U.S. patent number 3,900,025 [Application Number 05/463,463] was granted by the patent office on 1975-08-19 for apparatus for distracting or compressing longitudinal bone segments.
Invention is credited to Walter P. Barnes, Jr..
United States Patent |
3,900,025 |
Barnes, Jr. |
August 19, 1975 |
**Please see images for:
( Certificate of Correction ) ** |
Apparatus for distracting or compressing longitudinal bone
segments
Abstract
An orthopedic apparatus for selectively distracting or
compressing contiguous longitudinal bone segments comprising a
first and second support member each of which can be placed
longitudinally coextensively adjacent respective bone segments. A
first longitudinal bore extends within the first support member for
receiving and threadably engaging one portion of a threaded driving
rod, and a second longitudinal bore, axially aligned with the first
longitudinal bore, extends within the second support member for
receiving and threadably engaging another portion of the threaded
driving rod. Upon rotation of the threaded driving rod the first
and second support members are longitudinally simultaneously
adjusted. The apparatus can be inserted into the limb according to
standard orthopedic surgical procedures and then mounted adjacent
the bone segments after which the support members are periodically
adjusted to stimulate the growth of new bone matter between the
distracted bone segments. A method for distracting longitudinal
bone segments by insertably mounting an adjustable distracting
apparatus adjacent longitudinal bone segments and periodically
adjusting the apparatus to stimulate a build up of new bone growth
between the bone segments.
Inventors: |
Barnes, Jr.; Walter P. (Macon,
GA) |
Family
ID: |
23840174 |
Appl.
No.: |
05/463,463 |
Filed: |
April 24, 1974 |
Current U.S.
Class: |
606/71 |
Current CPC
Class: |
A61B
17/8004 (20130101) |
Current International
Class: |
A61B
17/68 (20060101); A61B 17/80 (20060101); A61f
005/04 (); A61b 017/18 () |
Field of
Search: |
;128/92D,92R,92A,92G,92E,84R,84B,85 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
1,051,847 |
|
Sep 1953 |
|
FR |
|
274,210 |
|
May 1914 |
|
DD |
|
1,538,053 |
|
Jul 1968 |
|
FR |
|
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Merriam, Marshall, Shapiro &
Klose
Claims
What is claimed is:
1. An orthopedic apparatus of a size for implantation within a limb
in direct contact with a bone for selectively positioning
contiguous longitudinal bone segments, said apparatus
comprising:
a first elongated support member;
a second elongated support member;
means on said first support member for placement longitudinally
adjacent one of said bone segments in direct contact therewith;
means on said second support member for placement longitudinally
adjacent another bone segment contiguous to said one bone segment
and in direct contact therewith and substantially longitudinally
aligned with said first support member;
means for releasably mounting said first and second support members
to said bone segments;
a manually operable adjusting member;
means on said first and second support members for imparting
longitudinal movement to one of said support members in response to
operation of said adjusting member and for maintaining substantial
longitudinal alignment of said first and second support members;
and,
means for preventing rotational movement of said first and second
support members during said longitudinal movement thereof.
2. An orthopedic apparatus as set forth in claim 1, wherein said
placement means on said first and second support members comprises
a concave contoured surface on each of said support members.
3. An orthopedic apparatus as set forth in claim 1, wherein said
releasable-mounting means on said first and second support members
comprises:
a plurality of pin members for placement within said bone segments;
and,
a plurality of apertures in said first and second support members
for receiving said pin members.
4. An orthopedic apparatus as set forth in claim 1, and
comprising:
means mounting said adjusting member for rotational movement in
response to operation thereof; and,
said movement-imparting means includes means for imparting
longitudinal movement in respective opposed directions to said
first and second support members in response to rotational movement
of said adjusting member.
5. An orthopedic apparatus as set forth in claim 4, wherein:
each support member includes a first portion and a second
portion;
said first portion having means for placement longitudinally
adjacent a respective bone segment; and,
said rotation-preventing means comprises means on each second
portion for slidably connecting the second portion of one support
member to the second portion of the other support member.
6. An orthopedic apparatus as set forth in claim 5, wherein:
said adjusting member includes driving gear means; and,
said movement-imparting means comprises first and second gear means
on the respective second portions of the first and second support
members for simultaneous engagement with said driving gear
means.
7. An orthopedic apparatus as set forth in claim 6, and further
including movement-restricting means for permitting longitudinal
movement of the support members in a first set of opposed
directions while preventing longitudinal movement in a second set
of opposed directions opposite of said first set.
8. An orthopedic apparatus as set forth in claim 7, and
comprising:
means for mounting said movement-restricting means in a first
position in which said movement-restricting means permits diverging
longitudinal movement of the support members while preventing
converging longitudinal movement thereof; and,
means for mounting said movement-restricting means in a second
position in which said movement-restricting means prevents
diverging longitudinal movement of the support members while
permitting converging longitudinal movement thereof.
9. An orthopedic apparatus as set forth in claim 7, wherein said
movement-restricting means includes:
a gear on one of said support members;
a pawl;
means for mounting said pawl in a first position on said one
support member for a first biased engagement with said gear;
and,
means for mounting said pawl in a second position on said one
support member for a second biased engagement with said gear.
10. An orthopedic apparatus as set forth in claim 4, wherein said
rotation-preventing means comprises:
a first bore extending longitudinally within said first support
member;
a second bore extending longitudinally within said second support
member and axially aligned with said first bore;
a rod having opposed end portions;
means for fixing one end portion of said rod to said first bore;
and,
means for slidably mounting another end portion of said rod to said
second bore.
11. An orthopedic apparatus as set forth in claim 10, wherein said
adjusting member comprises a threaded second rod including first
and second oppositely threaded sections.
12. An orthopedic apparatus as set forth in claim 11, wherein said
rotational-movement mounting means comprises:
a third bore extending longitudinally within said first support
member; and,
a fourth bore extending longitudinally within said second support
member and axially aligned with said third bore.
13. An orthopedic apparatus as set forth in claim 12, wherein said
movement-imparting means comprises:
means on said third bore for threadably engaging said first
threaded section; and,
means on said fourth bore for threadably engaging said second
threaded section.
14. An orthopedic apparatus as set forth in claim 10 wherein said
movement-imparting means further includes means for imparting
longitudinal movement to one of said support members in response to
rotational movement of said adjusting member.
15. An orthopedic apparatus as set forth in claim 14, wherein:
said adjusting member comprises a threaded second rod including
first and second opposed end portions;
said rotational-movement mounting means comprises:
a. a third bore extending longitudinally within said first support
member; and,
b. a fourth bore extending longitudinally within said second
support member and axially aligned with said third bore; and,
said movement-imparting means comprises:
a. means on said fourth bore for threadably engaging said first end
portion of said threaded second rod;
b. a first gear;
c. means mounting said first gear to said first support member for
rotational movement of the first gear; and,
means mounting said second end portion of the threaded second rod
within said third bore for imparting longitudinal movement to said
second support member in response to rotational movement of said
first gear.
Description
BACKGROUND OF THE INVENTION
This invention relates to an orthopedic apparatus for distracting
or compressing contiguous longitudinal bone segments whereby the
apparatus is releasably mounted immediately adjacent the bone
segments within the limb. Reference may be made to the following
U.S. patents: U.S. Pat. Nos. 1,997,466, 2,024,325, 2,101,889,
2,204,266, 2,238,869, 2,250,417, 2,317,519, 2,391,537, 2,393,694,
2,393,982, 2,687,720 and 3,547,113.
There are known orthopedic surgical procedures, see for example,
U.S. Pat. No. 3,547,113, for lengthening a bone, such as the tibia,
whereby one of two bone fixation pins is inserted through the limb
and bone on either side of the desired bone breaking point. The
bone is broken between the pins and a support member is attached to
the ends of each fixation pin outside the limb. The support members
are then periodically adjusted by means of a threaded connecting
rod until the desired distracted bone length is attained. A cast is
applied around the limb and pins to hold the bone segments in a
substantially axially aligned position and the outside support
members are then detached from the pins.
The prior art devices cause many surgical and post operative
problems because of their inherent structural deficiencies. None of
the prior art devices presently in use or previously mentioned
adequately hold the distracted bone segments in rigid axial
alignment, because the rigidity of the connection between the
support apparatus is dependent upon the rigidity of the bone
fixation pins. Thus, not only is angulation and rotation of the
bone segments difficult to control when these prior art devices are
used, but there is also an increased chance of infection in the
open wounds surrounding the pins and pressure necrosis of the skin
adjacent the pins. The use of a cast has the disadvantages of
causing the patient general discomfort and delaying the time within
which the distracted limb may be therapeutically exercised to
alleviate muscular tightening, muscle atrophy, and joint
stiffness.
SUMMARY OF THE INVENTION
According to the present invention, an apparatus is provided of a
size for implantation within a limb in direct contact with a bone
for selectively positioning, i.e., distracting or compressing
contiguous longitudinal bone segments, comprising a first elongated
support member and a second elongated support member, each having
means for placement longitudinally coextensively adjacent a
respective bone segment. The first and second support members are
operatively connected together for adjusting the longitudinal
displacement between each support member and for preventing
rotational movement of the first and second support members during
the longitudinal movement thereof and each have means for
releasable attachment immediately adjacent their respective bone
segments.
The apparatus is surgically placed within the limb and mounted
immediately adjacent the bone segments. The support members may
then be periodically adjusted to distract or compress the bone
segments.
The invention not only prevents angulation and rotation of the bone
segments, but also eliminates the need for a post operative cast,
since the bone segments are rigidly held in place by the support
members in an axially aligned position. Therefore, there is no
chance of infection due to pin tract wounds in the limb, and
rehabilitation of the limb may be commenced soon after the
operation. The apparatus is lightweight and simple in design, and
may be constructed to accommodate almost any bone size.
Other advantages of the invention will become apparent to those
skilled in the art upon reading and understanding the further
detailed description of this invention.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of the preferred apparatus embodiment
of the invention in a closed position and mounted on illustrated
bone segments within a limb;
FIG. 2 is a top view of the apparatus of FIG. 1 shown in the
partially opened position with new bone growth formed between the
bone segments;
FIG. 3 is an end sectional view along line 3--3 of FIG. 1 with the
limb shown in phantom lines;
FIG. 4 is a front sectional view along line 4--4 of FIG. 2;
FIG. 5 is a perspective view of a second apparatus embodiment of
the invention in an opened position;
FIG. 6 is an end sectional view along line 6--6 of FIG. 5;
FIG. 7 is a rear sectional view along line 7--7 of FIG. 6;
FIG. 8 is a front view of a third apparatus embodiment of the
invention in a closed position;
FIG. 9 is an end sectional view along line 9--9 of FIG. 8;
FIG. 10 is a top view of the apparatus of FIG. 8;
FIG. 11 is a perspective view of the apparatus of FIG. 8 in an open
position;
FIG. 12 is a front sectional view along line 12--12 of FIG. 11
showing the pawl mechanism in a closing position;
FIG. 13 is a front sectional view along line 12--12 of FIG. 11
showing the pawl mechanism in an opening position; and,
FIG. 14 is an exploded perspective view of the pawl mechanism.
DETAILED DESCRIPTION adaptable
Referring initially to FIGS. 1-4, the preferred apparatus
embodiment of the invention is shown generally at 5 and is
releasably mounted to bone 4 within a limb (see FIG. 3), comprising
a first or proximal longitudinal bone segment 18, and a second or
distal longitudinal bone segment 22. For purposes of example,
reference will be made to the distraction of the femur bone
although it will become apparent to those skilled in orthopedic
surgery that the invention is adaptable to be used on any
relatively long bone and for either distraction or compression, as
desired.
As shown in FIGS. 1-4, the apparatus includes a pair of elongated
support members 6 and 8. Each support member comprises a
rectangular block of stainless steel that has a concave rear
surface 52 which permits each support member to lie immediately
adjacent to each respective bone segment.
Screws or pin members 14 may be used to releasably mount the
apparatus to femur bone 4 through a plurality of screw holes or
apertures 15 in support members 6 and 8. Although the size of the
screws may vary according to the size of the apparatus and bone,
screws having a diameter of 0.164 inches and a suitable length are
recommended so that the apparatus is firmly secured to each of the
femur bone segments. Other means for mounting the support members
may be utilized, as long as each support member is securely mounted
to the bone segments.
Support members 6 and 8 are rigidly adjustably connected together
by driving rod 10 and guiding rod 12. Driving rod 10 not only
imparts longitudinal movement to the support members but also
maintains substantial longitudinal alignment of the first and
second support members. Driving rod 10 comprises oppositely
threaded and axially aligned sections 40 and 43, which are
engageable with similarly oppositely threaded bores 44 and 46,
extending within support members 6 and 8. Bore 44 has an internal
left-handed thread corresponding to section 40 of rod 10, and bore
46 has an internal right-handed thread corresponding to section 42
of rod 10. This feature permits second support member 8 to move or
impart bone segment 22 a longitudinal distance in the direction of
arrow 1 in response to the rotational movement of driving rod
10.
Smooth guiding rod 12 is mounted or fixed within bore 48 in support
member 6, and the opposite portion of guiding rod 12 is slidably
engageable or mounted within bore 50 in support member 8. Guiding
rod 12 gives the apparatus rigidity as it is adjustably opened or
closed by preventing rotational movement of the first and second
support members during the longitudinal movement thereof and
maintains each support member in constant axial alignment, thereby
eliminating angulation and rotation of the bone segments. Fluid
drainage holes 56 are interspaced along the top of each support
member.
Small threaded pin or screw 9 is threadably screwed into bore 11,
in socket head 26, of rod 10 and is then screwed into bone segment
18 after the apparatus is adjusted to insure that the distracted
distance remains constant.
In use as a distraction device, the apparatus is inserted into the
limb adjacent the bone segments and distraction is accomplished in
periodic adjustments to position the bone segments as desired,
thereby enabling the formation of new bone growth 54 between the
bone segments. The method of distracting the bone segments is
hereinafter described in more detail.
FIGS. 5-7 show a second apparatus embodiment of the present
invention, comprising first and second elongated support members 60
and 62 that are rigidly adjustably connected by means of threaded
driving rod 58 and smooth guiding rod 82. Guiding rod 82 is
connected to support members 60 and 62 in the same manner as shown
in the previously described preferred apparatus embodiment and
prevents rotational movement of the support members during the
longitudinal movement of second support member 62. An internally
threaded bore 64 extends within support member 62 for engagement
with one end portion of driving rod 58; and smooth bore 66, axially
aligned with threaded bore 64, extends within support member 60 for
receiving another end portion of rod 58.
End 71 of driving rod 58 is mounted to beveled gear 72 for
engagement with beveled gear 74 which is rotatably mounted in,
bushing 76 within support member 60 (see FIGS. 6 and 7). When gear
74 is rotated gear 72 rotates which in turn moves or imparts
longitudinal movement to support member 62 in the direction of
arrow 61.
FIGS. 8-14 show a third embodiment of the invention wherein support
members 91 and 93 comprise first portions, 92 and 94 and L-shaped
second portions 96 and 98, respectively, extending a distance b
from bone 4 (see FIG. 9). Second portions 96 and 98 are slidably
connected to each other and are operatively connected to each other
by means of a rack and pinion mechanism. The interconnection of
second portions 96 and 98 inherently prevents support members 91
and 93 from rotating during the longitudinal movement thereof. The
rack and pinion mechanism comprises a driving gear pinion 108
having a wrench receiving aperture 111. Arms 96 and 98 have slots
107 and 109 for first and second gear racks 103 and 105,
respectively. Thus, as shown in FIG. 8, pinion 108 is locked within
arms 96 and 98 and is simultaneously operatively engageable with
gear racks 103 and 105. Support member 94 will longitudinally move
or impart in the direction of arrow 117 (see FIG. 11) when pinion
108 is rotated in the direction of arrow 115.
A pawl and gear rack mechanism is shown in FIGS. 12-14 which
restricts the longitudinal displacement of the support members in a
first set of opposed directions while preventing longitudinal
movement in a second set of opposed directions opposite the first
set. The pawl mechanism comprises a pawl 118 having a flange 120
and a shank 122. The shank is inserted into spring 124. Cylindrical
housing 126 contains slots 128 and 129 for receiving flange 120,
and is threaded at 127 for insertion into bottom surface 113 of
housing 112. Gear rack 119 is machined out of the bottom surface of
arm 98 (see FIGS. 12 and 13). Thus, pawl 118 is held in a biased
position against rack 119 when housing 126 is screwed into position
within housing 112. FIGS. 12 and 13 respectively show the
adaptability of the pawl mechanism to be mounted in housing 126 in
a first position in which the biased engagement of pawl 118 against
rack 119 permits converging longitudinal movement of the support
members while preventing diverging longitudinal movement therof,
and in a second position in which the biased engagement of pawl 118
against rack 119 prevents converging longitudinal movement while
permitting diverging longitudinal movement thereof.
In FIG. 12, flange 120 is inserted into slot 129 so that the
support members may simultaneously converge towards pinion 108.
FIG. 13, shows flange 120 inserted and, in slot 128 thus permitting
the support members to simultaneously diverge away from pinion
108.
Adaptable with all of the embodiments is a follower apparatus 28,
as shown in use with the third apparatus embodiment in FIG. 10 and
11, that may be used to increase the rigidity of the coupled bone
segments. Follower plate 28 is attached to the medial side of the
bone by using longer screws 95. If the follower is used, onlay
graft 24 may be placed on the top of the bone, as shown in FIGS. 8,
10, and 11.
It is to be noted that all of the apparatus embodiments may be used
to reduce fractures by simply closing the support members until the
fractured segments of bone are joined by compression.
Referring, for example, to the preferred embodiment of FIGS. 1-4,
the method of using the invention for distraction comprises the
steps of attaching the proximal or first support member 6 to
proximal bone segment 18. Onlay graft 24 is not mounted to the bone
until after the bone is broken and both support members are in
place. Bone 4 is then cut in a step-cut fashion or may be drilled
in a transverse direction, and then fractured. Care is taken while
fracturing the bone to prevent the tearing of the periosteum. The
periosteum is split longitudinally and incised circumferentially at
the distal end of the incision to form a split sleeve of
periosteum; thus, periostial growth of new bone is not endangered.
The distal or second support member 8 is clamped to the distal bone
segment after the bone is broken, and the bone segments are then
manually axially aligned to correct angulation and rotation of the
bone segments which occurs after the bone is broken. Once the bone
segments are aligned, the second support member is mounted to
distal bone segment 22 in the same manner as the first support
member was mounted to proximal bone segment 18.
To insure complete and rapid ossification of bone segments 18 and
22, an onlay graft 24 is taken from the fibula and/or ileum during
the operation and is loosely affixed to bone segment 4 by using
longer screw 20 (see FIG. 3). The onlay graft is mounted on the
medial side of bone 4 bridging gap 3 between bone segments 18 and
22 after the apparatus is adjusted. The onlay graft will become
incorporated into new bone growth 54 as the bone ends are
completely joined by callus. Screw 20 may be placed in any of the
pin receiving apertures 15, but is preferably placed in the second
opening of support member 6.
After onlay graft 24 is affixed to the bone, the apparatus is
adjustably opened by rotating rod end 26 with a screwdriver or the
like, until the apparatus and bone segments are distracted
approximately three/fourths inch to 1 inch. Onlay graft 24 will
slide along the medial side of the bone as shown in FIG. 2. The
wound in the limb is then closed according to standard surgical
techniques. After a week to ten days, a small incision is made in
the limb over the rod end and rod 10 is rotated again, thereby
opening the apparatus another one/fourth inch to one/eight inch.
This procedure may be repeated about every 10 days over a period of
3 to 6 weeks until a maximum distraction of approximately 2 inch to
2 1/2 inch is effectuated. The purpose of this periodic adjustment
is to insure that the gradual build up of callus or new bone growth
54 will be maintained between the bone segments. Each time the
apparatus is adjusted, the newly formed callus is broken up and new
callus growth is stimulated. There are some cases, however, in
which it may be desirable, in addition to using an onlay graft(s),
to fill the gap between the bone segments with cancellous bone
grafts in the form of chips.
After the initial operation, the patient may be placed in traction
because a cast need not be used. The traction relieves the pressure
that the lengthened bone exerts against the knee and hip socket.
Note, however, that the apparatus is suitable for use even if a
cast is used. While in traction, the patient may exercise the lower
portion of the leg in order to further alleviate the socket
pressure and to stretch the tight muscles. After the patient is
taken out of traction, the limb is placed within a brace until
complete ossification of the bone has occurred. The brace will
relieve any undue stress on the apparatus and on the new bone
before complete bone union occurs. The bone ends will be completely
joined after six months to one year. The apparatus and brace may
then be removed as soon as a new medullary canal forms.
It is to be noted that the present invention is susceptible to
dimensional change depending upon the size of the bone to be
distracted. It will be understood that the particular embodiments
illustrated and described represent the best form of the invention
presently known, and that the invention is not intended to be
limited to the particular details so illustrated and described, but
encompasses all embodiments falling within the scope of the
appended claims.
* * * * *