U.S. patent number 3,669,102 [Application Number 04/831,427] was granted by the patent office on 1972-06-13 for orthopedic traction apparatus.
Invention is credited to Norman M. Harris.
United States Patent |
3,669,102 |
Harris |
June 13, 1972 |
ORTHOPEDIC TRACTION APPARATUS
Abstract
Traction apparatus for externally splinting the cervical spine
to effect fixation thereof. The apparatus is characterized by
providing adjustment of the height, tilt, rotation and anterior and
posterior position of the patient's head while affording no or only
minor inconvenience during anterior or posterior surgical
procedures while the traction apparatus is in position on a
patient. The traction apparatus includes a skull-gripping mechanism
adapted to grip a patient's skull and thereby be fixedly related
thereto, a platform or device supporting the skull-gripping
mechanism and being inter-connected therewith so as to positively
locate one with respect to the other and prevent relative
translational and rotational displacements thereof, a plurality of
struts interconnecting the platform and a body jacket positioned
about a patient, and means for adjusting the lengths of the struts
so as to select the magnitude of the tensile stress imparted
through the platform and skull-gripping mechanism to the cervical
spine of a patient equipped with such body jacket and having such
mechanism secured to his skull.
Inventors: |
Harris; Norman M. (Oakland,
CA) |
Family
ID: |
25259037 |
Appl.
No.: |
04/831,427 |
Filed: |
June 9, 1969 |
Current U.S.
Class: |
602/40 |
Current CPC
Class: |
A61F
5/055 (20130101) |
Current International
Class: |
A61F
5/04 (20060101); A61F 5/055 (20060101); A61f
005/04 () |
Field of
Search: |
;128/84,87,89,303,75,76 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Claims
What is claimed is:
1. In traction apparatus for externally splinting the cervical
spine to effect fixation thereof, skull-gripping mechanism having a
large skull-receiving opening and being equipped at a plurality of
angularly spaced locations with adjustable skull engaging members
adapted to be moved into and held in respectively adjacent areas of
a skull positioned within said opening to grip such skull and
thereby fixedly relate the same to said mechanism, a device
supporting said mechanism for angular displacement relative thereto
about an axis extending through said opening generally along the
cervical spine of a patient having his skull therewithin, structure
interlocking said mechanism and device so as to prevent relative
translational displacements therebetween along such axis, a
foundation member adapted to be supported by the patient's torso, a
plurality of struts each adapted to be supported at one end portion
thereof on said foundation member and at its other end portion
being adapted to be connected to said device, certain of said
struts being located for disposition on the front side of the
patient's torso and certain other of said struts being located for
disposition on the rear side thereof, means for adjusting the
length of at least certain of said struts so as to select the
tensile stress imparted thereby through said device, mechanism and
skull engaging members to the cervical spine of a patient equipped
with such foundation member and having the skull attached to said
mechanism by means of said skull engaging members, said mechanism
being supported by said device for angular adjustments along the
arc of a circle generally circujacent said skull-receiving opening,
and means for locking said mechanism to said device when in
adjusted position.
2. The traction apparatus of claim 1 in which each of said struts
is equipped with means including a universal joint enabling the
struts to be angularly adjusted relative to said device.
3. The traction apparatus of claim 1 in which the device and
mechanism are in substantially the same plane oriented at right
angles to the axis of the skull receiving opening.
4. The traction apparatus of claim 1 in which the skull gripping
mechanism is mounted on the upper side of said device.
5. In traction apparatus for externally splinting the cervical
spine to effect fixation thereof, skull-gripping mechanism having a
large skull-receiving opening and including attachment structure
providing a plurality of apertures at angularly spaced locations
about said opening, at least certain of said apertures being
equipped with adjustable skull engaging members adapted to be moved
into and held in respectively adjacent areas of a skull positioned
within said opening to grip such skull and thereby fixedly relate
the same to said mechanism, a device supporting said mechanism for
angular displacement relative thereto about an axis extending
through said opening generally along the cervical spine of a
patient having his skull therewithin, structure interlocking said
mechanism and device so as to prevent relative translational
displacements therebetween along such axis, a foundation member
adapted to be supported by the patient's torso, a plurality of
struts adapted to be supported at one end portion thereof on said
foundation member and at their other end portion connected to said
device, means for adjusting the length of at least certain of said
struts so as to select the tensile stress imparted thereby through
said device, mechanism and skull engaging members to the cervical
spine of a patient equipped with such foundation member and having
the skull attached to said mechanism by means of said skull
engaging members, said skull-receiving opening being supported by
said device for angular adjustment along the arc of a circle
generally circumjacent said skull-receiving opening, and means for
locking said mechanism to said device when in adjusted position.
Description
This invention relates to orthopedic traction apparatus and, more
particularly, to orthopedic traction apparatus for externally
splinting the cervical spine to immobilize or effect fixation
thereof.
Until the advent of the "halo" traction apparatus, external
fixation of the cervical spine was usually obtained by means of a
plaster-of-Paris jacket which the patient usually found to be heavy
and frequently hot and uncomfortable. Moreover, even the best
fitting plaster jackets often allow more cervical movement than the
surgeon may desire, and adjustment of the position of the patient's
head or neck is essentially impossible once the plaster jacket has
hardened. Additionally, radiographic examination of the spine
through a plaster jacket is difficult; and if an unstable spine is
to be exposed for operation, the window or opening necessarily cut
in the plaster jacket at best gives very little room in which the
surgeon can work.
The halo traction apparatus obviates some of the disadvantages
characteristic of plaster jackets because it is somewhat more
comfortable for the patient to wear; lends itself to visual,
physical and radiographic examination of the patient; and allows
some adjustment long after the apparatus has been positioned upon
the patient. Such traction apparatus includes a band or halo
adapted to be placed about the skull of a patient and fixed thereto
by a plurality of skull screws that extend through threaded
apertures provided therefor in the band and can be forced into the
outer table of the patient's skull. Arms connected with the band
and extending upwardly therefrom are secured to superstructure
located in part above the patient's head and extending downwardly
along the back thereof to arcuate brackets that are adapted to be
bent in conformity with and secured to the shoulder padding of a
plaster body jacket positioned about the upper trunk of the
patient.
An object, among others, of the present invention is to provide
improved orthopedic traction apparatus generally of the halo type.
Another object is that of providing an improved traction device of
the character described which is easy for the surgeon to use, is
quite versatile in that it readily accommodates patients of
different size and body characteristics, and has various features
of adjustability enabling the surgeon to obtain the desired degree
of traction or tensile stress along a patient's cervical spine and
at the most advantageous orientation relative thereto.
Still another object is in the provision of an improved traction
apparatus, as stated, which has various degrees of translational
and rotational freedom concerning its adjustability so that the
surgeon can readily obtain the necessary rotation, tilt,
translation (especially anterior and posterior) and vertical
adjustments to best accommodate the particular requirements of any
patient. Additional objects and advantages of the invention,
especially as concerns particular features and details thereof,
will become apparent as the specification develops.
In general terms, the traction device includes a skull-gripping
mechanism having a large skull-receiving opening adapted to receive
the skull of a patient therein. Such mechanism is provided with
attachment structure including a plurality of angularly spaced
skull screws adapted to project into the patient's skull and grip
the same and thereby fixedly relate the mechanism thereto. A
generally planar platform or device provides a support for the
skull-gripping mechanisms and is attached thereto by means
permitting angular adjustments of the skull-gripping mechanism
relative to the platform. A plurality of elongated struts are
connected to the platform at corner portions thereof and extend
downwardly therefrom so as to be affixed at their lower ends to
connectors provided therefor along a relatively stiff plaster or
molded plastic body jacket secured about the upper trunk or chest
of a patient. The struts are individually adjustable in length and
thereby enable a tensile stress of appropriate force and
orientation to be developed between the body jacket and platform
for transmission through the skull-gripping mechanism to the
cervical spine of a patient.
Embodiments of the invention are illustrated in the accompanying
drawings, in which:
FIG. 1 is a perspective view illustrating an embodiment of the
traction apparatus in position on a patient;
FIG. 2 is an enlarged, fragmentary exploded perspective view
illustrating the components defining a corner portion of the
apparatus in spaced apart relation;
FIG. 3 is an enlarged, side view in elevation showing the
connection of one of the struts of the apparatus with a body
jacket;
FIG. 4 is a further enlarged, transverse sectional view taken along
the line 4--4 of FIG. 3;
FIG. 5 is a top plan view of the skull-gripping mechanism and
platform support therefor, each of which comprises a portion of the
apparatus;
FIG. 6 is a transverse sectional view taken along the line 6--6 of
FIG. 5;
FIG. 7 is a longitudinal sectional view taken along the line 7--7
of FIG. 5;
FIG. 8 is a sectional view along one of the skull screws of the
apparatus, the section being taken along the line 8--8 of FIG.
5;
FIG. 9 is a sectional view of a modified connector for affixing a
vertical strut to the body jacket of a patient;
FIG. 10 is a perspective view of a modified traction apparatus;
and
FIG. 11 is a top plan view of the modified apparatus shown in FIG.
10.
Traction apparatus embodying the invention is adapted for use with
a body jacket which, as respects the present invention, may be
essentially conventional and may comprise a molded body jacket or
plaster body cast, each of which is well known in the art. In FIG.
1 a molded body jacket 15 is shown in position about the upper
torso of a patient. Since such body jackets are well known, no
particular details concerning the same need be explained other than
to say that the jacket is quite rigid and therefore provides a
satisfactory perches for the traction apparatus 16. As respects its
rigidity, the particular jacket 15 shown is formed of a stiff, hard
plastic material as indicated in FIG. 4.
The traction apparatus 16 includes a skull-gripping mechanism 18
and a platform or device 19 supporting the same. The skull-gripping
mechanism 18 is adapted to grip the skull of a patient, therefore
providing means through which a tensile force can be developed
between the body jacket 15 and head of a patient so as to impart a
tensile stress to the cervical spine of the patient to effect
fixation thereof. Referring to FIGS. 5 through 8 in particular, it
will be observed that the skull-gripping mechanism 18 includes
attachment structure in the form of an upstanding band or ring 20
that is substantially continuous and defines a large
skull-receiving opening 21 therewithin adapted to receive the skull
of a patient, as shown in FIG. 1. As is most evident in FIG. 5, the
opening 21 is non-circular and, in a more particular reference, is
somewhat oblong or ovate so as to conform more accurately in a
geometric sense to the usual skull configuration.
The attachment structure further includes a plurality of threaded
apertures 22 at angularly spaced locations about the opening 21.
Usually several apertures 22 will be provided at each angularly
spaced location, and in the apparatus 16 (as shown in FIG. 5) three
such apertures are grouped or clustered at each angularly spaced
location. At least certain of the apertures 22 are equipped with
skull screws 24 adapted to be tightened into respectively adjacent
areas of a patient's skull located within the large opening 21 so
as to grip the skull and thereby fixedly relate the skull-gripping
apparatus 18 thereto. In FIG. 5 four such screws 24 are shown in
respective association with one of the apertures 22 in each of the
four angularly spaced clusters thereof. Skull screws are generally
old in the art and, as is well known, they have rather sharp
pointed ends 25 adapted to perforate the skin without incision
thereof having first been made and of sufficient length to
penetrate only the outer table of the skull. Each screw 24 may be
slotted (as shown at 26) to receive the end of a screwdriver and
may be equipped with a locking nut 28.
The attachment structure further includes an outwardly extending
flange or lip 29 about the upstanding band 20, and it defines the
circumference of a circle about its outer peripheral edge.
Accordingly, and because the band 20 is non-circular, the flange 29
is relatively narrow at the anterior and posterior end portions of
the generally ovate opening 21 (FIGS. 5 and 7) and is relatively
wide along the sides thereof (FIGS. 5 and 6). The mechanism 18, and
particularly the flange 29 thereof, is supported by the platform 19
for angular displacement relative thereto about an axis extending
through the opening 21 generally along the cervical spine of a
patient having his skull positioned within the opening as depicted
in FIG. 1. For this purpose, the platform 19 has a large open
center portion 30, as is most evident in FIGS. 6 through 8, so as
to accommodate the mechanism 18 and permit angular displacement
thereof. The lip or flange 29, it will be observed, overlies the
platform 19 about the opening 30 thereof and is supported
thereon.
Structure is provided for interconnecting the mechanism 18 and
platform 19 so as to prevent relative translational displacements
therebetween in axial or vertical directions (i.e., along the
cervical spine of a patient equipped with the traction device), and
also in both longitudinal and transverse directions referenced to
such axis. The structure further constrains the skull-gripping
mechanism 18 against angular displacements thereof relative to the
platform 19 after the desired angular disposition of the mechanism
18 with respect to the platform 19 has been obtained. As shown in
FIGS. 5, 6 and 7, such interconnecting structure includes a
plurality of guide plates 31 secured to the platform 19 in
overlying relation therewith at spaced apart locations therealong.
In the particular traction apparatus being considered, there are
four such guides 31 spaced about the circumference of the flange 29
at 90.degree. intervals center-to-center and riveted to the
platform 19, as indicated at 32.
The inner edges of the guides 31 are arcuate and together define
the circumference of a circle having a diameter somewhat larger
than that of the flange 29 so as to define a space between the
flange and each guide within which are provided a plurality of
threaded openings or apertures 34 adapted to receive
washer-equipped threaded fasteners or cap screws 35, as shown in
FIGS. 5 through 7. The fasteners 35 when tightened bring the
washers thereof into overlying frictional engagement with the
facing edges of the flange 29 and associated guide 31 so as to
clamp the flange to each guide 31 and platform 19 and thereby
constrain the flange and skull-gripping mechanism 18 against
rotational and translational displacements with respect to the
platform. In the traction apparatus 16 shown, nine such threaded
openings 34 are provided in association with each guide 31, and
alternate openings are equipped with fasteners 35 so that five such
fasteners are used with each guide.
A plurality of struts 36 are used to interconnect the platform 19
with the body jacket 15, and means are provided for adjusting the
lengths of the struts so that the tensile stress imparted thereby
between the body jacket and platform can be selectively varied. The
apparatus 16 includes four struts 36 that are respectively disposed
adjacent the corner portions of the platform 19 which has a
generally square-shaped configuration. Each strut 36 is an
elongated bar or rod that is substantially square-shaped at its
lower end 38 (as shown best in FIG. 4) so as to pass through a
square-shaped opening 39 provided in a mounting bracket 40 that is
secured to the body jacket 15 by any suitable means such as rivets
41 or equivalent fasteners, as shown in FIG. 1. The mating
polygonal configurations of the strut end portion 38 and opening 39
prevent relative rotation therebetween, and the vertical
disposition of the rod with respect to the bracket 40 is fixedly
determined by a plurality of set screws that extend through the
face of the bracket 40 and project into threaded openings provided
therefor in the end portion 38 of the strut 36. Accordingly, the
location of each strut 36 relative to the body jacket 15 is
positively determined.
At their upper ends each strut 36 is adjustably connected to the
platform 19; and in the embodiment illustrated in FIGS. 1 through
4, the adjustment accommodates selective longitudinal positioning
of each strut continuously along the platform 19 within certain
dimensional limits, and also permits limited step-wise adjustment
of each strut relative to the platform 19 in a transverse sense. In
more particular terms, the platform 19 at each of the four corner
locations thereof is provided with a pair of transversely spaced,
longitudinally extending slots 44 and 45 selectively adapted to
receive therein the tongue 46 of a connector 48 having a threaded
shank 49 extending upwardly from the tongue 46 and adapted to
receive a nut 50 which is used to fixedly locate the connector 48
along the particular slot 44 or 45 with which it is associated.
Accordingly, each strut 36 can be adjusted in a transverse
direction relative to the platform 19 by determining the particular
slot 44 or 45 with which the connector 48 is to be associated, and
it is also adjustable in the longitudinal sense within the
dimensional limits of each slot by determining the position of the
connector along the slot and then fixing the connector at such
position by tightening the nut 50 downwardly and into frictional
engagement with the upper surface of the platform 19. Evidently,
the tongue 46 is dimensioned so as to be displaceable
longitudinally along each slot 44 and 45 but constrains the
connector 48 against rotation relative to the platform.
A universal joint is provided along each strut 36 so as to
facilitate accommodation of the traction apparatus 16 to the
differing dimensional requirements of various patients, and the
universal joint in the apparatus 16 is provided by a ball and
socket assembly comprising a ball 51 provided at the end of a
downwardly extending pin 52 with which the connector 48 is equipped
and a socket provided within a coupling 54 having a nut 55 at its
lower end that cooperates with the upper end of threaded extension
56 of the strut 36 andis fastened in position thereon by a lock nut
58. At its lower end, the extension 56 is threadedly received
within an opening provided therefor in a coupling 59 with which the
upper end of the strut portion 38 is equipped, and which portion
thereof is hollow at least throughout its upper end so as to enable
the extension 56 to project thereinto. A lock nut 60 may be
tightened to positively maintain the extension 56 in any position
of adjustment thereof relative to the coupling 59.
Accordingly, each strut 36 is adjustable vertically,
translationally and longitudinally independently of the others so
as to best accommodate the physical characteristics of a particular
patient and to impart the desired degree of tensile stress to the
cervical spine thereof and at any particular orientation. That is
to say, if in stressing the spine best results would be expected if
the head were tilted slightly in any one direction, then any one or
more of the struts 36 could be elongated relative to the others so
as to provide such tilt. By the same token, tilt can be avoided by
individually adjusting the struts 36 until the desired orientation
of the head is attained, and then the stress imparted to the spine
can be selectively established and changed as necessary by varying
the elongation of each of the struts.
Essentially, 6 degrees of translational freedom are provided by the
apparatus since each strut 36 can be adjusted in opposite
directions transversely, longitudinally and vertically; and
rotational freedom is also provided generally about the axis of the
cervical spine since the skull-gripping mechanism 18 is angularly
adjustable relative to the platform 19. Further, because the length
of each strut 36 is adjustable independently of the others, an
additional angular freedom is afforded in that the tilt or angular
disposition of the platform 19 relative to the halo is also
adjustable. All such adjustments of the platform 19 and mechanism
18 are imparted directly to the skull and head of a patient using
the apparatus since it is fixedly attached thereto via the screws
24.
A modified mounting bracket useful in substitution for the
previously described bracket 40 is illustrated in FIG. 9 and is
denoted in general with the numeral 61. The bracket 61 in
association with the modified strut 62 defines a universal joint
generally of a ball and socket type configuration. The bracket
includes a plate 64 riveted or otherwise attached to the body
jacket 65, and the plate is deformed centrally so as to define a
ball 66. The strut 62 at its lower end (generally denoted 68) is
provided with a socket therealong adapted to seat the ball 66
therein and providing a relatively large opening 69 through which a
bolt 70 passes. A cup-shaped washer 71 overlies the socket-equipped
end 68 of the strut 62 and is tightened thereagainst by a wing nut
72 threadedly received on the bolt 70.
The head of the bolt 70 bears against the underside of the ball 66
through which the bolt extends, and it will be apparent that the
strut 62 is frictionally constrained between the ball 66 and washer
71 by tightening the nut 72. Whenever the nut is loosened, the
strut 72 is universally adjustable in an angular sense relative to
the ball 66 within the dimensional limits defined by the opening
69. Thus, by use of the modified mounting bracket 61, additional
adjustability is afforded for the traction apparatus since each of
the struts is then pivotally adjustable relative to the body
jacket. As respects the traction apparatus with which the modified
strut 62 and modified mounting bracket 61 are used, it may be the
same as the apparatus 16 heretofore described in detail.
A more generally modified traction apparatus is illustrated in
FIGS. 10 and 11, and as respects such modification it largely
pertains to the struts and manner in which they are connected to
the support platform of the apparatus and connected to a body
jacket. Generally, then, the modified traction apparatus is
essentially the same as the apparatus heretofore described, and it
includes a skull-gripping mechanism 74 supported by a platform 75
for adjustable angular displacements relative thereto, as in the
manner heretofore described. Thus, the skull-gripping mechanism 76
has an upstanding band or ring 76 of generally ovate configuration
equipped with a lip or flange 78 defining a circular configuration
along the periphery thereof. The flange 76 seats upon the upper
surface of the platform 75 and is confined for angular displacement
relative thereto by a plurality of guide plates 79, each of which
is secured to the platform 75 as heretofore explained and which in
conjunction with a plurality of fasteners 80 constrains the
mechanism 74 in any angular position relative to the support plate
75, all as heretofore explained.
The platform 75 is equipped along the longitudinal edges thereof
with a plurality of longitudinally extending tracks 82 each of
which is welded or otherwise rigidly secured to the platform and is
provided with an elongated slot 84 closed at its inner end. Each
longitudinal edge of the platform 75 is provided with two tracks 82
respectively disposed along the anterior and posterior ends
thereof, but it is evident that one continuous track could be
provided in apparatus in which it might be found advantageous. The
struts 62 are respectively associated with the rails 82, and each
strut at its upper end has a flattened connector having an
elongated slot 86 extending therealong. A bolt 88 having its head
located within the slot 84 extends outwardly therefrom and passes
through the slot 86 in the connector 85. A wing nut 89 cooperates
with the bolt 88 and may be tightened thereonto so as to
frictionally lock the connector 85 and therefore the strut 62 in
any position of adjustment relative to the track 82.
It will be apparent that the strut 62 may be slidably displaced
along the track 82 to any suitable position of adjustment within
the limits of the slot 84; the strut may also be pivotally adjusted
about the axis of the bolt 88; and it further may be adjusted in a
vertical sense within the limits of the slot 86. As respects
vertical adjustment, the lower end of each strut 62 is equipped
with a flattened connector 90 having an elongated slot 91
therealong passing therethrough the threaded shank of a bolt 92
that projects between the bifurcated end or spaced ears 94 of a
bracket 95 adapted to be secured by rivets or otherwise to a body
jacket, as heretofore described with reference to the brackets 40
and 61. A wing nut 96 cooperates with the bolt 92 so as to
constrain the strut 62 in any position of adjustment relative to
the bracket 95.
As concerns adjustment the strut 62 is pivotal relative to the
bracket 95 about the axis of the bolt 92, and the strut is
vertically adjustable within the limits defined by the slot 91
thereof. It will be appreciated that the vertical spacing between
the platform 75 and bracket 95 (and therefore any body jacket to
which the bracket is affixed) can be adjustably increased and
decreased to alter the tensile stress applied to the cervical spine
of a patient equipped with the modified traction apparatus shown in
FIGS. 10 and 11. However, the "turn-buckle" type adjustment of the
strut length shown in FIGS. 1 through 3 and heretofore described
can be provided along the strut 62 should this be desired.
Thus, in all forms of the traction apparatus, the cervical spine of
a patient is readily fixed or immobilized by external splinting
irrespective of the physical differences among patients and
irrespective of the magnitude and orientation of the stress that
the doctor desires to apply to the spine because of the
adjustability and various degrees of freedom described
hereinbefore. Therefore, the apparatus permits adjustment of
rotation, height, tilt, and interior or exterior positioning of the
patient's head and will permit rotation of the head while wearing
the apparatus (adjustable rotation if the fasteners 35 or 81 are
tightened and relatively free rotation if they are all loosened).
Further, anterior or posterior surgical procedures may be performed
with the struts 36 or 62 constituting only a minor inconvenience,
and if advantageous one or two of the struts may be removed
completely to make the surgeon's approach unhampered.
While in the foregoing specification embodiments of the invention
have been set forth in considerable detail for purposes of making a
complete disclosure thereof, it will be apparent to those skilled
in the art that numerous changes may be made in such details
without departing from the spirit and principles of the
invention.
* * * * *