U.S. patent number 3,877,424 [Application Number 05/306,214] was granted by the patent office on 1975-04-15 for methods and apparatus for external fixation of bone fractures.
Invention is credited to William M. Murray.
United States Patent |
3,877,424 |
Murray |
April 15, 1975 |
METHODS AND APPARATUS FOR EXTERNAL FIXATION OF BONE FRACTURES
Abstract
A method and apparatus are provided for external fixation of
bone fractures. The method comprises inserting at least one pin in
each major fragment of bone with a portion of the pins extending
above the skin surface, drawing the pins toward one another and
applying a bridge to the pins to hold them in place under
compression parallel to the bone being repaired. The apparatus is
at least two elongated pins adapted to be inserted at one end into
the bone on opposite sides of a fracture, bridge means engaging the
other ends and compression means acting on the pins generally
parallel to the bone.
Inventors: |
Murray; William M. (Pittsburgh,
PA) |
Family
ID: |
26473056 |
Appl.
No.: |
05/306,214 |
Filed: |
November 14, 1972 |
Current U.S.
Class: |
606/54;
606/92 |
Current CPC
Class: |
A61B
17/66 (20130101); A61B 17/6441 (20130101); A61B
17/60 (20130101) |
Current International
Class: |
A61B
17/60 (20060101); A61B 17/64 (20060101); A61B
17/66 (20060101); A61f 005/04 () |
Field of
Search: |
;128/92A,92R,92B,92D,83 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Buell, Blenki and Ziesenheim
Claims
I claim:
1. A method of external fixation of of bone fractures comprising
the steps of inserting at least one threaded pin into each major
fragment of bone with a portion of the threaded pin extending
beyond the soft tissue surrounding the fracture, reducing the
fracture by drawing the threaded pins into proper position under
compression generally transverse to the fracture line, applying a
compliant bridge to the threaded pins at the portions exposed from
the soft tissue while under compression, said compliant bridge
permitting relative adjustment of the pins in one bone fragment
with respect to those in another bone fragment and fixing the
compliant bridge in rigid position on the pins to hold the threaded
pins in place under compression during healing of the bone
fractures said compliant bridge having rigidifying means permitting
deformation of the bridge while the pins are placed therein and
causing said bridge to become rigid while said compression acts on
said pins.
2. A method of external fixation of bone fractures comprising the
steps of inserting at least one pin into each major fragment of
bone with a portion of the pin extending beyond the soft tissue
surrounding the fracture, reducing the fracture by drawing the pins
into proper position under compression generally transverse to the
fracture line, applying a bridge to the pins at the portions
exposed from the soft tissue to hold the pins in place under
compression during healing of the bone fractures, said bridge
comprising a bladder filled with soft cement which is applied to
the pin ends and hardened.
3. A method as claimed in claim 2 wherein the cement is epoxy
resin.
4. A method as claimed in claim 1 wherein pressure is applied to
the pins transverse to their length between the bridge and the bone
to urge the pins together.
5. An apparatus for fixation of fractured bones comprising at least
two elongated high strength threaded metal pins adapted to be
inserted at one end into a fractured bone on opposite sides of the
fracture, compliant bridge means adapted to engage said pins at the
other end outside the patient's body and spaced from the bone,
compression means acting on the pins generally parallel to the
bridge and bone to urge the bone ends together within the compliant
bridge means and means causing the compliant bridge to become rigid
while said compression means acts on said pins.
6. An apparatus for fixation of fractured bones comprising at least
two elongated high strength metal pins adapted to be inserted at
one end into a fractured bone on opposite sides of the fracture,
bridge means adapted to engage said pins at the other end outside
the patient's body and spaced from the bone and compression means
acting on the pins generally parallel to the bridge and bone to
urge the bone ends together, said bridge comprising a bladder
filled with a hardenable cement adapted to be placed over the said
other ends of the pin and hardened in situ.
7. An apparatus as claimed in claim 5 wherein the bridge is hinged
intermediate its ends.
8. An apparatus as claimed in claim 5 wherein the compression means
is an elastomer band.
Description
This invention relates to methods and apparatus for the external
fixation of bone fractures and particularly to a method and
apparatus for using an external bridge together with metal pins
which are driven into the fracture fragments either percutaneously
or under direct vision.
The treatment of fractures particularly fractures of the limbs such
as the arm and the leg has historically been based upon the
encapsulation of the limb within a cast of plaster after the bone
fragments have been moved into place by some mechanical
manipulation of the broken member. This practice has many draw
backs. For example, the area around the fracture is usually
contused and swells drastically out of its normal proportions. This
places great pressure on the area beneath the plaster cast and
consequently great pressure on the muscle and portion of the bone
at the fracture. As the healing progresses the area beneath the
plaster cast slowly shrinks so that some time after application of
the cast the cast no longer fits or significantly supports the
fracture area. Moreover, the period of time that the cast is in
place is so long the wearer finds the cast to be cumbersome and
uncomfortable as well as less than sanitary. I have developed a new
method and apparatus for external fixation of bone fractures which
eliminates the need for a plaster cast surrounding the fracture
area. The method of my invention involves the use of metal pins
driven into fracture fragments either percutaneously or under
direct vision. The pins are held in appropriate position externally
of the skin by the use of a bridge which spaces and holds the pins
and the bone fragments into which they are driven in fixed position
for healing. Preferably the bridge is made of a cement material
which can be positioned while soft and will quickly harden in
position holding the pins in the desired arrangement with respect
to the fracture fragments. In a preferred practice of my invention,
I form the bridge by using a flexible bladder of oblong shape
filled with a cement in the plastic condition which is capable of
hardening in the bladder. A particularly suitable material for this
is epoxy resin. Preferably I provide flexible oblong bladders
filled with a resin base into which the hardener or catalyst may be
added by injection at the time of use and thoroughly mixed by hand
manipulation prior to application. The bladder could be furnished
with a reenforcing material such as chopped fiberglass, metal
filings or any of a variety of other strengthening fillers and any
reenforcing material. In addition, wires or similar reenforcing
members could be contained within the bladder to add strength to
the completed bridge. Preferably the pins are held in proper place
during hardening of the cement by a temporary bridge which is
removed after the final bridge has hardened. Preferably this is
done by attaching the temporary bridge to the pins at a point
between their site of exit from the skin of the limb being treated
and the point of entry into the bladder. Preferably such temporary
bridge has mechanism for adjusting the position of the pins
relative to the bridge and thus to allow manipulation for
improvement of positioning of the bone and bone fragments at the
fracture, prior to final hardening of the cement.
In the foregoing general description I have set out certain
objects, purposes and advantages of my invention. Other purposes,
objects and advantages of this invention will be apparent from a
consideration of the following description and the accompanying
drawings in which:
FIG. 1 is an isometric view of an arm showing the arrangement of
the apparatus of this invention for the purpose of holding a
fractured radius.
FIG. 2 is a vertical section through the forearm and radius as well
as the bridge holding the fractured bone in place according to FIG.
1.
FIG. 3 shows a second embodiment of the pin for use in this
invention.
FIG. 4 shows a third embodiment of the pin for use in this
invention.
FIG. 5 shows a fourth embodiment of the pin for use in this
invention.
FIG. 6 shows a second embodiment of a bladder and pin arrangement
according to this invention.
FIG. 7 shows a third embodiment of pin and bridge structure
according to this invention.
FIG. 8 shows a fourth embodiment of the pin and bridge structure
according to this invention.
FIG. 9 shows one form of temporary bridge which may be used during
the installation of the bridge and pin structure of this
invention.
Referring to the drawings I have illustrated in FIG. 1 the fixation
of a fracture of the radius in the forearm of a human being. In
FIG. 2 are seen two portions of the radius on opposite sides of the
fracture 10, identified by the numerals 11 and 12. Pins 13, 14, 15
and 16 are driven percutaneously into the two portions of the
radius 11 and 12, spaced in line from the fracture 10. A bridge 17
is fixed to the ends of the pins 13, 14, 15 and 16. The bridge is
made up of an external pliable bladder 18 of polyethylene filled
with fortified epoxy resin and formed to hold the pins and the key
portions of the radius in fixed relation. The bridge is applied by
pushing the pins 13, 14, 15 and 16 through the bladder and the
resin while the resin is in the soft and unhardened condition and
held in place until the cement hardens in the bladder. The bladder
can be removed or left in place as desired.
In the installation of the pins and bladder I preferably provide a
temporary bridge such as is shown in FIG. 9. In using this
temporary bridge the pins 13, 14, 15 and 16 are driven into the
bone portions. A temporary bridge made up of two portions connected
by a ball and socket universal joint 20 is connected to the pins
above the skin line. The two portions 21, 22 which are connected to
universal joint 20 are preferably formed of spaced plates 21a, 21b,
22a, and 22b held together by clamp screws or bolts 23. The pins
are clamped between these clamp plates and held in position by them
during the time the bladder filled with the unhardened cement is
placed over the exposed ends of the pins and hardened.
The function of the bladder 18 is simply to contain the cement
while it hardens about the pin along with any desirable
reenforcement material or accessory devices which might be desired
to be incorporated in the system. The bladder must hold the cement
in shape and contain a sufficient volume to provide a mechanically
adequate and convenient bridge for the pins used in the
fracture.
The pins may take a variety of shapes. They may be in the form of a
straight pin with sharpened ends, one end designed to cut through
soft tissue and bone so that it may be readily implanted. The other
end is simply sharpened sufficiently to permit skewering of the pin
on the bladder. The pin end may be threaded for more secure
engagement of the pin in the bone and it may be provided with some
mechanism for applied tension between two or more pins on opposite
sides of the fracture. Typical of such pins are those shown in
FIGS. 3, 4 and 5. In FIG. 3 I have shown a pin 30 having a side
flange 31 with an opening 32 to which a spring or other device for
imparting tension may be applied. In FIG. 4 I have shown a pin 35
with an eyelet 35a intermediate its ends to receive a spring or
other tensioning device. In FIG. 5 I have shown a pin 50 having a
crimp 51 or bend intermediate its ends to form a placement device
for a spring or other tensioning device.
In FIG. 6 I have shown a form of truss structure where extreme
strength is required. In the structure shown in FIG. 6 I have
illustrated straight pins 45 and bent pins 46 entering the soft
tissue and the bone ends 47, 48 to provide the extra strength
necessary in some bone fractures. Trussing could be provided in a
transverse plane or other planes as desired. It will be obvious
from the drawings that extreme rigidity in the longitudinal axis as
shown would interfer with the application of compression forces at
the fracture site. However, this can be overcome by using the
structure shown in FIG. 7. In FIG. 7 I have illustrated truss
arrangements in which a hinge 60 is provided in the bridge 61 and
62. This may be done by applying two end to end bladders 61 and 62
with a hinge connection 60 to harden into place or the hinge 60 may
be inserted in the bridge after the bridge is in place and
hardened. In the structure shown in FIG. 7 I have shown two bridge
segments 61 and 62 connected by a hinge 60. Each bridge segment is
provided with a straight pin 64 and two bent pins 65, 66. Each of
the bent pins 65 adjacent to the break 67 are connected by a spring
68 to exert compression on the bone. The arrangement which is shown
in FIG. 7 is particularly desirable in order to create compression
perpendicularly to a plane closer to that of a fracture so as to
avoid any tendency toward telescoping, such as might occur in an
oblique break, e.g., certain spiral fractures.
In FIG. 8 I have shown a structure in which two bridges on opposite
sides of the fracture are used. Here the two bone sections 71 and
72 to be connected are implanted with pins 73, 74, 75 and 76 which
pass through the bone section 71 and 72 and through the soft tissue
77 on each side of the bone. A bladder 78 is fixed on the ends
projecting from one side and a bladder 79 from the ends projecting
on the other side. The fluid cement in the bladders is solidified
to hold the pins in place. As shown in the drawings the pins may be
threaded intermediate their ends at the portion engaging the bone.
They may also be threaded at the extreme ends to engage the
solidified resin.
A sterile dressing, not illustrated, would be desirable over the
pin entry sites and a rubber band could be applied to the pin above
the dressing to help keep them in place. Alternatively, specialized
dressings for the pin sites might be found useful. These might take
the form of waterproof sterile bushings of soft material which
could be impregnated with anti-bacterial ointment. For example,
such bushings might be of soft rubber or plastic or they may be of
some sponge-like material impregnated with ointment or any other
variety of other devices.
It is obvious from the foregoing description of my invention that
the practice as set out therein has a variety of advantages over
the prior art practices. For example, fixation of the bones is
completely unaffected by soft tissue swelling. Soft tissue swelling
cannot cause circulatory deficit through pressure exerted by the
fixation device as it can in the case where the fixation device is
a plaster cast. There is no joint immobilization whatever required
after the cement is fully hardened and compression is applied.
Bending, torsional and tensile stress to the fractured bone should,
however, be minimized as one would expect. Deformity resulting from
loss of reduction would not be obscured by the fixation device as
it is in the case of a plaster cast and such deformities could be
promptly corrected before they become a part of the healed bone
structure. Finally topical therapy indicated on the injured
extremity can be carried out with little impediment from the
fixation device. This can be very helpful in cases where
significant soft tissue injury has occured along with the bone
fracture.
While I have illustrated and described certain preferred
embodiments of my invention in the foregoing specification, it will
be understood that this invention may be otherwise practiced within
the scope of the following claims.
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