U.S. patent number 3,835,860 [Application Number 05/372,029] was granted by the patent office on 1974-09-17 for surgical bone punch.
Invention is credited to Henry D. Garretson.
United States Patent |
3,835,860 |
Garretson |
September 17, 1974 |
SURGICAL BONE PUNCH
Abstract
A surgical instrument for punching holes in bone or other
substantially solid matter such as cartilaginous tissue. A
relatively easy to operate trigger mechanism permits a very large
force to be applied to the punch to penetrate the bone. The punch
is advanced incrementally by means of a ratchet mechanism, and a
reversible floating ratchet assembly permits the instrument to
supply substantially the same force to an elongated surgical punch
for both driving and retracting purposes. The device may also be
used for cutting hard tissue or shaping other materials such as
surgical metal plates due to the large forces which it is capable
of developing.
Inventors: |
Garretson; Henry D.
(Louisville, KY) |
Family
ID: |
23466415 |
Appl.
No.: |
05/372,029 |
Filed: |
June 21, 1973 |
Current U.S.
Class: |
606/79; 30/363;
606/184; 30/241; 606/53 |
Current CPC
Class: |
B26F
1/36 (20130101); A61B 17/1611 (20130101); B26F
2001/365 (20130101) |
Current International
Class: |
A61B
17/16 (20060101); A61B 17/28 (20060101); B26F
1/36 (20060101); B26F 1/32 (20060101); A61b
017/16 (); B26f 001/14 () |
Field of
Search: |
;30/241,358,363,366,368
;128/305,310,329,92E,92EC |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Weingarten, Maxham &
Schurgin
Claims
What is claimed is:
1. A surgical instrument for shaping or penetrating bone or other
substantially solid material, said instrument comprising:
a body having a forward end, a rearward end and a handle projecting
transversely of said rearward end;
a rearward facing foot plate mounted to the forward end of said
body;
an elongated rod longitudinally movable in said body and having its
forward end provided with a cutting edge, said forward end being
arranged for confronting engagement with said foot plate;
a lever pivotally mounted to said body; and
first ratchet means in said body coupled to said lever for
incrementally driving said rod toward said foot plate in response
to oscillating movement of said lever.
2. The surgical instrument of claim 1 and further comprising a
second ratchet means in said body coupled to said lever for
incrementally retracting said rod from said foot plate in response
to said oscillating movement of said lever.
3. The surgical instrument of claim 2 and further comprising
selector means for selectively actuating one of said ratchet means
for moving said rod in response to said oscillating movement of
said lever.
4. The surgical instrument of claim 1 and further comprising:
guide means formed with said foot plate and mounted between said
foot plate and said body; and
a base member mounted to said guide means in confronting
relationship and spaced from said foot plate, said base member
being adjustable so as to vary the distance between said foot plate
and said base member.
5. The surgical instrument of claim 4 wherein the forward end of
said rod passes through said base member and said guide means.
6. The surgical instrument of claim 1 and further comprising:
a handle projecting from said body;
a spring for normally biasing said lever away from said handle.
7. The surgical instrument of claim 3 wherein the non-actuated
ratchet means remains coupled to said lever and floats freely in
said body with said oscillating movement of said lever.
8. The surgical instrument of claim 3 and further comprising a
resilient member mounted to said body for frictional engagement
with said rod to hold said rod in place during each return motion
of said lever, said return motion of said lever to normal position
moving said actuated ratchet means to a new position.
9. The surgical instrument of claim 3 wherein;
each said ratchet means comprises a ratchet rod having a plurality
of annular teeth thereon, one said ratchet rod having said teeth
facing rearwardly, the second said ratchet rod having said teeth
facing forwardly;
said selector means including a rocker arm pivotally and slidably
mounted to said rod, said rocker arm having a pawl at either end
adapted to engage the adjacent ratchet rod.
10. The surgical instrument of claim 9 wherein said selector means
further comprises a selector lever pivotally connected to said body
and engaging said rocker arm for positioning said rocker arm to
selectively engage said ratchet rods.
11. The surgical instrument of claim 1 wherein said foot plate is
formed with a projection for engaging a surface of said material
opposite the side engaged by said rod when said rod is driven
toward said foot plate.
12. A surgical instrument for penetrating bone or other
substantially solid tissue, said instrument comprising:
a body having a handle projecting therefrom;
a foot plate mounted to said body and adapted for placement against
a surface of bony structure facing away from said body;
an elongated surgical punch rod longitudinally movable in said body
and having a cutting edge directed toward a surface of said bony
structure facing said body and in alignment with said foot
plate;
a reversible ratchet assembly in said body; and
a lever pivotally interconnecting said ratchet assembly and said
punch rod, said lever causing intermittent longitudinal motion of
said punch rod when moved in an oscillating manner.
13. The surgical instrument of claim 12 wherein said foot plate is
formed with a projection extending therefrom for preventing sliding
movement of said foot plate with respect to said bone.
14. The surgical instrument of claim 12 and further comprising
selector means for selectively actuating a portion of said ratchet
assembly to move said punch rod in a predetermined longitudinal
direction in response to said an oscillating motion of said
lever.
15. The surgical instrument of claim 14 and further comprising:
guide means formed with said foot plate and mounted between said
body and said foot plate; and
a base member mounted to said guide means in confronting
relationship with and spaced from said foot plate, said base member
being adjustable so as to vary the distance between said foot plate
and said base member;
said punch rod passing through said guide means and said base
member.
16. The surgical instrument of claim 15 wherein:
said foot plate provides a bearing surface for the end of said
punch rod when said punch rod is driven through said bone; and
said base member is adjusted to contact the interior surface of
said bony structure and provide a bearing surface when said punch
rod is retracted from said bone.
Description
FIELD OF THE INVENTION
This invention relates to a bone punch and more particularly to a
surgical instrument for converting lever action to longitudinal
motion having a great deal of force. The instrument also provides
substantially the same force for driving a surgical punch through
solid fibrous material and for retracting it therefrom.
BACKGROUND OF THE INVENTION
Surgical operations within the cranium normally require that a
portion of the skull be removed. It is usually desirable after such
operations to replace and anchor the removed bone portion at the
site of its removal. Such replacement and positioning of bone or
other cartilaginous tissue facilitates the process of healing to
fuse the bone with surrounding tissue and dispenses with the
requirement of artificial plates or foreign matter for the
protection of vital organs. Replacement of the original tissue
requires maintaining its position securely in the location from
which it was removed in order to promote the desired physiological
healing. In some cases an artificial plate is necessary and it too
must be firmly anchored in place. Securing such natural or
artificial member in the site of the operation requires the
formation of small holes in the cranium surrounding the opening and
the formation of matching holes in the covering member so that
surgical wires may be used for connecting and anchoring
purposes.
The fibrous nature of bone and other rigid body tissue has been
particularly troublesome in punching holes because prior punches
have required excessive force to penetrate the bone and have tended
to become wedged in the tissue making removal quite difficult. Such
wedging of the surgical punch in tissue sometimes required the use
of a second instrument to rongeur the punch out. The application of
such forces could result in the possibility of cracking or breaking
of the surrounding bone causing brain damage, shock and possibly
even death to the patient.
SUMMARY OF THE INVENTION
In accordance with the present invention, a surgical instrument is
provided for punching holes in or through bone or other tissue
wherein a relatively easily operated mechanism provides a large
force to the punch itself by the use of a lever and ratchet
assembly. Furthermore, this instrument provides a force
substantially equal yet opposite in direction to the driving force
to remove the surgical punch from the fibrous tissue. An adjustable
gap between bearing surfaces of the surgical punch is provided to
accommodate bone thickness against which a punch moves in either
direction through the bone. The adjustable bearing surfaces and the
mechanism of the surgical punch permits the force of the punch to
be controlled and absorbed within the instrument.
A reversible floating ratchet assembly is provided for selection of
ratchet rods for either driving or retracting the surgical punch
with substantially the same mechanical force and similar effort. A
simple pistol grip structure is employed where the trigger is
squeezed toward the handle several times to drive the punch through
the bone and a substantially equal number of times to remove the
punch from the bone when the ratchet mechanism is reversed. A
selector lever is employed to determine whether the punch moves in
a forward or reverse direction. This instrument, by providing a
similar mechanical advantage for incrementally driving and after
the formation of the hole, incrementally retracting the surgical
punch, allows holes to be made rapidly, efficiently and safely,
thereby decreasing operation time and providing important time
advantage to the patient.
BRIEF DESCRIPTION OF THE DRAWING
The invention will be more fully understood from the following
detailed description taken in conjunction with the accompanying
drawing in which:
FIG. 1 is a perspective view of a surgical bone punch constructed
according to the invention and illustrating its operation;
FIG. 2 is a partial cutaway side view of the bone punch of FIG. 1
with the mechanism in an intermediate position;
FIG. 3 is a partial cutaway view similar to FIG. 2 depicting the
operative arrangement of parts in driving the surgical punch;
FIG. 4 is a view similar to FIG. 3 showing the arrangements of
parts in retracting the surgical punch; and
FIG. 5 is a partially exploded cutaway perspective view of a bone
punch of FIG. 1 depicting various parts of the ratchet selection
mechanism.
DETAILED DESCRIPTION OF THE INVENTION
The surgical bone punch 10 as shown in FIG. 1 includes a body 12 of
a generally rectangular cross-sectional configuration with a handle
14 extending downwardly therefrom. A hand restraining and leverage
directing guide 16 projects rearwardly from handle 14 below body
12. The body is shaped at its forward end 18 for a dovetail
connection with the rearward end 20 of punch guide 22. A forwardly
projecting key 24 is provided on the lower front face of body 12
for mating with a slot 26 in the bottom of guide 22 to assure
proper orientation of the guide when mounting it to the body.
Trigger lever 27 of bone punch 10 is coupled with selectable
ratchet rods and a punch rod for punching holes through bone tissue
as will be described in more detail hereinafter. FIG. 1 also
illustrates an incision showing retracted tissue 28 from an
operation incision site 30 from which bone has been removed.
Cranial bone 32 is shown having holes 34 formed therein by the
surgical instrument of the present invention.
As illustrated in FIG. 2, punch guide 22 contains a bore 36
therethrough forming a passage through which bit 38 of elongated
punch rod 40 moves. The forward end 42 of bore 36 is threaded for
mating with external threads 44 of hollow bolt 46 having a knurled
head 45 and forming an adjustable base member 48. Punch guide 22 at
its forward end has a projecting arm 50 terminating in a foot plate
or anvil 52 orientated at a right angle to the axis of arm 50.
Anvil 52 has a positioning pin 54 and a cone-shaped bore 56 in
alignment with cutting end 39 of bit 38, the apex of the bore being
of a diameter sized to receive the cutting end of the bit
therewithin.
Three bores 58, 60 and 62, each a different size, are provided
longitudinally through body 12 of the bone punch. Passage 58, the
smallest of the bores, receives a longitudinally movable retracting
ratchet rod 72 having a series of forward facing annular teeth 74,
a slot 78 and a cylindrical portion 81 at the forward portion
thereof. Similarly, bore 62, which is the largest of the three, is
formed to receive a longitudinally movable driving ratchet rod 80
having a series of rearwardly facing annular teeth 82, a slot 84
and a cylindrical portion 86 at the forward portion thereof.
Intermediate size bore 60 is formed to receive elongated punch rod
40 which has bit 38 at the forward end and a knob shaped projection
90 at the rearward end. Punch rod 40 has flat surfaces 92 on
opposite sides of a portion of its length and a slot 94
therethrough parallel to the flat surfaces.
Trigger lever 27 having a ribbed grip 98 and a hand restraining and
leverage directing guide 100 is coupled to body 12. The trigger is
formed with a flat portion 102 adapted to extend through slot 84 of
the driving ratchet rod 80, slot 94 of punch rod 40 and slot 78 of
retracting ratchet rod 72. In the area adjacent forward end 18 and
in the vicinity of the aforementioned bores, body 12 has a reduced
thickness from one side as indicated by reference numerals 104,
108, 110 and 112 upon which the flat portion 102 of the trigger
lever slides during operation. A hole 114 of appropriate size is
formed in trigger lever 27 at a point between leverage guide 100
and flat portion 102 for receiving guide pin 116. The guide pin 116
has a knurled head 118 at the forward end and is threaded to engage
a tapped hole in handle 14. Return spring 124 surrounds guide pin
116 between the handle and the trigger lever to normally bias the
trigger away from handle 14.
FIGS. 1, 2 and 5 best illustrate the floating ratchet selector
mechanism. Rocker arm 130 has a loop 132 formed thereon for
disposition and pivoting around the rearward portion of punch rod
40. A pawl 134 (FIG. 2) is provided adjacent the end of arm 130
below loop 132 for individually engaging the rearward facing teeth
82 on ratchet rod 80. The pawl is formed with a beveled rearward
face and a forward face which is substantially perpendicular to the
axis of the ratchet rod. A similarly shaped but oppositely facing
pawl 136 is formed adjacent the end of rocker arm 130 above loop
132 for individually engaging the forward facing teeth 74 on
ratchet rod 72. Rocker arm 130 may be positioned to selectively
engage one or the other of ratchet rods 72 and 80 to retract or
drive punch rod 40 respectively.
A slot 140 is provided in body 12 for receiving rocker arm 130. A
key guide 142 for receiving key pin 144 projecting rearwardly from
the rocker arm is formed as a notch along the rear side of slot
140. The purpose of the key pin and guide is to assure proper
orientation of rocker arm 130 when the instrument is assembled.
Selector lever 150 having a projecting handle 152 thereon is
pivoted to body 12 and slides over concave edge 138 of rocker arm
130 to cause the appropriate pawl to engage the teeth of the
selected ratchet rod. As shown in FIG. 1, driving ratchet rod 80
has been selected and engaged by pawl 134. Lever 150 is pivotally
connected to body 12 by means of a bolt 154 having a vane 156
projecting therefrom, the vane being provided to assist in
assembling and disassembling the instrument. The bolt is provided
with a bearing surface (not shown) which is larger than the
threaded portion and is adapted to fit in hole 153 in the forward
end of selector lever 150. Restraining stops 158 and 160 project
outwardly from the rocker arm at either end of concave edge 138 to
act as positive positioning means for selector lever 150. Bolt 154
in addition to securing selector lever 150 to body 12 also secures
resilient drag spring 162 in opening 164 in the body to
frictionally engage flat surface 92 of punch rod 40. This spring is
captured by lever 150 and its function will be explained
hereinbelow.
In using the instrument of this invention for punching, cutting or
shaping purposes as previously described, anvil 52 is placed under
the working surface and bolt 46 is adjusted until base member 48 is
securely positioned above the working surface, herein referred to
as bone tissue. Thus the distance between base 48 and anvil 52 is
adjusted to accommodate the thickness of the bone. Selector lever
150 is set in the position as shown in FIG. 1 and surgical punch 40
is advanced forward by pressing against knob 90 or by repeatedly
squeezing trigger lever 27 until bit end 39, passing through hollow
bolt 46, becomes flush with base 48 or comes in contact with the
surface of the bone. Advancing punch rod 40 results in teeth 82
sliding by pawl 134 with a snapping sound as the pawl disengages
from each succeeding tooth. It should be noted that selector lever
150 is formed to act as a relatively stiff leaf spring to permit
the pawls of the rocker arm to ride over the ratchet teeth.
Squeezing of trigger 27 toward handle 14 causes pawl 134 to
positively engage one of the teeth 82 on driving ratchet rod 80. At
this time trigger 27 pivots about the rearward end of slot 84 of
the ratchet rod, thereby applying forward pressure against the
forward end of slot 94 of punch rod 40 and driving the punch rod 40
in the direction indicated by arrow 163 (FIG. 3). Each time the
trigger is squeezed, the punch rod moves forward a distance
substantially equal to the distance between the ratchet teeth. Upon
release of trigger 27, spring 124 urges the trigger to return to
its normal position. The pivot point then shifts to the rearward
end of slot 94 in punch rod 40, applies forward force to the
forward end of slot 84 in ratchet rod 80 urging the ratchet rod
forward so that pawl 134 slides to the next tooth. All the while,
ratchet rod 72 is disengaged and floating freely in bore 58 under
the influence and control of the upper end of the trigger in slot
78. Punch rod 40 does not float freely because of the friction
engagement of spring 162 against the flat side of the punch rod,
permitting the punch rod to act as a pivot for the trigger on its
return to normal position. This action is repeated in an
oscillating manner until the punch fully penetrates the bone and
cutting end 39 enters into bore 56 in the anvil. A small plug of
bone cut out by the punch is forced through bore 56. While the
punch is penetrating the bone, positioning pin 54 engages the
underside thereof, assuring positive placement of the instrument.
As an alternative embodiment, the cutting tip of the punch may be
hollow and the anvil may be flat so that the bone plug is forced
into the hollow punch. Enlarged knob 90 of punch rod 40, in
cooperation with the forward ends 86 and 81 of the ratchet rods 80
and 72, respectively, prevent damage to the instrument and the
patient which might otherwise result from the continued driving of
punch 40 after bit 38 has penetrated the bone or other material and
has entered recess 56.
After the desired holes is punched, removal of punch bit 38 often
requires the application of a significant retracting force. Such a
retracting force is provided by setting selector lever 150 in the
position shown in FIG. 4 so that pawl 134 disengages from ratchet
rod 80 and pawl 136 engages the teeth of ratchet rod 72. Upon
squeezing trigger 27, pawl 136 positively engages one of the teeth
74 on rod 72 and the pivot for the trigger becomes the forward end
of slot 78 of retracting rod 72, thereby providing a rearward force
against the rearward end of slot 94 of punch rod 40 moving the
punch rod in the direction indicated by arrow 168 (FIG. 4). With
adjustable base 48 resting against the outer surface of the bone,
the punch pin pulls against the base, preventing anvil 52 from
being driven inward, resulting in the punch being withdrawn from
the bone and thereby providing an added measure of safety for the
patient. Upon release of the trigger and under the influence of
spring 124, the pivot point shifts to the forward end of slot 94 of
punch rod 40 and with drag spring 162 acting against surface 92 of
the punch rod, ratchet rod 72 is pushed backward and pawl 136 slips
over one of teeth 74 to engage the next succeeding tooth. The
intermittent retracting action is then continued until the punch
pin is removed from the hole which it has made. Surgical instrument
10 is then removed from the incision and the small plug of bone
falls out of or is easily removed from bore 56 before additional
holes are punched in the bone. When retracting, the instrument
operates substantially the same way as when driving, only ratchet
rod 80 floats freely at that time.
It will be noted that in FIG. 3 an alternative embodiment is shown
where mound 170 is substituted as a positioning device in place of
pin 54. In FIG. 4, base 48 is also shown with such a mound 172 as
an alternative structure.
It can be seen that the surgical instrument of the present
invention is easily disassembled for cleaning by simply removing
guide pin 116 from the handle and trigger and removing trigger 27
from the slots in the rods so that all of the rods may be removed.
Punch guide 22 is slid off the end of the body and bolt 154 is
removed to complete the dismantling process. Different size punch
rods and punch guides and a wide variety of foot plates may be
provided for various purposes such as punching, cutting or shaping.
The ratchet rods and the punch rod are each of different diameters
which fit in the different size passages to prevent accidental
misassembly. Typical dimensions for the bone punch shown in the
drawing include 1 mm. diameter for the cutting bit and
approximately 3 mm. longitudinal movement for each trigger motion,
the trigger may move as much as 50 mm.
The present invention can also be embodied in surgical instruments
for obtaining samples of tissue for biopsy or further study by
slight modification of the size, shape and function of the punch
and punch guide.
While the complete description of this surgical bone punch as been
directed to a dual reversible ratchet mechanism, it should be
recognized that the driving ratchet mechanism is novel in itself
and that there are likely to be instances where large retracting
forces are not necessary. Specifically contemplated are alternative
embodiments such as where the tip of the cutting bit is slightly
larger in diameter than the shaft of the bit and is made to
separate therefrom after the hole is formed. The anvil could have
an opening of sufficient size to receive such a separable cutting
bit element.
It will be appreciated that the invention can be implemented in
different ways by those skilled in the art to suit particular
requirements which are within the scope of this invention.
* * * * *