U.S. patent application number 16/181795 was filed with the patent office on 2019-10-10 for method and apparatus for treating a bone fracture.
The applicant listed for this patent is The Vertical Group, Inc.. Invention is credited to Hadley Callaway, Dennis McDevitt, Vince Novak.
Application Number | 20190307494 16/181795 |
Document ID | / |
Family ID | 48903545 |
Filed Date | 2019-10-10 |
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United States Patent
Application |
20190307494 |
Kind Code |
A1 |
McDevitt; Dennis ; et
al. |
October 10, 2019 |
METHOD AND APPARATUS FOR TREATING A BONE FRACTURE
Abstract
Apparatus for treating a bone fracture, the apparatus
comprising: an anchoring tube comprising a hollow elongated shaft
adapted for disposition in a hole formed in a bone and having a
distal end, a proximal end and a lumen extending therebetween, and
a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone; wherein the plate comprises a top
surface and a bottom surface, and further wherein the bottom
surface of the plate is convex, such that when the anchoring tube
is disposed in a hole formed in a bone and is rotated about the
longitudinal axis of the hollow elongated shaft, the convex bottom
surface of the plate maintains supporting contact with the outer
surface of the bone.
Inventors: |
McDevitt; Dennis; (Raleigh,
NC) ; Novak; Vince; (Raleigh, NC) ; Callaway;
Hadley; (Raleigh, NC) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The Vertical Group, Inc. |
Basking Ridge |
NJ |
US |
|
|
Family ID: |
48903545 |
Appl. No.: |
16/181795 |
Filed: |
November 6, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15053726 |
Feb 25, 2016 |
10117686 |
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16181795 |
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13762054 |
Feb 7, 2013 |
9277945 |
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15053726 |
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61596056 |
Feb 7, 2012 |
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61669852 |
Jul 10, 2012 |
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61699387 |
Sep 11, 2012 |
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61699715 |
Sep 11, 2012 |
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61706385 |
Sep 27, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/0401 20130101;
A61B 17/1725 20130101; A61B 17/8872 20130101; A61B 17/72 20130101;
A61B 17/7233 20130101; A61B 17/7266 20130101; A61B 2017/0404
20130101; A61B 2017/0496 20130101; A61B 17/808 20130101; A61B
2017/0409 20130101; A61B 17/88 20130101; A61B 17/921 20130101; A61B
17/1717 20130101 |
International
Class: |
A61B 17/72 20060101
A61B017/72; A61B 17/88 20060101 A61B017/88; A61B 17/04 20060101
A61B017/04; A61B 17/17 20060101 A61B017/17; A61B 17/92 20060101
A61B017/92 |
Claims
1.-6. (canceled)
7. Apparatus for treating a bone fracture, the apparatus
comprising: an anchoring tube comprising a hollow elongated shaft
adapted for disposition in a hole formed in a bone and having a
distal end, a proximal end and a lumen extending therebetween, and
a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone; wherein the hollow elongated shaft
comprises at least two diametrically-opposed holes extending
therethrough; and a suture assembly extending through a bone
fragment, through at least one of the diametrically-opposed holes
in the hollow elongated shaft, and through the lumen of the
anchoring tube, the suture assembly securing the bone fragment to
the anchoring tube under tension, whereby to secure the bone
fragment to the bone receiving the anchoring tube.
8. Apparatus according to claim 7 wherein a first portion of the
suture assembly bears against the bone fragment and a second
portion of the suture assembly is secured to the anchoring
tube.
9. Apparatus according to claim 8 wherein the suture assembly
comprises a buckle mounted to the first portion of the suture
assembly, wherein the buckle bears against an outer surface of the
bone fragment.
10. Apparatus according to claim 9 wherein the buckle comprises a
plate having at least one hole formed therein.
11. Apparatus according to claim 8 wherein the second portion of
the suture assembly is secured to the plate.
12. Apparatus according to claim 11 wherein the second portion of
the suture assembly is secured to the plate by a screw which also
secures the plate to the bone.
13. Apparatus according to claim 7 wherein the plate comprises a
top surface and a bottom surface, and further wherein the bottom
surface of the plate is convex, such that when the anchoring tube
is disposed in a hole formed in a bone and is rotated about the
longitudinal axis of the hollow elongated shaft, the convex bottom
surface of the plate maintains supporting contact with the outer
surface of the bone.
14. Apparatus according to claim 7 further comprising at least one
pin extending through at least two diametrically-opposed holes
formed in the hollow elongated shaft.
15. Apparatus according to claim 14 wherein the pin is
threaded.
16. Apparatus according to claim 7 further comprising at least one
bone screw extending through at least two diametrically-opposed
holes formed in the hollow elongated shaft.
17. Apparatus according to claim 7 further comprising at least one
barb extending through at least one hole formed in the hollow
elongated shaft.
18.-25. (canceled)
26. Apparatus for treating a bone fracture, the apparatus
comprising: a suture assembly comprising a suture and a buckle for
mounting to the suture, wherein the buckle comprises a plate having
two holes formed therein, a bridge extending between the two holes,
and a slot connecting one of the two holes to a perimeter of the
plate.
27. Apparatus according to claim 26 further comprising a buckle
holder for holding the buckle while the suture is secured to the
buckle, the buckle holder comprising a body having a proximal end,
a distal end, a top surface and a bottom surface, a pair of holes
extending from the top surface to the bottom surface, a buckle seat
adjacent the distal end and extending proximally, and a vertical
slot opening on the distal end and extending proximally, the
vertical slot extending between the top surface and the bottom
surface, the buckle holder being sized so that the buckle seat can
receive the buckle, with the two holes in the buckle being aligned
with the two holes in the buckle holder.
28. Apparatus according to claim 27 wherein the buckle seat
comprises a recess opening on the distal end of the buckle holder
and extending proximally.
29. Apparatus according to claim 28 wherein the recess comprises a
horizontal slot opening on the distal end of the buckle holder and
extending proximally.
30. (canceled)
31. A buckle holder for holding a buckle while suture is secured to
the buckle, wherein the buckle has two holes therein and a slot
connecting one of the holes to an end of the buckle, the buckle
holder comprising a body having a proximal end, a distal end, a top
surface and a bottom surface, a pair of holes extending from the
top surface to the bottom surface, a buckle seat adjacent the
distal end and extending proximally, and a vertical slot opening on
the distal end and extending proximally, the vertical slot
extending between the top surface and the bottom surface, the
buckle holder being sized so that the buckle seat can receive the
buckle, with the two holes in the buckle being aligned with the two
holes in the buckle holder.
32. Apparatus according to claim 31 wherein the buckle seat
comprises a recess opening on the distal end of the buckle holder
and extending proximally.
33. Apparatus according to claim 32 wherein the recess comprises a
horizontal slot opening on the distal end of the buckle holder and
extending proximally.
34.-44. (canceled)
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATIONS
[0001] This patent application claims benefit of:
[0002] (i) pending prior U.S. Provisional Patent Application Ser.
No. 61/596,056, filed Feb. 7, 2012 by Dennis McDevitt et al. for
ANCHORING POST IMPLANT (Attorney's Docket No. MNR-1 PROV);
[0003] (ii) pending prior U.S. Provisional Patent Application Ser.
No. 61/669,852, filed Jul. 10, 2012 by Dennis McDevitt et al. for
ANGLED FIXATION POST (Attorney's Docket No. MNR-2 PROV);
[0004] (iii) pending prior U.S. Provisional Patent Application Ser.
No. 61/699,387, filed Sep. 11, 2012 by Dennis McDevitt et al. for
FIXATION POST IMPLANT (Attorney's Docket No. MNR-3 PROV);
[0005] (iv) pending prior U.S. Provisional Patent Application Ser.
No. 61/699,715, filed Sep. 11, 2012 by Dennis McDevitt et al. for
FIXATION POST IMPLANT (Attorney's Docket No. MNR-5 PROV); and
[0006] (v) pending prior U.S. Provisional Patent Application Ser.
No. 61/706,385, filed Sep. 27, 2012 by Dennis McDevitt et al. for
SURGICAL FASTENER (Attorney's Docket No. MNR-4 PROV).
[0007] The five (5) above-identified patent applications are hereby
incorporated herein by reference.
FIELD OF THE INVENTION
[0008] This invention relates to surgical methods and apparatus in
general, and more particularly to surgical methods and apparatus
for treating a bone fracture.
BACKGROUND OF THE INVENTION
[0009] It is common for bones to become fractured as the result of
trauma, e.g., a fall, an automobile accident, a sporting injury,
etc. Where a bone has become fractured, it is frequently necessary
to stabilize the bone in the area of the fracture so as to support
the bone during healing. The ultimate goal of fracture treatment is
to restore function to the bone, and the key to restoring function
to the bone is to ensure proper healing of the fracture site. The
critical factors associated with proper healing of a fractured bone
are (i) stable fixation of the fractured bone, and (ii) protection
of the blood supply.
[0010] In general, a fracture fixation system is used to create a
bridge across the fracture site, and the fracture fixation system
principally consists of two components: (i) a bridging device
(e.g., an internal fracture fixation plate, an intramedullary rod
or nail, an external fracture fixation stabilizer, etc.), and (ii)
bridge-to-bone interface elements (e.g., bone screws, pins, hooks,
suture, wire, etc.). The location of the fracture, and the quality
of the patient's bone, generally play major roles in determining
the particular fracture fixation system which is used to treat a
fracture.
[0011] Treating fractures in the proximal humerus is particularly
challenging due to the anatomy of the proximal humerus and the
surrounding tissue (e.g., soft tissue such as muscles, tendons and
ligaments, neurovascular structures, etc.). Recent innovations in
proximal humeral fracture fixation have primarily focused on
specific incremental advances in the art, e.g., improved thread
designs for bone screws, improved designs for fracture fixation
plates, locking mechanisms between fracture fixation plates and
bone screws, improved drill guides for more accurate placement of
threaded pins, improved intramedullary nails and rods with varying
apertures for improved bone screw placement, etc. However, these
recent innovations in proximal humeral fracture fixation have not
adequately addressed all of the clinical issues faced by the
physician.
[0012] Significantly, the number of proximal humeral fractures
occurring in osteopenic patients (particularly women) is growing.
Treating proximal humeral fractures in osteopenic patients is even
more challenging than treating proximal humeral fractures in
non-osteopenic patients, due to the poor bone quality common in
osteopenic patients. Furthermore, increasing numbers of these
fractures are being treated in ambulatory surgical settings, which
require the physician to treat the patient using less invasive
techniques. Current approaches for treating proximal humeral
fractures in osteopenic patients have proven inadequate,
particularly where minimally invasive techniques must be used.
[0013] Thus there is a need for a new and improved method and
apparatus for treating bone fractures in general, and for treating
proximal humeral fractures in particular.
SUMMARY OF THE INVENTION
[0014] The present invention provides a novel method and apparatus
for treating bone fractures in general, and for treating proximal
humeral fractures in particular.
[0015] In one form of the invention, there is provided apparatus
for treating a bone fracture, the apparatus comprising:
[0016] an anchoring tube comprising a hollow elongated shaft
adapted for disposition in a hole formed in a bone and having a
distal end, a proximal end and a lumen extending therebetween, and
a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone;
[0017] wherein the plate comprises a top surface and a bottom
surface, and further wherein the bottom surface of the plate is
convex, such that when the anchoring tube is disposed in a hole
formed in a bone and is rotated about the longitudinal axis of the
hollow elongated shaft, the convex bottom surface of the plate
maintains supporting contact with the outer surface of the
bone.
[0018] In another form of the invention, there is provided
apparatus for treating a bone fracture, the apparatus
comprising:
[0019] an anchoring tube comprising a hollow elongated shaft
adapted for disposition in a hole formed in a bone and having a
distal end, a proximal end and a lumen extending therebetween, and
a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone;
[0020] wherein the hollow elongated shaft comprises at least two
diametrically-opposed holes extending therethrough; and
[0021] a suture assembly extending through a bone fragment, through
at least one of the diametrically-opposed holes in the hollow
elongated shaft, and through the lumen of the anchoring tube, the
suture assembly securing the bone fragment to the anchoring tube
under tension, whereby to secure the bone fragment to the bone
receiving the anchoring tube.
[0022] In another form of the invention, there is provided
apparatus for treating a bone fracture, the apparatus
comprising:
[0023] an anchoring tube comprising a hollow elongated shaft
adapted for disposition in a hole formed in a bone and having a
distal end, a proximal end and a lumen extending therebetween, and
a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone;
[0024] wherein the hollow elongated shaft comprises at least two
diametrically-opposed holes extending therethrough;
[0025] a breakaway rod for disposition within the lumen of the
hollow elongated shaft, the breakaway rod comprising a distal end,
a proximal end, a hole proximal to the distal end for alignment
with at least two diametrically-opposed holes formed in the hollow
elongated shaft, and a breakaway section proximal to the hole
formed in the breakaway rod; and
[0026] a fixation element for extending through a bone fragment,
through two diametrically-opposed holes in the hollow elongated
shaft, and through the hole in the breakaway rod for securing the
bone fragment to the anchoring tube, whereby to secure the bone
fragment to the bone receiving the anchoring tube.
[0027] In another form of the invention, there is provided
apparatus for treating a bone fracture, the apparatus
comprising:
[0028] a suture assembly comprising a suture and a buckle for
mounting to the suture, wherein the buckle comprises a plate having
two holes formed therein, a bridge extending between the two holes,
and a slot connecting one of the two holes to a perimeter of the
plate.
[0029] In another form of the invention, there is provided
apparatus for treating a bone fracture, the apparatus
comprising:
[0030] a suture assembly comprising a suture and a buckle, the
buckle comprising means for attaching a closed end of the suture to
the buckle without tying.
[0031] In another form of the invention, there is provided a buckle
holder for holding a buckle while suture is secured to the buckle,
wherein the buckle has two holes therein and a slot connecting one
of the holes to an end of the buckle, the buckle holder comprising
a body having a proximal end, a distal end, a top surface and a
bottom surface, a pair of holes extending from the top surface to
the bottom surface, a buckle seat adjacent the distal end and
extending proximally, and a vertical slot opening on the distal end
and extending proximally, the vertical slot extending between the
top surface and the bottom surface, the buckle holder being sized
so that the buckle seat can receive the buckle, with the two holes
in the buckle being aligned with the two holes in the buckle
holder.
[0032] In another form of the invention, there is provided a method
for treating a bone fracture, the method comprising:
[0033] providing an anchoring tube comprising a hollow elongated
shaft adapted for disposition in a hole formed in a bone and having
a distal end, a proximal end and a lumen extending therebetween,
and a substantially planar plate mounted to the proximal end of the
hollow elongated shaft and adapted for disposition against the
outer surface of the bone; [0034] wherein the plate comprises a top
surface and a bottom surface, and further wherein the bottom
surface of the plate is convex, such that when the anchoring tube
is disposed in a hole formed in a bone and is rotated about the
longitudinal axis of the hollow elongated shaft, the convex bottom
surface of the plate maintains supporting contact with the outer
surface of the bone;
[0035] forming a hole in the bone;
[0036] positioning the hollow elongated shaft of the anchoring tube
in the hole in the bone; and
[0037] rotating the anchoring tube about the longitudinal axis of
the hollow elongated shaft while the convex bottom surface of the
plate maintains supporting contact with the outer surface of the
bone.
[0038] In another form of the invention, there is provided a method
for treating a bone fracture, the method comprising:
[0039] providing apparatus comprising: [0040] an anchoring tube
comprising a hollow elongated shaft adapted for disposition in a
hole formed in a bone and having a distal end, a proximal end and a
lumen extending therebetween, and a substantially planar plate
mounted to the proximal end of the hollow elongated shaft and
adapted for disposition against the outer surface of the bone;
[0041] wherein the hollow elongated shaft comprises at least two
diametrically-opposed holes extending therethrough; and [0042] a
suture assembly extending through a bone fragment, through at least
one of the diametrically-opposed holes in the hollow elongated
shaft, and through the lumen of the anchoring tube, the suture
assembly securing the bone fragment to the anchoring tube under
tension, whereby to secure the bone fragment to the bone receiving
the anchoring tube;
[0043] forming a hole in the bone;
[0044] positioning the hollow elongated shaft of the anchoring tube
in the hole in the bone; and
[0045] extending a suture assembly through a bone fragment, through
at least one of the diametrically-opposed holes in the hollow
elongated shaft, and through the lumen of the anchoring tube, the
suture assembly securing the bone fragment to the anchoring tube
under tension, whereby to secure the bone fragment to the bone
receiving the anchoring tube.
[0046] In another form of the invention, there is provided a method
for treating a bone fracture, the method comprising:
[0047] providing apparatus comprising: [0048] an anchoring tube
comprising a hollow elongated shaft adapted for disposition in a
hole formed in a bone and having a distal end, a proximal end and a
lumen extending therebetween, and a substantially planar plate
mounted to the proximal end of the hollow elongated shaft and
adapted for disposition against the outer surface of the bone;
[0049] wherein the hollow elongated shaft comprises at least two
diametrically-opposed holes extending therethrough; [0050] a
breakaway rod for disposition within the lumen of the hollow
elongated shaft, the breakaway rod comprising a distal end, a
proximal end, a hole proximal to the distal end for alignment with
at least two diametrically-opposed holes formed in the hollow
elongated shaft, and a breakaway section proximal to the hole
formed in the breakaway rod; and [0051] a fixation element for
extending through a bone fragment, through two
diametrically-opposed holes in the hollow elongated shaft, and
through the hole in the breakaway rod for securing the bone
fragment to the anchoring tube, whereby to secure the bone fragment
to the bone receiving the anchoring tube;
[0052] forming a hole in the bone;
[0053] positioning the breakaway rod within the lumen of the hollow
elongated shaft, and positioning the hollow elongated shaft of the
anchoring tube in the hole in the bone; and
[0054] extending a fixation element through a bone fragment,
through two diametrically-opposed holes in the hollow elongated
shaft, and through the hole in the breakaway rod, the fixation
element securing the bone fragment to the anchoring tube, whereby
to secure the bone fragment to the bone receiving the anchoring
tube.
BRIEF DESCRIPTION OF THE DRAWINGS
[0055] These and other objects and features of the present
invention will be more fully disclosed or rendered obvious by the
following detailed description of the preferred embodiments of the
invention, which is to be considered together with the accompanying
drawings wherein like numbers refer to like parts, and further
wherein:
[0056] FIG. 1 is a schematic view showing fracture fixation in the
proximal humerus using novel fracture fixation apparatus formed in
accordance with the present invention;
[0057] FIGS. 2-7 are schematic views showing details of the
anchoring tube of the novel fracture fixation apparatus shown in
FIG. 1;
[0058] FIGS. 8 and 9 are schematic views showing details of the
suture assemblies of the novel fracture fixation apparatus shown in
FIG. 1;
[0059] FIGS. 10-12 are schematic views showing a lateral entry
drill guide which may be used in conjunction with the novel
fracture fixation apparatus shown in FIG. 1;
[0060] FIGS. 13-15 are schematic views showing an inserter which
may be used in conjunction with the novel fracture fixation
apparatus shown in FIG. 1;
[0061] FIG. 16 is a schematic view showing a hoop guide which may
be used in conjunction with the novel fracture fixation apparatus
shown in FIG. 1;
[0062] FIGS. 17-19 are schematic views showing a crossbore aimer
which may be used in conjunction with the novel fracture fixation
apparatus shown in FIG. 1;
[0063] FIG. 20 is a schematic view showing a suture retriever which
may be used in conjunction with the novel fracture fixation
apparatus shown in FIG. 1;
[0064] FIGS. 21-43 are schematic views showing fracture fixation in
the proximal humerus using the novel fracture fixation apparatus
shown in FIG. 1;
[0065] FIG. 44 is a schematic view showing an alternative suture
assembly buckle formed in accordance with the present
invention;
[0066] FIGS. 45-47 are schematic views showing a buckle holder
which may be used in conjunction with the suture assembly buckle
shown in FIG. 44;
[0067] FIGS. 48-56 are schematic views showing a suture being
mounted to the suture assembly buckle shown in FIG. 44 using the
buckle holder shown in FIGS. 45-47;
[0068] FIG. 57 is a schematic view showing fracture fixation in the
proximal humerus using another novel fracture fixation apparatus
formed in accordance with the present invention;
[0069] FIG. 58 is a schematic view showing apparatus for use with
the novel fracture fixation apparatus shown in FIG. 57;
[0070] FIGS. 59-66 are schematic views showing fracture fixation in
the proximal humerus using the novel fracture fixation apparatus
shown in FIG. 57;
[0071] FIG. 67 is a schematic view showing a variation of the
fracture fixation apparatus shown in FIG. 57;
[0072] FIG. 68 is a schematic view showing fracture fixation in the
proximal humerus using still another novel fracture fixation
apparatus formed in accordance with the present invention;
[0073] FIGS. 69-73 are schematic views showing apparatus for use
with the novel fracture fixation shown in FIG. 68; and
[0074] FIG. 74 is a schematic view showing fracture fixation in the
proximal humerus using yet another novel fracture fixation
apparatus formed in accordance with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
Fracture Fixation with Suture Assembly
[0075] Looking first at FIG. 1, there is shown novel fracture
fixation apparatus 5 for treating bone fractures in general, and
for treating proximal humeral fractures in particular. As seen in
FIG. 1, novel fracture fixation apparatus 5 generally comprises an
anchoring tube 10 for disposition in a proximal humerus 15, and one
or more suture assemblies 20 for securing bone fragments to
anchoring tube 10 and, as a result, for securing bone fragments to
proximal humerus 15.
[0076] Anchoring tube 10 is shown in greater detail in FIGS. 2-7.
Anchoring tube 10 generally comprises a hollow elongated shaft 25
having a distal end 30, a proximal end 35 and a lumen 40 extending
therebetween, and a generally planar plate 45 mounted to proximal
end 35 of hollow elongated shaft 25. In one form of the invention,
plate 45 is formed integral with hollow elongated shaft 25. Plate
45 is mounted to proximal end 35 of hollow elongated shaft 25 so
that the plane of plate 45 extends at an angle of approximately
15-45 degrees, and preferably 25 degrees, to the longitudinal axis
of hollow elongated shaft 25. Hollow elongated shaft 25 has a
plurality of holes 50 extending transversely therethrough. Holes 50
are formed so that for every hole 50, there is a diametrically
opposing hole 50. Plate 45 has a substantially flat upper surface
55 and a convex lower surface 60. Plate 45 has a recess 65 formed
in its upper surface 55. Recess 65 communicates with interior lumen
40 of hollow elongated shaft 25. Plate 45 also has three holes 70,
75, 80 extending transversely therethrough. More particularly,
holes 70 and 75 extend from upper surface 55 of plate 45 to lower
surface 60 of plate 45. Hole 80 extends from upper surface 55 of
plate 45 to lumen 40 of hollow elongated shaft 25.
[0077] One of the suture assemblies 20 is shown in greater detail
in FIGS. 8 and 9. More particularly, each suture assembly 20
comprises a buckle 85 and a suture 90. As seen in FIGS. 8 and 9,
buckle 85 comprises an elongated body 95 having a first end 100 and
a second end 105, and a first hole 110 and a second hole 115. A
bridge 120 is disposed between first hole 110 and second hole
115.
[0078] As seen in FIG. 1, anchoring tube 10 of fracture fixation
apparatus 5 is intended to be disposed in proximal humerus 15, and
the one or more suture assemblies 20 of fracture fixation apparatus
5 are intended to secure bone fragments to anchoring tube 10 and,
as a result, to proximal humerus 15. To this end, various
instrumentation is provided in order to appropriately deploy
fracture fixation apparatus 5 in proximal humerus 15. More
particularly, in one preferred form of the invention, this
instrumentation comprises:
[0079] (i) a lateral entry drill guide 125 (FIGS. 10-12) for
forming a hole in proximal humerus 15 for receiving anchoring tube
10;
[0080] (ii) an inserter 130 (FIGS. 13-15) for inserting anchoring
tube 10 in the hole formed in proximal humerus 15;
[0081] (iii) a hoop guide 135 (FIG. 16) for providing information
about the disposition of holes 50 in anchoring tube 10 when
anchoring tube 10 is disposed in proximal humerus 15;
[0082] (iv) a crossbore aimer 140 (FIGS. 17-19) for forming
crossbores through proximal humerus 15; and
[0083] (v) a suture retriever 145 (FIG. 20) for pulling suture
through anchoring tube 10.
[0084] Lateral entry drill guide 125 is shown in detail in FIGS.
10-12. Lateral entry drill guide 125 generally comprises a body 150
and a handle 155 for manipulating body 150. Body 150 comprises a
concave distal surface 160, a proximal surface 165 and a surface
170 extending therebetween. Three holes 175, 180 and 185 extend
from proximal surface 165 to distal surface 160. A transverse hole
190 extends between surface 170 and distal surface 160. Holes 175,
180 and 190 are positioned such that holes 175 and 180 straddle,
but do not intersect, hole 190. Holes 185 and 190 are positioned
such that hole 190 opens on distal surface 160 of body 150
laterally spaced from where hole 185 opens on distal surface
160.
[0085] Inserter 130 is shown in detail in FIGS. 13-15. Inserter 130
generally comprises an elongated shaft 195 having a distal end 200
and a proximal end 205. A mount 210 is formed at the distal end of
elongated shaft 195. In one form of the invention, mount 210 is
formed integral with elongated shaft 195. Mount 210 comprises a top
surface 215 and a substantially flat inclined surface 220
diametrically opposed to top surface 215. A lumen 225 opens on
inclined surface 220 of mount 210 and extends along the length of
elongated shaft 195. Mount 210 comprises a recess 230 in its top
surface 215. Recess 230 comprises a floor 235. A hole 240 extends
between top surface 215 and inclined surface 220. Two holes 245,
250 extend from floor 235 of recess 230 to inclined surface 220. A
plurality of holes 255 are formed on the proximal end of elongated
shaft 195. Holes 255 are formed in a pattern which corresponds to
the pattern of holes 50 formed on the distal end of hollow
elongated shaft 25 of anchoring tube 10, such that when anchoring
tube 10 is mounted to inserter 130, holes 255 in elongated shaft
195 of inserter 130 can be used to determine the disposition of
holes 50 in hollow elongated shaft 25 of anchoring tube 10, as will
hereinafter be discussed in further detail.
[0086] Hoop guide 135 is shown in detail in FIG. 16. Hoop guide 135
generally comprises an elongated body 260 having a distal end 265
and a proximal end 270. A hoop member 275 is connected to the
distal end 265 of elongated body 260. Hoop member 275 has a
generally arcuate configuration sized to extend around the soft
tissue surrounding proximal humerus 15, and comprises a plurality
of holes 280 formed therein. A mount 285 is connected to proximal
end 270 of elongated body 260. Mount 285 comprises a slot 290
formed therein.
[0087] Crossbore aimer 140 is shown in detail in FIGS. 17-19.
Crossbore aimer 140 comprises an outrigger 295 having a distal end
300 and a proximal end 305. Distal end 300 of outrigger 295
comprises a pair of parallel holes 310, 315 for receiving drill
sleeves 320, 325 therein. Proximal end 305 of outrigger 295
comprises a hollow mount 330 having a lumen 335 extending
therethrough. Hollow mount 330 includes a transverse hole 340 which
communicates with lumen 335 of hollow mount 330. Transverse hole
340 receives a set screw 345, such that set screw 345 can
selectively intrude across lumen 335. Transverse hole 340 in hollow
mount 330 extends parallel to parallel holes 310, 315 formed in
distal end 300 of outrigger 295.
[0088] Suture retriever 145 is shown in detail in FIG. 20. Suture
retriever 145 comprises an outer tube assembly 350 and an inner
eyelet assembly 355. Outer tube assembly 350 comprises an elongated
tube 360 having a distal end 365 and a proximal end 370, and a
handle 375 secured to proximal end 370 of elongated tube 360. A
lumen 380 extends from distal end 365 of elongated tube 360 to
handle 375. A marking 385 is disposed on handle 375. Inner eyelet
assembly 355 comprises a shaft 390 having a distal end 395 and a
proximal end 400, a flexible loop 405 secured to distal end 395 of
shaft 390, and a handle 410 secured to proximal end 400 of shaft
390. Flexible loop 405 preferably has a substantially planar
configuration. A marking 415 is disposed on handle 410. Marking 415
on handle 410 is set at a right angle to the plane of flexible loop
405, such that the orientation of flexible loop 405 may be
determined by observing the orientation of marking 415 on handle
410. Outer tube assembly 350 and inner eyelet assembly 355 are
sized such that shaft 390 of inner eyelet assembly 355 may be
slidably received within lumen 380 of outer tube assembly 350.
Furthermore, outer tube assembly 350 and inner eyelet assembly 355
are sized such that when shaft 390 of inner eyelet assembly 355 is
received within lumen 380 of outer tube assembly 350, and when
handle 410 of inner eyelet assembly 355 abuts handle 375 of outer
tube assembly 350, flexible loop 405 will protrude out of the
distal end of outer tube assembly 350.
[0089] Fracture fixation apparatus 5 may be used for treating bone
fractures in general, and for treating proximal humeral fractures
in particular. Such treatment generally comprises:
[0090] (a) preparing a seat in proximal humerus 15 to receive
anchoring tube 10;
[0091] (b) positioning anchoring tube 10 in proximal humerus
15;
[0092] (c) preparing at least one crossbore in proximal humerus 15
to receive the suture 90 of at least one suture assembly 20;
and
[0093] (d) positioning the at least one suture assembly 20 so that
its buckle 85 bears against the outer surface of a bone fragment
and its suture 90 extends through the at least one crossbore and
through anchoring tube 10, whereby to secure the bone fragment to
anchoring tube 10 and, as a result, secure the bone fragment to
proximal humerus 15.
[0094] (A) Preparing A Seat in Proximal Humerus 15 to Receive
Anchoring Tube 10.
[0095] 1. As seen in FIG. 21, an insertion location is identified
approximately 10 cm below the lateral aspect of the acromion.
[0096] 2. As seen in FIGS. 22-25, lateral entry drill guide 125 has
its concave distal surface 160 positioned against proximal humerus
15 at the insertion location so that body 150 of lateral entry
drill guide 125 is aligned with the humeral shaft while handle 155
is in line with the radius. This will cause hole 190 of lateral
entry drill guide 125 to be directed toward the humeral head with
an inferior-lateral aspect. With lateral entry drill guide 125
positioned in this manner, the lateral entry drill guide is secured
to proximal humerus 15 using drilled guide pins 417 which extend
through holes 175 and 180 of the lateral entry drill guide and into
proximal humerus 15.
[0097] 3. A drill sleeve 420 is positioned in hole 190 of lateral
entry drill guide 125. A set screw 422 is inserted through hole 185
in lateral entry drill guide 125 so as to secure drill sleeve 420
in position relative to lateral entry drill guide 125. Then a
guidewire 425 is drilled through drill sleeve 420, along the
proximal humerus and up into the humeral head.
[0098] 4. Drill sleeve 420 is removed from hole 190, lateral entry
drill guide 125 is removed from proximal humerus 15, and a
cannulated drill (not shown) is advanced over guidewire 425 and up
into proximal humerus 15.
[0099] 5. The cannulated drill and guidewire 425 are removed from
proximal humerus 15, leaving a hole 430 formed in the proximal
humerus, as seen in FIG. 26. Note that this hole is offset from the
intramedullary canal of proximal humerus 15 and opens on the
inferior-lateral aspect of the proximal humerus.
[0100] At this point, an appropriate seat has been prepared in
proximal humerus 15 to receive anchoring tube 10.
[0101] (B) Positioning Anchoring Tube 10 in Proximal Humerus
15.
[0102] 6. As seen in FIGS. 27-29, anchoring tube 10 is mounted to
inserter 130, i.e., by positioning inclined surface 220 of inserter
130 against upper surface 55 of anchoring tube 10, by passing a
screw 435 through hole 240 in inserter 130 and into hole 80 in
anchoring tube 10, and by passing a screw 440 through hole 250 in
inserter 130 and into hole 170 in anchoring tube 10. As a result,
anchoring tube 10 and inserter 130 may thereafter be manipulated as
a single unit. It will be appreciated that when anchoring tube 10
is so mounted to inserter 130, lumen 40 of anchoring tube 10
communicates with, and is coaxial with, lumen 225 of inserter 130.
Furthermore, it will be appreciated that when anchoring tube 10 is
so mounted to inserter 130, holes 255 of inserter 130 correspond to
holes 50 of anchoring tube 10, such that holes 255 in inserter 130
can be used to determine the disposition of holes 50 in anchoring
tube 10.
[0103] 7. Inserter 130 is used to advance anchoring tube 10 into
hole 430 formed in proximal humerus 15. Anchoring tube 10 is
advanced into proximal humerus 15 until convex lower surface 60 of
plate 45 of anchoring tube 10 seats against the outer surface of
the proximal humerus. Note that the plane of plate 45 of anchoring
tube 10 will be generally aligned with the outer surface of
proximal humerus 15. Either before anchoring tube 10 is advanced
into hole 430 in proximal humerus 15, or after anchoring tube 10
has been advanced into hole 430 of proximal humerus 15, hoop guide
135 is secured to inserter 130 so that hoop member 275 extends
around the soft tissue surrounding proximal humerus 15. See FIG.
30. Significantly, when hoop guide 135 is secured to inserter 130,
holes 280 in hoop guide 135 are aligned with holes 50 in anchoring
tube 10. Thus, the disposition of holes 280 in hoop guide 135 can
be used to determine the disposition of holes 50 in anchoring tube
10. Preferably a drill guide 445 is interposed between inserter 130
and hoop guide 135 when hoop guide 135 is mounted to inserter 130,
with a hole 450 in drill guide 445 being aligned with hole 245 in
inserter 130 and with a hole 455 in drill guide 445 being aligned
with hole 250 in inserter 130.
[0104] 8. Using holes 280 in hoop guide 135 as a visual guide, the
physician uses inserter 130 to rotate anchoring tube 10 as needed
so as to ensure that holes 280 in hoop guide 135, and hence holes
50 in anchoring tube 10, are aligned with a bone fragment which is
to be secured to the anchoring tube (and hence to proximal humerus
15). Significantly, convex lower surface 60 of plate 45 allows for
at least 30 degrees of anchoring tube rotation, while still
providing a stable footing for anchoring tube 10 against proximal
humerus 15, thereby allowing the physician to properly align one or
more of the holes 50 in anchoring tube 10 with a bone fragment
which is to be secured to the anchoring tube (and hence to proximal
humerus 15).
[0105] 9. After optimal positioning of anchoring tube 10 has been
determined, hole 450 in drill guide 445 is used to form a hole in
proximal humerus 15, and then a screw 460 is used to secure
anchoring tube 10 to proximal humerus 15. See FIG. 31. Note that by
forming hole 245 in inserter 130 with a larger diameter than hole
75 in anchoring tube 10, screw 460 is able to pass through inserter
130 without directly coupling inserter 130 to proximal humerus 15.
Then hoop guide 135 and drill guide 445 may be removed.
[0106] At this point, anchoring tube 10 has been appropriately
positioned in proximal humerus 15. Note that anchoring tube 10 is
set in proximal humerus 15 in a position which is not aligned with
the intramedullary canal of the proximal humerus. It should be
appreciated that by positioning anchoring tube 10 in proximal
humerus 15 in the foregoing manner, deployment of the anchoring
tube is achieved via a minimally invasive procedure, thereby
minimizing trauma to the soft tissue surrounding the proximal
humerus. Moreover, by preserving the outer layer of cortical bone,
bone loss is minimized. In addition, blood loss during the surgical
procedure is also minimized. Finally, by positioning anchoring tube
10 in hole 430 formed in proximal humerus 15, rather than in the
intramedullary canal of the proximal humerus, the intramedullary
canal is preserved, thereby maintaining bone structure and
function.
[0107] (C) Preparing at Least One Crossbore in Proximal Humerus 15
to Receive the Suture 90 of at Least One Suture Assembly 20.
[0108] 10. As seen in FIG. 32, crossbore aimer 140 is mounted on
inserter 130, i.e., by fitting hollow mount 330 of crossbore aimer
140 over elongated shaft 195 of inserter 130. A spacer 465 may be
interposed between mount 210 of inserter 130 and hollow mount 330
so as to properly position crossbore aimer 140 on inserter 130.
Then crossbore aimer 140 is rotated about inserter 130 so that
transverse hole 340 formed in hollow mount 330 of crossbore aimer
140 is aligned with one of the holes 255 in inserter 130 (and,
hence, parallel holes 310, 315 formed in distal end 300 of
outrigger 295 are aligned with one or more of the holes 50 in
anchoring tube 10). Note that this alignment of holes 310, 315 in
crossbore aimer 140 is reliably achieved even though holes 50 in
anchoring tube 10 are hidden from sight within the interior of
proximal humerus 15. Then set screw 345 is advanced along
transverse hole 340 in crossbore aimer 140 and into one of the
holes 255 formed in inserter 130, whereby to ensure that holes 310,
315 in crossbore aimer 140 are locked in alignment with one or more
of the holes 50 in anchoring tube 10.
[0109] 11. As seen in FIGS. 33 and 34, suture retriever 135 is
advanced up lumen 225 of inserter 130 and lumen 40 of anchoring
tube 10 so that flexible loop 405 extends across the axes of holes
310, 315 of crossbore aimer 140 (and hence across the axis/axes of
one or more of the holes 50 in anchoring tube 10). Using markings
385, 415 of suture retriever 145, flexible loop 405 is turned as
necessary so that the plane of flexible loop 405 is set at a right
angle to holes 310, 315 of crossbore aimer 140.
[0110] 12. As seen in FIG. 35, one or both of the drill sleeves
320, 325 are positioned in holes 310, 315 of crossbore aimer 140,
respectively.
[0111] 13. A guidewire 470 is drilled through one of the drill
sleeves 320, 325 so as to pass through two diametrically-opposing
holes 50 of anchoring tube 10, passing through flexible loop 405 of
suture retriever 145 in the process (FIG. 36).
[0112] 14. A cannulated drill 475 is passed along guidewire 470 so
that the cannulated drill passes through two diametrically-opposing
holes 50 of anchoring tube 10, and through flexible loop 405 of
suture retriever 145 (FIG. 37).
[0113] At this point, at least one crossbore has been formed in
proximal humerus 15 to receive the suture 90 of at least one suture
assembly 20.
[0114] (D) Positioning the at Least One Suture Assembly 20 so that
its Buckle 85 Bears Against the Outer Surface of a Bone Fragment
and its Suture 90 Extends Through the at Least One Crossbore and
Through Anchoring Tube 10, Whereby to Secure the Bone Fragment to
Anchoring Tube 10 and, as a Result, Secure the Bone Fragment to
Proximal Humerus 15.
[0115] 15. Guidewire 470 is removed from cannulated drill 475, and
the two free ends of suture 90 of a suture assembly 20 are fed
through the lumen of cannulated drill 475, so that the two free
ends of suture 90 pass through two diametrically-opposing holes 50
of anchoring tube 10, and through flexible loop 405 of suture
retriever 145 (FIG. 38). At this point, the closed loop 477 of
suture 90 will reside outside cannulated drill 475.
[0116] 16. Cannulated drill 475 is removed from anchoring tube 10
as inner eyelet assembly 355 is pulled proximally, thereby reducing
the portion of flexible loop 405 extending out of elongated tube
360, whereby to capture the two free ends of suture 90 of suture
assembly 20 to the distal end of suture retriever 145 (FIG.
39).
[0117] 17. Suture retriever 145 is withdrawn from anchoring tube 10
and inserter 130 (FIG. 40), whereby to cause the two free ends of
suture 90 to extend through proximal humerus 15, down anchoring
tube 10 and out inserter 130. The closed loop 477 of suture 90 will
remain protruding from the proximal end of a drill sleeve.
[0118] 18. Drill sleeves 320, 325 are removed from crossbore aimer
140, and crossbore aimer 140 is removed from inserter 130 (FIG.
41). Buckle 85 can then be attached to the portion of closed loop
477 of suture 90 which extends out of proximal humerus 15. This may
be done by passing closed loop 477 of suture 90 through first hole
110 of buckle 85. After passing closed loop 477 through first hole
110 of buckle 85, closed loop 477 is then passed over bridge 120 of
buckle 85 and through second hole 115 of buckle 85. Next, closed
loop 477 is passed over second end 105 of buckle 85, so that one
strand of closed loop 477 slides along each side of buckle 85.
Finally, closed loop 477 is passed over first end 100 of buckle 85,
and the suture is pulled taut, thereby securing buckle 85 to closed
loop 477. See FIG. 41.
[0119] 19. After buckle 85 has been mounted to suture 90, inserter
130 is removed from anchoring tube 10 (alternatively, inserter 130
may be removed from anchoring tube 10 before buckle 85 is mounted
to suture 90). Then the two free ends of suture 90 are pulled taut
so as to pull buckle 85 of the suture assembly against the outer
surface of the bone fragment, and a screw 480 is passed through
hole 70 in anchoring tube 10, with screw 480 securing the two free
ends of suture 90 to the anchoring tube under tension (FIG. 42). As
a result of the foregoing, the tensioned suture assembly 20 will
secure the bone fragment to anchoring tube 10 and, as a result,
will secure the bone fragment to proximal humerus 15.
[0120] If desired, the foregoing procedure may be used to position
multiple suture assemblies 20 in proximal humerus 15 (FIG. 43),
thereby providing the opportunity to fix multiple bone fragments to
proximal humerus 15.
Alternative Suture Assembly
[0121] If desired, a novel buckle 85A (FIG. 44) may be utilized,
together with a novel buckle holder 485 (FIGS. 45-47).
[0122] Buckle 85A comprises an elongated body 95A having a first
end 100A and a second end 105A, and a first hole 110A and a second
hole 115A. A bridge 120A is disposed between first hole 110A and
second hole 115A. A slot 122A connects first hole 110A with first
end 100A.
[0123] Novel buckle holder 485 comprises a shaft 490 having a
distal end 495 and proximal end 500. A horizontal slot 505 opens on
distal end 495 and extends into buckle holder 485. Horizontal slot
505 (FIG. 45) is sized so as to receive buckle 85A therein (FIG.
47). A first hole 510 and a second hole 515 extend from one side of
buckle holder 485 to the other side of buckle holder 485, passing
through slot 505. A vertical slot 520 opens on distal end 495 and
extends into buckle holder 485. Vertical slot 520 intersects both
first hole 510 and second hole 515.
[0124] Looking now at FIGS. 47-56, buckle 85A may be loaded onto a
suture 90 (which has already been threaded through proximal humerus
15, anchoring tube 10 and inserter 130) in the following manner.
First, buckle 85A is loaded into horizontal slot 505 of buckle
holder 485 so that first hole 110A of buckle 85A is aligned with
first hole 510 of buckle holder 485, second hole 115A of buckle 85A
is aligned with second hole 515 of buckle holder 485, and slot 122A
of buckle 85A is aligned with vertical slot 520 in buckle holder
485 (FIG. 47). Then the loop 525 emanating from anchoring tube 10
and proximal humerus 15 is passed through second hole 515 of buckle
holder 485 and second hole 115A of buckle 85A (FIG. 48). Loop 525
is looped around the proximal end 500 of shaft 490 of buckle holder
485 (FIG. 49) and moved along the body of shaft 490 (FIG. 50) to a
point distal to distal end 495 (FIGS. 51 and 52). The two free ends
of suture 90 are then tensioned, drawing loop 525 along vertical
bore 520 and into second hole 515 of buckle holder 485 (FIGS. 53
and 54). At this point, suture 90 is wound around bridge 120A of
buckle 85A. Then buckle 85A may be pulled free from buckle holder
485 by pulling on the two free ends of suture 90, which slides
buckle 85A out of horizontal slot 505 in buckle holder 485 (FIGS.
55 and 56), thereby completing the task of uniting buckle 85A and
suture 90.
Fracture Fixation with Threaded Pins
[0125] Looking next at FIG. 57, there is shown novel fracture
fixation apparatus 530 for treating bone fractures in general, and
for treating proximal humeral fractures in particular. As seen in
FIG. 57, novel fracture fixation apparatus 530 generally comprises
the aforementioned anchoring tube 10 for disposition in proximal
humerus 15, and one or more threaded pins 535 for securing bone
fragments to anchoring tube 10 and, as a result, for securing bone
fragments to proximal humerus 15. Except as will otherwise be
described below, novel fracture fixation apparatus 530 is identical
to novel fracture fixation apparatus 5 discussed above.
[0126] The primary differences between novel fracture fixation
apparatus 530 and novel fracture fixation apparatus 5 are (i) the
substitution of threaded pins 535 in place of suture assemblies 20,
and (ii) the provision of a breakaway rod 540 (FIG. 58) for use in
conjunction with threaded pins 535. Breakaway rod 540 comprises a
shaft 545 having a distal end 550 and a proximal end 555, at least
one transverse hole 560 extending through distal end 550, and a
breakaway section 565 located proximal to the at least one
transverse hole 560.
[0127] In use, novel fracture fixation apparatus 530 is used in a
manner similar to novel fracture fixation apparatus 5, except that
after the aforementioned step 10, when the apparatus is in the
state shown in FIGS. 32 and 59, breakaway rod 540 is inserted up
lumen 225 of inserter 130 and into lumen 40 of anchoring tube 10
(FIG. 60). Proper sizing of breakaway rod 540, and an appropriate
marking 570 on proximal end 555 of breakaway rod 540, permits the
at least one transverse hole 560 in breakaway rod 540 to be aligned
with one or both of the holes 310, 315 in crossbore aimer 140.
Thereafter, using drill sleeves 320, 325, drill 475 is advanced
through proximal humerus 15, through two diametrically-opposed
holes 50 in anchoring tube 10 and through the at least one
transverse hole 560 in breakaway rod 540 (FIG. 61). Then cannulated
drill 475, drill sleeves 320, 325 and crossbore aimer 140 are
removed (FIG. 62), leaving a bore 575 extending through proximal
humerus 15, two diametrically-opposed holes 50 in anchoring tube 10
and through the at least one transverse hole 560 in breakaway rod
540 (FIG. 62). Next, a threaded pin 535 is advanced through
proximal humerus 15, two diametrically-opposed holes 50 in
anchoring tube 10 and through the at least one transverse hole 560
in breakaway rod 540 (FIG. 63). At this point proximal end 555 of
breakaway rod 540 is pulled proximally so as to cause breakaway rod
540 to separate at breakaway section 565 (FIG. 64). The distal
section of breakaway rod 540 remains in anchoring tube 10, pierced
by threaded pins 535, while the proximal section of breakaway rod
540 is removed. Then inserter 130 is removed, and screw 480 is
passed through hole 470 in anchoring tube 10 (FIG. 65). As a result
of the foregoing, threaded pin 535 will secure the bone fragment to
anchoring tube 10 and, as a result, to proximal humerus 15.
[0128] If desired, the foregoing procedure may be used to position
multiple threaded pins 535 in proximal humerus 15 (FIG. 66),
thereby providing the opportunity to fix multiple bone fragments to
proximal humerus 15.
Fracture Fixation with Bone Screws
[0129] If desired, and looking now at FIG. 67, bone screws 580 may
be used in place of the aforementioned threaded pins 535.
Preferably, bone screws 580 are cannulated and delivered over a
guidewire.
Fracture Fixation with Projecting Barbs
[0130] Looking next at FIG. 68, there is shown novel fracture
fixation apparatus 585 for treating bone fractures in general, and
for treating proximal humeral fractures in particular. As seen in
FIG. 68, novel fracture fixation apparatus 585 generally comprises
the aforementioned anchoring tube 10 for disposition in a proximal
humerus 15, and one or more projecting barbs 590 for securing bone
fragments to anchoring tube 10 and, as a result, for securing bone
fragments to proximal humerus 15. Except as will otherwise be
described below, novel fracture fixation apparatus 585 is identical
to novel fracture fixation apparatus 5 discussed above.
[0131] The primary differences between novel fracture fixation
apparatus 585 and novel fracture fixation apparatus 5 are (i) the
substitution of projecting barbs 590 in place of suture assemblies
20, and (ii) the provision of a deployment mechanism 595 for
deploying projecting barbs 590 out of anchoring tube 10. More
particularly, projecting barbs 590 are secured to a mount 600, and
deployment mechanism 595 comprises a tube 605 and a plunger 610. As
seen in FIGS. 69-71, mount 600 is releasably carried by tube 605,
with projecting barb 590 being disposed in tube 605 distal to
plunger 610. Distal movement of plunger 601 within tube 605 causes
projecting barbs 590 to advance distally and proximally out of
mount 600 and, at the limit of its throw, to separate mount 600
from tube 605.
[0132] As a result of this construction, and looking now at FIGS.
68-73, deployment mechanism 595 can be used to carry mount 600 and
projecting barbs 590 into the anchoring tube 10, then cause
projecting barbs 590 to advance distally and proximally out of
mount 600 and through holes 50 of anchoring tube 10 and into
adjacent bone and, at the limit of its throw, to separate mount 600
from tube 605. Mount 600 makes a friction fit with the surrounding
anchoring tube 10 to securely seat therein. As a result of the
foregoing, projecting barbs 590 are able to secure bone fragments
to anchoring tube 10 and, as a result, to proximal humerus 15.
Fracture Fixation with Various Combinations of Suture Assemblies,
Threaded Pins (or Bone Screws) and/or Projecting Barbs
[0133] It should be appreciated that anchoring tube 10 may be used
with various combinations of suture assemblies 20, threaded pins
535 (or bone screws 580) and/or projecting barbs 590, as preferred
by the physician. Thus, for example, and looking now at FIG. 74,
there is shown a fracture fixation utilizing a plurality of suture
assemblies 20, threaded pins 535 and projecting barbs 590.
Use of the Present Invention for Fracture Fixation in Applications
Other than the Proximal Humerus
[0134] It should also be appreciated that the present invention may
be used for fracture fixation in applications other than the
proximal humerus. By way of example but not limitation, the present
invention may be used for fracture fixation in the femur.
MODIFICATIONS OF THE PREFERRED EMBODIMENTS
[0135] It should be understood that many additional changes in the
details, materials, steps and arrangements of parts, which have
been herein described and illustrated in order to explain the
nature of the present invention, may be made by those skilled in
the art while still remaining within the principles and scope of
the invention.
* * * * *