U.S. patent application number 16/013852 was filed with the patent office on 2018-10-18 for pelvic cable solution.
The applicant listed for this patent is DePuy Synthes Products, Inc.. Invention is credited to Guido HERTIG, Simon STUCKI.
Application Number | 20180296210 16/013852 |
Document ID | / |
Family ID | 40524511 |
Filed Date | 2018-10-18 |
United States Patent
Application |
20180296210 |
Kind Code |
A1 |
STUCKI; Simon ; et
al. |
October 18, 2018 |
PELVIC CABLE SOLUTION
Abstract
A device for treating bone fractures, comprises an actuating
mechanism removably coupleable to a clamping mechanism including a
clamp defining a cable receiving channel extending therethrough and
a compression member coupled to the clamp for movement relative
thereto, movement of the compression member relative to the clamp
in a first direction moving the clamping mechanism into a clamping
configuration in which at least a portion of the clamp is
compressed into the channel to fix a cable received therein
relative to the clamping mechanism. The actuating mechanism
includes a first member and a second member removably engagable
with a clamping mechanism so that, when engaged, relative movement
between the first and second members causes relative movement
between the clamp and the compression member to move the clamping
member between the clamping configuration and a release
configuration, the actuating mechanism further including a
tensioning mechanism.
Inventors: |
STUCKI; Simon; (Thun,
CH) ; HERTIG; Guido; (Burgdorf, CH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
DePuy Synthes Products, Inc. |
Raynham |
MA |
US |
|
|
Family ID: |
40524511 |
Appl. No.: |
16/013852 |
Filed: |
June 20, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14312331 |
Jun 23, 2014 |
10028737 |
|
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16013852 |
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|
12863858 |
Jul 21, 2010 |
8795343 |
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PCT/US09/33404 |
Feb 6, 2009 |
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14312331 |
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61026807 |
Feb 7, 2008 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/8066 20130101;
A61B 17/8869 20130101; A61B 17/0487 20130101; A61B 17/842
20130101 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1-17. (canceled)
18. A clamp, comprising: a head including a head distal end shaped
to conform to a surface of bone against which it is to be applied
and a head proximal end; a body including a body distal end coupled
to the head proximal end and extending to a body proximal end, the
body proximal end divided by longitudinal slots into spaced
portions configured to press against a cable received in the clamp,
the body proximal end including threading configured to engage
corresponding threading of a compression member of a tensioning
apparatus such that rotational movement of the clamp in a clamping
direction relative to the compression member draws the clamp into
the compression member crushing the spaced portions against the
cable received in the clamp to fix the cable within the clamp,
wherein the longitudinal slots are sized and positioned to engage
an inner sleeve of the tensioning apparatus preventing relative
rotation between the inner sleeve and the clamp as the clamp is
drawn into the compression member; and a cable receiving channel
extending through the head and the body shaped and configured to
receive the cable therethrough.
19. The clamp of claim 18, wherein the clamp is moveable along a
longitudinal axis of the compression member toward the body
proximal end when the compression member is rotated in the clamping
direction.
20. The clamp of claim 19, wherein, when the clamp is moved along
the longitudinal axis of the compression member toward the body
distal end, the cable received within the cable receiving channel
slides longitudinally therethrough.
21. The clamp of claim 18, wherein the longitudinal slots include
two longitudinal slots substantially orthogonal to one another
dividing the proximal end into four evenly spaced portions.
22. The clamp of claim 18, wherein the body proximal end is tapered
to engage a correspondingly tapered surface of the compression
member.
23. The clamp of claim 22, wherein the body proximal end has a
cross sectional area greater than that of a proximal end of a clamp
receiving channel of the compression member configured to receive
the body proximal end therein.
24. The clamp of claim 23, wherein the rotational movement in the
clamping direction causes the larger body proximal end to engage
the reduced diameter proximal end of the clamp receiving channel
such that the spaced portions are crushed radially into the cable
receiving channel against the cable.
25. The clamp of claim 18, wherein the head is spherically shaped
to conform to the surface of bone against which it is to be
applied.
26. The clamp of claim 18, wherein the body is tapered such that a
diameter of the body distal end is greater than a diameter of the
body proximal end.
27. The clamp of claim 18, wherein the cable receiving channel
extends along a longitudinal axis of the clamp.
28. The clamp of claim 18, wherein the spaced portions are biased
towards a released configuration in which the spaced portions do
not compress the cable.
29. A clamp extending longitudinally from a distal end to a
proximal end, the clamp, comprising: a cable receiving channel
extending through the clamp from the distal end to the proximal
end, the channel configured to receive a cable therethrough; and a
compressible portion at the proximal end, the compressible portion
comprising longitudinal slots extending along a portion of a length
of the clamp to divide the proximal end to separated portions,
wherein the compressible portion is configured to move between a
released configuration in which the separated portions do not
compress the cable, and a clamping configuration in which the
separated portions are moved radially into the channel to fix a
cable received therein.
30. The clamp of claim 29, wherein the proximal end of the clamp is
configured to engage a compression member such that movement of the
clamp into the compression member moves the separated portions into
the clamping configuration.
31. The clamp of claim 29, wherein the proximal end of the clamp
includes threading configured to engage corresponding threading of
the compression member such that rotational movement of the clamp
in a clamping direction relative to the compression member draws
the clamp into the compression member to apply a radial force
moving the separated portions into the clamping configuration.
32. The clamp of claim 30, wherein, when the clamp is moved into
the compression member, the cable received within the channel
slides longitudinally therethrough.
33. The clamp of claim 32, wherein the proximal end of the clamp
has a cross sectional area greater than that of a proximal end of a
clamp receiving channel of the compression member configured to
receive the proximal end of the clamp therein.
34. The clamp of claim 29, wherein the separated portions are
biased towards the released configuration.
35. The clamp of claim 29, wherein the longitudinal slots include
two longitudinal slots substantially orthogonal to one another
dividing the proximal end into four evenly spaced portions.
36. The clamp of claim 29, wherein the cable receiving channel
extends along a longitudinal axis of the clamp.
37. The clamp of claim 29, wherein the proximal end is tapered to
engage a correspondingly tapered surface of the compression member.
Description
[0001] This application claims priority to the U.S. Provisional
Application Ser. No. 61/026,807, entitled, "PELVIC CABLE SOLUTION"
filed on Feb. 7, 2008. The specification of the above-identified
application is incorporated herewith by reference.
BACKGROUND
[0002] Acetabular (hip socket) fractures are serious orthopedic
injuries usually resulting from significant trauma. Surgery to
realign and stabilize the displaced joint surfaces (e.g., using
plates and screws), allows the patient to avoid traction and
prolonged bedrest and accurate fracture realignment promotes
improved bone and cartilage healing, which in turn improves
long-term results. Early fracture stability allows comfortable hip
movement which improves joint cartilage healing. Additionally, this
allows patients to be out of bed and ambulatory.
[0003] However, acetabular fractures with medial displacement
patterns, particularly those with medial displacement of the
quadrilateral surface, may be technically challenging to treat. The
location of the affected area deep in the pelvic part of the
abdominal cavity, minimal bone stock and difficulty obtaining
stable internal fixation in the true pelvis contribute to the
surgical challenge of open reduction and internal fixation of such
fractures. Applying a medial buttress plate across the
quadrilateral surface may assist in preventing the femur head from
penetrating into the pelvic cavity. However, because of the limited
access to the quadrilateral surface and the thin bone structures
around the acetabulum, it is often difficult to treat such
fractures with standard plates and screws. Although procedures have
previously been described for treating quadrilateral surface
fractures, there is still no optimal mechanical solution. Most of
the techniques involve fixations with forces acting at 90.degree.
to a screw axis, which may, when bone thickness is limited, result
in a cut out of the screws.
SUMMARY OF THE INVENTION
[0004] The present invention is directed to a device for treating
bone fractures, comprising an actuating mechanism removably
coupleable to a clamping mechanism including a clamp defining a
cable receiving channel extending therethrough and a compression
member coupled to the clamp for movement relative thereto, movement
of the compression member relative to the clamp in a first
direction moving the clamping mechanism into a clamping
configuration in which at least a portion of the clamp is
compressed into the channel to fix a cable received therein
relative to the clamping mechanism. The actuating mechanism
includes a first member removably engagable with a clamping
mechanism so that, when engaged, the first member prevents relative
movement between the clamp and the first member, a second member
removably engagable with a clamping mechanism and movably coupled
to the first member so that, when engaged, the second member
prevents relative movement between the compression member and the
second member, relative movement between the first and second
members causing relative movement between the clamp and the
compression member to move the clamping member between the clamping
configuration and a release configuration in which the cable is
permitted to move through the clamping mechanism and a tensioning
mechanism for drawing the cable through the clamping mechanism and
applying a desired degree of tension thereto.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] FIG. 1 shows a system of an exemplary embodiment of the
present invention, with all its components fully assembled;
[0006] FIG. 2 shows a perspective view of a handle of an exemplary
system of the present invention;
[0007] FIG. 3 shows a perspective view of longitudinal member of an
exemplary system of the present invention;
[0008] FIG. 4a shows a perspective view of a clamping mechanism
according to an exemplary system of the present invention;
[0009] FIG. 4b shows a first perspective view of a clamping
mechanism according to an exemplary system of the present
invention;
[0010] FIG. 5a shows a second perspective view of a clamp according
to an exemplary embodiment of a system according to the present
invention;
[0011] FIG. 5b shows a front plan view of the clamp of FIG. 5a;
[0012] FIG. 6a shows a perspective view of a clamping ring
according to an exemplary embodiment of a system of the present
invention;
[0013] FIG. 6b shows a front plan view of the clamping ring of FIG.
6a;
[0014] FIG. 7a shows a first perspective view of a longitudinal
member assembled with a clamping mechanism according to an
exemplary embodiment of a system of the present invention;
[0015] FIG. 7b shows a second perspective view of a longitudinal
member engaging a clamping mechanism according to an exemplary
embodiment of a system of the present invention;
[0016] FIG. 7c shows a third perspective view of a longitudinal
member engaging a clamping mechanism according to an exemplary
embodiment of a system of the present invention;
[0017] FIG. 8 shows an anatomically repositioning a fractured bone,
according to an exemplary embodiment of a method of the present
invention;
[0018] FIG. 9 shows the insertion of a cable (e.g., a Kirschner
wire) from a dorso-lateral side of a pelvic bone through the
repositioned quadrilateral surface of a bone fragment, according to
an exemplary embodiment of the present invention;
[0019] FIG. 10 shows holding a repositioned bone fragment,
according to an exemplary embodiment of the present invention;
[0020] FIG. 11 shows drilling a hole through the fractured bone,
according to an exemplary embodiment of the present invention;
[0021] FIG. 12 shows assembling a component of an exemplary system,
according to an exemplary embodiment of the present invention;
[0022] FIG. 13 shows inserting a cable into the drilled hole in the
fractured bone, according to an exemplary embodiment of the present
invention;
[0023] FIG. 14 shows the buttress plate abutting the surface of the
bone, according to an exemplary embodiment of the present
invention;
[0024] FIG. 15 shows inserting a cable into the drilled hole in the
fractured bone, according to an alternate exemplary method of the
present invention;
[0025] FIG. 16 shows positioning a buttress plate, according to the
alternate exemplary method of FIG. 15;
[0026] FIG. 17 shows assembling components of an exemplary system,
according to an exemplary method of the present invention;
[0027] FIG. 18 shows other components of an exemplary system,
according to an exemplary method of the present invention;
[0028] FIG. 19 shows assembled components of an exemplary system,
according to an exemplary embodiment of the present invention;
[0029] FIG. 20 shows the components of the present invention, fully
assembled, according to an exemplary embodiment of the present
invention;
[0030] FIG. 21 shows tensioning and crimping a cable, according to
an exemplary embodiment of the present invention;
[0031] FIG. 22 shows implanted components of an exemplary system,
according to an exemplary embodiment of the present invention;
[0032] FIG. 23 shows inserting additional screws through a plate,
according to an exemplary embodiment of the present invention;
and
[0033] FIG. 24 shows a perspective view of a clamping mechanism
according to an alternate embodiment of the present invention, in a
first configuration;
[0034] FIG. 25 shows a perspective view of the clamping mechanism
of FIG. 24, in a second configuration;
[0035] FIG. 26 shows a side view of the clamping mechanism of FIG.
24, in the first configuration;
[0036] FIG. 27 shows a side view of the clamping mechanism of FIG.
24, in the second configuration;
[0037] FIG. 28 shows a bottom view of the clamping mechanism of
FIG. 24, in the first configuration; and
[0038] FIG. 29 shows a bottom view of the clamping mechanism of
FIG. 24, in the second configuration.
DETAILED DESCRIPTION
[0039] The present invention, which may be further understood with
reference to the following description and the appended drawings,
relates to a system and method for treating fractures, and in
particular relates to internal fixation devices for treating
fractures. Specifically, exemplary embodiments of the present
invention describe a system and method for securing a cable or wire
through the fractured quadrilateral surface of the acetabulum. It
should be noted however, that although the embodiments of the
present invention are described in regard to the application of a
buttress plate to the quadrilateral surface of the acetabulum using
surgical cable or wire, the present invention is relevant to the
use of cable or wire to secure any bone fixation device to any
bone.
[0040] As shown in FIGS. 1-6, a system according to an exemplary
embodiment of the present invention includes a handle 6 for
tensioning a cable 56 and a longitudinal member 4 for operating a
clamping mechanism 2 to secure a clamp 8 about the cable 56 fixing
the cable 56 at a desired location and tension as will be described
in more detail below. The longitudinal member 4 is coupled to the
handle 6 so that the cable 56 may be passed into the longitudinal
member 4 and therethrough into the handle 6. As will be described
in more detail below, the cable 56 is first inserted through and
coupled to a bone plate 50 passed through a fractured bone and then
fed through a clamping mechanism 2 into the longitudinal member 4
and from there into the handle 6. The longitudinal member 4 engages
the clamping mechanism 2 which includes a clamping ring 10 screwed
over a threaded, proximal end of a clamp 8 such that rotation of
the longitudinal member 4 rotates the clamping ring 10 over the
clamp 8, crushing the clamp 8 and securing it over the cable 56
maintaining a position of the clamp 8 on the cable 56. Thus, any
tension on the cable 56 at this point is maintained by the clamp 8
securing the bone plate 50 against the fractured bone.
[0041] As shown in FIG. 2, the handle 6 is preferably
longitudinally shaped to facilitate handling by a user with a
channel 76 extending therethrough for slidably receiving the cable
56. However, those skilled in the art will understand that the
shape of the handle is not critical to the invention and may be any
selected shape. The channel 76 extends to a tensioning mechanism
operated by a knob 72 formed, for example, at a proximal end of the
handle 6. As would be understood by those skilled in the art, the
tensioning mechanism may, for example, include a spool coupled to
the knob 72. The cable 56 is coupled to the spool and a ratchet
mechanism (or other suitable device) maintains tension on the cable
56 as the cable 56 is wound up on the spool by rotation of the knob
72. As would be understood by those skilled in the art, the
tensioning mechanism may further include a manual release
disengaging the ratchet mechanism to release tension from the cable
56 as desired. The handle 6 may further include an indicator or
scale allowing a user to determine a current level of tension on
the cable 56. A distal end 66 of the handle 6 is adapted to be
coupled to the longitudinal member 4 as will be described in more
detail below. In an exemplary embodiment, the distal end 66 may
includes a recess adapted to receive a complimentarily shaped
proximal end of an inner sleeve 32 of the longitudinal member 4 to
prevent rotation of the end of internal sleeve 32 relative to the
handle 6.
[0042] As shown in FIG. 3 and mentioned above, the longitudinal
member 4 comprises an outer sleeve 30 and an inner sleeve 32
rotatably housed therewithin. A distal end of the outer sleeve 30
includes a recess 34 shaped to engage a proximal end of the
clamping ring 10 preventing the clamping ring 10 from rotating
relative thereto. In a preferred embodiment, for example, the
recess 34 and the proximal end of the clamping ring 10 are
hexagonally shaped. However, those skilled in the art will
understand that any of a variety of shapes may be selected for the
clamping ring 10 and the recess 34 so long as the two elements are
non-rotatable relative to one another when coupled together. A
proximal end 36 of the outer sleeve 30 may be shaped to facilitate
engagement with a wrench, or other tool for applying torque thereto
to rotate the outer sleeve 30 about a longitudinal axis thereof
while the handle 6 is held stationary. A distal end 38 of the inner
sleeve 32 includes a mating feature sized and shaped to
non-rotatably engage a proximal end of the clamp 8 (e.g., via a
hole in the proximal end of the clamping ring 10). Thus, the
rotation of the outer sleeve 30 relative to the handle 6 and,
consequently, the inner sleeve 32, causes the clamping ring 10 to
rotate relative to the clamp 8, screwing the clamping ring 10 over
the clamp 8. In a preferred embodiment the distal end 38 may be
crown-shaped. As indicated above, a proximal end 40 of the inner
sleeve 32 extends through the outer sleeve 30 to non-rotatably
engage a distal end 66 of the handle 6 with a channel 74 extending
through the inner sleeve 32 being in communication with the channel
76 of the handle 6. Thus, as shown in FIGS. 4a and 4b, the cable 56
may pass through the longitudinal member 4 via channel 74 into the
handle 6 and pass therethrough to the tensioning mechanism via the
cannel 76. In an exemplary embodiment, the proximal end 40 may be
hexagonally shaped to be received within a hexagonal recess of the
distal end 66 of the handle 6.
[0043] As shown in FIGS. 5a and 5b, the clamp 8 includes a head 12
and a body 14 extending proximally from the head 12 to a proximal
end 18. The head 12 of the clamp 8 may be spherically shaped to
adapt to the bone surface. However, it will be understood by those
of skill in the art that the head 12 may be of a variety of shapes.
The body 14 may be tapered with a diameter of a distal end 16
thereof slightly greater than that of the proximal end 18. The
clamp 8 may further include a channel 20 extending therethrough so
that the cable 56 may pass through the entire length of the clamp
8. The channel 20 may be substantially cylindrical and extend along
a longitudinal axis of the clamp 8. Alternatively, the channel 20
may taper with the shape of the body 14. The body 14 may include
threading 24 along all or a portion of its length and includes at
least one slot 22 extending substantially longitudinally
therethrough from the proximal end 18 toward the distal end 16. The
longitudinal slots 22 may be parallel to the longitudinal axis of
the clamp 8 along at least a portion of a length of the body 14 at
its proximal end 18. The longitudinal slots 22 may, for example, be
positioned substantially symmetrically about the longitudinal axis
such that separated portions 62 of the proximal end 18 created by
the longitudinal slots 22 are free to flex radially into the
channel 20 against the cable 56. For example, in an exemplary
embodiment, two longitudinal slots 22 substantially orthogonal to
one another divide the proximal end 18 of the body 14 into four
substantially equally sized and spaced portions 62.
[0044] As indicated above, the body 14 is threaded to engage a
threading of a channel 26 of extending through a clamping ring 10
formed, for example, as a nut. A distal end of the channel 26 is
sized and shaped to receive larger distal end 16 of the body 14
while a chamfer 29 necks down a proximal portion of the channel 26
so that, as the clamping ring 10 is threaded further distally over
the body 14, the reduced diameter proximal portion of the channel
26 engages the portions 62 of the clamp 8 and forces them radially
into the channel 20 against the cable 56. In a preferred
embodiment, an outer surface 64 of the clamping ring 10 is
hexagonally shaped to engage a corresponding recess 34 in the outer
sleeve 30 as shown in FIGS. 7a-7c. It will be understood by those
in the art however, that the outer surface 64 of the clamping ring
10 may take any shape so long as the outer surface 64 of the
clamping ring 10 is non-rotatably engaged by the outer sleeve 30.
As the clamping ring 10 is rotated relative to the clamp 8, the
threads 28 engage the threads 24 of the clamp 8 to draw the
clamping ring 10 distally relative to the body 14 compressing the
portions 62 against the cable 56. Furthermore, as indicated above,
the distal end 38 of the inner sleeve 32 engages the longitudinal
slots 22 or any other feature of the clamp 8 to non-rotatably
couple thereto. For example, in a preferred embodiment, the distal
end 38 include projections (e.g., in the shape of an X or a cross)
to extend into the longitudinal slots 22 to prevent relative
rotation between the inner sleeve 32 and the clamp 8.
[0045] As shown in FIGS. 8-21, a method according to an exemplary
embodiment of the present invention provides improved mechanical
buttressing of a fractured pelvis by fixing a plate over the
quadrilateral surface of the acetabulum via a cable 56 and clamp 8
as described above. As shown in FIG. 8, to prepare for the surgical
reduction of the fracture, the fractured bone 42 is anatomically
repositioned (e.g., using clamps, forceps or any other surgical
tool for holding the fractured bone 42 in place) and held in place
as a wire is fixed to a target location on a dorso-lateral side 46
of the bone 42, as shown in FIG. 9. Those skilled in the art will
understand that the wire may be any thin wire that can act as a
guidewire for surgical tools such as, a K-wire, which is a
sterilized, sharpened, smooth stainless steel pin that may be
driven into the bone using a power or hand drill. The wire may be
inserted into the bone 42 until an end is within the center of a
target area of the quadrilateral surface of the bone 42, as shown
in FIG. 10. A cannulated drill bit may then be mounted over the
wire so that the wire functions as a guidewire aiming the drill to
create a channel 48 through the quadrilateral surface, as shown in
FIG. 11. Once the channel 48 has been drilled through the bone, the
wire is removed from the body, while a physician continues to hold
the fractured bone 42 in place.
[0046] As shown in FIG. 12, a plate 50 may be pre-assembled for
implantation into the body. The plate 50 may be selected according
to the type of fracture of the bone and the support required to
reduce the fracture. For example, the plate 50 may include one or
more buttressing wings 52 and a brim fixation wing 54. The
buttressing wings 52 may be pre-bent to adapt to the curve and
shape of the quadrilateral surface. Additionally, the brim fixation
wing 54 may be pre-bent to fit the curve if the pelvic brim.
Alternatively, a user of the plate 50 may shape the plate 50 as
desired to accommodate the anatomy of the target area as would be
understood by those skilled in the art. Thus, the plate 50 is
preferably formed of a material sufficiently strong to withstand
the forces to which it will be exposed when implanted but which is
sufficiently flexible to adapt to the shape of the bone 42 and to
receive any bending required by a user. The plate 50 may be
assembled with a cable 56 inserted through a hole 58 formed, for
example, at or near a center thereof so that tension applied to the
cable 56 draws the entire plate 50 snugly against the bone 42. The
cable 56 may be fixed to the plate 50 by any known mechanism (e.g.,
by an enlarged distal end 68 sized to prevent the cable 56 from
slipping through the plate 50). Thus, if the end 68 is rounded, a
diameter of the rounded end 68 is selected to be greater than the
diameter of the hole 58. The plate 50 may further include an
indentation 70, or cavity, to accommodate the end 68 of the cable
56. It will be understood by those of skill in the art that the
plate 50 need not be pre-assembled prior to implantation and that
the cable 56 may be inserted through the hole 58 after the plate 50
has been positioned on the quadrilateral surface.
[0047] As shown in FIGS. 13-14, the proximal end of the cable 56 is
passed through the channel 48 to the dorso-lateral side 46 of the
bone 42 and pulled proximally until the plate 50 is held against
the quadrilateral surface supporting the fractured bone 42, as
shown in FIG. 14. Once the cable 56 is pulled taught, the cable 56
will extend at an angle that is approximately 45.degree. relative
to a plane in which the plate 50 rests, minimizing the likelihood
of cut-out of the bone while continuing to sufficient support to
stabilize the fragments of the bone 42 in the desired position. The
plate 50 is preferably positioned such the buttressing wings 52
optimally buttress the quadrilateral surface and so that the
fixation wing 54 fits over the pelvic brim.
[0048] Alternatively, as shown in FIGS. 15 and 16, the cable 56 may
be passed through the channel 48 from the dorso-lateral side 46 of
the bone 42 such that the distal portion of the cable 56 may extend
past the quadrilateral surface. The distal end 68 of the cable 56
may be enlarged, but small enough to pass through the hole 58 of
the plate 50 and the channel 48 of the bone 42. Thus, the distal
end 68 is passed through the hole 58 and the plate 50 positioned
against the quadrilateral surface. It will be understood by those
of skill in the art that the plate 50 may have more than one hole
58 such that the distal end 68 of the cable 56 may be inserted
through the hole 58 that best positions the plate 50 against the
quadrilateral surface. The distal end 68 of the cable 56 may be
fixed to the plate 50 via a slotted spherical washer 78, which is
affixed to the distal end 68 of the cable 56. The cable 56 is
passed through a slot of the slotted spherical washer 78. It will
be understood by those of skill in the art that an opening 80 of
the spherical washer may be smaller than the distal end 68 such
that the distal end 68 may not pass through the opening 80. It will
also be understood by those of skill in the art that the spherical
washer 78 may be deformed such that a width of the slot is
decreased, preventing the cable 56 from coming loose. Thus, when
the cable 56 is pulled taught, the plate 50 is held in position
against the quadrilateral surface.
[0049] As shown in FIGS. 17-20, while continuing to hold tension on
the cable 56, the proximal end thereof is threaded through a
clamping mechanism 2, into the inner sleeve 32 and from there into
the handle 6 wherein it is engaged with the tensioning mechanism.
The proximal end of the clamp 8 is then engaged with the distal end
38 of the inner sleeve 32 while the outer surface 64 of the
clamping ring 10 is engaged with the recess 34 at the distal end of
the outer sleeve 30 and the entire assembly is slid along the cable
56 until the head 12 of the clamp 8 abuts the dorso-lateral side 46
of the bone 42. The tension through the cable 56 is then increased
by actuating the knob 72 of the handle 6 in the direction of arrow
A, as shown in FIG. 21. Those skilled in the art will understand
that, during this phase, the clamping ring 10 is only screwed over
the tapered proximal end of the body 14 so that the portions 62 do
not engage the cable 56 and the cable 56 remains slidable through
the clamp 8.
[0050] It will be understood by those of skill in the art that the
clamping mechanism 2 may be clamped over and released from the
cable 56 as desired as the clamp 8 may be moveable between a
clamping configuration in which the cable 56 is compressed by the
radially inward flexing of the portions 62 and a released
configuration in which the portions 62 do not compress the cable 56
by biasing the portions 62 toward the released configuration and
designing the taper of the portions 62 and the chamfer 30 so that
the portions 62 are not plastically deformed when moved to the
clamping configuration.
[0051] Once the desired tension has been placed on the cable 56,
the outer sleeve 30 of the longitudinal member 4 may be rotated in
direction B, about the inner sleeve 30, such that the clamping ring
10, to which the outer sleeve 30 is engaged, is screwed over the
clamp 8 compressing the portions 62 against the cable 56 and fixing
the clamping mechanism 2 on the cable 56 as described above. It
will be understood by those in the art that rotating the outer
sleeve 30 in one direction relative to the inner sleeve 32 (e.g.,
direction B) tightens the clamping ring 10 about the body 14 of the
clamp 8 while rotating the outer sleeve in the opposite direction
loosens the clamping ring 10 from the clamp 8 disengaging the
portions 62 from the cable 56.
[0052] The clamping mechanism 2, when in the clamped configuration,
maintains a desired tension on the cable 56 securing the plate 50
firmly over the quadrilateral surface of the bone 42 while the
clamping mechanism 2 is secured firmly against the dorso-lateral
side 46 of the bone 42. The head 12 of the clamp 8 abuts and
orients to the surface of the bone 42, providing optimal mechanical
buttressing. Once the clamping mechanism 2 has been fixed in the
clamped configuration, the longitudinal member 4 and the handle 6
may be disassembled, as shown in FIG. 20 by releasing the cable 56
from the tensioning mechanism of the handle 6 and disengaging the
distal end 66 of the handle 6 from the proximal end 40 of the inner
sleeve 32 of the longitudinal member 4. The handle 6 may then be
slid off of the cable 56 and the longitudinal member 4 may then be
disengaged from the clamping mechanism 2 by removing the distal end
38 of the inner sleeve 32 from the slots 22 of the clamp 8 and the
recess 34 of the outer sleeve 30 from the clamping ring 10. The
longitudinal member 4 may then be slid off of the cable 56.
[0053] As shown in FIG. 22, the remaining cable 56 may then be cut
as close to the clamping mechanism 2 as desired so that only the
clamping mechanism 2 remains, projecting out slightly from the
dorso-lateral side 46 of the bone 42. As shown in FIG. 23 and as
would be understood by those skilled in the art, additional brim
screws 74 may be inserted through an additional brim plate 76 to
enhance the stability and support of the bone fragments.
[0054] As shown in FIGS. 24-29, an alternate embodiment of a
clamping mechanism 100 comprises a clamp 102 and a clamping ring
104. The clamping mechanism 100 may be used in the system, as
described above, to secure the clamp 102 about the cable 56, at a
desired location. The clamp 102 is engagable with the clamping ring
104 to move a mandrel 106 of the clamping ring 104 from a first
configuration in which the mandrel 106 permits the cable 56 to
slide through the clamping mechanism 100 to a second configuration
in which the mandrel 106 crushed against the cable 56 such that the
cable 56 is fixed at a desired location.
[0055] The clamp 102 includes a head 108 and a body 110 extending
distally from a distal end 112 of the head 108 to a distal end 114.
The clamp 102 further includes a lumen 116 extending longitudinally
therethrough sized to slidably accommodate the cable 56. The head
108 may be sized and shaped to engage a portion of the longitudinal
member 4 such that the longitudinal member 4 may move the clamp 102
relative to the clamping ring 104. In a preferred embodiment, the
head 108 may be hexagonally shaped to mate with a correspondingly
shaped distal end 38 of the inner sleeve 32 of the longitudinal
member 4. It will be understood by those of skill in the art that
the distal end 38 of the inner sleeve 32 may be a hexagonally
shaped recess to accommodate the head 108 of the clamp 102 or any
other shaped protrusion or recess so long as the distal end 38 of
the inner sleeve 32 mates with the head 108. The body 110 of the
clamp 102 may be sized and shaped to engage with the clamping ring
104. The body 110 may include a threading (not shown) about an
outer surface 118 thereof. It will be understood by those of skill
in the art, however, that the body 108 may include any arrangement
or mechanism for engaging with the clamping ring 104. In the
embodiment shown, a diameter of the body 110 may be larger than a
diameter of the head 108. However, it will be understood by those
of skill in the art, that the body 110 may be any size or shape so
long as the body 110 is engagable with the clamping ring 104.
[0056] As described above, the clamping ring 104 is engagable with
at least a portion of the body 110 of the clamp 102 and may be
formed as, for example, a nut. The clamping ring 104 includes a
channel 120 extending longitudinally therethrough for accommodating
the cable 56. The channel 120 may include a first portion 122 and a
second portion 124 proximal of the first portion 122. The first
portion 122 may be sized and shaped to slidably accommodate the
cable 56. Thus, a size of the first portion 122 may be only
slightly larger than a size of the cable 56. The second portion 124
may be sized and shaped to accommodate at least a portion of the
body 110. Thus, an inner diameter or size of the second portion 124
will be larger than an inner diameter of the first portion 122. The
second portion 124 may include a threading (not shown) along an
inner surface 126 thereof for rotatably engaging with the threading
of the body 110. However, it will be understood by those of skill
in the art that the clamping ring 104 may include any mechanism or
arrangement for engaging with the clamp 102. An outer surface 128
may be shaped such that the clamping ring 104 may mate with the
outer sleeve 30 of the longitudinal member 4. For example, the
outer surface 128 may be hexagonally shaped to mate with the
hexagonal recess 34 of the outer sleeve 30. Thus, it will be
understood by those of skill in the art that when the inner sleeve
32 is rotated relative to the outer sleeve 30, the clamp 102 will
rotate relative to the clamping ring 104 such that the clamp 102
engages the clamping ring 104.
[0057] The mandrel 106 may be substantially longitudinally shaped
and positioned within the clamping ring 104 such that the mandrel
106 is movable from the first configuration, shown in FIGS. 24, 26
and 28, to the second configuration, shown in FIGS. 25, 27 and 29.
The clamping ring 104 includes a slot 130 extending laterally
therethrough for accommodating the mandrel 106 such that a length
of the mandrel 106 is housed within the channel 120 of the clamping
ring 102. The slot 130 is elongated such that a proximal end 132 of
the slot 130 accommodates the mandrel 106 in the first
configuration while a distal end 134 of the slot 130 accommodated
the mandrel 106 in the second configuration. The slot 130 is angled
such that the proximal end 132 passes through the second portion
124 of the channel 120 and is radially outward of the first portion
122. Thus, in the first configuration, the mandrel 106 does not
interfere with the slidable insertion of the cable 56. The slot 130
angles radially inward from the proximal end 132 toward the distal
end 134 such that the distal end 134 is at least partially within
the first portion 122, interfering with the channel 120. Thus, the
mandrel 106 may slide from the proximal end 132 in the first
configuration to the distal end 134 in the second configuration to
crush the cable 56 passing through the channel 120, thereby fixing
the cable 56.
[0058] The mandrel 106 may be moved from the first configuration to
the second configuration as the clamp 102 engages the clamping ring
104. The distal end 114 of the clamp 102 abuts the mandrel 106 such
that as the clamp 102 is moved relative to the clamping ring 104 to
engage with the clamping ring 104, the distal end 114 moves the
mandrel 106 distally relative to the clamping ring 104. Thus, the
mandrel 106 slides from the proximal end 132 of the slot to the
distal end 134 of the slot 130, crushing the cable 56 within the
first portion 122 of the channel 120.
[0059] It will be apparent to those of skill in the art that
various modifications and variations can be made in the structure
and the methodology of the present invention, without departing
from the spirit or scope of the invention. Thus, it is intended
that the present invention cover the modifications and variations
of this invention provided that they come within the scope of the
appended claims and their equivalents.
* * * * *