U.S. patent number 3,842,825 [Application Number 05/414,711] was granted by the patent office on 1974-10-22 for hip fixation device.
Invention is credited to Richard F. Wagner.
United States Patent |
3,842,825 |
Wagner |
October 22, 1974 |
HIP FIXATION DEVICE
Abstract
A hip fixation device for reconstructing fractures of the upper
end of the femur comprising a spoon-shaped plate having a handle
portion which extends laterally along the top of the femur shaft
and a bowl portion which conforms to the lower portion of the
greater trochanter. A plurality of bores transverse the bowl
portion for receiving hip screws adapted to be driven into the
upper end of the femur generally parallel to the long axis of the
femur head and a flat headed boss surrounds the outer opening of
each bore against which the undersides of the screw heads seat. A
cover plate is attached tightly over the outer side of the bowl
portion against the screw heads by means of bolts. It has a raised
section on its inner side which fits down between the screw heads
to keep them from rotating. A pair of bending tools for bending the
spoon shaped plate so that it conforms to the femur contour and a
driving tool for driving the hip screws into the femur are also
disclosed.
Inventors: |
Wagner; Richard F. (San
Francisco, CA) |
Family
ID: |
23642626 |
Appl.
No.: |
05/414,711 |
Filed: |
November 12, 1973 |
Current U.S.
Class: |
606/66; 606/101;
606/104 |
Current CPC
Class: |
A61B
17/746 (20130101); A61B 17/8863 (20130101) |
Current International
Class: |
A61B
17/74 (20060101); A61B 17/68 (20060101); A61B
17/88 (20060101); A61f 005/04 () |
Field of
Search: |
;128/92BB,92B,92R,92BC,92CA,92C,92D,83 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Townsend and Townsend
Claims
I claim:
1. A hip fixation device comprising:
a. a spoon-shaped plate comprising an elongated handle portion
adapted to extend laterally along and conform to the upper portion
of the shaft of a femur and a bowl portion adapted to conform to
the lower portion of the greater trochanter of said femur;
b. a plurality of spaced bores transversing the bowl portion said
bores being adapted to receive hip screws therethrough in
substantially parallel relationship to each other;
c. a flat plate surface surrounding the outer opening of each of
the bores, against which the heads of the hip screws are adapted to
seat;
d. a cover plate adapted to be attached over the outer side of the
bowl portion and against the heads of said hip screws;
e. a raised portion on the inner side of the cover plate adapted to
fit between the heads of said hip screws and prevent rotation
thereof; and
f. means for attaching the cover plate over the outer side of the
bowl portion whereby pressure is exerted against the heads of the
screws to keep them from loosening from the femur.
2. The hip fixation device according to claim 1 in which the handle
portion has a plurality of bores transversing it for receiving bone
screws therethrough.
3. The hip fixation device of claim 1 including:
g. a boss surrounding the outer opening of each of the bores,
against which the heads of the hip screws are adapted to seat.
4. The hip fixation device according to claim 1 in which there are
four of said bores in a square configuration sized to the
dimensions of the neck of said femur.
5. The hip fixation device according to claim 1 wherein said raised
portion is a vertical, generally rectangular bar.
6. The hip fixation device according to claim 1 wherein said means
for attaching the cover plate over the outer side of the bowl
portion includes:
g. a pair of bolts adapted to be received through said bowl portion
and cover plate; and
h. a pair of nuts adapted to be screw threadedly received on the
shanks of said bolts.
7. The hip fixation device according to claim 3 in which said bores
are ovular and the tops of the bosses are planar whereby the
substantially parallel relationship of the hip screws is permitted
and maintained.
8. A hip fixation device comprising:
a. a spoon-shaped plate comprising an elongated handle portion
adapted to extend laterally along and conform to the upper portion
of the shaft of a femur and a bowl portion adapted to conform to
the lower portion of the greater trochanter of the femur;
b. four ovular bores transversing said bowl portion said bores
being in a square configuration sized to the dimensions of the neck
of said femur and being adapted to receive hip screws therethrough
in substantially parallel relationship to each other;
c. a boss surrounding the outer opening of each of said bores, the
tops of said bosses being flat and planar and against which the
heads of the hip screws are adapted to seat whereby said
substantially parallel relationship is maintained;
d. a cover plate adapted to be attached over the outer side of the
bowl portion and against the heads of said hip screws;
e. a vertical bar on the inner side of said cover plate adapted to
fit between the heads of the hip screws and prevent rotation
thereof;
f. a plurality of bolts adapted to be received through said bowl
portion and cover plate; and
g. a plurality of nuts adapted to be screw threadedly received on
the shanks of said bolts whereby said cover plate is secured to
said bowl portion and pressure is exerted against the heads of said
hip screws to keep them from loosening from the femur.
9. The hip fixation device according to claim 8 in which the handle
portion has a plurality of bores transversing it for receiving bone
screws therethrough.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to a hip fixation device and tools which are
used to conform and affix that device to a femur.
2. Description of the Prior Art
A great variety of plates, nails, pins, screws and combinations
thereof are presently used in performing reconstructions of
fractures of the upper end of the femur. In general the presently
used plates extend along the upper portion of the shaft and curve
up and around a portion of the greater trochanter. They have a
plurality of transverse bores through which bone screws are screwed
into the shaft and upper end of the femur. The screws which extend
into the upper end of the femur are skewed relative to each other
because of the curvature of the plate about the greater trochanter.
Such skewed fixation is less desirable than fixation along several
lines parallel to the long axis of the femur head. It is believed
that the only devices which permit fixation along such parallel
lines are pins and nails which are inserted independently of each
other and have no associated plate.
All of the prior art fixation elements which are screwed or driven
into the upper end of the femur are susceptible to loosening or
backing out which weakens or, in chronic instances, totally
destroys the fixation.
SUMMARY OF THE INVENTION
The present invention is a novel hip fixation device for use in
reconstructing fractures of the upper end of the femur which
permits fixation along a plurality of lines parallel to the long
axis of the femur head and inherently prevents the fixation
elements from loosening from or backing out of the upper end of the
femur. It comprises a spoon-shaped plate having an elongated handle
portion which extends along the upper portion of the femur shaft
and a bowl portion which is shaped to conform to the lower portion
of the greater trochanter. The bowl portion of the plate has a
plurality of spaced bores, preferably four in a rectangular
configuration, extending transversely through it for receiving the
fixation elements. The outer opening of each bore has a boss
surrounding it. The heads of the bosses are flat and parallel to
each other so that when the heads of the fixation elements are
driven into the femur flush to the heads of the bosses, the shanks
of the elements will be parallel to each other. The device also
includes a cover plate which is placed over the outer side of the
bowl portion of the spoon-shaped plate and means for attaching it
tightly thereover so as to exert positive compression on the heads
of the fixation elements to prevent them from loosening from the
femur. The inside of the cover plate has a raised section which
fits between the heads of the fixation elements to prevent them
from turning and backing out of the femur.
Additional features of the invention are a pair of bending tools
which are used to bend the spoon-shaped plate so that it closely
conforms to the contour of the femur and a driving tool for driving
the fixation elements into the upper end of the femur.
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings FIGS. 1-6 illustrate an embodiment of the device of
this invention and FIGS. 7-12 illustrate tools which are used to
affix said device to a femur. Specifically:
FIG. 1 is a dimetric view of a hip fixation device according to
this invention attached to a femur;
FIG. 2 is an enlarged sectional view taken along line 2--2 of FIG.
1;
FIG. 3 is a sectional view taken along line 3--3 of FIG. 2;
FIG. 4 is an exploded, enlarged view of the hip fixation device
shown in FIG. 1;
FIG. 5 is a sectional view taken along line 5--5 of FIG. 3;
FIG. 6 is a sectional view taken along line 6--6 of FIG. 3;
FIG. 7 is a dimetric view of a bending tool being used to bend the
hip fixation device of FIG. 1;
FIG. 8 is a sectional view taken along line 8--8 of FIG. 7;
FIG. 9 is a dimetric view of a tool used to attach the hip fixation
device of FIG. 1 to a femur;
FIG. 10 is an enlarged sectional view taken along line 10--10 of
FIG. 9;
FIG. 11 is a sectional view taken along line 11--11 of FIG. 10;
and
FIG. 12 is an enlarged view of the head of the tool shown in FIG. 9
in position to receive a screw for affixing the hip fixation device
to a femur.
DETAILED DESCRIPTION OF EMBODIMENT SHOWN IN DRAWINGS
As seen in FIG. 1 the illustrated device is designed to accomplish
an anatomical reconstruction of a fracture of the upper end of a
femur, generally designated 1, such as an intracapsular,
intercervical or intertrochantoric fracture. It may also be
employed in femoral arthrodeses and osteotomies.
The main component of the device is a spoon-shaped plate, generally
designated 2, comprising an elongated handle portion 3 and a bowl
portion 4. The handle portion 3 is convexly curved so that it
generally conforms to the curvature of the upper portion of shaft 5
of femur 1. The bowl portion 4 is similarly curved and angled from
the handle portion so that it generally conforms to the curvature
of the lower portion of the greater trochanter 6 of femur 1.
Bowl portion 4 has four equidistantly spaced, ovular bores 7
running transversely through it. Desirably bores 7 form either a
3/4 inch square configuration or a 5/8 inch square configuration,
which dimensions are, respectively, ideal for use with adult male
and women or children patients. The outer opening of each of bores
7 has a boss 8 surrounding it, the head 9 of which is flat. Bores 7
receive four hip screws 10 having square heads 14 the flat
undersides of which seat flush against the heads 9. As shown in
FIGS. 1 through 3 hip screws 10 are adapted to extend through the
upper end of femur 1 axially to the long axis of the head 15
thereof (FIG. 1) in parallel relationship to each other with their
square heads 14 aligned (FIG. 6) in a square configuration.
A curved, ovular cover plate 16 fits over the outer side of bowl
portion 4 and is seated against the top sides of heads 14 of hip
screws 10. The inner side of ovular cover plate 16 has a
rectangular raised section 17 (FIGS. 4 and 6) formed along its
short axis which extends snugly between the opposed sides of the
aligned heads 14 of hip screws 10 (FIGS. 2, 3 and 6). When so
positioned, section 17 prevents hip screws 10 from rotating. Cover
plate 16 is secured to bowl portion 4 by two plow bolts 18 which
are threadedly received through two countersunk, threaded bores 19
which transverse bowl portion 4 at flared sections 20 thereof.
Cover plate 16 has two elongated holes 24 at opposite ends of its
long axis through which bolts 18 pass. Lock washers 25 and nuts 26
are threaded onto the shafts of bolts 18. By tightening nuts 26
positive compression is exerted on the heads 14 of screws 10
thereby keeping them in place and preventing them from backing out
of the femur.
The handle portion 3 of plate 2 has a plurality of countersunk
bores 27 transversing it through which bone screws 28 pass for
purposes of securing handle portion 3 to the shaft 5 of the
femur.
The above described hip fixation device is used as follows. The
surgeon first drills a guide bore into the upper end of the femur
along a preselected line. (The hip is usually X-rayed at this point
to make sure the line of the guide bore is proper.) A guide wire or
pin is then inserted into the guide bore. Bowl section 4 of plate 2
has a central hole 29 for receiving the guide wire and plate 2 is
slipped over the guide wire up against the femur. In the event the
angle between handle portion 3 and bowl section 4 is not such that
permits a snug fit of the plate against the shaft 5 and greater
trochanter 6, plate 2 must be removed and bent. Bending tools,
generally designated 30, 34 and shown in FIGS. 7 and 8, are used
for this purpose.
As seen in FIGS. 7 and 8 tool 30 is adapted to grip the handle
portion 3 of plate 2, whereas tool 34 is adapted to grip bowl
portion 4. Bending tool 34 operates on a principal similar to that
of a vise. It includes an upper jaw 35 and a lower jaw 36 pivotally
interconnected at their one ends by a pair of bars 37 and pins 38,
39. Their other ends are releasably interconnected by a swing bolt
40, one end of which is journalled on a pin 41 within a way 42 in
said other end of upper jaw 35. Lower jaw 36 has a way (not shown)
in its said other end for receiving the other end of swing bolt 40.
Said other end of swing bolt 40 is threaded and fitted with a wing
nut and collar (not shown) which are adapted to slide under the
bottom side of lower jaw 35 when it and jaw 36 are closed. The jaws
35, 36 are secured tightly together by merely tightening said wing
nut.
The inner surface of lower jaw 36 has a dome shaped protrusion 46
(FIG. 8) of the same curvature as the bowl portion 4.
Correspondingly the inner surface of upper jaw 36 has four spaced
nipples 47 formed on it which register with bores 7 of bowl portion
4. As shown in FIG. 8 the bowl portion 4 is placed between jaws 35,
36 with the inner surface thereof against dome shaped protrusion
46. When the jaws are closed nipples 47 are slidably engaged within
bores 7. In this manner said bowl portion is held firmly between
the jaws.
Upper jaw 35 has an anvil plate 48 mounted on its side adjacent the
location at which handle portion 3 emerges from between the jaws.
Screws 50 secure plate 48 to said side. The lower edge 51 of plate
50 has the same curvature as handle portion 3 and is adapted to
engage handle portion 3 at the point at which it joins bowl portion
4. A second anvil plate 45 is mounted on lower jaw 36 at the side
opposite anvil plate 48 for bending of plate 2 when it is
positioned in tool 34 with handle portion 3 extending in the
direction opposite that shown in FIGS. 7 and 8. The upper edge 56
of anvil plate 45 is convexly curved so as to engage the concave
surface of handle portion 3 at the point of its juncture with bowl
portion 4.
Lower jaw 36 has a handle 52 attached to its bottom surface.
Bending tool 30 operates similarly to a positive, lock action
compression wrench. It comprises a generally rectangular housing 53
having a longitudinal channel 54 extending through its entire
length. The surface defining the upper side of channel 54 has the
same curvature as handle portion 3. Otherwise channel 54 is
rectangular. Disposed within channel 54 is a jaw member 55 adapted
for vertical movement within channel 54. The top side of jaw member
55 also has the same curvature as handle portion 3 and is spaced
from said surface defining the upper side of channel 54. Otherwise,
it too is rectangular. A pair of screws 59 interconnect housing 53
and jaw member 55. As shown in FIG. 8 screws 59 are received
through bores 60 and counterbores 61 which combined extend from the
bottom of housing 53 through to channel 54. Screws 59 have
decreased diameter, threaded end portions 62 which are screw
threadedly received within bores 63 in the bottom of jaw member 59.
A compression spring 64 is seated within each counterbore 61, one
end of which bears on the shoulder of the counterbore and the other
end of which bears on the bottom of the head of screw 59.
Tool 30 is equipped with a handle 65 having a threaded end 66 (FIG.
8). Threaded end 66 is screw threadedly received within a threaded
bore 67 located in the center of the bottom of housing 53 and
opening through said bottom to the channel 54. End 66 has a flat
head 68 which is adapted to bear against the bottom of jaw member
55. Jaw member 55 is raised and lowered within channel 54 by
turning handle 65. By tightening handle 65 head 68 is moved
upwardly against the bottom of jaw member 55. Further tightening
forces member 55 upwardly within channel 54. When handle 65 is
backed off the weight of jaw member 55 and compression springs 64
force member 55 downwardly in channel 54.
Plate 2 is bent by locking bowl portion 4 within tool 34 and
inserting handle portion 3 longitudinally through the space in
channel 54 between the curved top of jaw member 55 and the curved
surface defining the upper side of channel 54 and tightening handle
65. Such tightening forces jaw member 55 up against handle portion
3 thereby locking it within channel 54. Handles 52 and 65 are then
gripped and pulled in opposite directions thereby forcing the joint
between handle portion 3 and bowl portion 4 against the lower edge
51 of anvil plate 50 and bending said joint thereagainst.
After plate 2 is bent to conform to the femur it is replaced over
the guide wire as described above. Using bores 7 and the guide wire
as guides four parallel holes 66 (FIG. 9) are drilled with a bone
drill in the upper end of the femur. These holes are for the
purpose of starting hip screws 10. Hip screws 14 may be screwed
into the femur and driven home with a screw driver, generally
designated 67 and shown partially in FIGS. 9 through 12. Screw
driver 67 comprises a shaft 68 having an end 69 which is flared at
70 and has a box socket 71 in it for receiving head 14 of hip screw
10. The other end 72 of shaft 68 is adapted to fit into a chuck 73
of a conventional drill or screw driver handle. At a point along
shaft 68 a series of four skived surfaces 74 are formed to define a
rectangular cross-section. The rectangle so defined is in alignment
with the surfaces of box socket 71 so that the surfaces may be used
to ascertain the position of heads 14 of hip screws 10 for assuring
correct seating of the heads with respect to cover plate 16. A
tempered steel spring retainer collar, generally designated 77,
fits around end 69. Collar 77 comprises a pair of clamping prongs
78 which are slidably secured at one end about shaft 68 by means of
a collar 79. Each prong 78 has a bowed central section 80 which
extends out around the flaring 70 on end 69 and a semicircular
nipper 81 at its other end.
FIG. 12 shows retainer collar 77 in a retracted position with the
driver ready to receive a screw 10. As shown the clamping prongs 78
are slightly spread apart due to their inherent spring tension.
FIGS. 10 and 11 show the retainer collar 77 in its operative
position, holding a screw 10 in place within socket 71 of driver
67. As shown the head 14 of screw 10 is secured within socket 71
and prongs 78 are clamped together snugly about end 69 with nippers
81 gripping the shaft of screw 10. Prongs 78 are held clamped
together by a collar 78 which is slid about bowed section 80.
As shown in FIG. 9 after the screw 10 is inserted into the driver
67 and the retainer collar is slid into its operative position with
collar 82 about bowed section 80 the screw 10 is inserted through a
bore 7 in plate 2 into the corresponding start hole 66 and screwed
into the femur. After the screw has been screwed in up to the
nippers 81 the collar 82 is slid off bowed section 80, causing the
prongs 78 to spread and the retainer collar is slid back on shaft
68 exposing the remainder of the screw 10. Screw 10 is then driven
home with its head 14 aligned with the heads of the other screws 10
as described above. The cover plate 16 is then put into position
and tightened down as described above.
The fixation is finished by screwing bone screws 28 through holes
27 into the shaft 5 of the femur.
Thus, the fixation device of this invention provides fixation along
a multiplicity of parallel lines extending through the upper end of
the femur in which the primary fixation elements, i.e. the hip
screws, are held within the upper end of the femur under positive
compression and in a manner which prevents them from backing out of
the femur and weakening or even destroying the fixation.
Various modifications of the above described hip fixation device
and tools may be made without departing from the spirit or scope of
the invention. Means other than said flat-headed bosses, such as a
single continuous flat plate surface, might be used to ensure that
the hip screws remain parallel within the femur. Also, the
undersides of the screw heads might be appropriately contoured or
the bores in the bowl portion might have contoured counterbores.
Likewise, means other than bolts and nuts might be used to attach
the cover plate to the spoon-shaped plate. Further, the raised
section which keeps the hip screws from rotating could be
independent of the cover plate and separately attachable to the
spoon-shaped plate. These modifications and other modifications
which are obvious to one of ordinary skill in the mechanical arts
are intended to be within the scope of the following claims.
* * * * *