge element (511) comprised in said upper plate portion (87) intermediate an upper end and lower end of said upper plate portion (87).
  • the female liinge element (511) comprises a plurality of lateral apertures (95) for selectively articulatingly engaging said plates (510) in one of a corresponding plurality of relative linear relationships with respect to said lower plate portion (88) via an articulating pin.
  • the upper end of said upper plate portion (87) comprises at least one and preferably two or more said first aperture (90)
  • said lower end of said upper plate portion (87) comprises at least one and preferably tow or more second apertures (90').
  • the said fixing means (500) is associated with said second aperture (90') comprised in said lower end of said upper plate portion (89).
  • the fixing means comprises a at least one screw device (not shown) having a first threaded portion engaged with and adapted for axial displacement with respect to complementary threaded aperture comprised in said upper end of said lower plate portion (88).
  • the tlireaded portion has a distal end that passes through the second aperture (90') comprised in said upper plate portion (89), and the screw device further comprises an actuating portion having means for engaging with a suitable external tool (or manually) so as to enable said at least one screw device to be axially displaced with respect to said lower plate portion (88).
  • the screw device also has a tlirusi surface for moving the said upper plate portion (89) via the second aperture (90') as the screw device is moved with respect to the lower plate portion (88).
  • the upper plate portion (89) is preferably S-shaped in transverse profile and may be selectively engaged with respect to the said lower plate portion (88) in one of a first or a second orientation corresponding to having said upper end or said lower end respectively, of said upper plate portion (89) uppermost.
  • second apertures (90') are substantially identical to said first apertures (90), and thus in the second orientation any one of apertures (90') is used for securing the pressure plate (87) to the device (200), while the first apertures (90) are associated with the fixing means (500).
  • the upper end and lower ends of the upper plate portion (89) are of different linear lengths to increase the range of linear adjustments possible with this embodiment.
  • a fourth and preferred embodiment (96) of the pressure plate (400) comprises an upper plate portion (98) having profiled proximal surface (101), and a first aperture (99) adapted for engaging with the distal end of device (200).
  • aperture (99) is of a size to allow the distal end of device (200) to be threaded therethrough, if the device (200) is used without any extension (24), or alternatively for the distal end of the extension member (24) to protrude therefrom, according to whether the stepped tubular extension member (24') or tubular extension member (24") is used with the device (200).
  • the aperture (99) has a concave rounded edge (100) complementary to the rounded annular edge (52) or (60), according to whether nut element (51) or nut element (59), respectively, is used as the compression means (210).
  • the pressure plate (400) also comprises a lower plate portion (97) having profiled proximal surface (102) and a plurality of apertures (105) for enabling nails or wood screws to secure the lower plate portion (97) to the femur.
  • said adjustment means (430) is in the form of a curved lower end (530) comprised in said upper plate portion (98) and having a slot (103).
  • the slot (103) comprises laterally disposed shoulders (525) parallel thereto and cooperating with a male reaction block (520) comprised an upper end of said lower plate portion (97).
  • the said curved lower end (530) and said block (520) comprise suitable profiles such as to enable the area of contact between said lower end (530) and said block (520) to be adjusted such as to provide at least one of a range of relative angular dispositions and a range of relative linear displacements between said upper plate portion (98) and said lower plate portion (97).
  • the shoulders (525) may slide along the distal portion (526) of block (520) to adjust the relative linear dispositions of the upper plate portion (98) and the lower plate portion (97). Additionally or alternatively, the shoulders (525) may rotate over the distal portion (526) of block (520) to adjust the relative angular dispositions of the upper plate portion (98) and the lower plate portion (97).
  • the fixing means (500) comprises at least one and preferably two screw devices (104) for clamping said upper plate portion (98) to said lower plate portion (97).
  • Each screw device (104) comprises a first threaded portion engaged with and adapted for axial displacement with respect to a complementary threaded third aperture comprised in the distal portion (526) of said block (520) of said lower plate portion (97).
  • each screw device (104) further comprises a thrust surface for clamping contact with a distal surface of said lower portion (530), and an actuating portion having means for engaging with a suitable external tool so as to enable said at least one screw device to be axially displaced with respect to said lower plate portion, particularly by means of corresponding rotation of said external tool.
  • said slot (103) has an open lower end, enabling the upper plate portion (98) to be attached or detached from the lower plate portion (97) without removing the screw devices (104).
  • the pressure plate (400) of the present invention may be advantageously used in conjunction with said screw member (20) (optionally including extension member (24)) and compression means (210), the said pressure plate (400) is novel per se, and in fact may be used with any suitable femur screw or nail arrangement having a distal end, the upper plate portion (410) being adapted for rigid securement with respect to such a distal end of the femur screw or nail arrangement instead of the screw member (20) / compression means (210) of the present invention, mutatis mutandis.
  • the device (200) of the present invention is associated with a set of adjusting tools including: a first spiral drill for the bone, a second spiral drill for the bone; a tlurd spiral drill; a screw holder for femur neck osteosynthesis; a special wrench for adjusting the screw for femur neck osteosynthesis together with the antimigration device; a special wrench for adjusting the hold-down and additional nut of the screw for femur neck osteosynthesis; an all-purpose wrench for femur neck osteosynthesis.
  • the first spiral drill (106) for the bone has a central axis (107) and a coaxial lumen (108) sized to accommodate an alignment needle, and an outer diameter no less than the inner diameter of tliread (31) of screw member (20).
  • the length of the cutting spiral (109) is typically not less than the maximum femur neck length.
  • the second spiral drill (110) for the bone also has a central axis (111) and a coaxial lumen for accommodating the alignment needle.
  • the outer diameter of the second drill is greater than the inner diameter of thread (31) and serves to drill tolerance in bone material.
  • the length of cutting spiral (113) is typically not less than the maximum femur neck length.
  • the third spiral drill (114) for the bone has an outer diameter greater than the outer diameter of the second cylindrical member (260), and the length of the cutting spiral is typically not less than the length of the second cylindrical member (260).
  • screw holder (116) for femur neck osteosynthesis comprises a body (117) having a handle (118) at a distal end thereof, and an axial well (119) on the proximal end thereof.
  • the well (119) comprises an internal screw thread (550) complementary to the external screw tliread (34) of screw member (20).
  • Holder (116) further comprises a lumen (120) coaxial with a central axis thereof and extending through said body (117) and handle (1 18), the lumen (120) being sized to accommodate said alignment needle.
  • Holder (116) is used for imparting rotary movement to screw member (20) and thus enabling the screw member (20) to be driven into the proximal part of femur neck.
  • Screw member (20) is implanted into the proximal part of femur neck without extension sleeve, when this is also needed, the extension sleeve being subsequently engaged with screw member (20) separately, after removing holder (116).
  • a special wrench (121) may be used for adjusting the screw member (20) for femur neck osteosynthesis together with ant nigration device (300).
  • Wrench (121) comprises a body portion (122) having a handle (123) at a distal end thereof, and further comprising a well (124) on the proximal end of the body portion (122).
  • At least a proximal portion of the external surface (125) of body portion (122) comprises an external screw tliread (126), and two diametrically opposed longitudinal slots (127) are formed in the body within the externally threaded portion of the body portion (122).
  • a reciprocable spring-loaded actuator in the form of a tab (128) has its lateral ends extending through said longitudinal slots, enabling the tab to slide axially between the ends of the slots (127).
  • the lateral ends of the tab (128) are enclosed within a hollow nut member (129) having an internal screw tliread complementary to and engaged with said external screw thread (126), enabling the nut member (129) to be axially translated over the body member (122), taking said tab (128) therewith.
  • Tab (128) is biased in the proximal direction by means of a pushing element (130) coupled to a spring (131) comprised in the body portion (122).
  • This wrench (121) is typically applied when the bone material offers a considerable resistance to the implantation of screw member (20), wherein considerable effort is required to drive it in and then to separate wrench (121) from screw member (20). Furthermore, wrench (121) is also particularly useful for removing screw member (20) from the femur once the osteosynthesis process has been completed and complete union of femur neck chips has occurred (according to medical indications or the patient's desire).
  • a special wrench (132) is provided for adjusting nut members (51) or (59).
  • the wrench (132) comprises a body (133) having a turning handle (134) disposed at a distal end thereof
  • the proximal end of the body (133) comprises a well (135) adapted for receiving a distal end of second cylindrical member (260) (or the distal end of extension member (24), and has an internal diameter greater that the external diameter thereof including a radial clearance therebetween.
  • a pair of diametrically opposed pins (136) are arranged on the annular distal face (555) of the body (133).
  • the pins (136) are adapted for registration and engagement with recesses (53) or (61) comprised in nut members (51) and (59), respectively.
  • the set of adjusting tools further includes all-purpose wrench (137) comprising an elongate body (138) having a detachable handle intermediate the axial ends thereof.
  • body (138) On one end of body (138) are comprised means for imparting rotary motion to screw member (20) or to extension sleeve (54), and such means include a step-shaped ribbed pin (140) having diametrically opposed axial ribs (141) which are adapted for registration and engagement with slits (21) or (58), respectively.
  • a well (142) is provided with a pair of diametrically opposed axially projecting flanges (143).
  • Said flanges are adapted for registering and engaging with complementary recesses (145) comprised at one end of an elongate element (144).
  • the other end of elongate element (144) comprises a tab (146) adapted to engage lateral slot (63) or (66) of said stub (62) or thrust member (64), respectively.
  • All-purpose wrench (137) is typically used after screw member (20) has been fully driven into the bone, and it is necessary to deepen it proximally a little further to mount the extension sleeve.
  • the wrench (137) is also particularly useful for mounting the extension sleeve, as well as (in combination with additional element (144) for adjusting the location of the antimigration device (300) with respect to stub (62), or for actuating the antimagration device (300) by means of thrust member (64).
  • the device (200) of the present invention may be used as follows..
  • Fracture fragments are reponed under periodic X-ray observation.
  • a 3-4 cm long cut is made to expose undertrochanter area (6) of the femur.
  • an alignment needle is passed, by means of a drill, in direction of the femur neck axis (19).
  • the bone cortical layer (7), approximately 2 cm thick, around the distal end of the needle, is removed typically with a chisel.
  • a stepped bore is drilled out in the femur using in succession first spiral drill (106), second spiral drill (110) and tliird spiral drill (114), as illustrated in Figure 44.
  • the first spiral drill (106) and second spiral drill (110) are aligned by means of lumens (108), (112) respectively and the alignment needle, and each drill is in turn advanced proximally along the femur neck axis (19) using the alignment needle as a guide rod.
  • the drilling depth for each of the first drill (106) and for the second drill (110) is a little greater than the length of screw member (20).
  • the first drill (106) is needed, since introduction of the screw member (20) does not pose too great a resistance given the close tolerance between the first cylindrical member (220) and the bore created by the first drill (106).
  • the resistance is generally greater and therefore greater dimensional tolerance is required, and this is accomplished by drilling a wider bore with second drill (110), in addition to or instead of the original bore drilled out by the first drill (106).
  • the third spiral drill (114) is typically advanced by a brace to the depth of this part of the bore which exceeds a little the length of second cylindrical member (260), thereby expanding radially the distal part of the bore drilled by the first drill (106) and second drill (110).
  • the alignment needle may be used instead of the brace for aligning the third drill.
  • the screw member (20) is driven into the femur along axis (19) by rotating same about its axis (230) using holder (116), wherein the distal end of screw member (20) is engaged in well (1 19) thereof, and relative axial movement between member (20) and the holder (116) is prevented by nut member (51).
  • the screw member (20) is advanced proximally into the full length of the wider part of the bore drilled by the third drill (114), and then driven into the remaining proximal part of this bore using the elf-taping screw thread (31).
  • Bone chips generated in the self-tapping process fill grooves (42) comprised in the mid-section of the first cylindrical body.
  • the lumen (29) may used in conjunction with the alignment needle as a guide rod to align the screw member (20) more precisely.
  • the alignment needle is passed in through lumen (29) and cavity (35) of the screw member (20) (the antimigration device (300) having been removed previously), and in through the lumen (120) of holder (1 16).
  • the holder (116) is separated from screw member (1 16), for example by first advancing the nut member (51) in a proximal direction and then rotating the holder (1 16) so that it translates in a distal direction.
  • the antimigration device (300) is mounted into the cavity (35) via the distal end of the screw member (20).
  • Such a procedure of setting screw member (20) is used when the severity of bone osteoporosis is very high.
  • the screw member (20) is implanted together with the antimigration device (300).
  • special wrench (121) may be used for this purpose, wherein screw member (20) is initially engaged by its external screw thread (34) with the threaded well (124) up to abutment with nut member (51). Then, tab (128) is advanced proximally via hollow nut (129) until it engages with slits (21), and then the screw member (20) is driven proximally by turning handle (123) of the special wrench (121) This is carried out in a similar manner as with holder (116). Once screw member (20) has been implanted to the required depth, the special wrench (121) is separated therefrom. To facilitate this uncoupling hollow nut (129) is rotated to advance slightly in a proximal direction, wherein tab (128) is slightly advanced along slits (127) and acting axially on slits (21).
  • femur head (2) and neck (3) are brought together and held down in compression.
  • end special wrench (132) is used to turn nut member (51) via pins (136) and recesses (53), until nut member (51) is pressed against the bone cortical surface (7). Tightening the nut member (51) further provides a distal force to the screw tliread (31) and a reaction force to the pressure face (215), causing compression of the bone endosteum.
  • the femur head (2) and neck (3) are thus made coincident and pressed together tightly.
  • extension member (20) is inadequate, it can be increased by using one or several extension sleeves (24), for example.
  • the extension member (24) is partly screwed in along tliread (36) into internal axial cavity (35) by means of all-purpose wrench (137). If the tubular extension member (24") is used, then to hold together femur head (2) and neck (3), second nut element (59) may be used, and this may also be screwed in place using special wrench (137).
  • the stepped extension member (24') is used, then the first nut element (51) can be used as with the basic screw member (20).
  • antimigration device (300) when the bone parts are brought together in compression, antimigration device (300) is positioned in the desired place and fixed.
  • threaded stub (62) is turned by means of additional element (144) of all-purpose wrench (137), for example, causing ring member (50) to advance axially within cavity (35) (under periodic X-ray monitoring) until the ends of its arms (47) come into the necessary position inside the bone, near cortical layer (7).
  • the arms (47) drawn aside and extended from slots (39) by means of thrust member (64) as this is advanced proximally by means of the additional element (144), for example.
  • the tabs (48) are then driven into the bone and the antimigration device (300) is fixed in the desired position and a paddle-like anchoring system is formed to hold screw member (20) inside the bone and minimise mobility and rotation of bone fragments.
  • pressure plate (400) may be mounted onto the femur external surface near undertrochanter area (6), using the following generalised procedure.
  • Screw member (20) is mounted to the femur as described above, and bone parts are brought mto coincidence compressively by tightening nut member (51) (or nut member (59) if the tubular extension member (24") is also used), antimigration device (300) is set in necessary position and fixed.
  • the nut member (51) is unscrewed, pressure plate (400) is mounted onto screw member (20), and then nut member (51) re-screwed onto screw member (20) to rigidly hold in place pressure plate (400) with respect to the screw member (20).
  • a similar procedure is used with nut member (59), mutatis mutandis.
  • the pressure plate (400) also acts as a washer between the nut member and the bone. If the pressure plate is a unitary plate, it is then fixed to the femur in the usual manner.
  • fixing of the pressure plate (400) to the femur is effected when the desired angular and/or linear dispositions between the upper plate portion (410) and the lower plate portion (420) is adjusted and fixed, as will be described below in the context of several embodiments of said pressure plate (400).
  • the upper plate portion (69) is rigidly attached to the distal end of screw member (20) via aperture (70) and by screwing nut member (51) or nut member (59) to screw member (20). Then, the lower plate portion (68) is mounted to the upper plate portion (69) via the liinge arrangement (450).
  • both parts of pressure plate (67), the upper plate portion (69) and the lower plate portion (68) are matched within a certain range of angular and/or spatial positions by detachable articulated hinge arrangement (450), and this is performed until pressure plate (67) tightly fits to femur undertrochanter area (6). Then, the upper plate portion (69) and the lower plate portion (68) are rigidly fixed together in this position by screw device (75).
  • lower plate portion (68) is rigidly mounted, by means of nails and/or wood screws to the external surface of femur undertrochanter area (6) via apertures (74), which are preferably in staggered arrangement as illustrated in Figure 10 to provide more reliable attachment of pressure plate (67) to femur undertrochanter area (6).
  • Proxunal surfaces, (72) and (73) of the pressure plate (67) have profiles complementary in relation to the adjacent external surface of femur undertrochanter area (6) to provide better fit therebetween.
  • the second embodiment of the pressure plate (76) is mounted in a similar manner as for the said first embodiment (67), mutatis mutandis.
  • the upper plate portion (78) is rigidly attached to the distal end of screw member (20) via aperture (79) and by screwing nut member (51) or nut member (59) to screw member (20). Then, the lower plate portion (77) is mounted to the upper plate portion (78) via the hinge arrangement, i.e., the male hinge element (505) an the female hinge element (506).
  • both parts of pressure plate (67), the upper plate portion (69) and the lower plate portion (68) are matched within a certain range of angular and/or spatial positions by means of the apertures (86) and corresponding articulating pin, and this is performed until pressure plate (76) tightly fits to femur undertrochanter area (6). Then, the upper plate portion (78) and the lower plate portion (77) are rigidly fixed together in this position by screw device (84).
  • lower plate portion (77) is rigidly mounted, by means of nails and/or wood screws to the external surface of femur undertrochanter area (6) via apertures (503), which are preferably in staggered arrangement as illustrated in Figure 16 to provide more reliable attachment of pressure plate (76) to femur undertrochanter area (6).
  • Proximal surfaces, (81) and (82) of the pressure plate (76) have profiles complementary in relation to the adjacent external surface of femur undertrochanter area (6) to provide better fit therebetween.
  • the third embodiment of the pressure plate (87) is mounted in a similar manner as for the said first embodiment (67) and said second embodiment (76), mutatis mutandis.
  • the upper plate portion (87) is rigidly attached to the distal end of screw member (20) via one aperture (90) and by screwing nut member (51) or nut member (59) to screw member (20). Then, the lower plate portion (88) is mounted to the upper plate portion (89) via the liinge arrangement, i.e., the male hinge element (510) and the female hinge element (511).
  • both parts of pressure plate (87), the upper plate portion (89) and the lower plate portion (88) are matched within a certain range of angular and/or spatial positions by means of the apertures (95) and co ⁇ esponding articulating pin, and this is performed until pressure plate (87) tightly fits to femur undertrochanter area (6). Then, the upper plate portion (89) and the lower plate portion (88) are rigidly fixed together in this position by screw device via aperture (90').
  • lower plate portion (88) is rigidly mounted, by means of nails and/or wood screws to the external surface of femur undertrochanter area (6) via apertures (509), which are preferably in staggered arrangement as illustrated in Figure 19 to provide more reliable attaclunent of pressure plate (87) to femur undertrochanter area (6).
  • Proximal surfaces, (92) and (93) of the pressure plate (87) have profiles complementary in relation to the adjacent external surface of femur undertrochanter area (6) to provide better fit therebetween.
  • the upper plate portion (89) is designed to be mountable onto the lower plate portion (88) in any one of two opposed orientations, in order to increase the versatility of the pressure plate (87).
  • the said upper plate portion (89) may be turned around by 180°, and connected to the screw member (20) via aperture (90') instead of aperture (90), to achieve tighter fit to femur undertrochanter area (6).
  • the fourth embodiment of the pressure plate (96) is mounted in a similar manner as for the said first embodiment (67), second embodiment (76) and third embodiment (87), mutatis mutandis.
  • the upper plate portion (98) is rigidly attached to the distal end of screw member (20) via aperture (99) and by screwing nut member (51) or nut member (59) to screw member (20). Then, the lower plate portion (97) is mounted to the upper plate portion (98) via the curved lower end (530) and block (520). To suit patients with different antliropometric dimensions of femur neck, both parts of pressure plate (96), the upper plate portion (98) and the lower plate portion (97) are matched within a certain range of angular and/or spatial positions by means of rotating and/or translating the shoulders (525) with respect to the distal portion (526) of block (520).
  • At least one screw device (104) is partially engaged in said block (520) to facilitate this procedure, which is performed until pressure plate (96) tightly fits to femur undertrochanter area (6).
  • the upper plate portion (98) and the lower plate portion (97) are rigidly fixed together in this position by a pair of screw devices (104).
  • lower plate portion (97) is rigidly mounted, by means of nails and/or wood screws to the external surface of femur undertrochanter area (6) via apertures (105), which are preferably in staggered arrangement as illustrated in Figure 29 to provide more reliable attachment of pressure plate (96) to femur undertrochanter area (6).
  • Proximal surfaces, (101) and (102) of the pressure plate (96) have profiles complementary in relation to the adjacent external surface of femur undertrochanter area (6) to provide better fit therebetween.
  • said pressure plate (400) in particular the first, second, tliird and fourth embodiments thereof, (67), (76), (87) and (96) respectively, may be adapted for mounting to a femur in conjunction with a regular femur screw or nail instead of said device (200) using a similar procedure as described above with reference to Figures 48 to 51, mutatis mutandis.
  • screw member (20) may be removed after the union of femur neck parts.
  • First thrust member (64) is removed, then, by turning axial threaded stubhunt discipline discipline_-,__, O 00/67653
  • Each component of the device (200), including screw member (20), nut member (51) (or nut member (59), as necessary), antimigration device (300), extension member (24) and pressure plate (400), is made from a medically compatible material, typically titanium, for example.
  • the claimed device for femur neck osteosynthesis provides accurate and secure matching of bone fragments in compression during the whole period of the fracture union. Further, the duration of surgical interference is essentially reduced and traumatization of endosteum and bone marrow of the femur head and neck is insignificant.
  • the claimed device is suitable for compression treatment of all kinds of femur neck fractures, including medial fractures, such as subcapital fracture and lateral fractures, including undertrochanter fractures. And finally the claimed device is adapted to any anthropological parameters of different patients, easily mounted and, when necessary, easily removed.
  • screw member (20) in combination with nut member (51) (or nut member (59), as necessary), antimigration device (300), optionally extension member (24) and pressure plate (400) form a unifiable integrated spatial system which provides reliable compression fixing of bone fragments for patients having different anthropomefric dimensions and for any kind of femur neck fractures, including undertrochanter, intertrochanter and transtrochanter lateral fractures.
  • the present invention provides a universal means for reliable osteosynthesis of all known femur neck fractures.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Dentistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Surgical Instruments (AREA)

Abstract

Ce dispositif universel d'ostéosynthèse, qui est destiné à fixer des fractures du fémur, se présente sous la forme d'un élément à vis possédant un filetage proximal venant s'insérer de manière compressive dans le fémur sous l'effet d'une charge axiale fournie par un écrou de compression placé à l'extrémité distale de l'élément à vis. Cet élément à vis comporte dispositif de migration, pouvant se décaler axialement et s'ouvrant, lorsque il est nécessaire, pour ancrer le dispositif dans le fémur. Des éléments auxiliaires sont ajoutés au dispositif, ce qui permet de l'utiliser avec un large éventail de patients. Le dispositif comporte une plaque de blocage pouvant être rapidement et facilement adaptée en fonction des particularités du fémur du patient.
PCT/IL2000/000269 1999-05-11 2000-05-11 Dispositif universel de compression de la hanche Ceased WO2000067653A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU46072/00A AU4607200A (en) 1999-05-11 2000-05-11 Universal hip compression device
IL14642400A IL146424A0 (en) 1999-05-11 2000-05-11 Universal hip compression device

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
IL129903 1999-05-11
IL12990399A IL129903A0 (en) 1999-05-11 1999-05-11 Osteosynthesis device for holding together in compression the parts of a fractured femur neck
IL132742 1999-11-04
IL13274299A IL132742A0 (en) 1999-05-11 1999-11-04 Osteosynthesis device for holding together in compression the parts of a fractured femur neck

Publications (1)

Publication Number Publication Date
WO2000067653A1 true WO2000067653A1 (fr) 2000-11-16

Family

ID=26323838

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL2000/000269 Ceased WO2000067653A1 (fr) 1999-05-11 2000-05-11 Dispositif universel de compression de la hanche

Country Status (3)

Country Link
AU (1) AU4607200A (fr)
IL (1) IL132742A0 (fr)
WO (1) WO2000067653A1 (fr)

Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003032853A3 (fr) * 2001-10-17 2004-03-18 Synthes Usa Systeme de fixation d'os
WO2004045389A2 (fr) 2002-11-19 2004-06-03 Acumed Llc Plaques vissees reglables
US7094236B2 (en) 2003-03-25 2006-08-22 Marc Waisman Hybrid interlocking proximal femoral fracture fixation
WO2006097729A1 (fr) * 2005-03-17 2006-09-21 Desmond Meiring Dall Système configurable de fixation osseuse
RU2332953C1 (ru) * 2007-03-22 2008-09-10 Государственное учреждение Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ им. М.Ф. Владимирского) Устройство для остеосинтеза при переломах шейки бедра
WO2010061410A1 (fr) * 2008-11-25 2010-06-03 Intrauma S.R.L Plaque modulaire d'ostéosynthèse à crochet
CN101721242B (zh) * 2008-10-30 2012-07-04 法玛科技顾问股份有限公司 髋关节动态交锁螺钉
US8221419B2 (en) 2003-08-29 2012-07-17 Synthes Usa, Llc Intramedullary nail
US8282675B2 (en) 2008-01-25 2012-10-09 Depuy Spine, Inc. Anti-backout mechanism
US8361130B2 (en) * 2006-10-06 2013-01-29 Depuy Spine, Inc. Bone screw fixation
US8465489B2 (en) 2003-06-12 2013-06-18 Synthes Usa, Llc Surgical nail
US8888779B2 (en) 2003-03-07 2014-11-18 DePuy Synthes Products, LLC Locking screw for an intramedullary nail
US9237909B2 (en) 2003-07-30 2016-01-19 DePuy Synthes Products, Inc. Surgical nail
WO2017123118A1 (fr) * 2016-01-15 2017-07-20 Николай Свиридович ГАВРЮШЕНКО Dispositif arthromédullaire (variantes)
US9737347B2 (en) 2003-06-12 2017-08-22 DePuy Synthes Products, Inc. Surgical nail
US9956015B2 (en) 2014-07-03 2018-05-01 Acumed Llc Bone plate with movable joint

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2595090C2 (ru) * 2014-12-09 2016-08-20 Михаил Васильевич Казарезов Способ блокируемого остеосинтеза проксимальных переломов бедра и устройство для его осуществления
RU2598759C1 (ru) * 2015-08-20 2016-09-27 Государственное бюджетное учреждение здравоохранения Свердловской области "Центр специализированных видов медицинской помощи "Уральский институт травматологии и ортопедии имени В.Д. Чаклина" (ГБУЗ СО "ЦСВМП "УИТО им. В.Д. Чаклина") Способ коррекции варусной деформации проксимального отдела бедра

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CH475754A (de) * 1968-01-04 1969-07-31 Paul Kleuser Chirurgische Inst Knochenschraube, insbesondere für Oberschenkelhalsfrakturen
US4236512A (en) * 1978-02-12 1980-12-02 Jacob Aginsky Connector for fractured bones
US4432358A (en) * 1982-01-22 1984-02-21 Fixel Irving E Compression hip screw apparatus
FR2653660A2 (fr) * 1988-01-21 1991-05-03 Hechard Patrick Prothese de hanche perfectionnee, du type cervicale pure.
EP0636346A1 (fr) * 1993-07-23 1995-02-01 Massimo Santangelo Dispositif à but préventif pour le support du fémur
US5437674A (en) * 1992-08-25 1995-08-01 Alexandre Worcel Osteosynthesis device
WO1998002105A1 (fr) * 1996-07-17 1998-01-22 Bramlet Dale G Ensemble pour fixation chirurgicale

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CH475754A (de) * 1968-01-04 1969-07-31 Paul Kleuser Chirurgische Inst Knochenschraube, insbesondere für Oberschenkelhalsfrakturen
US4236512A (en) * 1978-02-12 1980-12-02 Jacob Aginsky Connector for fractured bones
US4432358A (en) * 1982-01-22 1984-02-21 Fixel Irving E Compression hip screw apparatus
FR2653660A2 (fr) * 1988-01-21 1991-05-03 Hechard Patrick Prothese de hanche perfectionnee, du type cervicale pure.
US5437674A (en) * 1992-08-25 1995-08-01 Alexandre Worcel Osteosynthesis device
EP0636346A1 (fr) * 1993-07-23 1995-02-01 Massimo Santangelo Dispositif à but préventif pour le support du fémur
WO1998002105A1 (fr) * 1996-07-17 1998-01-22 Bramlet Dale G Ensemble pour fixation chirurgicale

Cited By (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
KR100953149B1 (ko) * 2001-10-17 2010-04-19 신세스 게엠바하 뼈 고정 시스템
WO2003032853A3 (fr) * 2001-10-17 2004-03-18 Synthes Usa Systeme de fixation d'os
US6835197B2 (en) 2001-10-17 2004-12-28 Christoph Andreas Roth Bone fixation system
AU2002340218B2 (en) * 2001-10-17 2005-08-04 Synthes Gmbh Bone fixation system
CN1301088C (zh) * 2001-10-17 2007-02-21 斯恩蒂斯有限公司 骨固定系统
US7182765B2 (en) 2001-10-17 2007-02-27 Synthes (Usa) Bone fixation system
US7306600B2 (en) 2001-10-17 2007-12-11 Synthes (U.S.A.) Bone fixation system
US10271881B2 (en) 2001-10-17 2019-04-30 DePuy Synthes Products, Inc. Bone fixation system
US9918757B2 (en) 2001-10-17 2018-03-20 DePuy Synthes Products, Inc. Bone fixation system
US9308033B2 (en) 2002-07-22 2016-04-12 Acumed Llc Adjustable bone plates
US10456180B2 (en) 2002-07-22 2019-10-29 Acumed Llc Adjustable bone plates
EP1567071A4 (fr) * 2002-11-19 2010-04-28 Acumed Llc Plaques vissees reglables
WO2004045389A2 (fr) 2002-11-19 2004-06-03 Acumed Llc Plaques vissees reglables
US8888779B2 (en) 2003-03-07 2014-11-18 DePuy Synthes Products, LLC Locking screw for an intramedullary nail
US7094236B2 (en) 2003-03-25 2006-08-22 Marc Waisman Hybrid interlocking proximal femoral fracture fixation
US8465489B2 (en) 2003-06-12 2013-06-18 Synthes Usa, Llc Surgical nail
US9737347B2 (en) 2003-06-12 2017-08-22 DePuy Synthes Products, Inc. Surgical nail
US9237909B2 (en) 2003-07-30 2016-01-19 DePuy Synthes Products, Inc. Surgical nail
US8221419B2 (en) 2003-08-29 2012-07-17 Synthes Usa, Llc Intramedullary nail
US9814500B2 (en) 2003-08-29 2017-11-14 DePuy Synthes Products, Inc. Intramedullary nail
GB2439503A (en) * 2005-03-17 2007-12-27 Desmond Meiring Dall Configurable bone fixation system
GB2439503B (en) * 2005-03-17 2010-06-09 Desmond Meiring Dall Configurable bone fixation system
WO2006097729A1 (fr) * 2005-03-17 2006-09-21 Desmond Meiring Dall Système configurable de fixation osseuse
US9119676B2 (en) 2006-10-06 2015-09-01 DePuy Synthes Products, Inc. Bone screw fixation
US8361130B2 (en) * 2006-10-06 2013-01-29 Depuy Spine, Inc. Bone screw fixation
RU2332953C1 (ru) * 2007-03-22 2008-09-10 Государственное учреждение Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ им. М.Ф. Владимирского) Устройство для остеосинтеза при переломах шейки бедра
US8282675B2 (en) 2008-01-25 2012-10-09 Depuy Spine, Inc. Anti-backout mechanism
CN101721242B (zh) * 2008-10-30 2012-07-04 法玛科技顾问股份有限公司 髋关节动态交锁螺钉
WO2010061410A1 (fr) * 2008-11-25 2010-06-03 Intrauma S.R.L Plaque modulaire d'ostéosynthèse à crochet
US10159515B2 (en) 2014-07-03 2018-12-25 Acumed Llc Bone plate with movable joint
US9956015B2 (en) 2014-07-03 2018-05-01 Acumed Llc Bone plate with movable joint
WO2017123118A1 (fr) * 2016-01-15 2017-07-20 Николай Свиридович ГАВРЮШЕНКО Dispositif arthromédullaire (variantes)

Also Published As

Publication number Publication date
IL132742A0 (en) 2001-03-19
AU4607200A (en) 2000-11-21

Similar Documents

Publication Publication Date Title
AU670456B2 (en) Osteosynthesis device
WO2000067653A1 (fr) Dispositif universel de compression de la hanche
AU764857B2 (en) Orthopaedic bone screw apparatus
US6524313B1 (en) Intramedullary nail system
US6033407A (en) Apparatus and method for intramedullary nailing and intramedullary nail therefor
EP0192840B1 (fr) Appareil pour soigner les fractures du fémur
US7306600B2 (en) Bone fixation system
AU2003290901B2 (en) Compression bone fragment wire
KR101926352B1 (ko) 확대가능한 대퇴골 전자 못
CA2343378C (fr) Systeme de fixation pour fracture
CA2707241C (fr) Systeme de pose de plaque d'osteosynthese tibiale distale
US6607531B2 (en) Medullary nail for the surgical treatment of forearm fractures
EP2240100B1 (fr) Solution de câble pelvien
US20060036248A1 (en) Fixation elements
US8876822B2 (en) Intramedullary nail system with tang fixation after lock screw placement
US20070219636A1 (en) implant assembly for proximal femoral fracture
WO2009004603A2 (fr) Appareil de cheville
MXPA02011712A (es) Hoja espiralada humeral.
EP1996102A2 (fr) Plaque orthopédique et ensemble de vis
EP0359793A1 (fr) Dispositif de fixation a longueur variable
US20100211073A1 (en) Intramedullary compression rod
US10736675B2 (en) Endosseous screw assembly and internal fixation system comprising said endosseous screw assembly
EP3150154B1 (fr) Ensemble vis endo-osseuses et système de fixation interne comprenant ledit ensemble
CN116269706A (zh) 用于骨折的髓内钉组件
US20140378974A1 (en) Bone fixation device

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BY CA CH CN CR CU CZ DE DK DM DZ EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT TZ UA UG US UZ VN YU ZA ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GH GM KE LS MW SD SL SZ TZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

WWE Wipo information: entry into national phase

Ref document number: 10031652

Country of ref document: US

122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: JP