U.S. patent number 3,759,252 [Application Number 05/296,332] was granted by the patent office on 1973-09-18 for apparatus for hip dislocation treatment.
Invention is credited to Seymour S. Berman.
United States Patent |
3,759,252 |
Berman |
September 18, 1973 |
APPARATUS FOR HIP DISLOCATION TREATMENT
Abstract
Apparatus for hip dislocation treatment adapted for positioning
and securing the bones of the leg and hip of an individual patient
in a selected relative position for immobilizing said bones during
a healing period. The apparatus comprises a cradle shell for
cradling the patient's body; a first support bar for engaging the
individual about the underneath side of the individual's knees so
as to support the patient's legs at a fixed elevation, said first
support bar being positionally adjustable to select the degree of
flexion of the individual's legs relative to his trunk; and an
adjustable support yoke assembly for engaging about the top side of
the patient's leg to anchor the leg in a fixed degree of abduction
and to anchor the leg in said degree of flexion and abduction.
Inventors: |
Berman; Seymour S. (Los Altos,
CA) |
Family
ID: |
23141586 |
Appl.
No.: |
05/296,332 |
Filed: |
October 10, 1972 |
Current U.S.
Class: |
602/19; 5/603;
5/621 |
Current CPC
Class: |
A61F
5/04 (20130101); A61F 5/0193 (20130101); A61F
5/01 (20130101) |
Current International
Class: |
A61F
5/04 (20060101); A61F 5/01 (20060101); A61f
005/00 () |
Field of
Search: |
;128/70,68,71,72,73,74,80,83 ;5/68 ;269/328 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Claims
I claim:
1. An apparatus for hip dislocation treatment, said apparatus
comprising, in combination:
a body-support platform for supporting an individual patient in a
supine position, the body-support platform forming a leg-support
region and a back support region;
a knee support structure projecting at an elevated position over
the platform and laterally across the platform above said
leg-support region for supporting the knees of said patient at a
desired elevation and angle relative to the individual's hip joint
and for restricting hip motion in flexion and leg motion in one
rotational direction, said knee support structure means including a
first column support means having at least one support column
engaged about one end to the platform and about the other end to a
knee support bar projecting laterally over the leg-support region
of the platform; and
an adjustable yoke assembly supported over the platform at an
elevated position, the yoke assembly including a second support
column means having at least one support column projecting
vertically from the platform and engaged to a lateral member
projecting laterally over the platform, a yoke engagement means
coupled to said lateral member and projecting from said lateral
member for engagement about the top side of the leg to restrict hip
motion in flexion and leg motion in the other rotational
direction.
2. The apparatus of claim 1 in which the first column support means
includes a support column engaged about one lateral side of said
leg-support region of the platform, said support column being
engaged about one terminal end to a first pivot-lock assembly means
to interconnect said support column and the platform, said support
column being pivotable about the engaged pivot-lock assembly in a
plane normal to the plane of the platform, said pivot-lock assembly
including lock means to lock said support column in a selected
angular position.
3. The apparatus of claim 2 in which the pivot-lock assembly of the
knee support structure includes a female bushing integral with the
platform, a fastening bolt coaxial with and lockable to said
bushing, said bolt carrying a shoulder adjacent the head of the
bolt for receiving the column, said column being pivotable about
said shoulder.
4. The apparatus of claim 2 in which the knee support structure
includes a traveler engaged to said support column of the first
column support means, said traveler interconnecting the associated
column and said knee support bar, the position of said traveler
along said column being adjustable.
5. The apparatus of claim 4 in which the knee support structure
includes a lock fastener means for locking said travelers in
position of engagement to the associated column.
6. The apparatus of claim 1 in which the second column support
means of the yoke assembly includes a support column engaged about
one lateral side of the platform with said support column engaged
about one terminal end to a second pivot-lock assembly means to
interconnect said support column of the second column support means
and platform, said column of the second column support means being
pivotable about the second pivot-lock assembly means in a plane
normal to the plane of the platform, said second pivot-lock
assembly means including lock means to lock said support column in
a selected angular position.
7. The apparatus of claim 6 in which the second pivot-lock assembly
of the yoke assembly includes a female bushing integral with the
platform, a fastening bolt coaxial with and lockable to said
bushing, said bolt carrying a shoulder adjacent the head of the
bolt for receiving the engaged column, said engaged column being
pivotable about said shoulder.
8. The apparatus of claim 6 in which
the yoke assembly includes a traveler engaged to said support
column of the second column support means, said travelers
interconnecting the associated column and said lateral projecting
member, the longitudinal position of said traveler along said
column being adjustable.
9. The apparatus of claim 8 in which the yoke assembly includes a
lock fastener means for locking said traveler in position of
engagement to the associated column of the second column support
means.
10. The apparatus of claim 9 in which
the yoke assembly further includes at least one yoke projecting
from the lateral member, said yoke being interconnected to said
lateral member by means of a ball-and-socket coupling to permit
said yoke to be polar positioned and rotated about its own
axis.
11. The apparatus of claim 10 in which the yoke assembly includes a
traveler coupled to said lateral member and to said yoke, the
traveler being slideable along said lateral member, and lock means
for locking said traveler in place to said lateral member at a
select position.
12. The apparatus of claim 11 in which said traveler is rotatable
about the axis of the lateral member, and keying means for keying
said yoke assembly traveler to said lateral bar in a desired
relative angular position.
13. The apparatus of claim 1 in which
the body-support platform carries an opening about the bottom side
to permit access to the perineal region of the individual supported
on said body-support platform, and door means for opening and
closing said opening.
14. The apparatus of claim 5 further including an inclined platform
means positioned in the leg support region of the body-support
platform for establishing a seat support for the buttocks and
thighs of the individual while maintaining a selected degree of hip
flexion.
15. The apparatus of claim 14 in which
the inclined platform means includes means for adjusting the angle
of incline and means for adjusting the length of the platform.
16. The apparatus of claim 14 in which
the body-support platform carries an opening about the bottom side
to permit access to the perineal region of the individual supported
on said body-support platform;
door means for opening and closing said opening, said inclined
platform means being engaged to said door means to facilitate
removal of said inclined platform from engagement with the
patient.
17. The apparatus of claim 1 further including
a support frame means for supporting the body-support platform in
an elevated position, the support frame means including a first
subframe engaged about said leg-support region of the body-support
platform and a second subframe engaged about said back-support
region of the body-support platform, the elevation of said first
and second subframes being adjustable to vary the elevation of said
leg-support region relative to said back-support region.
18. The apparatus of claim 17 further including
a third subframe engaged intermediate said first and second
subframes, said first subframe being pivotable relative to said
third subframe and said second subframe being pivotable relative to
said third subframe.
19. The apparatus of claim 18 in which
said first subframe includes a pair of frontal column means engaged
to said leg-support region of the body-support platform and
interconnected with said third subframe, said frontal column means
being pivotable relative to the body-support platform.
20. The apparatus of claim 19 in which
said second subframe includes a pair of back support column means
engaged to said back support region of the body-support platform
and interconnected with said third subframe, said back support
column means being pivotable relative to the body-support
platform.
21. The apparatus of claim 14 in which
said first column support means of the knee support structure
includes a support column engaged about each lateral side of said
leg-support region of the body-support platform, each of said
support columns being engaged about one terminal end to a first
pivot-lock assembly means to interconnect said engaged support
column and the platform, each of said columns being pivotable about
the engaged pivot-lock assembly in a plane normal to the plane of
the platform, each of said pivot-lock assemblies including lock
means to lock said support column in a selected angular position;
and
the second column support means of the adjustable yoke assembly
includes a support column engaged about each lateral side of the
platform with each of said support columns engaged about one
terminal end to a second pivot-lock assembly means to interconnect
said support columns of the second column support means and
platform, each of said columns of the second column support means
being pivotable about the second pivot-lock assembly means in a
plane normal to the plane of the platform, each of said second
pivot-lock assembly means including lock means to lock said support
columns in a selected angular position.
22. The apparatus of claim 21 in which
the first pivot-lock assemblies of the knee support structure and
the second pivot-lock assemblies of the yoke assembly each include
a female bushing integral with the platform, a fastening bolt
coaxial with and lockable to said bushing, said bolt carrying a
shoulder adjacent the head of the bolt for receiving the engaged
column, said engaged column being pivotable about said
shoulder.
23. The apparatus of claim 21 in which
the knee support structure includes a traveler engaged to each of
said support columns of the first column support means, said
traveler interconnecting the associated column and said knee
support bar, the position of each of said travelers along each of
said columns being adjustable; and
the yoke assembly includes a traveler engaged to each of said
support columns of the second column support means, said travelers
interconnecting the associated column and said lateral projecting
member, the position of each of said travelers along each of said
columns being adjustable.
24. The apparatus of claim 22 in which
the knee support structure includes a first lock fastener means for
locking said travelers of each of said support columns of the first
column support means in position of engagement to the associated
column;
the yoke assembly includes a second lock fastener means for locking
said travelers of each of said support columns of the second column
support means in position of engagement to the associated column of
the second column support means.
25. The apparatus of claim 24 in which
the yoke assembly further includes a yoke means for engagement
about the top and sides of each of the patient's legs, said yoke
means projecting from a traveler coupled to the lateral member and
slideable along said lateral member, said yoke means being
interconnected to said traveler by means of a ball-and-socket
coupling to permit said yoke to be polar positioned relative to
said body-support platform and rotated about its own axis, and lock
means for locking said traveler in place to said lateral member at
a selected position.
26. The apparatus of claim 25 in which
the body-support platform carries an opening about the bottom side
to permit access to the perineal region of the individual supported
on said platform;
door means for opening and closing said opening, said inclined
platform means being engaged to said door means to facilitate
removal of said inclined platform from engagement with the patient.
Description
BACKGROUND OF THE INVENTION
The present invention relates to an orthopedic device and more
specifically to an apparatus for aiding in the treatment and
healing of hip dislocations of an individual.
Dislocation of the hip is a common ailment suffered by infant
individuals. In some instances hip dislocation is accompanied by
hip dysplasia. Frequently an infant suffers from hip dislocation
occuring before, during or shortly following birth. With newborn
and young children, non-surgical treatment is conducted by
manipulation of the bones, under anesthesia, to place the head of
the femur in the acetabulum and then anchoring the bones in said
set position by the use of plaster casts. The set position is
maintained during a healing period of approximately four to 6
months.
The hip is a "ball and socket" joint, such that the applied cast
generally encompasses a very large portion of the patient's body so
as to limit leg motion in flexion and extension, and sometimes in
rotation. The cast frequently extends from the patient's rib cage
to the proximity of the knees. The cast is set by the attending
physician or nurse so as to establish the patient's hip in a fixed
flexion position, in a fixed abduction-adduction position and to
restrict flexion and abduction-adduction movement during the
healing period. In some instances it is necessary to affix a rigid
bar between the patient's ankles so as to restrict rotation of the
femur during the healing period.
The use of casts to aid in treatment of hip dislocation and
dysplasia poses various shortcomings and inconveniences to patients
and the patient's attendants. The use of the casting process
dictates that the initially selected position of the bone be done
with a high degree of care and that the cast be carefully applied
so as not to disturb the selected position. Once the cast is
applied it assumes a permanent position, and once applied it does
not allow for adjustments of the relative bone position.
Accordingly, initial application of the cast requires that the
bones be retained in a precise desired set position. This requires
considerable skill. Not only must the persons applying the cast
possess and exercise a great deal of skill in selecting the bone
position, but they must possess and exercise a great deal of skill
in supporting the bones in the selected position during application
of the cast. Misalignment of the relative position of the bones
during the difficult casting process requires tedious removal and
replacement of the cast to support the bones in the adjusted reset
position. Due to the long period of time involved in the casting
process, and due to the need to maintain cooperative patient
immobility, anesthesia must be employed in babies and children
thereby adding an element of risk to the patient care process.
Since setting the hip joint is must faster with the present
invention, the need for anesthesia is minimized, if not completely
eliminated.
Immediately following the casting, the physician frequently desires
to obtain a confirming x-ray of the hip region. Also, the attending
physician frequently needs to take x-ray pictures of the hip during
the healing period in order to monitor its healing progress and to
determine the desirability of resetting the relative position of
the femur and the acetabulum. The cast offers inconvenience in
taking such x-rays, increases the x-ray dosage that must be imposed
upon the patient and degrades the quality of the resulting x-ray
picture.
Discharge of body waste is of key concern during the period the
patient wears the cast. The cast must be designed to include
openings about the patient's perineal region to permit the release
or urine and feces. Even with said openings in the cast,
cleanliness of the patient's body and the cast about the perineal
region is difficult to maintain. This cleanliness problem together
with the need to cleanse and aerate the patient's skin beneath the
cast requires cast removal and recasting, sometimes as often as
every thirty days. Further, as the infant patient increases in size
during the healing period it may become necessary to periodically
remove the cast and replace it.
Further, the cast adds considerable weight and makes the patient's
body difficult to lift, carry and transport by the attendant caring
for the patient.
The present invention provides an appliance adapted to overcome, at
least in part, all of the above mentioned shortcomings of
casts.
SUMMARY OF THE INVENTION
The present invention provides an improved apparatus for aiding in
the treatment of hip dislocation and its possible accompanying hip
dysplasia. The apparatus is adapted to provide a portable
orthopedic appliance for supporting a patient and the patient's hip
and leg bones in any of numerous selected positions over an
extended period of time. The apparatus is adapted to avoid the need
for casts and to provide readily adjustable means for adjusting the
relative support position within broad dimensional ranges at any
time during the healing period. Continuous visual monitoring of the
patient's body and skin surface during the healing period is
readily facilitated. Further, the patient may be easily removed
from and replaced in the apparatus. The apparatus is adapted to
provide assurance that the same relative position of the patient's
leg bones are retained after the patient is replaced in the
apparatus. The patient may be transported while positioned in the
apparatus. The apparatus is further adapted to permit change of the
patient's diapers without disturbance of the set bones.
The apparatus includes a support cradle adapted to support the body
of the individual in a relatively supine position and to secure the
hip and thigh bones in a set fixed position. The fixed positioning
of the femur relative to the hip joint's acetabulum is provided
from outside the body by means of polar positioning to obtain hip
and knee flexion combined with linear transverse positioning for
hip and knee abduction. The apparatus includes an adjustable
elevated horizontal support means engaged to the cradle and adapted
to provide support beneath the patient's knees to maintain the
thighs in elevation at a predetermined relative fixed flexion
position. It also includes an adjustable angled support means
engaged to the cradle and adapted to provide support beneath the
patient's thighs. The apparatus also includes a first adjustable
elevated projecting arm means positioned above the patient's body
for engagement with the patient's thighs to adjustably support the
relative abduction-adduction position of the patient's legs. It may
include a second adjustable elevated projecting arm means
positioned above the patient's lower legs for positional engagement
with the tibia to adjustably restrict the relative rotational
position of the hip joint. The cradle further includes opening
means about the patient's perineal region to readily permit
changing of clothing and cleansing of the patient's body due to
discharge of urine and feces. Said changing and cleansing may be
conducted without disturbance of settings of the patient's hip,
thigh and leg bones, and to permit unobstructed x-ray photographing
of the hip region.
The apparatus is adapted to permit the attending physician to
continuously monitor the healing process, to take x-ray pictures
when desired without removing the patient from the fixed position
and to alter and adjust the position settings as desired during the
healing process. The apparatus is further adapted to permit the
patient to be removed from and replaced in the apparatus as desired
by the attendant. The patient may be removed and replaced without
disturbance of the predetermined position setting or adjustment of
the setting. The apparatus may further be of a compact design to
permit the attendant to readily transport the patient as desired
while the patient is positioned in the apparatus.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a hip treatment apparatus of the
present invention illustrating an infant patient in place;
FIG. 2 is a side view of the apparatus of FIG. 1;
FIG. 3 is a top view of the apparatus of FIG. 1;
FIG. 4 is a side view of the cradle shell of the apparatus of FIG.
1 with access doors released;
FIG. 5 is a sectional end view of a lock assembly of the projecting
arms of the apparatus;
FIG. 6 is a side view of the lock assembly of FIG. 5;
FIG. 7 is a plan view of a traveler assembly of the apparatus of
FIG. 1;
FIG. 8 is a perspective view of a yoke hold-down assembly of the
apparatus;
FIGS. 9 and 10 illustrate the cradle shell of the appliance of FIG.
1 in various relative elevated positions; and
FIG. 11 illustrates a perspective view of the adjustable seat
platform of the apparatus of FIG. 1.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to the drawings, FIGS. 1-3 depict a hip dislocation and
treatment apparatus referred to by the general reference character
1, adapted for use by a small child suffering from hip dislocation.
The apparatus is adapted for positioning and anchoring a patient's
femur relative to the hip joint's acetabulum and to provide a
padded couch-like structure for long-term and round-the-clock use.
The apparatus is portable and may be carried by the patient's
attendant while the patient is supported in position. The apparatus
thus simultaneously functions as an orthopedic appliance, cradle
and chair during the healing period.
The apparatus 1 comprises a pivotable removable support frame 3 for
supporting a body-support platform 5 in an elevated position
relative to a reference plane, e.g., floor or table. The frame 3 is
combined of three rigid subframes A, B, and C capable of pivoting
relative to one another while subject to limiting angular and
lateral movement constraints. The frame 3 carries a pair of front
vertical support columns 7 and 9 respectively, engaged to a pair of
corner bosses 11 and 13; and a pair of rear vertical support
columns 15 and 17 respectively engaged to a pair of corner bosses
19 and 21 adjacent the back end of the platform 5. The front
columns 7 and 9 and rear columns 15 and 17 are pivotable about
their respective bosses. The subframe A includes the front vertical
support columns 7 and 9. The columns 7 and 9 are each fixed at
opposite ends and at right angles to a lateral base member 23. A
pair of pivot assemblies 25 and 27 are engaged adjacent the corners
of the columns 7 and 9 to permit the subframe A to be pivoted about
the axis of the lateral base member 23. The pivot assemblies 25 and
27 each include a rectangular-shaped anchor member 29. The member
29 carries a pair of longitudinally extending apertures 31 and 33.
The brace 23 is engaged within the apertures 31 to permit the
columns 7 and 9, and brace 23 to be pivoted about the axis of the
brace 23.
The subframe B is a stationary subframe comprising a pair of
parallel longitudinal members 35 and 37 interconnected at opposite
ends by a pair of lateral parallel base members 39 and 41. The
lateral member 39 is engaged within the apertures 33 of the pivot
assemblies 25 and 27. The pivot assemblies 25 and 27 each carry a
pair of set screws for impinging on the lateral brace 39 and
locking it in place. The pivot assemblies 25 and 27 each further
carry a skid-resistance foot 45 to permit the framing to be placed
on a smooth surface. The subframe B is further engaged to a pair of
stabilizer-pivot assemblies 47 and 49. Each assembly 47 and 49
includes a rectangular-shaped anchor member 51 possessing two
laterally-extending parallel slots 53 and 55 and a pair of set
screws 57 in vertical alignment with the slots 53. The brace 41 of
the subframe B is positioned in the slots 53 and the set screws 57
are adapted to lock the brace 41 in place.
The subframe C is pivotable about the bosses 19 and 21 of the
platform 5 and the stabilizer-pivot assemblies 47 and 49. The
subframe C includes the rear vertical columns 15 and 17. The
columns 15 and 17 are integral with a lateral support member 59
engaged to a pair of support feet 61 and 63 which clamp on the
member 59. A pair of longitudinal braces 65 and 67 are integral
with the columns 15 and 17 and extend at right angles relative to
said columns. The braces 65 and 67 are interconnected by a lateral
brace 68. Opposite ends of the brace 68 are engaged about the
aperture 55 of the pivot assemblies 47 and 49. The brace 68 may be
pivoted about its axis and the axis of the apertures 55. The pivot
assemblies 47 and 49 each further include a stabilizer member 69 so
as to provide further lateral stabilization to the braces 35 and 37
of subframe B and braces 65 and 67 of subframe C. Said stabilizer
members 69 further provide restriction of pivot of braces 65 and 67
in a vertical plane by permitting only elevation above the
horizontal. Accordingly, as hereinafter discussed in further detail
and as illustrated in FIGS. 9 and 10, the frame 3 may be pivoted in
various elevational positions with the subframes A and C pivoting
about the subframe B. The stabilizer-pivot assemblies 47 and 49
each further carry a foot pad 70.
The platform 5 is illustrated as comprised of a cradle shell having
a back-support segment 71 for supporting the trunk and back of the
patient in a supine position and a leg-support segment 73 adapted
to support the legs of the patient. The apparatus 1 may be readily
transported by an attendant by grasping the segments 71 and 73 at
their respective ends, suitably recessed for finger gripping.
Transport of the platform may be made with the frame 3 attached or
removed and while the patient is supported by the cradle shell 5.
The back-support segment 71 is integrally engaged to the
leg-support segment 73 at a fixed permanent angle so as to cradle
the patient's body with the buttocks and hip region of the body
positioned to approximately coincide with the apex of the angle.
The cradle shell 5 carries a pair of curved side rails 75 and 77
extending longitudinally along the sides of the back-support
section 71 and portions of the leg-support section 73.
Within the cradle shell 5 is a rectangular opening 79 (see FIG. 3)
extending partially through both the back-support segment 71 and
the leg-support segment 73 of the shell. This opening 79 is
established to coincide with the perineal region of the patient's
body when the patient is supported within the shell cradle 5. A
pivotable access door 83 (see FIG. 4) is engaged to the underside
of the shell 5 for partially closing and opening passage through a
portion of the opening 79 in the segment 71. The door 83 is hinged
to a pivot boss 85 and a hinge-pin 87 extending laterally across
the underside of the back-support segment 71. A pivotable access
door 89 is engaged about the underside of the leg-support segment
73 for opening and closing the passage through the corresponding
portion of the opening 79. The door 89 is hinged by means of a
pivot support boss 91 and a hinge-pin 93 extending the lateral
width of the shell 5 about the leg-support segment 73. Accordingly,
passage through both portions of the opening 79 may be opened or
closed by controlling the opening and closing of the doors 83 and
89, respectively.
To secure the door 83 in place, a boss 95 is engaged to each of the
side rails 75 and 77 about the apex of the angle formed by the
back-support segment 71 and leg-support segment 73. Each of the
bosses 95 carries an aperture 96. The door 83 further carries a
bolt 97 about each lateral side and which bolt is slideable within
a longitudinal guide 99. Accordingly, when the door 83 is
positioned to close the back portion of the opening 79, the bolts
97 are slid within the guides 99 such that the bolts 97 project
within the apertures 96 to lock the door in place. When the door 83
is to be released, the bolts 97 are slid back along the guides 99
such that the end of the bolts are out of engagement with the
bosses 95, thereby releasing the door.
The front door 89 carries a bolt 101 within a guide 102 along each
lateral side. Each of the bolts 101 is adapted for engagement
within an aperture 103 of each of the boss members 95. When the
door 89 is positioned to close the front portion of the opening 89,
it is pivoted such that the bolts 101 may be inserted within the
apertures 103. To release the door 89, the bolts 101 are slid back
along the guides 102 such that the bolts are out of engagement with
the bosses 95.
The cradle shell 5 further carries a pair of anchor bosses 109 for
anchoring a chest strap for securing the patient when the doors 83
and 89 are opened (FIGS. 1, 2 and 3). The anchor bosses 109 extend
longitudinally along the exterior of the side rails 75 and 77 of
the back support segment 71. Each anchor bar 109 carries a
plurality of spaced apertures 111. A threaded bolt 113 projects
through an aperture 111 and is engaged to a wing-nut 115. The
threaded bolt 113 carries an eye 117 in turn engaged to an O-ring
121 positioned within the interior of the shell 5 (see FIG. 1).
Each of the O-rings 121 is engaged to a pliable chest strap segment
123 adapted to be secured about the chest of the patient. The
apertures 111 for engaging the bolts 113 are selected depending
upon the physical size of the patient. Preferably, the bolts 113
are positioned such that the strap 123 will extend beneath the
arm-pits of the patient to support the patient's body from sliding
through the opening 79 when the doors 83 and 89 are released.
Depending on the size of the patient, an auxiliary support plate
125 (see FIG. 3) may be positioned within the back-support region
71 to cover a portion of the opening 79. The plate 125 may be used
when a very small infant patient must be supported when the door 83
is open.
The leg-support segment 73 of the cradle shell 5 includes a knee
support structure referred to by the general reference character
131 for engaging the patient about the underneath side of the
patient's knees so as to support the patient's legs at a fixed
elevation and set degree of flexion. The knee support structure 131
is adapted to be readily positioned to a desired elevation and
angular relationship. Once positioned, it is adapted to retain said
position and restrict motion in flexion of the individual's thigh
in a counter-clockwise direction as viewed in FIG. 2. The knee
support structure 131 includes a pair of pivotable column support
arms 133 and 135 respectively engaged to the side rails 75 and 77
and projecting vertically therefrom. Each of the column support
arms 133 and 135 carries a number of vertically spaced apertures
136 as illustrated in FIG. 1 and 2.
The arms 133 and 135 are each engaged about one terminal end to a
pivot-lock assembly 137. FIG. 5 illustrates a pivot-lock assembly
137 in an enlarged section view and FIG. 6 illustrates an enlarged
side view. The pivot-lock assemblies 137 permit the column arms to
be pivoted within a plane normal to both planes of the platform 5.
For engagement to the side rails 75 and 77 each of the pivot-lock
assemblies 137 include a threaded lock-bolt 139 coaxial with an
axis 140 of an aperture 141 of the arm 133. The lock-bolt 139
carries a smooth-surfaced shoulder 142 about which the arm 133 may
be rotated. A female bushing 143, for receiving and interconnecting
with the bolt 139, is embedded within the side rail of the cradle
shell 5. The bushing 143 carries internal threads for receiving the
lock-bolt 139. The inter-engagement between the head of the
lock-bolt 139, the column-arm 133 and bushing 143 provides for the
locking of the column arm in a select angular position relative to
the plane of the leg-support segment of the cradle shell 5. When
the bolt 139 is loosened within the bushing 143, the column arm 133
is free to pivot about the axis 140 in a plane perpendicular to the
planes of the cradle shell 5. As the bolt 139 is tightened within
the bushing 143, it provides a pressure lock of the arm 133
intermediate the bushing 143 and interior wall of the head of the
bolt 139. With the bolt 139 locked in place the degree of hip
flexion is established.
An angular reference marker 144 is inscribed on the column support
arm 133 adjacent to the terminal end to facilitate in establishing
and recording the angular setting. A circular scale 145 coaxial
with the axis 140 and inscribed with angular markings is carried
adjacent to the bolt 139 and the reference marker 144 to permit
precise relative positioning and selection of the relative angular
position of the column arm along a vertical plane relative to the
plane of the knee support segment 73.
The head of the bolts 139 is smooth and carries a pair of
diametrically-opposed indents 146. The indents 146 are adapted to
receive a wrench to permit control of the adjustments of the bolt
139. Accordingly, once the angular position of the arms 133 is
selected, the bolt 139 is locked in place with a tool designed to
inter-engage with the indents 146. Adjustments of the angular
position may only then be made through use of the tool. Preferably,
the attending physician will retain control of the tool such that
alterations of the positions may only be made under the physician's
control.
A traveler 149 is engaged to each of the column support arms 133
and 135 and is adapted to be positioned at a desired elevation.
Viewing the enlarged view of FIG. 7, the traveler 149 carries a
rectangular shaped slot 151 to permit the traveler to travel along
the associated rectangular-shaped column support arm. The traveler
149 carries an internally threaded aperture 153 extending laterally
through the slot 151. A threaded, removable lock fastener in the
form of a lock bolt 154 is positioned within the aperture 153 such
that when the bolt is tightened, it provides a friction lock about
the column. The lock bolt 154 is adapted such that when loosened,
the traveler 149 may be slid and vertically positioned along the
associated column support arm 133 and 135 to a desired elevation.
The head of the bolt 154 carries a pair of indents 155 similar to
the indents of the head of the bolt 137 such that the bolt 154 may
only be adjusted through use of the special tool. The column
support arms 133 and 135 carry an inscribed millimeter scale 156 to
provide a reference for positioning the elevation of the traveler
149 (see FIG. 6). When the desired elevation is attained, the bolt
154 may be tightened within the threaded aperture 153 to lock the
traveler 149 in place to the associated column arm.
The traveler 149 further carries a laterally projecting channel
157. An aperture 158 extends transversely through the channel 157
to receive a lock pin 159. The lock pin 159 is adapted to extend
through the aperture 158 and the channel 157. The lock pin 159
carries a pair of spring loaded bosses 161 which extend outwardly
to lock the pin 159 in place. The pin 159 further carries a head
163. To remove the pin, an individual exerts end pull on the head
163 thereby causing the bosses 161 to retract and permit the pin to
be released through the aperture 158.
The knee support structure 131 further includes a circular
horizontal knee support bar 171 projecting laterally across the
cradle shell 5. Opposite ends of the bar 171 are engaged to the
travelers 149 on the column support arms 133 and 135 (see FIGS. 3
and 7). The bar 171 carries an aperture 173 adjacent each terminal
end. The apertures 173 are adapted for alignment with the
aperatures 157 of the travelers 149 to receive the pins 159. When
the bar 171 is positioned within the channel 157 and the apertures
158 and 173 are in alignment, the pin 159 may be inserted to lock
the bar in place to the traveler. Accordingly, as provided, the
horizontal bar 171 may be positioned at a desired elevation along
the column support arms 133 and 135 by selecting the elevational
position of the travelers 149 and at a desired angular position by
pivoting the column arms about the lock-bolts 139 to a select
angular position.
A hollow cylinder of fabric-covered-foam 174 surrounds and provides
a cushion on the bar 171. With the patient resting on the cradle
shell 5, the bar 171 engages the patient about the underside of the
patient's knees (see FIGS. 1 and 2). To further support the
patient's legs, a triangular shaped support platform 177 is placed
in position on the leg-support segment 73. The platform 177 is
positioned to support the below-knee region of the patient's leg.
Platform 177 may be comprised of disposable lightweight material,
e.g., foam rubber, styrene, etc., and may be cut to shape by the
attending physician. An additional removably affixed pad 179 is
positioned over the bar 171 and the support platform 177 to provide
further comfort to the patient. Accordingly, the knee support
structure 131 establishes the degree of flexion and restricts
movement of the patient's thighs counter-clockwise as viewed in
FIG. 2.
Fixed to the door 89 and pivotable with it, is an adjustable seat
platform 180. The platform 180 is illustrated in detail in FIG. 11.
The platform 180 is adapted to provide an inclinable surface to
support the patient within the region extending from the patient's
buttocks to his knees. At the same time the platform 180 may be
removed from engagement with the patient by opening the door 89.
The platform is further adapted such that the angle of inclination
may be readily supported to correspond with the angle of flexion
selected by the positioning of the crossbar 171.
Viewing FIGS. 1 and 11, the platform 180 includes a support plate
181 engaged to the door 89 by means of a hinge 182 to permit the
plate to be rotated relative to the plane of the door 89 and the
plane of the leg support segment 73 of the cradle shell 5. An
extension plate 182A is guided by a pair of u-shaped guides 182B
bearing upon the two lateral edges of the plate 181. The extended
position of the plate 182A relative to plate 181 is locked in place
by means of pressure sensitive tape 182C. The plate 182A may be
extended to provide complete thigh-length support of the patient.
The plate 181 is engaged about the back side to a support brace 183
engaged about one terminal end to an anchor 184 by means of a pivot
pin 185. The anchor 184 is in turn secured in place to the rear
surface of the plate 181. The other terminal end of the brace 183
is secured to a slide anchor 186 by means of a pivot pin 187. The
slide anchor 186 is supported within a guide track 188 integral
with the door 89. The track 188 extends longitudinally of the door
89 such that the angle of incline of the plate 181 relative to the
plane of the door 89 may be adjusted to a select angle. The slide
anchor 186 is retained within the guide track 188 by means of a
clamp 189 positioned about the underside of the door 89 and secured
to the slide anchor 186 by means of a threaded fastener 189A. The
fastener pin 189A carries a pair of indents 189B such that the
special tool is required to adjust the tension between the slide
anchor 186 and the clamp 189. Accordingly, to adjust the angle of
inclination of the plate 181, the pin 189A is loosened such that
the guide 186 may be slid along the track 188. Once the desired
angle is realized, the pin 189A is tightened. The platform 181 may
be removed from contact with the patient and pivoted out of the way
simply by releasing the door 89. In position, the fixed platform
177 and adjustable platform 180 establish a pyramid type support
with the apex of the pyramid positioned adjacent the cross-bar 171.
Said pyramid type support may be viewed as a flexion support
platform for supporting the patient in the selected degree of hip
flexion. A pad 189C may be secured over the top surface of the
plates 181 and 182A to provide a cushion for the patient.
An adjustable support yoke assembly referred to by the general
reference character 190 is positioned about the shell cradle 5 for
engaging the thighs of the patient in order to anchor the thighs in
a fixed degree of hip flexion and abduction (see FIGS. 1 and 3).
The support yoke assembly 190 includes a second pair of vertical
support columns 191 and 193 anchored to the sidewalls 75 and 77,
respectively, of the cradle shell 5 about the back support region
71. The columns 191 and 193 are structurally similar to the columns
133 and 135. Each of the support columns 191 and 193 is engaged to
a pivot-lock assembly 195 of similar structure to the pivot-lock
assembly 137 as illustrated in FIGS. 5 and 6. Each column 191 and
193 carries a number of spaced apertures 197 for belt attachment
similar to those at columns 133 and 135. Each of the columns 191
and 193 is engaged to a traveler 199 of similar structure to the
travelers 149 illustrated in FIG. 7.
Protruding laterally from each of the travelers 199 of the support
yoke assembly 190 is a hexagonal shaped arm 201 (see FIGS. 1, 3 and
8). The arm 201 supports a pair of hold-down yoke assemblies 203.
FIG. 8 illustrates an enlarged view of one of the hold-down yoke
assemblies 203. Each hold-down yoke assembly 203 comprises a
traveler 205 adapted to travel over the arm 201. The traveler 205
is adapted to permit the associated yoke assembly to be positioned
laterally and angularly relative to the arm 201. The arm 201
carries an inscribed millimeter scale 210 to provide a reference to
aid in placing the lateral location of the yoke assemblies 203. The
traveler 205 carries an aperture 211 for receiving the cross-bar
201. A slot 212 extends from the aperture 211 to the edge of the
traveler. A fastener in the form of a lock-bolt 213 extends through
the traveler 205 in alignment with the slot 212. The lateral
position of the traveler 205 relative to the arm 201 is controlled
by means of the lock-bolt 213 and a set screw 215. The lock screw
213 carries a pair of indents 216 similar to the indents of the
bolt 139 and 195 such that the special tool is required to make
adjustments of the lateral position of the traveler 205. The
traveler 205 may be rotationally adjusted on the cross-bar 201 and
keyed into rotational position to the cross-bar 201 with a set
screw 215. When the desired lateral position of the traveler 205 is
attained, the lock bolt 213 will lock the traveler 205 in place by
pressure engagement with a surface of the cross-bar.
The traveler 205 further carries an internal conically shaped
socket 217. A threaded pin 219, having a pair of indents 220 at the
head end and a conical concavity at the other end, projects through
a threaded aperture 221 such that the concave tip of the bolt 219
projects to within the socket 217. Within the circular socket 217
is a ball end 223 which in turn is engaged to an arm 225. The arm
225 in turn is engaged to a shoulder 227 integral with a yoke 229.
The yoke 229, illustrated in the form of a u-shaped yoke, carries a
cushion lining about the interior and is adapted to cup the
patient's thigh. Accordingly, the yoke 229 may be swiveled and
adjusted to polar position by turning the yoke 229 with the pin 219
slightly retracted and ball end 223 free to pivot within the socket
221. When the yoke 229 is in the desired polar position, the pin
219 is tightened to lock the ball end 223 in place in the socket
217. The yokes 229 may then be engaged to the patient's thighs, as
illustrated in FIGS. 1 and 2. When so engaged, the yokes 229 secure
the patient's legs in place at the desired degree of abduction as
set by the positioning of the yoke assemblies 203 and at the
desired degree of flexion as established by the knee support
structure 131.
Accordingly, the apparatus 1 provides for three dimensional fixed
positioning of the femur relative to the hip joint's acetabulum
from outside the patient's body. The fixed position is adjustable
and lockable in the adjusted position. The apparatus provides polar
positioning for hip and knee flexion combined with linear
transverse positioning for hip and knee abduction. As illustrated
by FIG. 3, the yoke assembly 190 may be moved in its entirety in
and out of engagement with the patient by removing the pin 159 from
one traveler 149 to free one end of the cross-bar 201. The
cross-bar 201 may then be pivoted about the pin 159 of the other
engaged traveler 149. When so pivoted, the patient may be removed
from the apparatus 1. It may be noted that when the yoke assembly
190 is moved, the positions of the columns 191 and 193 and the
position of the yokes 203 are not disturbed. Thus the preselected
positions may be retained even though the yoke assembly 190 is
removed from engagement with the patient and then placed back in
engagement. When placed back in position, the yoke assembly 190
assumes its preset position. Thus, the patient may be removed,
reinserted, and/or repositioned without loss of the preset
positions.
For the comfort of the patient, a pair of pad segments 231 and 233
are placed over the interior surface of the back support segment 71
(see FIG. 1). The pad 231 is positioned to pivot with the door 83
when it opened (see FIG. 4).
FIGS. 1, 9-10 illustrate various elevational positions which the
apparatus 1 may assume by adjusting the relative positions of the
subframes A, B and C. For illustrative purposes, only the framing 3
and cradle shell 5 are illustrated in the embodiments of FIGS.
9-10. As previously discussed in FIG. 1 the cradle shell 5 is
supported such that the patient may rest in substantially a prone
position. FIG. 9 illustrates the cradle shell 5 in a mid-upright
position from the lying position illustrated in FIGS. 1 and 2. The
cradle shell 5 is urged forward such that subframe A rotates
90.degree. relative to subframe B, and the corner braces 29 and 39
to a horizontal position. At the same time the subframe C rotates
about the common pivot assemblies 47 and 49.
FIG. 10 illustrates the cradle shell 5 in a near direct upright
position. To assume the position of FIG. 10, the rear vertical
columns 15 and 17 of the subframe C are removed from the rear boss
members 19 and 21 and inserted in a pair of bosses 260 located to
the side rails 75 and 77 of the cradle shell 5 and adjacent to the
braces 95.
As illustrated by FIGS. 1, 2 and 3, the apparatus provides for
unobstructed visual and manipulative access to the patient's upper
thighs, buttocks, excretory, lower abdominal and lower back areas
for diapering, hygenic, examination and radiographic purposes. It
permits continuous air circulation about much of the patient's body
and the patient has unrestricted freedom of movement above the
waist and below the knees. The apparatus 1 further provides for
adjustment of the angular and linear positions of the legs during
the healing period. The selected set positions may be readily
calibrated, lock-in place and recorded to aid the attending
physician. The selected positions are relatively tamper-proof since
a special tool is necessary in order to make adjustments. At the
same time, the attending physician may make positional adjustments
if at any time during the healing period such adjustments are
deemed advisable.
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