U.S. patent number 3,717,146 [Application Number 05/111,206] was granted by the patent office on 1973-02-20 for threaded intramedullary compression and fixation device.
Invention is credited to William X. Halloran.
United States Patent |
3,717,146 |
Halloran |
February 20, 1973 |
THREADED INTRAMEDULLARY COMPRESSION AND FIXATION DEVICE
Abstract
An intramedullary compression and fixation device for
compressing a long bone of a predetermined length which has been
fractured medially to form first and second bone segments. The
compression and fixation device includes an elongated
intramedullary rod of sufficient length to project from one end of
the bone past the fracture site and which is formed with a cross
section of sufficient size to substantially occupy the cross
section of the medial portion of the medullary canal of the bone.
Peripheral thread means are formed on such rod and are of
sufficient size to engage the cancellous bone forming the interior
wall of the medullary canal to drive the rod axially in such canal
upon rotation of the rod. Coupling threads are formed on one end of
the rod for connection with an intramedullary rod driver-retractor
device whereby an opening may be formed in one end of the bone and
the end of the rod opposite the one end passed through the open
end, the driver-retractor device engaged with the coupling threads
and such device rotated to screw the rod through the one bone
segment and into the second bone segment to thereby span the
fracture and maintain the bone segments in fixed relationship with
respect to one another.
Inventors: |
Halloran; William X. (Costa
Mesa, CA) |
Family
ID: |
22337159 |
Appl.
No.: |
05/111,206 |
Filed: |
February 1, 1971 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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765608 |
Oct 7, 1968 |
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Current U.S.
Class: |
606/64;
606/71 |
Current CPC
Class: |
A61B
17/72 (20130101) |
Current International
Class: |
A61B
17/68 (20060101); A61B 17/72 (20060101); A61b
017/18 (); A61f 005/04 () |
Field of
Search: |
;128/92BB,92BC,92R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Advertisement of De Puy Mfg. Co. In Jour. Bone and Joint Surg.,
Vol. 38 A, No. 4, July 1956. Page 32..
|
Primary Examiner: Pace; Channing L.
Parent Case Text
CROSS REFERENCE TO RELATED APPLICATION
This application is a continuation-in-part of Ser. No. 765,608,
filed Oct. 7, 1968, and now abandoned.
Claims
I claim:
1. In a threaded intramedullary compression and fixation device for
compressing a long bone having a medullary canal of a predetermined
length and cross section and which has been fractured medially to
form first and second bone segments, the improvement
comprising:
an elongated intramedullary rod of sufficient length to project
from one end of said bone past said fracture and formed with a
fixation area having a cross section of sufficient size to project
substantially across the transverse cross section of the medial
portion of said medullary canal;
peripheral bone-engaging thread means on said fixation area of
sufficient size to engage cancellous bone forming the wall of said
medullary canal in the area of said fracture site; and
coupling means on one end of said rod whereby rod driver-retractor
device may be coupled with said coupling means and after said
fracture has been set and while it is held compressed, said
compression and fixation device may be inserted into said
intramedullary canal from one end thereof and said driver-retractor
device rotated to engage said thread means with said cancellous
bone forming said intramedullary canal thus resulting in said rod
spanning said fracture site with said thread means engaging said
cancellous bone in both said bone segments to hold said segments in
fixed relationship to maintain said fracture compressed.
2. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said rod is of sufficient length to
project substantially the full length of said bone.
3. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said rod includes a plurality of through,
transverse, screw-receiving passages for receiving transverse
screws inserted through the wall of said bone.
4. A threaded intramedullary compression and fixation device as set
forth in claim 1 for use in a femur wherein said rod is of
sufficient length to project substantially the full length of said
femur.
5. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said rod is regularly shaped in its
longitudinal direction.
6. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said rod is greater than three-eighths of
an inch in cross section and is at least 15 inches long.
7. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said rod is one-half inch in cross section
and 19 inches long.
8. A threaded intramedullary compression and fixation device as set
forth in claim 1 that includes coupling means on the end of said
rod opposite said one end for connection with an intramedullary rod
driver-retractor device.
9. A threaded intramedullary compression and fixation device as set
forth in claim 1 wherein said thread means forms a lead greater
than 1 inch.
10. A threaded intramedullary compression and fixation device as
set forth in claim 1 that includes:
an exterior compression plate for securement to the exterior of
said bone; and
transverse screws for being connected with said plate whereby said
plate may be positioned on the exterior of said bone and said
transverse screws inserted through the wall of said bone and
through said transverse passages on opposite sides of said fracture
and coupled with said plate to assist in holding said bone segments
in spaced fixed relationship.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to intramedullary fixation and
compression devices.
2. Description of the Prior Art
In treating the fractures of long bones, it is desirable to provide
intramedullary fixation to prevent transverse shifting of the bone
segments with respect to one another and to also provide
longitudinal compression to compress the bone segments together at
the fracture site. A particularly serious shortcoming of prior art
bone setting devices is that they force the surgeon at the time of
the operation to elect between use of an intramedullary fixation
rod or else use of a compression device disposed externally of the
bone thereby failing to provide both fixation and compression.
It has been common practice to provide intramedullary fixation rods
which are formed throughout their lengths with unthreaded
peripheries for conveniently being driven telescopically into the
medullary canal of a fractured bone. Devices of this type are shown
in U. S. Pat. Nos. 2,136,471; 2,998,007; and 3,334,624. While the
devices shown in these patents serve to provide adequate fixation,
they inherently prevent simultaneous installation of known bone
compression devices. While threaded screws have been proposed for
use in a patient's trochanter as shown in U. S. Pat. No. 2,526,959,
no intramedullary rods have been proposed which would realistically
serve for use in a long bone such as a femur, tibia or radius.
SUMMARY OF THE INVENTION
The threaded intramedullary compression and fixation device of
present invention is characterized by an intramedullary rod for use
with a fractured long bone and of sufficient length to project from
the fracture site to one end of such bone. The rod is of sufficient
cross section at the fracture site to project entirely across the
cross section of the medullary canal and is formed on its exterior
at the fracture side with thread means for engaging the opposite
walls of the medullary canal so the fracture can be compressed by a
conventional compression device and such rod inserted to cause the
thread means to engage the walls of the medullary canal to hold the
bone segments on opposite sides of the fracture in fixed spaced
relationship to maintain such fracture in compression after the
conventional compression device has been removed.
An object of the present invention is to provide an intramedullary
compression and fixation device which offers the advantages of
intramedullary fixation as well as the advantages of concurrently
maintaining the fracture in compression.
Another object of the present invention is to provide a threaded
intramedullary compression and fixation device of the type
described which incorporates an intramedullary rod that projects
out one end of the bone so a surgeon may have convenient access
thereto for subsequent removal.
These and other objects and the advantages of the present invention
will become apparent from the following detailed description taken
in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a top view of a fractured femur in which a threaded
intramedullary compression and fixation device embodying the
present invention may be used;
FIG. 2 is a partial top view similar to FIG. 1 and showing a
threaded intramedullary compression and fixation device embodying
the present invention being inserted in the proximal femural bone
segment;
FIGS. 3, 4 and 5 are similar to FIG. 2 showing progressive steps of
reducing the fracture;
FIG. 6 is a horizontal sectional view, in enlarged scale, taken
along line 6--6 of FIG. 5; and
FIG. 7 is a top view of a second embodiment of the threaded
intramedullary compression and fixation device of present
invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to FIGS. 1, 5 and 6, the threaded intramedullary
compression and fixation device of present invention may
conveniently be used to reduce a fractured femur, generally
designated 21, and includes a threaded intramedullary rod,
generally designated 23, which is of sufficient length to project
from the lower extremity of the medullary canal 25 of such femur
upwardly past the site of the fracture 27 to project from the upper
end of such femur as shown in FIG. 5. Referring to FIG. 6, the
intramedullary rod 23 is of sufficient cross section to project
fully across the cross section of the medial portion of the
intramedullary canal 25 and is formed with elongated bone-engaging
threads 31 for engagement with the cancellous bone 33 forming the
interior wall of such medullary canal 25. Thus, an incision may be
made adjacent the fracture site 27 and the upper end of the
intramedullary rod 23 inserted through such incision and into the
lower end of the upper, or proximal segment of the fractured femur
21 and a driver-retractor device (not shown) connected with the
lower end of the rod 23 and such rod rotated to cause the threads
31 to engage the cancellous material 33 and draw the rod 23
upwardly in the medullary canal to project from the upper end of
the femur 21. An incision may then be made in the buttock of the
patient to permit the upper extremity of such rod to project from
the buttock as shown in FIG. 3 until the lower extremity of such
rod is fully drawn into the lower end of the proximal femur
segment. The driver-retractor device (not shown) may then be
disconnected from the lower extremity of the intramedullary rod 23
and the fracture 27 set and a compression device employed to place
the fracture site in compression. With the fracture site maintained
in compression, the driver-retractor device may be coupled with the
upper end of the intramedullary rod 23 and such rod rotated to
drive the lower extremity thereof downwardly into the distal femur
segment to position such rod in spanning relationship with the
fracture site 27 to hold the bone segments in fixed spaced
relationship to maintain such fracture in compression.
The intramedullary rod 23 shown in FIGS. 2-6 is intended for use in
an adult male and is approximately 19 inches in length and is
one-half inch in diameter. It has been found that the cylindrical
shape of such rod provides desirable load carrying characteristics
which enable such rod to withstand the loads applied thereon by
patients under normal conditions.
The threads 31 are formed by a groove that is approximately
one-tenth of an inch deep and forms a 5 inch lead such that when
the rod is turned 1 full turn it will feed into the intramedullary
canal 25 5 full inches. For practical purposes the lead of such
threads should be no less than one-half inch.
The opposite ends of the intramedullary rod 23 are tapered to
thereby define pointed extremities and such extremities are formed
with coupling threads 41 and 43, respectively, for connection with
mating threads of a conventional intramedullary rod
driver-retractor device. It is particularly important that such rod
include coupling threads on both ends thereof so the rod can be
installed in a retrograde fashion as will be described
hereinafter.
Referring to FIGS. 2 and 5, the intramedullary rod 23 is formed
throughout its length with a plurality of longitudinally extending,
through, transverse passages 45 adapted for receipt of transversely
extending compression plate screws 49 and 51 to thereby enable a
compression plate 53 to be secured to the exterior of the femur 21
after such rod has been inserted therein.
In operation, when a patient that has fractured a long bone, such
as a femur, is examined it is usually determined that the bone
segments are offset at the fracture side as shown in FIG. 1.
Consequently, it is convenient for the surgeon to make an incision
at the fracture site and insert the intramedullary rod 23 from such
site in a retrograde manner.
In operation, the surgeon selects a rod 23 of sufficient length to
project throughout the length of the medullary canal of the
fractured bone and to project from one end thereof. For a fractured
femur, the surgeon can make an incision on the interior side of the
thigh to expose the fracture site 27 and the upper end of the rod
23 may be inserted in such incision and fed into the lower end of
the medullary canal formed in the proximal femur segment 55. A
conventional driver-retractor device is coupled with the coupling
threads to guide insertion of the intramedullary rod into the
proximal segment 55 and to facilitate rotation of the
intramedullary rod to cause the threads 31 to engage the cancellous
bone 33 to cause such rod to be fed into the bone segments 55 as it
is rotated. When the upper end of the rod 23 reaches the trochanter
57 forming the upper extremity of the femur 21, continued rotation
of such rod will apply a breaking force to the wall of such
trochanter to thereby punch a hole therein for egress of the upper
extremity of the rod 21. If necessary, a moderate amount of
hammering may be done on the driver-retractor to facilitate
breakthrough of the upper end of the rod 23. As the rod 23 is
driven upwardly through the top wall of the trochanter 57, the
surgeon will locate a resulting rise in the patient's buttock and
by merely making a 3/4 inch incision will allow such rod to project
upwardly through such incision to project from the buttock.
Continued rotation of the rod 23 will cause it to continue its
travel upwardly in the medullary canal of the proximal femur
segment 55 until the lower end of such rod is entirely drawn into
the lower extremity of the segment 55.
The surgeon may then set the fracture 27 by placing the proximal
femur segment 55 in axial alignment with the lower femur segment 61
as shown in FIG. 4. As a practical matter, the natural tightening
of the patient's thigh muscles which results from the trauma of the
fracture is, in many cases, sufficient to provide a substantial
amount of compression at the fracture site thereby eliminating the
necessity of any additional external compression.
However, if additional external compression is desired, a
conventional compression device may have its clamps applied to the
bone segments 55 and 61 and the segments then drawn together to
maintain the fracture site 27 in compression while the rod 23 is
screwed downwardly into the lower segment 61. In either case
disposition of the rod 23 in spanning relationship with the
fracture 27 while such fracture is compressed will result in such
fracture being held in compression after the thigh muscles have
relaxed and the compression device has been removed.
Alternatively, the compression plate 53 may be applied in a
conventional manner by using short screws which project only into
the adjacent wall of the femur 21 rather than entirely through the
femur as is the case for the bolts 49 and 51.
Assuming that the surgeon elects to rely on the natural compression
provided by the taut thigh muscles, the driver-retractor device is
coupled with the coupling threads 41 on the upper end of the rod 23
and such rod rotated in a direction to cause it to be driven
downwardly in the upper femur segment 55 and into the distal femur
segment 61. As the lower extremity of the rod 23 engages the distal
segment 61, the threads 31 will engage the cancellous bone 33
thereof to, in effect, tap the medullary canal and draw such rod 23
downwardly as rotation of such rod is continued.
It is particularly important that when insertion of the
intramedullary rod 23 is completed, the upper coupling threads 41
remain projecting from the trochanter 57 so a surgeon may have
convenient access thereto by merely making a subsequent incision in
the patient's buttock and may engage his driver-retractor with such
threads and rotate the rod 23 to screw it out of the medullary
canal. This feature becomes particularly important when
complications arise which make removal mandatory and enables such
removal to be accomplished without making a new break to obtain
access to such rod.
If the surgeon elects to also apply external compression to the
fracture 27, he may conveniently do so by merely X-raying the thigh
to determine the disposition of the transverse through passages 45
and may then drill holes in alignment with a selected one of such
passages for passage of the bolts 49. The compression plate 53 may
then be placed in position and the bolts 49 inserted. A
conventional compression device may then be secured to the free end
of such plate 53 and to the distal femur bone segment 61 and such
compression device actuated to draw bone segments 55 and 61
together to place the fracture 27 under even greater compression.
While the compression device holds such fracture in compression,
holes may be drilled in the femur in alignment with a selected
passage 45 for receipt of the bolts 51. The bolts 51 may then be
inserted and tightened to thereby maintain the fracture site 27
under compression after the compression device is removed. The
incisions may then be closed and recovery of the patient will be
commenced.
The threaded intramedullary compression and fixation device shown
in FIG. 7 is similar to that shown in FIGS. 2-6 except that it
includes an intramedullary rod 63 that includes elongated threads
64 and is tapered from its upper end 65 to its lower end 67.
Consequently, such rod may conveniently be inserted from the upper
end of the fractured femur 21. In operation, a surgeon using the
rod 63 to reduce a fractured femur will first set the fracture and
then make an incision in the patient's buttock and will then
operate through such incision to drill a hole in the top of the
trochanter 57. The rod 63 may then be inserted and an
intramedullary rod driver-retractor device connected with the upper
end 65 thereof to rotate such rod and cause it to feed downwardly
into the upper femur segment and into the lower femur segment to
engage the threads 64 with the cancellous bone to thereby tap the
medullary canal and draw such rod into spanning relationship with
the fracture site to thereby maintain the bone segments in fixed
longitudinal spaced relationship.
From the foregoing description it will be apparent that the
threaded intramedullary compression and fixation device provides an
intramedullary rod which may conveniently be installed in a
retrograde fashion and which will provide both fixation and
longitudinal compression.
* * * * *