U.S. patent number 3,835,849 [Application Number 05/327,137] was granted by the patent office on 1974-09-17 for bone clamp and adjustable drill guide.
Invention is credited to George McGuire.
United States Patent |
3,835,849 |
McGuire |
September 17, 1974 |
BONE CLAMP AND ADJUSTABLE DRILL GUIDE
Abstract
A bone clamp for aiding a surgeon in positioning bones and
securing them together and having means for properly orientating
drills so that aligned holes may be drilled through the two bones,
and also having means for locating the screw to be inserted through
the bones to hold them together. One member of the clamp includes a
generally V-shaped portion which can be inserted under the
innermost bone so that the latter can be accurately located with
respect to the guide means for positioning the drills and
screw.
Inventors: |
McGuire; George (Depere,
WI) |
Family
ID: |
23275300 |
Appl.
No.: |
05/327,137 |
Filed: |
January 26, 1973 |
Current U.S.
Class: |
606/96 |
Current CPC
Class: |
A61B
17/1739 (20130101); A61B 17/8866 (20130101) |
Current International
Class: |
A61B
17/16 (20060101); A61B 17/17 (20060101); A61B
17/88 (20060101); A61f 005/04 () |
Field of
Search: |
;128/92EB,92R,92BA,83 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Nilles; James E.
Claims
I claim:
1. A bone clamp for holding two bones together in proper
relationship while drilling said bones and inserting a screw
therein, said clamp comprising, a first member having an elongated
threaded portion and a generally V-shaped bone holding portion
which is offset from said threaded portion, a second member
slidably engaged on said first member and having an elongated
opening therethrough including a central portion which is alignable
with said V-shaped portion, a nut threadably engaged on said
threaded portion for forcing said members toward one another so
that said first and second members clampingly engage said two bones
therebetween with one of said bones being located in said V-shaped
portion, and a pair of drill guide members shiftably mounted in
said opening and selectively shiftable into said central portion in
said opening in alignment with said bones and said V-shaped
portion, said guide members each having an aperture for receiving a
drill for drilling through said bones, and said V-shaped portion
defines a limit of drill travel.
2. The clamp set forth in claim 1 further characterized in that
said guide members can both be shifted in said opening to a
position out of said central portion of said opening after
performing their drill guiding function, and screw means can be
inserted in said central portion of said opening in alignment with
the holes formed by said drills in said bones.
3. The clamp defined in claim 1 further characterized in that said
threaded portion of said first member is non-circular in cross
section, and said second member has an aperture therethrough for
slidably receiving said threaded portion, said aperture being of a
complementary shape to said threaded portion to prevent relative
rotation between said clamp members.
4. The clamp defined in claim 2 further characterized in that said
threaded portion of said first member is non-circular in cross
section, and said second member has an aperture therethrough for
slidably receiving said threaded portion, said aperture being of a
complementary shape to said threaded portion to prevent relative
rotation between said clamp members.
5. A bone clamp for holding two bones together in proper
relationship while drilling said bones and inserting a screw
therein, said clamp comprising, a first member having an elongated
threaded portion and a generally V-shaped bone locating and holding
portion which is offset from said threaded portion, said V-shaped
member terminating in a sharp free end, a generally flat second
member having an aperture for slidable mounting on the threaded
portion of said first member and also having an elongated opening
therethrough including a central portion which is alignable with
said V-shaped portion, a nut threadably engaged on said threaded
portion for forcing said members toward one another to clampingly
engage said two bones between said member with one of said bones
being located in said V-shaped portion, and a pair of drill guide
members shiftably mounted in said opening and selectively shiftable
into said central portion in said opening in alignment with said
bones and said V-shaped portion, said guide members each having a
hole therein for receiving a drill for drilling into said bones,
said V-shaped portion acting as a stop for said drill to limit
drill travel.
6. The clamp set forth in claim 5 further characterized in that
said guide members can both be shifted in said opening to a
position out of said central portion of said opening after
performing its drilling function, and screw means can be inserted
in said opening in alignment with the holes formed by said drills
in said bones.
7. The clamp defined in claim 5 further characterized in that said
threaded portion of said first member is non-circular in cross
section, and said hole in said second member slidably receives said
threaded portion being of a complementary shape to said threaded
portion to prevent relative rotation between said clamp members.
Description
BACKGROUND OF THE INVENTION
The present invention pertains to surgical instruments and more
particularly to a clamp for aiding the surgeon in properly
positioning the bones or bone-like members that must be secured
together during the healing process. In operations of this
character, it is desirable to perform the operation with a minimum
amount of cutting or opening of the patient and yet on the other
hand, sufficient access to the injured area must be had to enable
the surgeon to properly locate the broken or dislocated bones and
hold them in proper relationship while the necessary drilling is
performed on the bones so as to provide holes for the securing
screw to be inserted through the bones. Furthermore, in operations
of this type, it is essential that the drills do not penetrate the
members further than absolutely necessary so as to avoid injury to
nerves, muscles, or other body parts located in the adjacent area.
It is furthermore essential that the required holes be drilled with
precision through the bones to be fastened, so that the screws can
be inserted in the properly aligned holes and precise location of
the bones maintained during the screw fastening operation. Many
bones are generally circular in cross section and consequently, it
is difficult to drill a hole transversely into such a bone and
particularly to have such a hole then properly aligned with the
bone to which it is to be attached.
Another requirement for clamping devices of this character is that
they be capable of being rendered absolutely sterile.
Prior art surgical clamps of this general type have been proposed
but have had several shortcomings, such as the inability to easily
render them sterile and disassembling them for cleaning purposes.
Furthermore, such clamps did not always aid the surgeon in securely
holding the dislocated or broken bones in proper position relative
to one another while drilling the holes therethrough. Furthermore,
it was difficult to then align the holes so drilled during the
screw driving process. Use of these prior art devices sometimes
resulted in improperly drilled holes, either as to location,
direction, or as to the extent of drilling, and consequently damage
to the bones or surrounding tissues or nerves occurred.
An example of a prior art bone clamp for clamping together two
parts of the same bone and providing a drill guide is shown in the
U.S. Pat. No. 2,181,746 issued Nov. 28, 1939 to Siebrandt for
"Combination Bone Clamp and Adjustable Drill Guide" and also in
U.S. Pat. No. 2,200,120, issued May 7, 1940 to Nauth for "Fracture
Nail Guide" for only guiding the nail through two broken parts of a
single bone. Still other examples of prior art bone clamps are
shown in the U.S. Pat. No. 3,477,429 issued Nov. 11, 1969 and U.S.
Pat. No. 2,460,470 issued Feb. 1, 1949.
SUMMARY OF THE PRESENT INVENTION
The present invention provides a bone clamp for holding bones or
the like firmly and correctly together, permitting a hole to be
accurately drilled through bones to be joined and insuring that the
hole being drilled only extends to the proper depth through the
bones and the drill is prevented from extending through the bones
and into surrounding nerves or the like. The clamp also insures
that a counterbore can be accurately drilled in one bone so the
latter can freely accept the threaded portion of the screw while
the other bone is engaged by the threaded portion of the screw. The
clamp also insures proper location of the screw in respect to the
drilled holes during the screwing operation, all this being
accomplished while the bones are accurately held together.
The present invention provides a bone clamp of the above type which
can be inserted into the body and located around the two bones to
be clamped together with a minimum of disturbance of the
surrounding tissues, muscles, nerves, etc.
Furthermore, the improved bone clamp can be easily manipulated
during the operation so as to position guide means for the drill,
the counterdrill and the screw. In addition, the clamp may be
readily removed after the operation with a minimum disturbance to
the surrounding parts.
The present invention provides a combination bone clamp and
adjustable drill guide means of the above type and which finds
particular utility in operations relating to the shoulder area and
more particularly to the coracoid process and clavicle.
These and other objects and advantages of the present invention
will appear hereinafter as this disclosure progresses, reference
being had to the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a bone clamp and drill guide means
made in accordance with the present invention;
FIG. 2 is a plan view of the clamp shown in FIG. 1;
FIG. 3 is an end view of the clamp shown in FIG. 1, certain parts
being shown in section for the sake of clarity; the view being
taken generally along the line 3--3 in FIG. 2;
FIG. 4 is a side elevational view of the clamp shown in FIG. 2, the
view being taken generally along the line 4--4 of FIG. 2;
FIG. 5 is an end elevational view of the clamp shown in FIG. 2, the
view being taken generally along the line 5--5 in FIG. 2;
FIG. 6 is a plan view of the clamp shown in FIG. 1, certain parts
being shown as removed or in section for the sake of clarity in the
drawings and showing the position of the guide means for the
initial drilling;
FIG. 7 is a view similar to FIG. 6, but showing the position of the
guide means in the position for the counter drilling process;
FIG. 8 is a view similar to FIGS. 6 and 7, but showing the guide
means when positioned so as to properly locate the screw which will
hold the body bones or bone-like members together;
FIG. 9 is a perspective view of parts of a human shoulder before
injury;
FIG. 10 is a view similar to FIG. 9 but showing the ruptured
ligaments and the dislocated clavicle;;
FIG. 11 is a fragmentary plan view showing the bones that are to be
fastened together in phantom lines and showing the clamp provided
by the present invention in place and holding the parts firmly
together;
FIG. 12 is a view of the parts shown in FIG. 11, the view being
taken generally from the line 12--12 in FIG. 11;
FIG. 13 is a view similar to FIG. 12, but showing the clamp removed
and the screw in place and holding the body parts together; and
FIG. 14 is a view taken generally along the lines 14--14 in FIG.
13.
DESCRIPTION OF A PREFERRED EMBODIMENT
The clamp C provided by the present invention includes a first
member 1 having an elongated threaded portion of generally square
cross section, the threads 3 being located only in the corners of
the portion 2, that is to say a full thread is not formed in the
portion 2. The first member 1 also includes a lower or inner,
generally V-shaped portion 5 which terminates in a rather sharp end
6 and has a lowermost portion 7 which acts to guidingly receive one
of the bones. The first member 1 also includes an off-set portion
11 which connects the portion 2 with the innermost, V-shaped
portion 5.
The clamp also includes an outer member 13 which is generally flat
and of considerable thickness. Member 13 has non-circular or square
holes 14 and 15 extending therethrough and of a size and shape that
complements the portion 2 of clamp member 1. Thus, member 13 can be
inserted on portion 2 in the square hole 15 in the position shown
in FIG. 1. With the member 13 positioned on member 1 as indicated
in FIG. 1, member 13 cannot turn in respect to member 1 and
consequently extends generally over the V-shaped portion 5 of
member 1. It will be appreciated that arrangement of the parts of
the body are different for the two sides, but with the two holes 14
and 15 in member 13, the member 13 can be used for an operation on
either the left or right side of the body, which a right hand
member, as shown, or reversely extending portions 11 and 5 that
would constitute a left side clamp.
Assume that the operation is to be performed on the right side of
the body, and the drawings have been shown to illustrate such a
situation.
The term "bones" will be used to describe the present invention but
it should be recognized that other bone-like growth, such as for
example, a bony process referred to as coracoid, can be
accomplished with the present invention.
The bones to be secured together, which will be referred to
hereinafter in detail, are thus clamped between members 1 and 2,
and a threaded thumb nut 17 is threaded on portion 2 of member 1
and can be tightened to bear against member 13 to thereby clamp
members 1 and 13 against the bones located therebetween. Bone
engaging projections 18 prevent clamp movement.
Member 13 has a rectangular slot 20 formed therethrough, the slot
also having guideways 21 and 22 (FIG. 3) formed along the sides
thereof. A first drill guide member 24 is located in the slot 20
and has corresponding guide members 27 and 28 which complement
guideways 21 and 22 and are slidably mounted therein. Thus, guide
member 24 can be slid in the opening 20 between a non-operative
position shown in FIGS. 1 and 7 and an operative position shown in
FIG. 6 where it is aligned with the lowermost V-shaped portion 7.
Another drill guide member 30 is formed similarly to member 24 and
is slidingly guided in the slot 20 between an inoperative position
shown in FIGS. 1 and 8 and the operative position shown in FIG. 7.
When the guides 24 and 30 are in the operative position shown in
FIG. 8, the central portion of the slot 20 is open so as to
guidingly receive the screw S which will hold the bones together.
It will be noted that the central portion of the guide slot 20 of
member 13 is located directly above the lowermost or V-shaped
portion 7 of clamp member 1.
The present invention finds particular utility when repairing the
human shoulder area and the invention will be described in
connection with such operation, but is not necessarily limited
thereto.
FIG. 9 illustrates an uninjured shoulder in which ligaments 43 hold
the clavicle 44 (collar bone) to the scapula (shoulder blade) 40
including the bony growth that extends from the scapula and which
is known as the coracoid process 42. The spine of the scapula
terminates in the acromion 41. In injuries to the shoulder, as
shown in FIG. 10, these coraco-acrominal ligaments 43 are torn and
it is necessary to anchor the coracoid process 42 to other bone
structure such as the clavicle 44, while healing of the injury
takes place.
It should be recognized that the entire area surrounding these
bones is covered or obstructed by nerves, tissue, muscles or other
parts, and consequently, visual observation and handling of the
bones is difficult.
The clamp provided by the present invention enables the surgeon to
perform this operation with a minimum of "opening up" of the
patient and enables him to properly locate the coracoid with
respect to the clavicle and hold those parts in proper relationship
while the drilling and fastening of the screw through the parts is
accomplished.
More specifically, after opening up the area, the surgeon will use
a scalpel or other instrument to cut through the necessary tissue,
etc. under the coracoid and then the sharp end 6 of clamp portion 5
is inserted into the cut area and under the coracoid. The coracoid
is then centered or guided into the V-shaped lowermost portion 7 of
the clamp member 1. The surgeon then properly reduces or orientates
the clavicle with respect to the scapula and its coracoid and after
the parts are in proper relationship, he will then insert the
member 13 of the clamp over the threaded portion 2 until it firmly
engages the upper part of the clavicle. The thumb nut 17 is then
screwed down firmly so as to hold the bones in clamped
relationship. The bone engaging, sharp projections 18 prevent
twisting of the assembled clamp relative to the bones. During this
process, the surgeon is unable to clearly see the parts he is
working on and the coracoid must be accurately centered in the
clamp.
A hole must then be drilled through the bones which will ultimately
receive a fastening screw, care being taken not to permit the drill
to penetrate through the lower bone, namely the coracoid, so as to
injure the nerves, vessels, muscles or other tissue indicated
generally at 47 in FIG. 14. It is also essential that the hole
being drilled is located centrally through the coracoid which is
generally circular in cross section. Obviously, it is undesirable
to drill a hole or portion thereof which cannot be used because it
is misplaced or drilled at an improper angle.
After the clamp has been inserted in place and tightened to
securely hold the bones together, the drill guide member 24 is slid
to the central, operative position so that its relatively small
hole 24a is located precisely in alignment with the bones and with
the curved portion 7 of the member 1. The surgeon then drills a
hole through the clavicle and coracoid. The portion 7 of the clamp
can act to stop the drill and prevent it from going entirely
through the coracoid. After withdrawing the drill, the surgeon
slides member 24 to the inoperative position shown in FIG. 1 and
the slides the second drill guide member 30, having a larger hole
30a into the central position. With the larger drill, the surgeon
can form a counterbore 48 through the upper bone 44 only.
The screw is inserted through the central portion of the slot 20,
when the guides 24 and 30 are slid to their inoperative positions,
(FIG. 1) and thus the central portion of the slot accurately
locates the screw in respect to the previously drilled holes.
The counterbore 48 permits the screw 50 to be inserted freely
through the clavicle without threadably engaging it, and the
threaded portion 50a of the screw threadably engages the smaller
hole 52 in the coracoid. Tightening of the screw by the surgeon
then firmly secures the bones together.
After the screw is firmly in place, the surgeon loosens the thumb
nut 17 and removes it from portion 2 of the clamp, lifts clamp
portion 13 outwardly off the portion 2 of clamp member 1, and
removes the clamp member 1 from the patient.
The clamp provided by the present invention insures accurate
positioning of the bones relative to one another and holds them in
that position while the guide means insures proper drilling of and
fastening of the screw in the bone members.
* * * * *