U.S. patent number 3,704,707 [Application Number 05/131,645] was granted by the patent office on 1972-12-05 for orthopedic drill guide apparatus.
Invention is credited to William X. Halloran.
United States Patent |
3,704,707 |
Halloran |
December 5, 1972 |
ORTHOPEDIC DRILL GUIDE APPARATUS
Abstract
Orthopedic drill guide apparatus for use in drilling a bore in a
fractured bone such as a trochanter for receipt of a pin. The
apparatus includes a portable pistol device having aiming means
mounted on the top thereof for alignment with an X-ray
image-producing target placed over such fractured trochanter. Drill
guide means is mounted on the pistol device below the aiming means
and transverse indicator means is provided on such pistol device.
Thus, the target may be placed over the fractured trochanter, an
X-ray taken thereof and such X-ray examined to determine the point
on such target which aligns with the desired orientation for the
bore to be drilled. The aiming means is then aimed at the selected
point on the target and the pistol device maneuvered to align the
drill means below the aiming means as indicated by the indicator
means so the drill may be inserted in such guide means for drilling
the bore in the trochanter at the desired location.
Inventors: |
Halloran; William X. (Costa
Mesa, CA) |
Family
ID: |
22450378 |
Appl.
No.: |
05/131,645 |
Filed: |
April 6, 1971 |
Current U.S.
Class: |
606/97; 600/587;
600/429; 600/427; 378/162; 606/102; D24/140; 378/177 |
Current CPC
Class: |
A61B
17/1721 (20130101); A61B 17/1703 (20130101) |
Current International
Class: |
A61B
17/16 (20060101); A61B 17/17 (20060101); A61f
005/04 () |
Field of
Search: |
;128/92EB,92R,92BC,92B,92EC |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Claims
I claim:
1. Orthopedic drill guide apparatus for use in drilling a bore in a
bone and comprising:
an X-ray machine and an X-ray image-producing target for placement
exteriorly on said patient adjacent said bone;
a portable pistol device
aiming means mounted on the top of said pistol device for alignment
with said target;
drill guide means mounted on said pistol device and disposed below
said aiming means and removably receiving a drill;
transverse indicator means mounted on said piston device for
indicating the transverse inclination of said pistol device whereby
said target may be placed exteriorly on a patient adjacent said
bone, said X-ray machine oriented in a selected plane over said
bone and aimed at said target and said bone, an X-ray picture
taken, a target point selected on the image of said target, said
aiming means aimed at the corresponding target point and said
pistol device maneuvered about while said aiming means is held on
said corresponding target spot until said transverse indicator
means indicates said aiming means and guide means are in a plane
perpendicular to the plane of said X-ray machine.
2. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said drill guide means is in the form of an elongated guide slot
for receiving said drill.
3. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said aiming means includes an elongated guide pin projecting from
said pistol device for having its projecting extremity aligned over
said target.
4. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said target includes a plurality of different shaped figures
disposed at selected distances from one another.
5. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said indicator means is in the form of pendulum means.
6. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said pistol device is in the form of an inverted L-shaped
element;
said aiming means includes an aiming pin projecting from the
horizontal leg of said pistol device.
7. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said drill guide means includes a guide disc rotatably mounted on
said pistol device and including a plurality of radially projecting
through guide passages of different cross sections.
8. Orthopedic drill guide apparatus as set forth in claim 1 that
includes:
a drill jig including a plurality of parallel drill passages
whereby said drill may be inserted through said drill guide means
to drill a first bore in said bone, one end of a pin inserted in
said first bore with the opposite extremity projecting therefrom,
said jig installed on said pin by inserting said extremity in one
of said drill passages and said drill inserted in other of said
drill passages to drill bores parallel to said first bore.
9. Orthopedic drill guide apparatus as set forth in claim 1 that
includes:
longitudinal indicator means on said pistol device for indicating
the longitudinal inclination of said pistol device and wherein;
said guide means includes indicia for indicating the angle of
anteversion of said drill.
10. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said pistol device is formed with a horizontally projecting portion
having said aiming means mounted thereon and a vertically
projecting portion having said guide means mounted thereon said
device, further including a telescoping means interconnecting said
horizontal section and said vertical section.
11. Orthopedic drill guide apparatus as set forth in claim 1 that
includes:
a fixed shank guide for use with a fixed shank hip pin having a
nail and a shank projecting therefrom at a selected angle, said
fixed shank guide including trochanteral aiming means, a shank
portion projecting at said selected angle from said trochanteral
aiming means, said fixed shank guide further including angular
index means extending at an angle to said trochanteral means
whereby said target may be positioned over a fractured trochanter,
an X-ray taken thereof, said fixed shank guide arranged on said
X-ray with said shank portion extending along the image of the
femoral shaft and said trochanteral aiming means projecting along
the image of the neck of said trochanter to enable the user to
obtain points on said target corresponding with the intersection
thereof of said trochanteral aiming means and said index means so
said fixed shank guide can be transferred to the patient with said
trochanteral aiming means and index means aligned with
corresponding points on said target and said first mentioned aiming
means aligned with said trochanteral aiming means to locate said
drill guide means for receipt of said drill.
12. Orthopedic drill guide apparatus as set forth in claim 1
wherein:
said pistol device is formed with an elongated track projecting
transversely to said aiming means; and
said drill guide is received for longitudinal sliding in said track
and includes a plurality of different sized through passages for
receipt of different sized drills.
13. Orthopedic drill guide apparatus as set forth in claim 1 that
includes:
an anteversion angle indicator including a base plate formed with a
drill passage therethrough and anteversion inclination indicator
means mounted on said plate.
14. Orthopedic drill guide apparatus as set forth in claim 3
wherein:
said pistol device includes an elongated passage for telescopical
receipt of said pin and tightening means for tightening said guide
pin in position.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The drill guide apparatus of present invention relates to a device
for guiding a drill to drill a bore in a fractured bone or the
like.
2. Description of the Prior Art
In hip pinning operations, it has been common practice for
orthopedic surgeons to obtain X-rays of a fractured trochanter and
then estimate the desired location and angularity for the hip pin
and then drill a series of guide bores in accordance with such
estimation. Thereafter, additional X-rays are taken to determine
the location of the guide bores and if such bores are not properly
located, additional bores are drilled and further X-rays taken.
Such a trial-and-error procedure is time consuming and expensive
while subjecting the patient to extended operative risks and
trauma.
Numerous hip pin guide devices have been proposed for insertion in
a large incision formed along the upper femoral shaft to locate and
maintain the desired angularity for a drill while drilling a bore
down the axis of the trochanter. However, such devices are
generally unsatisfactory because of the requirement of a large
incision and the additional risk of infection and trauma.
In the early 30's a rather cumbersome drill guide was proposed
which mounted directly on the fracture table. This device is
described in an article by Sven Johansson published in the
Scandinavian orthopedic journal entitled ACTA ORTHO SCAND 3, 1932.
A large cumbersome apparatus of this type suffers the shortcoming
that it is cumbersome to use and hinders access to the fracture
site. Further, such devices are difficult to sterilize and raise
the risk of contamination.
SUMMARY OF THE INVENTION
The orthopedic drill guide apparatus of present invention is
characterized by a hand-hold pistol device having aiming means
mounted thereon for being aligned over a selected point on an X-ray
image-producing target disposed over the fracture site. Guide means
is mounted on the pistol device in alignment with the aiming means
and an indicator is provided for indicating when the pistol device
is oriented to align the guide means with the aiming means to
thereby guide the drill directly along a line corresponding with
the location and orientation of the aiming means.
The object and advantages of the present invention will become
apparent from a consideration of the following detailed description
when taken in conjunction with the accompanying drawings.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a top plan view of a patient suffering a fractured
trochanter which may have a bore drilled therein by a drill guide
apparatus embodying the present invention;
FIG. 2 is a side elevational view of the patient shown in FIG
1;
FIG. 3 is a diagrammatic view of an X-ray of the trochanter of the
patient shown in FIG. 1;
FIG. 4 is a perspective view of a drill guide apparatus embodying
the present invention;
FIG. 5 is a front view of an ante-version angle indicator which may
be utilized with the drill guide apparatus shown in FIG. 4;
FIG. 6 is a top view, in reduced scale, of the drill guide
apparatus shown in FIG. 4 being utilized to guide a drill down the
axis of a patient's trochanter;
FIG. 7 is a vertical sectional view taken along the line 7--7 of
FIG. 6;
FIG. 8 is a perspective view of an aiming pin which may be utilized
with the drill guide apparatus shown in FIG. 4;
FIG. 9 is a detailed view of a modification of the drill guide
apparatus shown in FIG. 4;
FIG. 10 is a vertical sectional view taken along the line 10--10 of
FIG. 9;
FIG. 11 is a vertical sectional view taken through a patient's hip
and showing the drill guide apparatus shown in FIG. 4 being
utilized to guide a bone drill;
FIG. 12 is a vertical sectional view, in enlarged scale, taken
along the line 12--12 of FIG. 11.
FIG. 13 is a schematic view of a patinet's trochanter which has had
hip pins inserted by means of the drill guide apparatus shown in
FIG. 4;
FIG. 14 is a front view of a second modification of the drill guide
apparatus shown in FIG. 1;
FIG. 15 is a partial front view of a third modification of the
drill guide apparatus shown in FIG. 1;
FIG. 16 is a perspective view of a fixed shank hip pin guide which
may be used with the drill guide shown in FIG. 4;
FIG. 17 is a front view of the drill guide shown in FIG. 16;
FIG. 18 is a vertical sectional view, in enlarged scale, taken
along the line 18--18 of FIG. 17;
FIG. 19 is a schematic view of an X-ray having the fixed shank
drill guide shown in FIG. 16 disposed thereover; and
FIG. 20 is a front view of a fixed shank hip pin.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to FIGS. 4, 6 and 7, the drill guide apparatus of present
invention includes, generally, a pistol device in the form of an
inverted L-shaped member 31 having an aiming pin 33 mounted on the
barrel thereof and a through vertically extending drill guide slot
35 formed in the vertical leg thereof. Suspended beneath the barrel
of the pistol device 31 is a pendulum type transverse indicator 41
for indicating the transverse inclination of such pistol device.
Thus, a metallic target, generally designated 43, (FIG. 6) may be
placed over a patient's groin area near a fractured trochanter and
the aiming pin 33 aligned over a selected point on such target and
the pistol device 31 rotated about its longitudinal axis until the
vertical indicator 41 indicates the drill guide slot 35 is aligned
directly below the aiming pin 33 for receipt of the bone drill 47
to maintain such drill in the vertical plan of the aiming pin
33.
Referring to FIG. 4, the pistol device 31 is formed with a
longitudinally extending barrel 51 which is formed in its upper
extremity with a longitudinally extending upwardly opening groove
53 for receipt of the aiming pin 33. A thumb screw 55 is screwed
into a threaded transverse bore whereby such screw may be tightened
against the aiming pin 33 to hold it in position. The pistol device
31 further includes a downwardly projecting vertical leg 57 which
has an extension 59 telescoped upwardly over the lower end thereof.
The extension 59 is formed with an upwardly opening passage 61 for
receipt of the lower extremity of the vertical leg 57. A thumb
screw 63 is secewed into a threaded bore formed in the extension 59
to be screwed inwardly against the vertical leg 57 to hold the
extension 59 in fixed telescopical relationship with a respect
thereto.
The transverse indicator 41 is suspended beneath the barrel 51 by
means of a pivot pin 67 for free rotation thereof.
A longitudinal indicator in the form of a pendulum type pointer,
generally designated 71, is mounted on the side of the pistol
device 31 by means of a pivot pin 73 and is formed with a
downwardly projecting weight 75 and an upwardly projecting pointer
77 which points to a vertical indicator line 81 to indicate the
longitudinal inclination of such pistol device.
The target 43 is constructed from a somewhat resilient, heavy
metallic wire and is formed with a plurality of longitudinally
spaced shaped elements 85 which are all of a different
configuration so each one can be easily identified on an X-ray. The
spaced elements 85 included in the target 43 shown in FIG. 6, are
in the form of turned-back loops to form a somewhat askewed sign
wave having the apexes of the individual elements disposed at one
inch spacings from one another. The opposite ends of the target 43
terminate in closed coils forming respective holding loops 87 which
may conveniently receive towel clips 89 for clipping the target 43
to the patient's skin or draping to thereby maintain such targets
securely in position.
In operation, when the drill guide apparatus of present invention
is to be utilized for drilling a bore in a fractured trochanter 45,
the patient is placed on his back on a fracture table 91 and the
patient rendered immobile and secured in position by conventional
traction devices or the like. The target 43 is then positioned over
the injured trochanter and arranged to extend generally transverse
to the axis 95 (FIG. 3) of the injured trochanter 45 and is pinned
in place by the towel clips 89. An X-ray camera 97 is mounted from
a vertical post 99 to be closely held in a horizontal plane and
such camera is moved into position over the trochanter area and an
anterior-posterior picture taken to produce an anterior-posterior
X-ray 101 as shown in FIG. 3. The surgeon will then review the
X-ray 101 to determine that the extended axis 95 of the trochanter
45 intersects the image of the target 43 at a point 103 formed by
the lower portion of the shaped element 85 disposed third from the
top end of such target 43.
The axis of the trochanter normally extends at an angle between
10.degree. and 30.degree. from the horizontal when the patient is
lying on his back as shown in FIG. 1. This angle is normally
referred to as the angle of anteversion. It is common practice to
obtain an estimate of the angle of anteversion by taking a lateral
X-ray looking inwardly from the side of the patient and then
viewing the X-ray to obtain an estimate of the angle of
anteversion. The drill 47 would then be held at the estimated angle
in order to follow the axis of the trochanter.
The surgeon will then loosen the thumb screw 55 to adjust the
aiming pin 33 in the passage 53 such that the projecting extremity
projects over the target 43. The surgeon will then align the aiming
pin 33 over the point 111 on the target 43 which corresponds with
the point 103 on the image 105. While maintaining this alignment
and holding the pistol device 31 to maintain the aiming pin 33
generally aligned over the axis 95 of the trochanter, the surgeon
will rotate such pistol device about the aiming pin 33 until the
transverse indicator 31 hangs directly downwardly along the front
side of the vertical leg 57 to thereby assure that the drill guide
slot 35 is aligned vertically under such aiming pin 33. The bone
drill 47 may then be inserted through the drill slot 35 and into a
puncture wound made in alignment with the axis 95 of the trochanter
45 to drill a bore that is aligned directly below the aiming pin
33. The elongated vertical slot 35 enables the vertical location of
the drill 47 to be easily adjusted and the estimated angle of
anteversion to be held.
I have provided an anteversion indicator, generally designated 121,
as shown in FIGS. 5, 6 and 7 for accurately holding the angle of
anteversion during drilling. The anteversion indicator 121 is in
the form of a base plate 123 having a series of bores 125 formed
through the upper extremity thereof for receipt of different sized
bone drills 47. Disposed on the front of the plate 123 is a
pendulum pointer 127 carried from a pivot pin 129. The angle marks
131 are scribed on the front of the plate 123 for indicating the
inclination of the anteversion indicator 121. Consequently, in use
if the angle of anteversion is determined to be 10.degree. the
drill is inserted through one of the bores 125 and then through the
drill guide slot 35 as shown in FIG. 7. The drill 47 will then be
held at the indicated anteversion angle of 10.degree. while the
bore is drilled in the trochanter 45.
An extension, generally designated 135, which may be substituted
for the extension 59 is shown in FIG. 9. The extension 135 includes
a through longitudinal slot 137 for receipt of a guide disc 139.
Formed in the walls of the extension 135 on opposite sides of the
slot 137 are a pair of vertically extending slots defining tracks
141 for receipt of respective hubs 143 projecting from opposite
sides of the disc 139. The disc 139 includes a plurality of
radially extending diametric drill guide bores 145 of different
diameters as shown in FIG. 10. A series of angle indication marks
147 are scribed on the extension 135 and radially extending lines
149 are drawn on the side of the disc 149 in alignment with the
respective bores 145 for cooperation with the marks 147 to
determine if the angle at which a drill extending through one of
the bores 145 is projecting.
Consequently, when the extension 137 is utilized with the pistol
device 31, the drill 47 may be inserted through the bore 145 of the
appropriate size and with the pistol device oriented to have the
aiming pin 33 extending horizontally as indicated by the
longitudinal indicator 71, the angle of the drill projecting from
one of the bores 145 may be determined by noting the degree line
147 with which the line 149 corresponding to the bore 145 through
which the drill extends is aligned.
Referring to FIGS. 11 and 12, a drill jig, generally designated
151, is provided with a plurality of spaced apart parallel
extending guide bores 153 whereby a bore may be drilled in the
trochanter 45 and a pin 155 inserted therein with a portion of such
pin projecting for receipt in one of the bores 153 in the jig 151.
With this arrangement, additional bores may be drilled in the
trochanter 45 in spaced apart relationship and projecting parallel
to the pin 155 by merely inserting the drill in different bores 153
and using such bores as a guide for drilling bores in the
trochanter for receipt of additional pins to thereby enable
installation of a plurality of parallel pins 155 as shown in FIG.
13.
The drill guide apparatus shown in FIG. 14 is similar to FIG. 4
except that the pistol device 31 includes a vertical extension 151
which has the lower end thereof angled inwardly to complement the
shape of the patient's hip.
The extension, generally designated 165, shown in FIG. 15 is
similar to the extension 59 except that it is formed with a
longitudinally extending through slot which slidably receives an
arm 167 that carries a guide disc 139 on the lower extremity
thereof. Extending longitudinally through the arm 157 is a threaded
brake rod which terminates at its upper end in a thumb screw head
171. Consequently, the guide disc 139 may be set at a particular
setting and the brake 171 tightened to hold such disc 139 locked in
the desired position.
Referring to FIGS. 16-20, a fixed shank hip pin guide, generally
designated 175, is provided for holding the angularity of a drill
while drilling a bore for receipt of a fixed shank hip pin,
generally designated 176, as shown in FIG. 20. The guide 175
includes a barrel 177 having a side opening longitudinal slot 179
formed therein for receipt of the guide pin 33. Thumb screws 185
are provided for tightening the aiming pin 33 in place. Extending
at an angle of approximately 135.degree. to the barrel 177 is a leg
187 which has a transverse bore 191 formed therein for receipt of
an indexing pin 193.
The fixed flange hip pin 176 includes a nail 195 that extends at an
angle of 135.degree. from the flange 197.
Installation of the hip pin 176 is similar to installation of the
aforementioned hip pin except that a second target 43' is laid over
the injured groin area prior to the taking of the
anterior-posterior X-ray to produce an X-ray image similar to that
shown in FIG. 19. The aiming pin 33 is again positioned over the
X-ray to extend along the trochanter axis and the flange 187 of the
guide 175 is laid along the lateral side of the femoral shaft 201.
The point at which pin 33 intersects the image of the target 43 is
then marked, as is the point at which the index pin 193 intersects
the target 43'. The guide 175 is then positioned over the patient's
hip and oriented to cause the aiming pin 33 and index pin 193 to
intersect the targets 43 and 43' at the respective points
corresponding with those marked on the X-ray. The passage 53 of the
guide apparatus 31 may then be inserted over the rear extremity of
the aiming pin 33 and such pistol device rotated to align the
transverse indicator 41 with the leg 57 to position the guide slot
35 directly below the aiming pin 33.
A lateral incision may be made along side the upper femoral shaft
201 and a drill 47 inserted through an anteversion angle indicator
121 and through the slot 35 to drill the desired bore in the
trochanter. The drill 47 may then be removed and the nail 195 of
the pin 176 inserted in the resultant bore, it being realized that
the shank 197 will then be disposed at the required angle to lie
along the lateral surface of the femoral shaft 201. Screws may be
inserted through the shanks 197 to hold the pin in place.
While the procedures described hereinabove drastically reduce the
number of X-rays that must be taken during a pinning operation, it
will be appreciated that X-rays may be taken after the operation to
confirm the proper location of the pin installed.
From the foregoing it will be apparent that the drill guide
apparatus of present invention provides an economical and
convenient means for drilling a bore at a desired location in a
trochanter or the like. The bore may easily be located without the
necessity of trial and error drilling and the taking of numerous
X-rays thereby substantially reducing the cost of operation and
also the operating time thereby reducing the risk of contamination
and the patient trauma.
Various modifications and changes may be made with regard to the
foregoing detailed description without departing from the spirit of
the invention.
* * * * *