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WO1997010775A2 - Systeme de traitement des fractures de la cheville - Google Patents

Systeme de traitement des fractures de la cheville Download PDF

Info

Publication number
WO1997010775A2
WO1997010775A2 PCT/EP1996/004113 EP9604113W WO9710775A2 WO 1997010775 A2 WO1997010775 A2 WO 1997010775A2 EP 9604113 W EP9604113 W EP 9604113W WO 9710775 A2 WO9710775 A2 WO 9710775A2
Authority
WO
WIPO (PCT)
Prior art keywords
clamp
string
tibial
axis
screw
Prior art date
Application number
PCT/EP1996/004113
Other languages
English (en)
Other versions
WO1997010775A3 (fr
Inventor
Giovanni Faccioli
John Lawrence Marsh
Daniele Venturini
Original Assignee
Orthofix S.R.L.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Orthofix S.R.L. filed Critical Orthofix S.R.L.
Priority to AU74906/96A priority Critical patent/AU7490696A/en
Publication of WO1997010775A2 publication Critical patent/WO1997010775A2/fr
Publication of WO1997010775A3 publication Critical patent/WO1997010775A3/fr

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
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6425—Devices extending alongside the bones to be positioned specially adapted to be fitted across a bone joint

Definitions

  • the present invention relates to an apparatus for treating ankle fractures.
  • a conventional technique for treating ankle fractures includes the use of an external fixer comprising a proximal clamp anchored to two screws inserted in the tibial diaphysis and a distal clamp anchored to a screw inserted in the calcaneus and in the tarsus; both clamps are connected to a central member which can be extended by means of universal joints.
  • the particular distal clamp is articulated in order to rotate about an axis which approximately coincides with that of the tibial-heel joint.
  • the rotating axis is placed by hand and is usually identified by means of a Kirschner string fixed in the tarsal sinus.
  • a first inconvenience of the above fixing technique is that the axis of the distal clamp rarely coincides with the true axis of the tibial joint and this causes diastasis and compressions to the joint and tractions to the ligaments.
  • a main aim of the present invention is to eliminate the above mentioned drawbacks by providing an apparatus adapted to maintain a correct articulation of the tibial joint helping the rehabilitation and speeding the recovery.
  • a further aim is that of providing an apparatus adapted to ease the insertion of the distal screws allowing maximum freedom in placing the screws in order to reduce the operating time and the exposure to X rays.
  • an apparatus for treating ankle fractures comprising: an external fixer formed by a tibial clamp and a heel clamp connected to a central member extendable by means of respective universal joints, said heel clamp being articulated such that its rotation axis is arrangeable to be approximately centered on the tibial-heel joint axis; a positioner device of the true rotation axis of the tibial- heel joint, wherein said device comprises a support removably associated with a screw freely insertable in the astragalus, a Kirschner string adapted to identify said true rotation axis, a locking member of said Kirschner string selectively orientatable with respect to said support until the axis of said string is substantially still during the rotation of the tibial-heel joint.
  • FIG. 1 is a side view of an apparatus according to the invention installed at a tibial-heel joint;
  • FIG. 2 is a slightly elevated perspective front view of the apparatus of FIG. 1;
  • FIG. 3 is a lower perspective view of the apparatus of FIG. i;
  • FIG. 4 shows the apparatus of FIG. 1 without the distal clamp in order to better show the device for identifying the true axis of the joint;
  • FIG. 5 is a side view of a part of a first embodiment of the distal clamp
  • FIG. 6 is a section view according to the plane VI-VI of FIG. 5;
  • FIG. 7 is a section view of another component of a distal clamp
  • FIG. 8 is a front view of a further component of a distal clamp
  • FIG. 9 is a section view according to the plane IX-IX of FIG. 8;
  • FIG. 10 is a section view of a variated embodiment of the component of FIG. 9;
  • FIG. 11 is an exploded side view of a device which is part of the apparatus according to the invention.
  • FIG. 12 is a side partial view of a second embodiment of a distal clamp; and FIG. 13 is a section view according to the plane XIII-XIII of FIG. 5.
  • an apparatus according to the invention is used to consolidate an ankle fracture with a nidus F localized, for example, towards the lower part of the tibia T proximate to the tibial-heel joint B, more clearly visible in FIG. 4.
  • the apparatus comprises an axial fixer 2 and a device 3 for identifying and positioning the true axis of joint B.
  • axial fixer 2 comprises a per se known extendable central member 4 connecting a proximal clamp 5, anchored to two tibial screws 6 and 7, and a distal clamp, generally designated by the reference numeral 8, which will be described in more detail hereinafter.
  • Proximal clamp 5 and distal clamp 8 are connected to the central member by means of universal spherical joints 9, 10, provided with locking eccentric members 11, 12 protruding from central member 4 with Allen screws.
  • Distal clamp 8 is articulated, as shown in detail in FIGs. 5and 6, and comprises an extended fork 13 having two relatively thin longitudinal walls 14, 15. Two radial appendixes 16, 17 are associated with walls 14, 15 on a transversal axis c arranged at the free ends.
  • the pivotal axis of the clamp is defined by a bush 18 having a central through bore 19.
  • the bush also constitutes a first stop member of radial appendixes 16, 17 and has an hexagonal external profile shaped as a nut screw. By rotating of the bush by means of a wrench the rotation of the two appendixes is blocked with respect of fork 13.
  • Respective universal clamps 20,21 are associated with radial appendixes 16, 17 for anchoring to two distal screws 22, 23.
  • FIGs. 12 and 13 show a second embodiment of the distal clamp wherein like reference characters, provided with apostrophes, denote similar features.
  • a clamp 8' is different from the above described one in that it comprises two independent stop members of the arms constituted by a double stop bush: a first inner bush 18' , centrally provided with a central hexagonal bore adapted to lock radial appendixes 16', 17* with respect to fork 13', and a second external bush 18", provided with perpendicular diametral bores for locking the relative rotation of the two radial appendixes 16', 17'.
  • the positioning and identifying device 3 is adapted to search the true axis of the tibial-heel joint. Such true axis will be designated by the reference sign a on the figures.
  • Device 3 is illustrated in more detail in FIG. 11 and comprises a substantially cylindrical hollow support 24 having an end bore adapted to accommodate a screw 23, inserted in the astragalus, and locked by a lock screw 25.
  • screw 23 can be positioned by hand with no particular inclination taking only good care of not damaging the blood vessels and the ligaments that are particularly delicate in this region.
  • a rod 26 may be connected to support 24 by means of a spherical joint.
  • a spherical joint is constituted by a sphere 27 formed at the end of rod 26 and adapted to be inserted in the internal cavity of support 24 and locked therein by means of a threaded ring 28 provided with an inner conical abutment 29.
  • An eccentric pin 30, inserted in a transversal through bore of the cylindrical support 24 is adapted to compress sphere 27 towards conical abutment 29 of ring 28 by means of a bearing 31 having a substantially hemispherical cavity 32.
  • An annular member 33 can be mounted on rod 26 and has a central bore having an inner diameter which is slightly greater than the diameter of the rod in order to allow a desired rotation and sliding.
  • the annular member is also provided with a transversal bore 34 which is staggered with respect of the axis for the passage of a Kirschner string.
  • the position of the annular member 33 and the orientation of the transversal bore 34, and therefore of the Kirschner string K, can be locked by means of a lock screw 35 as shown in FIGs. 1 to 4.
  • FIGs. 7 to 10 schematically show side and section views of orientable prismatic clamps adapted to connect the radial appendixes 16, 17 and respectively, 16', 17' of radial clamp 8 or 8', to the heel and astragalus screws 22 without any limitation in choosing their position with respect of the Kirschner string K.
  • all the clamps shown in FIGs. 7 to 10 have a main prismatic body 36 having a through bore 37 for the passage of radial appendixes 16, 17, 16', 17 ', and a secondary body 38 having a through bore 39 having a smaller diameter for locking screws 22, 23.
  • the two bodies are locked together by means of a transversal general Allen screw 40.
  • the surgeon will insert the tibial screws 6, 7 and the clamp 5 on the screws, then the surgeon will connect the central member 4 by tightening the eccentric 11.
  • the surgeon will anchor the support of device 3 to the screw 23.
  • the surgeon will position the device 3 with the Kirschner string centered on that point. After locking the Kirschner string with respect of the screw 23, the surgeon will make the joint turn.
  • the Kirschner string moves eccentrically with respect of the point marked on the patient, that means that its position does not yet correspond to the true axis of the joint. Therefore, by sliding and rotating the annular member 34 about two axes, the Kirschner string will be moved and oriented to make its axis substantially still as the joint rotates. In this condition the axis of the Kirschner string coincides, with a good approximation, with the true axis of the tibial-heel joint preventing excessive diastasis and/or compression of the j oint bones .
  • the surgeon will position the distal clamp to articulate it such that its pivoting axis coincides with the axis of the Kirschner string.
  • the surgeon will then insert the calcaneus screw 22 in a free position thanks to the orientable prismatic clamp 20.
  • the surgeon will free the tibial-heel joint by loosening the screw 19 in order to allow the correct rotation of the joint, making the fracture dynamic and sensibly accelerating the rehabilitation.
  • the material employed for the axial fixer and for the positioning device are chosen among the stainless steels, light alloys, and the biocompatible special metals according to the standards set forth by the International medical and quality specifications.
  • the apparatus according to the invention may have numerous modifications and variations, all within the scope of the appended claims.

Landscapes

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

Abstract

La présente invention concerne un système de traitement des fractures de la cheville, qui comprend un organe de fixation extérieur constitué par une pièce tibiale et une pièce de talon, reliés à un élément central extensible au moyen de joints universels. La pièce de talon est articulée de telle manière que son axe de rotation puisse être approximativement centré sur l'axe de l'articulation tibia-talon. Le système de l'invention comprend aussi un dispositif de positionnement de l'axe de rotation véritable de cette articulation, ce dispositif possédant un support combiné de façon amovible avec une vis qui peut être introduite librement dans l'astragale, une corde de Kirschner conçue pour identifier cet axe de rotation véritable, un élément de verrouillage de la corde de Kirschner qui est orientable de manière sélective par rapport au support jusqu'à ce que l'axe de la corde soit sensiblement immobile pendant la rotation de l'articulation tibia-talon.
PCT/EP1996/004113 1995-09-20 1996-09-20 Systeme de traitement des fractures de la cheville WO1997010775A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU74906/96A AU7490696A (en) 1995-09-20 1996-09-20 Apparatus for treating ankle fractures

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT95VR000078A IT1278858B1 (it) 1995-09-20 1995-09-20 Strumentario per il trattamento di fratture articolari della caviglia
ITVR95A000078 1995-09-20

Publications (2)

Publication Number Publication Date
WO1997010775A2 true WO1997010775A2 (fr) 1997-03-27
WO1997010775A3 WO1997010775A3 (fr) 1997-04-17

Family

ID=11428074

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1996/004113 WO1997010775A2 (fr) 1995-09-20 1996-09-20 Systeme de traitement des fractures de la cheville

Country Status (3)

Country Link
AU (1) AU7490696A (fr)
IT (1) IT1278858B1 (fr)
WO (1) WO1997010775A2 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000040163A1 (fr) * 1998-12-31 2000-07-13 Orthofix S.R.L. Dispositif perfectionne pour la fixation externe de fractures de l'os, notamment des fractures de la cheville
EP1560532A4 (fr) * 2002-11-15 2010-02-17 Amei Technologies Inc Appareil et procede pour maintenir les os en position de guerison
WO2011042598A1 (fr) * 2009-10-05 2011-04-14 Teknillinen Korkeakoulu Support extérieur de mobilisation, personnalisé au plan anatomique, son procédé de fabrication, et utilisation d'un support extérieur à fixation invasive pour la détermination de la course d'une articulation
US8382755B2 (en) * 2003-01-10 2013-02-26 Smith & Nephew, Inc. External fixation apparatus and method
CN104887359A (zh) * 2015-06-29 2015-09-09 北京贝思达生物技术有限公司 一种人工踝关节
US9737336B2 (en) 2009-10-05 2017-08-22 Aalto University Foundation Anatomically personalized and mobilizing external support and method for controlling a path of an external auxiliary frame
US9770272B2 (en) 2012-12-12 2017-09-26 Wright Medical Technology, Inc. Orthopedic compression/distraction device

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7048735B2 (en) 2002-02-04 2006-05-23 Smith & Nephew External fixation system
US7004943B2 (en) 2002-02-04 2006-02-28 Smith & Nephew, Inc. Devices, systems, and methods for placing and positioning fixation elements in external fixation systems

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4696293A (en) * 1982-09-30 1987-09-29 Ciullo Jerome V Hinged external fixator
CH680769A5 (fr) * 1989-08-23 1992-11-13 Jaquet Orthopedie
FR2705882A1 (fr) * 1993-06-01 1994-12-09 Hardy Jean Marie Fixateur externe modulaire évolutif pour immobilisation d'un foyer de fracture.

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000040163A1 (fr) * 1998-12-31 2000-07-13 Orthofix S.R.L. Dispositif perfectionne pour la fixation externe de fractures de l'os, notamment des fractures de la cheville
US6461358B1 (en) 1998-12-31 2002-10-08 Orthofix, S.R.L. Device for the external fixation of bones fractures, in particular ankle fractures
EP1560532A4 (fr) * 2002-11-15 2010-02-17 Amei Technologies Inc Appareil et procede pour maintenir les os en position de guerison
US8382755B2 (en) * 2003-01-10 2013-02-26 Smith & Nephew, Inc. External fixation apparatus and method
WO2011042598A1 (fr) * 2009-10-05 2011-04-14 Teknillinen Korkeakoulu Support extérieur de mobilisation, personnalisé au plan anatomique, son procédé de fabrication, et utilisation d'un support extérieur à fixation invasive pour la détermination de la course d'une articulation
US8777946B2 (en) 2009-10-05 2014-07-15 Aalto University Foundation Anatomically customized and mobilizing external support, method for manufacture
US9737336B2 (en) 2009-10-05 2017-08-22 Aalto University Foundation Anatomically personalized and mobilizing external support and method for controlling a path of an external auxiliary frame
US9770272B2 (en) 2012-12-12 2017-09-26 Wright Medical Technology, Inc. Orthopedic compression/distraction device
US10631900B2 (en) 2012-12-12 2020-04-28 Wright Medical Technology, Inc. Orthopedic compression/distraction device
CN104887359A (zh) * 2015-06-29 2015-09-09 北京贝思达生物技术有限公司 一种人工踝关节

Also Published As

Publication number Publication date
AU7490696A (en) 1997-04-09
IT1278858B1 (it) 1997-11-28
WO1997010775A3 (fr) 1997-04-17
ITVR950078A1 (it) 1997-03-20
ITVR950078A0 (it) 1995-09-20

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