U.S. patent number 3,822,818 [Application Number 05/367,382] was granted by the patent office on 1974-07-09 for surgical instrument for joining osseous tissues by staples.
Invention is credited to Lev Konstantinovich Bogush, Georgy Sergeevich Kuklin, Viktor Sergeevich Severov, deceased, Sergei Ivanovich Severov, Zinaida Pavlovna Severova, Alexei Alexeevich Strekopytov, Tatyana Andreevna Strekopytova, Naum Aronovich Super-Fainshtein.
United States Patent |
3,822,818 |
Strekopytov , et
al. |
July 9, 1974 |
SURGICAL INSTRUMENT FOR JOINING OSSEOUS TISSUES BY STAPLES
Abstract
A surgical instrument for joining osseous tissue by V-shaped
staples, comprising a bearing stock with a hook carrying a
removable dies with depressions for bending staple legs; a staple
carrier accomodating a staple magazine, said staple carrier being
mounted in the guideways of the bearing stock so as to be moved
freely therealong, and a staple ejector mounted in the staple
carrier so as to move freely therealong the hook of the bearing
stock comprising two component members movable lengthwise relative
to each other permitting them to be disposed at different distances
from the staple magazine, the dies likewise comprising two portions
fixed respective to one of the respective component hook members
and serving as bearing surfaces for the respective legs of the
staple when the legs are being bent. whereby dimensional variations
between osseous tissue being joined is compensated for while the
portions and stabilized while being jointed; and the danger from
trauma due to protruding sharp staple-edges is minimized.
Inventors: |
Strekopytov; Alexei Alexeevich
(Moscow, SU), Strekopytova; Tatyana Andreevna
(Moscow, SU), Bogush; Lev Konstantinovich (Moscow,
SU), Kuklin; Georgy Sergeevich (Kolomna Moskovskoi
oblasti, SU), Super-Fainshtein; Naum Aronovich
(Moscow, SU), Severov, deceased; Viktor Sergeevich
(Moscow, SU), Severov; Sergei Ivanovich (Egorievsk
Moskovskoi oblasti, SU), Severova; Zinaida Pavlovna
(Egorievsk Moskovskoi oblasti, SU) |
Family
ID: |
26988743 |
Appl.
No.: |
05/367,382 |
Filed: |
June 6, 1973 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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333463 |
Feb 20, 1973 |
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117981 |
Feb 23, 1971 |
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Current U.S.
Class: |
227/124;
227/19 |
Current CPC
Class: |
A61B
17/0686 (20130101); A61B 2017/07264 (20130101) |
Current International
Class: |
A61B
17/068 (20060101); B25c 005/02 () |
Field of
Search: |
;227/19,124 |
References Cited
[Referenced By]
U.S. Patent Documents
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3252643 |
May 1966 |
Strekopytov et al. |
3601302 |
August 1971 |
Potekhina et al. |
3692224 |
September 1972 |
Astafiev et al. |
|
Primary Examiner: Custer, Jr.; Granville Y.
Attorney, Agent or Firm: Holman & Stern
Parent Case Text
This is a continuation-in-part application of Application Ser. No.
333,463 filed Feb. 20, 1973 which in turn is a continuation of
Application Serial No. 117,981, filed Feb. 23, 1971, both now
abandoned.
Claims
What is claimed is:
1. A surgical instrument for joining osseous tissues by staples
comprising a back and two legs, comprising: a bearing stock; a hook
at one end of said bearing stock, said hook being disposed
transverse relative to said bearing stock and comprising two
members movable lengthwise relative to each each other; a die
consisting of two portions fixed on the different members of said
hook for respectively bending a staple leg, a surface of said dies
facing the main portion of the bearing stock for contacting osseous
tissue to be stapled, depressions formed in said surface of said
dies, said depressions engaging and contacting the respective legs
of said staples as the same are being bent; a staple carrier freely
mounted on said bearing stock for movement therealong; a staple
magazine fixed on said staple carrier and having a surface facing
said die surfaces, said surface of the staple magazine including
portions for contacting osseous tissue to be stapled in opposition
to said die surfaces; a staple ejector mounted in said staple
carrier and adapted to move therealong, said staple ejector
including means for driving out the staples from said magazine as
said ejector moves toward said hook and as said staple carrier with
said magazine fixed thereon moves along said bearing stock toward
said hook whereby one of the bone fragments to be sutured is
clamped between said magazine surface and one of said die surfaces,
while another bone fragment to be sutured is clamped between said
magazine surface and the other said die portion, means connected to
one of said hook members carrying said die portions fixed thereon
for orienting it at different distances from said staple magazine
portions engaging the osseous tissue being sutured, said die
portions comprising bearing surfaces for the different legs of the
same staple when the legs of said staple are being bent and said
staple is driven out by movement of said ejector relative to said
staple carrier.
2. A surgical instrument according to claim 1, in which said die
depressions have widened portions for insuring initial contact with
the said staple legs.
3. A surgical instrument according to claim 1, in which said hook
member includes means replacably mounting the die portions, said
die surfaces contacting the osseous tissue being inclined relative
to said magazine surface contacting the osseous tissue for
providing the closest possible adherence of said die surfaces to
the osseous tissue.
4. A surgical instrument according to claim 1, in which said die
depressions widen from a bottom center portion toward edges
thereof.
5. A surgical instrument according to claim 3, in which said die
depressions widen from a bottom center portion toward edges
thereof.
6. A surgical instrument according to claim 1, in which said
depressions have a longitudinal section shaped as an arc of the
same radius with a chord, the length of the chord not exceeding
half the width of said staples.
7. A surgical instrument according to claim 3, in which said means
for replaceably mounting said die portions in said hook comprise
slots in said hook members, projections on said die portions
removably received in said slots, pins extending through said
projections and said slots, and spring plates operatively connected
to said pins and said bearing stock for retaining the pins in a
locking position.
8. A surgical instrument according to claim 1, in which said die
portions have projections located at the end of said hook and
extend toward said magazine and include depressions for
respectively receiving one leg of a staple.
9. A surgical instrument according to claim 8, in which on said die
surfaces for contacting the osseous tissue include projecting lugs
for fixing said dies in position with respect to the osseous
tissue.
10. A surgical instrument according to claim 1, in which at least
one of said die portions includes at least four depressions.
Description
FIELD OF THE INVENTION
The present invention relates to medical equipment, and more
particularly to surgical instruments for staple suturing osseous
tissues.
The surgical instrument of this invention may be employed as a
means of suturing ribs, the collarbone, the mandible and other flat
bones.
BACKGROUND OF THE INVENTION
Known in the present state of medical art is a surgical instrument
for staple-joining of osseous tissues, comprising a bearing stock
with an open longitudinal slot and a hook carrying a die or anvil
with depressions for bending staple legs. In an open slot of the
bearing stock there is mounted a staple carrier with a threaded
tailpiece and a fixed handle. The staple carrier is hollow to
accommodate a pusher or ejector with a head, the pusher being
adapted to move lengthwise relative to the staple carrier. Mounted
on the staple carrier is a replaceable staple magazine with staple
slots or recesses, said staple magazine being adapted to receive
the pusher head. The staple carrier is provided with a
screw-and-nut actuator moving along the bearing stock.
While in operation, the instrument is so positioned by the surgeon
so that the hook with the die is located under the bone fragments
being sutured. Further, the surgeon rotates the nut of the staple
carrier actuator to move the staple carrier forward toward the die,
causing the magazine to approach the die and the bone fragments are
clamped between the magazine and the die thereafter, the surgeon
urges the ejector toward the die and the ejector drives the staples
out from the magazine into the clamped bone fragments being
joined.
The two staple legs pierce the osseous tissue and, upon engagement
with die depressions, are deformed, thereby securing the bone
fragments being joined.
The foregoing known instrument, however, potentially give use to
from the following disadvantages:
When suturing bone fragments, both staple legs may be bent or
deformed same length consequently, where the bone fragments being
sutured differed in thickness, the staple leg that pierced the
thinner fragment formed a hook-shaped projection which protruding
beyond the osseous tissue and thus became a potential source of
trauma to adjacent soft tissues, when employed to join adjacent
bone fragments, the prior art instrument did not rule out the
possibility of separation or relative movement, since the design of
the instrument component elements failed to provide means for
positively clamping the bony tissues while staple legs were driven
therethrough and when being bent on the die. As a result, a staple
leg might form a hook with a tapered point protruding beyond the
surface of the osseous tissue and liable to traumatize the adjacent
soft tissues. Moreover, the known instrument failed to provide an
effective suturing of bone fragments of intricate configuration,
such as those of the mandible.
OBJECTS OF THE INVENTION
It is an object of the present invention to provide an instrument
for joining osseous tissues by V-shaped staples of a design that
makes it possible to securely join bone fragments, no matter
whether their thickness is identical or different, and also to join
bone fragments of intricate configuration, with the ends of the
staple legs surely stabilizing the osseous tissue after having
pierced the bone fragments being sutured when the staple legs are
being bent on the die.
Accordingly, there is provided a surgical instrument for stapling
osseous tissues by V-shaped staples, comprising a bearing stock, a
hook at one end of the bearing stock, which hook is positioned
transversely relative to the main portion of the bearing stock, a
die for the staple legs to bend, which die is fixed on said hook
and has a surface facing the main portion of the bearing stock and
intended to be in contact with osseous tissue, depressions on said
flat die intended to be in contact with the legs of said staples as
the legs are being bent, a staple carrier mounted in the bearing
stock and adapted to move therealong, a staple magazine attached to
the staple carrier and having a surface facing said surface of the
die which is intended to be in contact with osseous tissue, a
staple pusher mounted in the staple carrier and adapted to move
therealong, which staple pusher is designed to move toward the hook
and eject the staples out of the magazine, wherein, the improvement
in accordance with the invention, the hook of the bearing stock
comprises two component members movable lengthwise relative to each
other so that they can be set at different distances from the
magazine, and the die is likewise composed of two portions fixed
respectively on the different hook members and serving as bearing
surfaces for the different legs of a staple as the latter is being
bent, and as the staple carrier with the magazine fixed thereon
moves along the bearing stock toward the hook one of the bone
fragments being joined is clamped between the surface of the
magazine and one of the die portions, whereas the other bone
fragment being joined is clamped between the magazine surface and
the other die portion, the hook members carrying the die portions
fixed thereon being adapted to be set at different distances from
the magazine.
It is preferred that the die depressions serving to bend the staple
legs widen within the zone of their initial contact with the staple
legs.
It is further desirable that the die members be replaceable and
their surfaces in contact with osseous tissue slope relative to the
magazine surface in contact with osseous tissue to provide for the
closest possible contact of the die portions with the osseous
tissue.
It is also recommended that the die depressions widen or expand
from the bottom center toward the edges thereof, and that their
longitudinal section be shaped as an arc of the same radius with a
chord not longer than half the width of the staple.
It is also prefered that the die portions be fixed in the hook by
projections formed on the surfaces thereof that are in contact with
the hook so that the projections engage the respective slots on the
surface of the hook of the bearing stock and be kept from
disengaging therefrom by pins whereof the ends are interconnected
with the bearing stock through a spring plate.
The die can be provided with a projection located at the hook end
and having a depression for one of the staple leg to bend.
It is preferred that the die surfaces in contact with osseous
tissue have lugs.
Each of the die portions may have at least four depressions which
enable staple sutures to be obtained featuring different staple
spacings and different slope angles of the staples with respect to
one another.
The design of the proposed instrument permits joining bone
fragments both of identical and different thicknesses as well as
those of intricate configuration, with the staple leg ends
positively transfixing the osseous tissue at bending after having
pierced the bone fragments, thereby ensuring a smooth exposed of
the staple suture and ruling out any possibility of traumatizing
the adjacent soft tissues.
The staple sutures obtained with the instrument of this invention
provide for a secure fixation of the bone fragments being joined
and obviate any possibility of their disjunction or movability
relative to each other, which cuts down the post-operative period
considerably.
Depending on the width of the bone fragments being sutured, the
design of the proposed instrument enables a variety of sutures to
be applied, viz., single-staple; two-staple with various staple
spacings; two-staple with the staples inclined to each other.
Additionally, the use of replaceable and interchangeable dies and
various combinations thereof enables the surgeon to employ the
instrument of this invention to carry out diverse surgical suture
procedures on the collarbone, ribs or intricately configured
mandible.
DESCRIPTION OF THE DRAWINGS
An embodiment of the present invention will now be described, by
way of example, with reference to the accompanying drawings in
which:
Fig. 1 is a general generally schematic side elevation view,
partially broken away, of a surgical instrument for joining osseous
tissues by V-shaped staples, according to the invention;
Fig. 2 is a view, partially cut away, of the bearing stock of the
instrument of FIG. 1, according to the invention;
Fig. 3 is a general plan view of the surgical instrument, according
to the invention;
Fig. 4 is a section through the bearing stock taken on the line
IV--IV of FIG. 2;
Fig. 5 is an elevation of movable member of the hook of the bearing
stock, according to the invention;
Fig. 6 is a section through the staple carrier slot taken on the
line VI--VI in FIG. 2;
Fig. 7 is a pusher of the surgical instrument, according to the
invention;
Fig. 8 is a front elevational view taken along the arrow A of FIG.
7;
Fig. 9 is a fragmentary, horizontal sectional view of the mutual
arrangement of a die, a pusher head osseous tissues being joined
and a staple magazine in the surgical instrument, according to the
invention;
Fig. 10 is a fragmentary, partially broken away, horizontal section
of the staple magazine of the surgical instrument, according to the
invention;
Fig. 11 is an elevational view taken along the arrow B in FIG.
10;
Fig. 12 is a section through the hook-dies at the bearing stock
taken along the line XII--XII in FIG. 1;
Fig. 13 is a section through the bearing stock taken along the line
XIII--XIII in FIG. 2;
Fig. 14 illustrates an on an enlarged scale embodiment of a die of
the surgical instrument with one pair of depressions, according to
the invention;
Fig. 15 is similar to FIG. 14 and illustrates an alternative
embodiment of a die of the surgical instrument with four pairs of
depressions, according to the invention;
Fig. 16 is a section through one die taken on the line XVI--XVI in
FIG. 15;
Figs. 17, 18 19 illustrate different types of staple sutures
obtained with the surgical instrument according to the
invention;
Fig. 20 is similar to FIG. 14 and shows a modification of the die
of the surgical instrument with one pair of depressions, according
to the invention;
Fig. 21 shows diagrammatically in plan the joined bone fragments
with a staple using a surgical instrument, according to the
invention;
Fig. 22 (a, b, c, d, e) respectively are sections taken along the
line XXII--XXII in FIG. 14 showing various combinations of dies in
the surgical instrument, according to the invention.
DESCRIPTION OF PREFERRED EMBODIMENTS
The proposed surgical instrument for joining osseous tissues by
V-shaped staples comprises a bearing stock 1 (FIGS. 1, 2) with a
hook 2 at the end thereof, the hook 2 being positioned transversely
relative to the main portion of the bearing stock 1 (see FIG. 3).
The hook 2 is composed of two members, viz., a movable member 3
(FIG. 3) and a fixed member 4. The movable member 3 is free to move
lengthwise relative to the bearing stock and, inter alia, the fixed
member 4, in guideways 5 (FIGS. 2, 4) of the bearing stock 1.
The movable member 3 (FIG. 5) has a stem 6 with a threaded
tailpiece 7. The threaded tailpiece 7 interacts with a nut 8 (FIGS.
1, 2) located between projections 9 and 10 of the bearing stock 1,
which projections 9 and 10 prevent the nut 8 from moving
lengthwise. Rotation of the nut 8 causes the movable member 3 (FIG.
3) to move along the bearing stock 1 relative to fixed member
4.
The bearing stock 1 also has an open longitudinal slot 11 (FIGS. 2,
6) in which a staple carrier 12 (FIG. 1) is mounted.
A lateral handle 13 is attached to the bearing stock 1 (FIGS. 1,
3)
The staple carrier 12 has a longitudinal through hole 14 (FIG. 1)
housing a pusher 15 (FIGS. 1, 7). The pusher 15 is free to move
lengthwise along the staple carrier 12 (FIG. 1) in the longitudinal
through hole 14.
The pusher 15 has a head 16 (FIGS. 1, 7, 8) designed to drive the
staples out from a magazine 17 (FIG. 1), the latter mounted on the
head 16 of the pusher 15 (FIGS. 1, 9).
The surface of the magazine 17 which faces the hook 2 (FIG. 1) is
intended to be in contact with osseous tissue while the suturing
proceeds.
The magazine 17 is also fixed on the staple carrier 12 by means of
a flat spring 18 with a clamp 19 at the end thereof.
The flat spring 18 is anchored on the staple carrier 12 by a screw
20. The terminal lip 19 of the flat spring 18 enters through a hole
21 (FIGS. 1, 10) in the magazine 17 into a recess 22 (FIGS. 1, 7)
formed in the head 16 of the pusher 15, thereby clamping together
the magazine 17 (FIG. 1), the pusher 15 with the head 16 and the
staple carrier 12.
A slide 23 is fitted onto the flat spring 18 (FIGS. 1, 3), which
slide 23 is free to move along the spring 18, interacting, while
moving, with a sloping cam surface 24 (FIG. 1) of the staple
carrier 12, with the result that either the flat spring 18 is
lifted, drawing the lip 19 out of the recess 22 and the aperture 21
of the magazine 17 to release the magazine 17 and the pusher 15, or
to permit the flat spring 18 to lower, causing the lip 19 to clamp
together the pusher 15 with the head 16, the staple carrier 12 and
the magazine 17 in a manner described above. The magazine 17 has
projections 25 (FIGS. 1, 10) intended to be in contact with grooves
26 (FIGS. 1, 4) of the bearing stock 1, which grooves 26 serve as
guideways for the magazine 17 (FIG. 1) as it moves along the
bearing stock 1.
The magazine 17 has slots 27 (FIGS. 9, 10) to hold V-shaped staples
28 (FIGS. 9, 10).
The magazine 17 has a hole 29 (FIGS. 3, 10), so that the magazine
17 can be visually observed for the presence of staples therein and
the fracture zone is observed when osseous tissues are being
sutured. The suturing zone is observed at an angle to the
instrument as indicated by the arrow C in FIG. 1.
The staple carrier 12 incorporates a tailpiece 30 provided with
both a right-hand and a left-hand thread over the entire length
thereof. Screwed onto the tailpiece 30 is a nut 31 (FIGS. 1, 3)
with a left-hand thread, which nut 31 has a stem 32 interacting
with the flanged edges 33 (FIG. 3) of the bearing stock 1, said
flanged edges 33 preventing the nut 31 from moving lengthwise along
the bearing stock 1. Rotation of the nut 31 urges the staple
carrier 12 along the bearing stock 1 in the longitudinal slot 11
(FIG. 2). Also screwed onto the tailpiece 30 (FIG. 1) is a handle
bar 34 having a bush 35 with a right-hand inside thread. The handle
bar 34 has a stem 36 attached to a handle 37 of the handle bar and
disposed in coaxial relation to the bush 35 of the handle bar 34.
The stem 36 is inserted into the longitudinal through hole 14 of
the staple carrier 12. As the handle 37 of the handle bar 34 is
turned the handle bar 34 is screwed onto the tailpiece 30, urging
with its stem 36 the pusher 15 toward the hook 2 of the bearing
stock 1 along the staple carrier 12.
The instrument of this invention also comprises a die for bending
the staple legs, which die is composed of two portions 38 and 39
(FIG. 3). The die portion 38 is held on the movable member 3 of the
hook 2 of the bearing stock 1, whereas the die portion 39 is held
on the fixed member 4.
The die portions 38 and 39 are replaceable and are held on the
fixed member 4 and the movable member 3 by means of projections 40
(FIG. 12) engaging the respective slots formed in the movable
member 3 and fixed member 4. The die portions 38 and 39 are secured
in the slots of the movable member 3 and the fixed member 4 by
means of pins 41. The pins 41 are attached to the hook 2 (FIG. 1)
by spring plates 42, whereof one end of each is attached to the
respective pin 41 and the other end engages the respective slot 43
(FIGS. 1, 13). The die portions 38 and 39 (FIGS. 12, 14) have
depressions 44 (FIGS. 12, 14) on the surfaces thereof which face
the main portion of the bearing stock 1 (FIG. 1) and which are
intended to be in contact with osseous tissue, said depressions 44
serving to bend the staple legs so that the depression 44 on the
die portion 38 serves to bend one staple leg, while the depression
44 on the die portion 39 serves to bend the other leg of that same
staple.
The die may have both a single pair of depressions 44 ensuring the
bending of the legs of a single staple, as indicated in FIG. 14, or
a plurality of pairs of depressions 44 ensuring the bending of a
plurality of staples. In the latter case, as illustrated in FIG.
15, the depressions 44 are formed in die portions 45 and 46 held on
the members 3 and 4. The die portions 45 and 46 are mounted flush
with surfaces 47 of the members 3 and 4, as indicated in FIG. 16.
The die portions may have projections, if same is required, which
projections, located at the end of the hook 2, extend outward
beyond the surface 47 (the die portions 38 and 39 in FIG. 14),
which will be seen with respect to the die portion 39 in FIG. 1. In
such a case the depressions are formed in the protruding portions
of the dies.
Such a design of the die ensures tight adherence of the die
depressions to the surface being joined if the latter has an
intricate configuration, such as a jaw.
Ribs and the collarbone should be preferably sutured with the use
of the die modification of FIG. 15 having at least four pairs of
depressions 44. This particular embodiment of the die affords a
variety of sutures (FIGS. 17, 18, 19) and permits variations in
both the number of staples 28, which join bone fragments 48, and
their spacing and slope angle relative to one another, depending on
the size and shape of the bone fragments 48.
To this end, a required number of staples are loaded in the
magazine 17 (FIG. 11), the slots 27 with sloping guiding walls
providing means for the staples to be positioned both parallel and
at an angle relative to one another, which affords the types of
sutures shown in FIGS. 17, 18 and 19.
The head 16 (FIG. 8) of the pusher 15 may be fitted with
projections 49 engaging the respective slots 27 (FIG. 11) of the
magazine 17 as the staples are being ejected. Alternatively, the
pusher head may be made without these projections (not shown in the
drawings), in which case, while the staples are being ejected, the
pusher head is in contact only with the middle portion of the
staple back edge.
To fix the die in position relative to osseous tissue, it is
expedient to provide lugs 50 on the surface thereof intended to be
in contact with osseous tissue (FIGS. 1, 14).
It is expedient that within the zone of initial contact with the
staple legs the depressions should be widened at their outer ends,
such as depressions 51 in FIG. 20, which ensures that the staple
legs do not miss the depressions in suturing.
To make the die portions 38 and 39 (FIG. 14), as well as the die
portions 45 and 46 (FIG. 15), interchangeable, their depressions 44
should be made widening from the bottom center toward the edges
thereof, which ensures that the staple legs do not miss the
depressions in suturing.
The depression 44 have the shape of an arc in the longitudinal
section thereof, said arc having the same radius R (FIG. 12) with
the chord D whose length does not exceed half the width of the
staple, which ensures that in suturing the leg ends of the staple
28 positively transfix the bone fragments 48 when the staple legs
are being bent, as indicated in FIG. 21.
Surfaces 52 (FIG. 9) of the die portions 38 and 39, that are in
contact with the bone fragments 48, may be made both straight or
sloping so as to ensure that the die portions 38 and 39 tightly
adhere or clamp to the bone fragments 48.
Since the die portions 38 and 39 are replaceable, various
combinations of configurations of their surfaces 52 in contact with
the bone fragments 48 may be selected, as is shown in FIG. 22 (a,
b, c, d, e), which feature enables one and the same instrument to
be employed for suturing bone fragments of a variety of
configurations.
OPERATION
The operation of the proposed surgical instrument for
staple-suturing of osseous tissues is as follows:
The corresponding combinations of the die portions 38 and 39 (FIGS.
3, 14) or 45 and 46 (FIG. 15), depending on the configuration of
the bone fragments to be sutured, are set on the movable member 3
(FIG. 3) and the fixed member 4 of the hook 2 of the bearing stock
1 of the instrument.
The magazine 17 (FIG. 1) loaded with a required number of staples,
is set on the instrument and fixed thereon by the flat spring 18
and the grooves 26 of the bearing stock 1.
The fixed member 4 (FIG. 9) is brought under one of the bone
fragments 48 to be sutured, which is then fixed in position by
being clamped between the die portion 39 and the magazine 17. To
this end, the nut 31 (FIG. 1) is rotated to urge the staple carrier
12 with the pusher 15 and the magazine 17 fized thereon forward
toward the hook 2 of the bearing stock 1.
Then the other bone fragment is brought to the bone fragment 48
(FIG. 9) clamped in the instrument, the two fragments are
juxtaposed and then the former fragment is forced against the
magazine 17 by the die portion 38 fixed on the movable member 3.
The movable die portion 3 is moved by rotating the nut 8 (FIG. 1).
What with two hook members movable relative to each other, viz.,
the movable member 3 (FIG. 9) and the fixed member 4, bone
fragments differing in thickness may be juxtaposed and fixed in the
instrument.
The bone fragments having been fixed in the instrument, the handle
bar 34 is screwed onto the tailpiece 30 (FIG. 1) of the staple
carrier 12, said handle bar, while rotating, urging with its stem
36 the pusher 15 toward the hook 2.
While moving forward, the pusher 15 forces the back edges of the
staples 28 (FIG. 9) loaded into the magazine 17 and drives them
forward toward the bone fragments 48 being sutured, said bone
fragments 48 being positioned between the die portions 38 and 39
and the magazine 17.
The staples 28, while moving along the slots 27 of the magazine 17,
pierce the bone fragments 48 with their ends and, having thrusted
against the die depressions 44, get bent.
When being bent, the leg ends of the staples 28 come out of the die
depressions 44 and transfix the bony tissue from the reverse side,
as is shown in FIG. 21, thus providing a staple suture with the
parts of the staple protruding from the bony tissue having a smooth
surface free from any sharp irregularities, that is to say, the
staple suture has a smooth contour, which prevents injuring or
irritating the adjacent tissues and organs.
Finally, by rotating the nut 31 (FIG. 1) counterclockwise, the
magazine 17 is drawn off the sutured osseous tissues, and the
surgical instrument is withdrawn from the operation zone.
* * * * *