US20060052789A1 - Device for securing an implant - Google Patents
Device for securing an implant Download PDFInfo
- Publication number
- US20060052789A1 US20060052789A1 US11/253,874 US25387405A US2006052789A1 US 20060052789 A1 US20060052789 A1 US 20060052789A1 US 25387405 A US25387405 A US 25387405A US 2006052789 A1 US2006052789 A1 US 2006052789A1
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- Prior art keywords
- implant
- bone
- driving
- force
- cover
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/688—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for reattaching pieces of the skull
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/809—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0642—Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
- A61B17/1227—Spring clips
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
- A61B2017/0648—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks threaded, e.g. tacks with a screw thread
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
- A61F2/2875—Skull or cranium
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30112—Rounded shapes, e.g. with rounded corners
- A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0006—Rounded shapes, e.g. with rounded corners circular
Definitions
- the invention relates to an implant for attaching a bone cover or bone fragment, and more particularly for fixing a bone cover or a skull bone fragment removed in a craniotomy to a skull cap.
- the invention also relates to a device for securing the said implant to the bone cover or bone fragment.
- bone covers i.e. plate-shaped bone parts
- skull covers are often sawn out of the skull bone.
- skull bone fragments need to be fixed in the region of the top of the skull.
- implants which comprise two screw holes.
- implants of this type are secured by means of screws to the bone cover, for example, which is to be fixed in place.
- the implants screwed to the bone cover are additionally securely screwed to the skull bone.
- a self-retaining implant of this type is known, for example, from DE 199 07 354 A1.
- This implant is a clamp-like element, which is placed onto the bone cover which is to be fixed.
- the implant comprises two contact arms, which are arranged spaced apart from one another and in the fitted state of the implant engage around the bone cover. In this respect, the first of the two contact arms contacts the upper side of the bone cover and the second of the two contact arms contacts the underside.
- a disadvantage in a clamp-like implant of this type is that it is awkward to handle. The awkward handling is first and foremost a result of the fact that different bone covers are not always of the same thickness and the thickness of a single bone cover may even vary.
- a further disadvantage is that the contact arm resting against the underside of the bone cover rests upon the flaps of the meninges once the bone cover is secured and under certain circumstances may damage the flaps.
- an implant system which comprises a self-retaining implant with a spike which can be laterally driven into the bone cover or bone fragment as well as a driving-in device for the said implant.
- the self-retaining implant comprises a support element with an upper side and a lower side facing the bone cover or bone fragment.
- a support element Arranged on the lower side of the support element is an extension, which supports at least one spike extending in the direction of the bone cover. The spike is laterally driven into the bone cover or bone fragment.
- the driving-in device comprises a force-transmitting element in the form of e.g. a holding or receiving element for the self-retaining implant, as well as a driving-in mechanism, which can be coupled with the force-transmitting element, for driving-in the implant, preferably the at least one spike of the implant, laterally into the bone cover or bone fragment.
- the driving-in mechanism can be coupled with a force-receiving surface coupled with the force-transmitting element in such a manner that the driving-in force is transmitted by the driving-in mechanism into the force-receiving surface, from here into the force-transmitting element and from the force-transmitting element into the implant.
- the driving-in force is directly introduced, for example by means of a hammer-like tool, into the force-receiving surface, which is coupled with e.g. a receiving element for the implant in a force-transmitting manner.
- the self-retaining implant according to the invention is not secured by pushing onto the bone cover, but is secured by means of one or more spikes laterally driven into the bone cover or bone fragment.
- the driving-in of the at least one spike of the implant is preferably effected by using a driving-in device according to the invention, which to this end may comprise a suitable driving-in mechanism.
- a driving-in of the self-retaining implant in particular with the use of a driving-in device according to the invention, is particularly advantageous from the point of view of handling.
- the connection between the implant and the bone cover or bone fragment resulting from the driving of the spike of the implant into, for example, the spongy region or cortical region of the bone cover or bone fragment is extremely stable and reliable.
- the at least one spike of the self-retaining implant is arranged relative to the support element in such a manner that it can be reliably driven into the bone cover or bone fragment and ensures good anchoring of the implant.
- the spike preferably extends substantially parallel to the support element.
- the spike may also be inclined relative to the support element, so long as the spike can be driven in to a sufficient depth.
- the transition between the extension and the spike arranged on the extension may be continuous, so that no defined border is visible between the extension and the spike.
- the spike projects from the extension at an angle of, for example, 90°.
- the extension expediently forms an angle of between 45° and 135° with the implant element.
- the extension can function as an abutment, which allows for precise driving-in of the spike. In other words: as soon as the extension comes to rest against lateral regions of the bone cover or bone fragment, it prevents further driving-in of the spike.
- an analysis of the position of the extension relative to a lateral region of the bone cover or bone fragment provides a visual assessment as to whether the spike of the implant has been driven in to a sufficient depth.
- the extension is arranged relative to the support element in such a manner that the support element and the extension essentially form a T-shaped structure in cross section.
- the support element corresponds to the cross beam of the T and the extension corresponds to the longitudinal beam thereof.
- the extension thus divides the support element into two support arms extending in opposite directions. The first of the two support arms extends in the direction of the bone cover or bone fragment and the second of the two support arms in the direction of the skull bone.
- This type of design of the implant is advantageous, since the support arm extending in the direction of the bone cover, for example, and resting upon the upper side of the bone cover, together with the spike driven into the bone cover, allows for particularly reliable securing of the implant to the bone cover.
- the support arm cooperating with the bone cover can be advantageously used as a guide during the positioning and driving in of the implant.
- the implant could also have a Z-shaped structure, for example, the upper cross beam of the Z functioning as a support element on the skull bone and the lower cross beam forming the spike.
- the support element preferably has a flat, e.g. strip-shaped form.
- the underside of the support element can be concave or spherically curved at least in sections in order to ensure good adaptation of the implant to the curvature of the skull.
- the support element of the implant is flexible at least in certain regions, in order to allow for individual adaptation of the implant to the curvature of the skull.
- the spike of the implant which is to be driven in is arranged, for example, at an end of the extension remote from the support element.
- the spike can be designed in various ways. Thus, it is possible, for example, to provide a spike in the form of one or more spurs or a saw tooth structure.
- the spike preferably has a flat, triangular structure.
- the spike can be provided with sharpened edges.
- the length of the spike can be freely selected within a wide range, so long as sufficiently reliable anchoring of the implant is guaranteed.
- the support element may comprise a screw hole to allow for fixing of the bone cover or bone fragment provided with one or more implants to the skull bone by means of screws.
- the screw hole is consequently constructed in the support arm which cooperates with the skull bone.
- the support element preferably has a locally increased thickness in the region of the screw hole.
- the thickness of the support element in the region of the screw hole can be selected in such a manner that the screw head can be partially or fully recessed in the screw hole. This is advantageous for cosmetic reasons.
- the thickness of the support element can be markedly reduced.
- the interior of the screw hole is expediently spherically curved in order to allow for the recessing of bone screw heads having a corresponding spherical curvature.
- the implant according to the invention can be driven into the bone cover or bone fragment in different ways. This is possible in a particularly simple manner using the driving-in device according to the invention comprising a driving-in mechanism.
- the driving-in mechanism can be constructed in such a manner that it allows for the application of a striking force upon a receiving or holding element provided for the implant.
- the driving-in mechanism can comprise a striking element, which is displaceable against a spring force. By means of the spring force, the striking element can be prestressed in the driving-in direction, the striking force being actuated by a sudden reduction in the prestressing.
- the striking element is preferably formed by a first carriage guided coaxial to the receiving element.
- Guidance for the first carriage can be formed, for example, by a bolt arranged coaxial to the receiving element.
- the receiving element can be connected to the bolt or another stationary component of the driving-in device in such a manner that the receiving element is displaceable in the axial direction to a limited degree.
- the driving-in device expediently comprises an operating mechanism for the driving-in mechanism.
- an operating mechanism for the driving-in mechanism which comprises a striking element displaceable against a spring force
- the force required for the displacement of the striking element is preferably applied by means of the operating mechanism.
- the operating mechanism can be actuated with the aid of an electric motor or one or more fingers.
- a coupling device For the coupling of the operating mechanism with the striking element, i.e. for the prestressing of the striking element, for example, a coupling device can be provided.
- the coupling device comprises a driver, for example, for taking along the striking element.
- a corresponding decoupling device is expediently provided, which allows for a decoupling of the operating mechanism and striking element in order to activate the striking force.
- the driving-in device according to the invention has a gun-like construction. This type of design allows for particularly ergonomic and reliable driving in of the implants. Other designs of the driving-in device according to the invention are, however, also conceivable.
- the driving-in device can have a substantially cylindrical form, for example.
- a driving-in device having a gun-like design typically comprises a gun body and a gun barrel.
- the gun body can comprise a gun handle as well as a housing connected to the handle for accommodating the driving-in mechanism.
- the operating mechanism for the driving-in mechanism can be constructed as a finger-operated gun trigger.
- the gun trigger is preferably coupled with a second carriage displaceable against a spring force.
- the coupling device described above can be functionally arranged between the first and second carriages.
- the receiving element for the implant in the manner of a piston barrel in relation to the gun body.
- This type of arrangement of the receiving element allows for particularly simple positioning of the implant, which is to be driven into place, relative to the bone cover or bone fragment.
- the receiving element can be provided with a self-locking mechanism for the implant, so that the implant can be removed directly from the cartridge provided for the implant by means of the driving-in device. It is therefore unnecessary to touch the implant with the fingers during the entire securing procedure of the implant. This is desirable for ergonomic reasons.
- FIG. 1 is a side view of an embodiment of the implant according to the invention.
- FIG. 2 is a plan view of the underside of the implant according to FIG. 1 facing the bone plate;
- FIG. 3 is a sectional view through the support element of the implant according to FIGS. 1 and 2 in the region of a screw hole;
- FIG. 4 is a side view of a first embodiment of a driving-in device according to the invention.
- FIG. 5 is a longitudinal section through the driving-in device according to FIG. 4 ;
- FIG. 6 is a cross section through the driving-in device according to FIG. 4 along the line VI-VI according to FIG. 5 ;
- FIGS. 7 a and 7 b are a plan view and sectional view respectively of the receiving element for the implant
- FIG. 8 is a plan view of a second embodiment of a driving-in device according to the invention.
- FIG. 9 is a perspective view of the driven-in implant according to FIG. 1 following its securing in the skull bone.
- FIG. 1 is a side view of an embodiment of a self-retaining implant 10 according to the invention.
- the implant 10 comprises a support element 12 , an extension 14 connected to the support element 12 and a flat spike 16 connected to the extension 14 .
- the support element 12 comprises an upper side 18 and a lower side 20 .
- the lower side 20 contacts a bone cover or bone fragment, not shown in FIG. 1 , as well as a skull bone, also not shown in FIG. 1 .
- the lower side 20 is spherically curved.
- the radius of curvature R measures 79.5 mm.
- the support element 12 according to FIG. 1 is formed by two support arms 22 , 24 .
- the left support arm 22 in FIG. 1 rests upon the skull bone and the right support arm 24 in FIG. 1 rests upon the bone cover, for example.
- the length ratio between the left support arm 22 and the right support arm 24 can be varied by means of the position of the extension 14 relative to the two support arms 22 , 24 .
- the left support arm 22 has a somewhat greater length than the right support arm 24 .
- the left support arm 22 is provided at its end remote from the spike 16 with a screw hole 26 .
- the support element 12 has its maximum thickness d of approximately 0.5 mm. This thickness has been selected in order to allow for a cosmetically advantageous recessing of a bone screw head in the support element 12 .
- the support element 12 has a reduced thickness of, typically, 0.3 mm. This reduced thickness is selected in such a manner that the support element can be slightly bent in regions outside the screw hole. By bending the support element 12 , the lower side 20 can be individually adapted to the curvature of the bone cover or skull bone.
- the extension 14 of the implant 10 is secured to the lower side 20 of the support element 12 and extends substantially at right angles to the support element 12 . Together, the support element 12 and the extension 14 form a T-shaped structure. In this respect, the support element 12 represents the cross beam of the T-shaped structure and the extension 14 the longitudinal beam.
- the width b of the extension 14 needs to be small, so that the bone gap between the bone cover or the bone fragment and the skull bone can be kept to a minimum.
- the widths b are expediently less than one millimetre, for example 0.6 mm.
- the driving-in force is to be transmitted from the extension 14 to the spike 16 .
- the spike 16 is constructed at the end of the extension 14 lying opposite the support element 12 . It can be clearly seen in FIG. 1 that the spike extends perpendicular to the extension 14 and substantially parallel to the support element 12 . The thickness s of the spike 16 gradually decreases as its distance from the extension 14 increases. The edges 28 , 30 of the spike 16 are sharpened in order to facilitate the driving of the spike into the bone cover or bone fragment.
- the implant 10 according to FIG. 1 is shown in a plan view of the underside 20 of the support element 12 .
- the support element 12 comprises a substantially strip-shaped form with rounded ends.
- the spike 16 is flat and triangular in design and can therefore be fitted with a comparatively low driving-in force.
- Alternative designs of the spike 16 are also conceivable.
- the spike 16 could be additionally provided, for example, with barb-like structures in order to improve the anchoring of the spike 16 in the spongy region.
- FIG. 3 is a section through the implant illustrated in FIG. 2 in the region of the screw hole 26 .
- the interior of the screw hole 26 comprises a spherically curved region 32 , which in the direction of the underside 20 opens into a short, cylindrical region 34 .
- the spherically curved region 32 allows correspondingly shaped bone screw heads to be recessed in the support element 12 .
- the implant 10 according to FIGS. 1 to 3 is self-retaining, since it can be secured without securing elements such as screws, nails, etc. to a bone cover, for example.
- the retaining force of the implant 10 is substantially independent of the thickness of the bone cover. It is therefore possible to ensure a secure anchoring of the implant according to the invention even in the case of small bone cover thicknesses.
- the implant 10 is driven laterally into the bone cover or into the bone fragment.
- the anchoring of the implant 10 therefore requires no elements resting against the underside of the bone cover or bone fragment, so that damage to the meninges flaps by the implant 10 is ruled out.
- the length of the extension 14 i.e. the distance between the spike 30 and the support element 12 , is typically selected in such a manner that the implant 10 can be securely anchored in the case of bone cover thicknesses up to 3.5 mm.
- the implant 10 is manufactured from biocompatible TiAl6V4.
- the implant 10 can also be made entirely or partially of a reabsorbable material instead of a metal.
- FIG. 4 shows a first embodiment of a driving-in device 40 according to the invention for the implant 10 according to FIGS. 1 to 3 .
- the driving-in device 40 has the form of a gun with a gun body 42 and a gun barrel 44 .
- the gun barrel 44 is formed by a receiving element 46 for holding the implant which is to be driven into place.
- the gun body 42 is formed by a handle 48 and a housing 50 .
- the driving-in mechanism Arranged within the housing 50 is the driving-in mechanism, not shown in FIG. 4 , which cooperates with the receiving element 46 .
- the driving-in mechanism allows for the introduction of driving force into the receiving element 46 .
- the housing 50 comprises two laterally arranged and fully detachable housing covers. In the view according to FIG. 4 , a single housing cover 52 can be seen.
- the detachable housing cover allows for easy cleaning and lubrication of the driving-in mechanism following the operation.
- an operating mechanism in the form of a gun trigger 54 is provided.
- the gun trigger 54 has an ergonomic shape, which is adapted to actuation by means of index finger and middle finger or by means of middle finger and ring finger.
- FIG. 5 is a longitudinal section through the driving-in device 40 according to FIG. 4 and in particular the driving-in mechanism 56 of the driving-in device 40 .
- the driving-in mechanism 56 is constructed as a striking mechanism and comprises a striking element in the form of an upper carriage 58 .
- the upper carriage 58 comprises a central through aperture 59 , through which a stationary, upper guide bolt 60 extends, which is anchored on the housing 50 .
- the upper carriage 58 is displaceably guided by means of a ball implant 62 along the upper guide bolt 60 .
- the upper guide bolt 60 is radially enclosed on its outside by a helical spring 64 , which in the starting position of the driving-in mechanism 56 illustrated in
- FIG. 5 rests with one end against the housing 50 and with its other end against the upper carriage 58 .
- the helical spring 64 is compressed.
- the upper carriage 58 is prestressed to the right in FIG. 5 , i.e. in the driving-in direction.
- the upper guide bolt 60 projects in the manner of a gun barrel partially out of the housing 50 .
- the upper guide bolt 60 is coupled with the receiving element 46 for the implant radially enclosing the said end on the outside.
- the coupling of the upper guide bolt 60 with the receiving element 46 is effected by means of a cross bolt 66 rigidly connected to the upper guide bolt 60 .
- the cross bolt 66 projects through an opening 68 in the receiving element 46 .
- the opening 68 is a slot having an oval shape and therefore allows for limited movement of the receiving element 46 relative to the upper guide bolt 60 along the axis A.
- the relative displaceability of the receiving sleeve is necessary in order to transmit the striking force introduced into the receiving sleeve 46 to the implant accommodated by the receiving element 46 and not illustrated in FIG. 5 .
- the striking force is introduced into the receiving element 46 by means of the upper carriage 58 arranged coaxial to the receiving element 46 .
- a central guide bolt 70 Arranged within the housing 50 somewhat below the upper guide bolt 60 is a central guide bolt 70 .
- the central guide bolt 70 is secured in a stationary manner in the housing 50 and extends parallel to the upper guide bolt 60 .
- a lower carriage 72 is displaceably guided by a ball implant 74 along the central guide bolt 70 , which penetrates the lower carriage 72 .
- the central guide bolt 70 is enclosed radially on its outside by a helical spring 76 , which is supported at one end against the housing 50 and at its other end against the lower carriage 72 .
- the helical spring 76 is compressed.
- the lower carriage 72 is prestressed to the right in FIG. 5 .
- the lower carriage 72 is rigidly coupled with the gun trigger 54 .
- the lower carriage Upon actuation of the gun trigger 54 , i.e. during a displacement of the gun trigger 54 to the left in FIG. 5 , the lower carriage is therefore also displaced to the left.
- Pressed into the gun trigger 54 is a plastics material plug 82 .
- the plastics material plug 82 comes to rest against the gun handle 48 and thereby limits the displaceability of the gun trigger 54 .
- the gun trigger 54 is connected to a lower guide bolt 76 , which is displaceable relative to the housing 50 .
- the lower guide bolt 76 is displaceably guided along an axis B in a blind bore 78 constructed in the piston handle 48 .
- a plastics material sleeve 80 is pressed into the blind bore 78 which lines the blind bore 78 radially on the inside.
- the coupling device 84 allows for the coupling of the operating mechanism, i.e. the gun trigger 54 , with the striking element in the form of the upper carriage 58 .
- the coupling device 84 comprises a driver 86 , which is pivotable in the plane of the drawing, a leaf spring 88 and a coupling element 90 .
- the driver 86 is pivotably secured to the lower carriage 72 and is prestressed in the direction of the upper carriage 58 by the leaf spring 88 , which is also secured to the lower carriage 72 .
- the coupling element 90 is arranged on the upper carriage 58 .
- a decoupling device 92 which can cooperate with the coupling device 84 and can release the coupling between the gun trigger 54 and the upper carriage 58 .
- the decoupling device 92 comprises a pin 94 projecting into the housing 50 .
- the pin 94 is displaceable along its longitudinal axis C.
- the pin 94 comprises an external thread 96 radially on its outside, which cooperates with a matching internal thread 97 in the gun body 42 .
- a counter nut 98 allows for locking of the pin 94 in a desired, axial position.
- the pin 94 is provided with an internal polygon allowing for the application of a tool to the pin 94 in order to adjust the decoupling threshold.
- FIG. 6 is a cross section through the driving-in device 40 shown in FIG. 4 taken along the line IV-IV according to FIG. 5 .
- the housing 50 is closed laterally by two removable housing covers 52 , 52 ′.
- the driving-in mechanism with the upper carriage 58 guided along the upper guide bolt 60 and the lower carriage 72 guided along the central guide bolt 70 .
- the lower carriage 72 is connected by means of a screw 102 to the gun handle 54 .
- the screw 102 comprises an internal polygon 104 .
- the driver 86 of the coupling device 84 cooperating with the leaf spring 88 comprises a U-shaped groove 106 .
- the coupling device 84 cooperates with the pin 94 of the decoupling device.
- the groove 106 is arranged relative to the plane of the drawing in such a manner that the driver 86 can be forced downwards in FIG. 6 by the tip of the pin 94 against the spring force of the leaf spring 88 .
- FIGS. 7 a and 7 b show the receiving element 46 of the driving-in device 40 illustrated in FIG. 4 . Visible is the oval opening 68 , in which the cross bolt 66 illustrated in FIG. 5 is displaceably guided.
- the receiving element 46 is partially constructed in the manner of a sleeve and comprises a blind bore 108 for receiving an end region of the upper guide bolt 60 illustrated in FIG. 5 .
- the receiving element 46 At its end lying opposite the blind bore 108 , the receiving element 46 comprises a sleeve 112 , which radially encloses the cylindrical base element of the receiving element 46 on the outside.
- a flat slot 114 Formed between the cylindrical base element of the receiving element 46 and the sleeve 112 is a flat slot 114 , which is used to receive the implant.
- the slot 114 can be seen in the sectional view according to FIG. 7 b.
- the self-locking mechanism 110 comprises a ball 116 and a spring 118 prestressing the ball 116 in the direction of the slot 114 .
- the ball 116 cooperates with the screw hole 26 of the implant 10 illustrated in FIG. 2 .
- the implant 10 illustrated in FIGS. 1 to 3 is introduced with its left support arm 22 comprising the screw hole 26 into the slot 114 of the receiving element 46 .
- the ball 116 engages in the screw hole 26 and the self-locking mechanism 110 is actuated. Since the ball 116 engages with prestressing in the screw hole of the implant, it is no longer possible for the implant to accidentally slide out of the slot 114 .
- the implant is preferably directly removed from an implant container by means of the driving-in device 40 . It is therefore unnecessary to introduce the implant into the slot 114 with the aid of the fingers. In this manner, the handling of the implant system according to the invention, comprising implant and driving-in device 40 , is considerably improved.
- the secured implant is positioned by means of the driving-in device 40 in the region of the bone cover or bone fragment which is to be fixed in place.
- the positioning is effected in such a manner that the right-hand support arm 24 of the implant 10 illustrated in FIG. 1 comes to rest upon the surface of the bone cover or bone fragment and the spike laterally contacts the spongious or cortical region.
- the gun trigger 54 is displaced to the left in FIG. 5 by means of two fingers. This movement of the gun trigger 54 is also transmitted to the lower carriage 52 rigidly coupled with the gun trigger 54 .
- the driver 86 contacts the coupling element 90 of the upper carriage 58 .
- the upper carriage 58 is taken along by the driver 86 and is also displaced to the left in FIG. 5 against the spring force of the helical spring 64 .
- the coupling of the lower carriage 72 with the upper carriage 58 is recognized by the user of the driving-in device 40 in that the force required for the actuation of the gun trigger 54 increases. This increase in force results from the fact that it is now not only necessary to compress the lower helical spring 76 , but also the upper helical spring 84 , owing to the coupling of the lower carriage 72 and the upper carriage 58 .
- the gun trigger 54 can be released again.
- the compressed helical spring 76 expands again and the gun trigger 54 is moved by the helical spring 76 back into the starting position illustrated in FIG. 5 .
- the driving-in procedure described above can then be repeated, if necessary, to drive the spike 16 of the implant 10 deeper into position.
- the extension 14 rests laterally against the bone cover or bone fragment, the driving-in procedure is complete.
- the extension 14 then functions as a mechanical abutment, which prevents the spike 16 from being driven too deeply into the bone cover.
- FIGS. 1 to 3 It is usually necessary to position three to four implants 10 according to FIGS. 1 to 3 in a bone cover in order to reliably fix the bone cover in the skull bone.
- the bone cover is positioned in the corresponding opening in the skull bone and is secured to the skull bone by means of a bone screw for each implant. This is illustrated in further detail in FIG. 9 , which will be described in more detail below.
- FIG. 8 shows a second embodiment of a driving-in device 40 according to the invention for driving an implant laterally into a bone cover or bone fragment.
- the driving-in device 40 has an elongated structure and comprises a receiving element 46 for the implant as well as a knob-like force-receiving structure 120 having a spherically curved force-receiving surface 122 .
- the driving-in device 40 also comprises a substantially cylindrical body 124 , which is arranged in a force-transmitting manner between the force-receiving structure 120 and the receiving element 46 for the implant.
- the cylindrical element 124 At its end facing the receiving element 46 , the cylindrical element 124 comprises a grip 126 , which radially encloses the outside of the cylindrical body 124 .
- the grip 126 is coupled to the body 124 so as to be immovable in the axial direction.
- the receiving element 46 comprises the self-locking mechanism illustrated in FIGS. 7 a and 7 b for the implant.
- the implant is firstly fixed in the region of the receiving element 46 by means of the self-locking mechanism.
- the implant is then positioned as described above and a striking force is introduced into the force-receiving surface 122 of the force-receiving structure 120 by means of a hammer, for example.
- the striking force is transmitted from the force-receiving structure 120 via the body 124 and the receiving element 46 to the implant 10 , which is thereby driven laterally into the bone cover.
- FIG. 9 shows a bone cover 130 , which comprises an upper bone plate 132 (first cortical layer), a lower bone plate 134 (second cortical layer) as well as a spongious region 136 arranged between the upper bone plate 132 and the lower bone plate 134 .
- the implant 10 has been secured to the bone cover 130 by means of the driving-in device 40 described with reference to FIGS. 4 to 7 b .
- the spike 16 of the implant 10 has been driven into the spongious region 136 of the bone cover 130 to such a depth that the extension 14 rests laterally against the bone cover 130 .
- the bone cover 130 was positioned in the corresponding opening in the skull bone 140 .
- the underside of the support arm 22 of the implant 10 comes to rest against the upper bone plate 142 of the skull bone 140 .
- the skull bone 140 also comprises a spongious region 146 , which is arranged between the upper bone plate 142 and a lower bone plate 144 .
- the bone cover 130 needs to be fixed in position within the opening of the skull bone 140 .
- the implants 10 are secured to the skull bone 140 by means of bone screws 150 .
- the spherical head 152 of each bone screw 150 is fully recessed within the screw hole of the implant 10 .
Abstract
The invention relates to a self-retaining implant for fixing a bone cover or a bone fragment in an opening in a skull bone. The implant comprises a support element with an upper side and an lower side facing the bone cover. Arranged on the lower side of the support element is an extension, which supports a spike preferably extending parallel to the support element. The spike can be driven laterally into the bone cover or bone fragment by means of a driving-in device according to the invention. The driving-in device according to the invention comprises a receiving element for the implant. A driving-in mechanism for driving the implant into the bone cover or bone fragment can be coupled with the receiving element.
Description
- 1. Technical Field of the Invention
- The invention relates to an implant for attaching a bone cover or bone fragment, and more particularly for fixing a bone cover or a skull bone fragment removed in a craniotomy to a skull cap. The invention also relates to a device for securing the said implant to the bone cover or bone fragment.
- 2. Description of the Prior Art
- Within the framework of skull operations, bone covers, i.e. plate-shaped bone parts, are often sawn out of the skull bone. At the end of the operation, it is necessary to fix these bone covers again in the resulting opening in the top of the skull, so that the bone cover can heal into its old position again. A comparable problem arises when skull bone fragments need to be fixed in the region of the top of the skull.
- Various implants have been proposed for attaching bone covers or skull bone fragments. Thus, implants are known which comprise two screw holes. In a first step, implants of this type are secured by means of screws to the bone cover, for example, which is to be fixed in place. Subsequently, the implants screwed to the bone cover are additionally securely screwed to the skull bone. As a result of the fact that it is firstly necessary to secure each individual implant by means of a screw in each case to the bone cover and then to the skull bone, the fixing of the bone cover is very time-consuming. In order to reduce the time outlay associated with the fixing of a bone cover, self-retaining implants have been proposed.
- A self-retaining implant of this type is known, for example, from DE 199 07 354 A1. This implant is a clamp-like element, which is placed onto the bone cover which is to be fixed. To this end, the implant comprises two contact arms, which are arranged spaced apart from one another and in the fitted state of the implant engage around the bone cover. In this respect, the first of the two contact arms contacts the upper side of the bone cover and the second of the two contact arms contacts the underside.
- A disadvantage in a clamp-like implant of this type is that it is awkward to handle. The awkward handling is first and foremost a result of the fact that different bone covers are not always of the same thickness and the thickness of a single bone cover may even vary. A further disadvantage is that the contact arm resting against the underside of the bone cover rests upon the flaps of the meninges once the bone cover is secured and under certain circumstances may damage the flaps.
- It is the object of the invention to provide an implant system which comprises a self-retaining implant offering simplified handling.
- This object is attained according to the invention by an implant system which comprises a self-retaining implant with a spike which can be laterally driven into the bone cover or bone fragment as well as a driving-in device for the said implant.
- The self-retaining implant comprises a support element with an upper side and a lower side facing the bone cover or bone fragment. Arranged on the lower side of the support element is an extension, which supports at least one spike extending in the direction of the bone cover. The spike is laterally driven into the bone cover or bone fragment.
- According to a first variant, the driving-in device comprises a force-transmitting element in the form of e.g. a holding or receiving element for the self-retaining implant, as well as a driving-in mechanism, which can be coupled with the force-transmitting element, for driving-in the implant, preferably the at least one spike of the implant, laterally into the bone cover or bone fragment. In this respect, the driving-in mechanism can be coupled with a force-receiving surface coupled with the force-transmitting element in such a manner that the driving-in force is transmitted by the driving-in mechanism into the force-receiving surface, from here into the force-transmitting element and from the force-transmitting element into the implant. According to a second variant of the driving-in device, there is no driving-in mechanism. In this case, the driving-in force is directly introduced, for example by means of a hammer-like tool, into the force-receiving surface, which is coupled with e.g. a receiving element for the implant in a force-transmitting manner.
- The self-retaining implant according to the invention is not secured by pushing onto the bone cover, but is secured by means of one or more spikes laterally driven into the bone cover or bone fragment. The driving-in of the at least one spike of the implant is preferably effected by using a driving-in device according to the invention, which to this end may comprise a suitable driving-in mechanism. In practice, it has been found that a driving-in of the self-retaining implant, in particular with the use of a driving-in device according to the invention, is particularly advantageous from the point of view of handling. The connection between the implant and the bone cover or bone fragment resulting from the driving of the spike of the implant into, for example, the spongy region or cortical region of the bone cover or bone fragment is extremely stable and reliable.
- The at least one spike of the self-retaining implant is arranged relative to the support element in such a manner that it can be reliably driven into the bone cover or bone fragment and ensures good anchoring of the implant.
- To this end, the spike preferably extends substantially parallel to the support element. However, the spike may also be inclined relative to the support element, so long as the spike can be driven in to a sufficient depth. The transition between the extension and the spike arranged on the extension may be continuous, so that no defined border is visible between the extension and the spike. However, according to a preferred embodiment, the spike projects from the extension at an angle of, for example, 90°.
- The extension expediently forms an angle of between 45° and 135° with the implant element. Preferred is an extension which extends substantially at right angles to the support element. In this case, the extension can function as an abutment, which allows for precise driving-in of the spike. In other words: as soon as the extension comes to rest against lateral regions of the bone cover or bone fragment, it prevents further driving-in of the spike. In addition, an analysis of the position of the extension relative to a lateral region of the bone cover or bone fragment provides a visual assessment as to whether the spike of the implant has been driven in to a sufficient depth.
- According to a preferred embodiment, the extension is arranged relative to the support element in such a manner that the support element and the extension essentially form a T-shaped structure in cross section. In this respect, the support element corresponds to the cross beam of the T and the extension corresponds to the longitudinal beam thereof. The extension thus divides the support element into two support arms extending in opposite directions. The first of the two support arms extends in the direction of the bone cover or bone fragment and the second of the two support arms in the direction of the skull bone. This type of design of the implant is advantageous, since the support arm extending in the direction of the bone cover, for example, and resting upon the upper side of the bone cover, together with the spike driven into the bone cover, allows for particularly reliable securing of the implant to the bone cover. In addition, the support arm cooperating with the bone cover can be advantageously used as a guide during the positioning and driving in of the implant.
- It is, however, also possible to dispense with the support arm cooperating with the bone cover or bone fragment. Thus, instead of having a T-shaped design, the implant could also have a Z-shaped structure, for example, the upper cross beam of the Z functioning as a support element on the skull bone and the lower cross beam forming the spike.
- The support element preferably has a flat, e.g. strip-shaped form. The underside of the support element can be concave or spherically curved at least in sections in order to ensure good adaptation of the implant to the curvature of the skull. Expediently, the support element of the implant is flexible at least in certain regions, in order to allow for individual adaptation of the implant to the curvature of the skull.
- The spike of the implant which is to be driven in is arranged, for example, at an end of the extension remote from the support element. The spike can be designed in various ways. Thus, it is possible, for example, to provide a spike in the form of one or more spurs or a saw tooth structure. However, the spike preferably has a flat, triangular structure. In order to facilitate the driving-in of the spike, the spike can be provided with sharpened edges. The length of the spike can be freely selected within a wide range, so long as sufficiently reliable anchoring of the implant is guaranteed.
- At its end opposite the spike, the support element may comprise a screw hole to allow for fixing of the bone cover or bone fragment provided with one or more implants to the skull bone by means of screws. In the case of a support element with two or more support arms, the screw hole is consequently constructed in the support arm which cooperates with the skull bone. The support element preferably has a locally increased thickness in the region of the screw hole. In this respect, the thickness of the support element in the region of the screw hole can be selected in such a manner that the screw head can be partially or fully recessed in the screw hole. This is advantageous for cosmetic reasons. In contrast, in the region of the support element outside the screw hole, the thickness of the support element can be markedly reduced. The interior of the screw hole is expediently spherically curved in order to allow for the recessing of bone screw heads having a corresponding spherical curvature.
- The implant according to the invention can be driven into the bone cover or bone fragment in different ways. This is possible in a particularly simple manner using the driving-in device according to the invention comprising a driving-in mechanism. The driving-in mechanism can be constructed in such a manner that it allows for the application of a striking force upon a receiving or holding element provided for the implant. To this end, the driving-in mechanism can comprise a striking element, which is displaceable against a spring force. By means of the spring force, the striking element can be prestressed in the driving-in direction, the striking force being actuated by a sudden reduction in the prestressing.
- The striking element is preferably formed by a first carriage guided coaxial to the receiving element. Guidance for the first carriage can be formed, for example, by a bolt arranged coaxial to the receiving element. The receiving element can be connected to the bolt or another stationary component of the driving-in device in such a manner that the receiving element is displaceable in the axial direction to a limited degree.
- The driving-in device expediently comprises an operating mechanism for the driving-in mechanism. In the case of a driving-in mechanism which comprises a striking element displaceable against a spring force, the force required for the displacement of the striking element is preferably applied by means of the operating mechanism. To this end, the operating mechanism can be actuated with the aid of an electric motor or one or more fingers.
- For the coupling of the operating mechanism with the striking element, i.e. for the prestressing of the striking element, for example, a coupling device can be provided. The coupling device comprises a driver, for example, for taking along the striking element. In cases where a coupling device is present, a corresponding decoupling device is expediently provided, which allows for a decoupling of the operating mechanism and striking element in order to activate the striking force.
- According to a particularly preferred embodiment, the driving-in device according to the invention has a gun-like construction. This type of design allows for particularly ergonomic and reliable driving in of the implants. Other designs of the driving-in device according to the invention are, however, also conceivable. Thus, the driving-in device can have a substantially cylindrical form, for example.
- A driving-in device having a gun-like design typically comprises a gun body and a gun barrel. The gun body can comprise a gun handle as well as a housing connected to the handle for accommodating the driving-in mechanism. The operating mechanism for the driving-in mechanism can be constructed as a finger-operated gun trigger. The gun trigger is preferably coupled with a second carriage displaceable against a spring force. In this case, the coupling device described above can be functionally arranged between the first and second carriages.
- In the case of a gun-like design of the driving-in device, it is possible to arrange the receiving element for the implant in the manner of a piston barrel in relation to the gun body. This type of arrangement of the receiving element allows for particularly simple positioning of the implant, which is to be driven into place, relative to the bone cover or bone fragment.
- The receiving element can be provided with a self-locking mechanism for the implant, so that the implant can be removed directly from the cartridge provided for the implant by means of the driving-in device. It is therefore unnecessary to touch the implant with the fingers during the entire securing procedure of the implant. This is desirable for ergonomic reasons.
- An embodiment of the implant and an embodiment of the device will be explained in further detail in the following with the aid of several drawings, in which:
-
FIG. 1 is a side view of an embodiment of the implant according to the invention; -
FIG. 2 is a plan view of the underside of the implant according toFIG. 1 facing the bone plate; -
FIG. 3 is a sectional view through the support element of the implant according toFIGS. 1 and 2 in the region of a screw hole; -
FIG. 4 is a side view of a first embodiment of a driving-in device according to the invention; -
FIG. 5 is a longitudinal section through the driving-in device according toFIG. 4 ; -
FIG. 6 is a cross section through the driving-in device according toFIG. 4 along the line VI-VI according toFIG. 5 ; -
FIGS. 7 a and 7 b are a plan view and sectional view respectively of the receiving element for the implant; -
FIG. 8 is a plan view of a second embodiment of a driving-in device according to the invention; and -
FIG. 9 is a perspective view of the driven-in implant according toFIG. 1 following its securing in the skull bone. -
FIG. 1 is a side view of an embodiment of a self-retainingimplant 10 according to the invention. Theimplant 10 comprises asupport element 12, anextension 14 connected to thesupport element 12 and aflat spike 16 connected to theextension 14. - The
support element 12 comprises anupper side 18 and alower side 20. Following implantation, thelower side 20 contacts a bone cover or bone fragment, not shown inFIG. 1 , as well as a skull bone, also not shown inFIG. 1 . In order to ensure a implant of thelower side 20 which is as free of clearance as possible, thelower side 20 is spherically curved. The radius of curvature R measures 79.5 mm. - The
support element 12 according toFIG. 1 is formed by twosupport arms implant 10, theleft support arm 22 inFIG. 1 rests upon the skull bone and theright support arm 24 inFIG. 1 rests upon the bone cover, for example. The length ratio between theleft support arm 22 and theright support arm 24 can be varied by means of the position of theextension 14 relative to the twosupport arms FIG. 1 , theleft support arm 22 has a somewhat greater length than theright support arm 24. - The
left support arm 22 is provided at its end remote from thespike 16 with ascrew hole 26. In the region of thescrew hole 26, thesupport element 12 has its maximum thickness d of approximately 0.5 mm. This thickness has been selected in order to allow for a cosmetically advantageous recessing of a bone screw head in thesupport element 12. In regions remote from thescrew head 26, thesupport element 12 has a reduced thickness of, typically, 0.3 mm. This reduced thickness is selected in such a manner that the support element can be slightly bent in regions outside the screw hole. By bending thesupport element 12, thelower side 20 can be individually adapted to the curvature of the bone cover or skull bone. - The
extension 14 of theimplant 10 is secured to thelower side 20 of thesupport element 12 and extends substantially at right angles to thesupport element 12. Together, thesupport element 12 and theextension 14 form a T-shaped structure. In this respect, thesupport element 12 represents the cross beam of the T-shaped structure and theextension 14 the longitudinal beam. - The width b of the
extension 14 needs to be small, so that the bone gap between the bone cover or the bone fragment and the skull bone can be kept to a minimum. The widths b are expediently less than one millimetre, for example 0.6 mm. By means of theimplant 10, the bone cover or bone fragment can be positioned in the skull bone in such a manner that the bone gap along the contour of the bone cover or bone fragment is constant. However, in order to ensure faster growth of the bone cover or bone fragment, the bone cover or bone fragment can also be fixed by means of theimplant 10 in such a manner that it has contact with the skull bone in certain areas. - When the
support element 12 or theextension 14 is loaded with the driving-in force, which acts to the right inFIG. 1 , the driving-in force is to be transmitted from theextension 14 to thespike 16. Thespike 16 is constructed at the end of theextension 14 lying opposite thesupport element 12. It can be clearly seen inFIG. 1 that the spike extends perpendicular to theextension 14 and substantially parallel to thesupport element 12. The thickness s of thespike 16 gradually decreases as its distance from theextension 14 increases. Theedges spike 16 are sharpened in order to facilitate the driving of the spike into the bone cover or bone fragment. - In
FIG. 2 , theimplant 10 according toFIG. 1 is shown in a plan view of theunderside 20 of thesupport element 12. As can be seen inFIG. 2 , thesupport element 12 comprises a substantially strip-shaped form with rounded ends. Thespike 16 is flat and triangular in design and can therefore be fitted with a comparatively low driving-in force. Alternative designs of thespike 16 are also conceivable. Thus, thespike 16 could be additionally provided, for example, with barb-like structures in order to improve the anchoring of thespike 16 in the spongy region. -
FIG. 3 is a section through the implant illustrated inFIG. 2 in the region of thescrew hole 26. The interior of thescrew hole 26 comprises a sphericallycurved region 32, which in the direction of theunderside 20 opens into a short,cylindrical region 34. The sphericallycurved region 32 allows correspondingly shaped bone screw heads to be recessed in thesupport element 12. - The
implant 10 according to FIGS. 1 to 3 is self-retaining, since it can be secured without securing elements such as screws, nails, etc. to a bone cover, for example. In contrast to the clamp-like implants of the state of the art, the retaining force of theimplant 10 is substantially independent of the thickness of the bone cover. It is therefore possible to ensure a secure anchoring of the implant according to the invention even in the case of small bone cover thicknesses. Theimplant 10 is driven laterally into the bone cover or into the bone fragment. The anchoring of theimplant 10 therefore requires no elements resting against the underside of the bone cover or bone fragment, so that damage to the meninges flaps by theimplant 10 is ruled out. - The length of the
extension 14, i.e. the distance between thespike 30 and thesupport element 12, is typically selected in such a manner that theimplant 10 can be securely anchored in the case of bone cover thicknesses up to 3.5 mm. By preparingimplants 10 withshorter extensions 14, it is also possible to fix bone covers with a thickness of less than 3.5 mm. Theimplant 10 is manufactured from biocompatible TiAl6V4. However, theimplant 10 can also be made entirely or partially of a reabsorbable material instead of a metal. -
FIG. 4 shows a first embodiment of a driving-indevice 40 according to the invention for theimplant 10 according to FIGS. 1 to 3. The driving-indevice 40 has the form of a gun with agun body 42 and agun barrel 44. Thegun barrel 44 is formed by a receivingelement 46 for holding the implant which is to be driven into place. Thegun body 42 is formed by ahandle 48 and ahousing 50. - Arranged within the
housing 50 is the driving-in mechanism, not shown inFIG. 4 , which cooperates with the receivingelement 46. The driving-in mechanism allows for the introduction of driving force into the receivingelement 46. - The
housing 50 comprises two laterally arranged and fully detachable housing covers. In the view according toFIG. 4 , asingle housing cover 52 can be seen. The detachable housing cover allows for easy cleaning and lubrication of the driving-in mechanism following the operation. - For the actuation of the driving-in mechanism, an operating mechanism in the form of a
gun trigger 54 is provided. Thegun trigger 54 has an ergonomic shape, which is adapted to actuation by means of index finger and middle finger or by means of middle finger and ring finger. -
FIG. 5 is a longitudinal section through the driving-indevice 40 according toFIG. 4 and in particular the driving-inmechanism 56 of the driving-indevice 40. - The driving-in
mechanism 56 is constructed as a striking mechanism and comprises a striking element in the form of anupper carriage 58. Theupper carriage 58 comprises a central throughaperture 59, through which a stationary,upper guide bolt 60 extends, which is anchored on thehousing 50. Theupper carriage 58 is displaceably guided by means of aball implant 62 along theupper guide bolt 60. - The
upper guide bolt 60 is radially enclosed on its outside by ahelical spring 64, which in the starting position of the driving-inmechanism 56 illustrated in -
FIG. 5 rests with one end against thehousing 50 and with its other end against theupper carriage 58. During a movement of the carriage along theupper guide bolt 60 to the left inFIG. 5 , thehelical spring 64 is compressed. - At the same time, the
upper carriage 58 is prestressed to the right inFIG. 5 , i.e. in the driving-in direction. - The
upper guide bolt 60 projects in the manner of a gun barrel partially out of thehousing 50. At its end projecting from thehousing 50, theupper guide bolt 60 is coupled with the receivingelement 46 for the implant radially enclosing the said end on the outside. The coupling of theupper guide bolt 60 with the receivingelement 46 is effected by means of across bolt 66 rigidly connected to theupper guide bolt 60. Thecross bolt 66 projects through anopening 68 in the receivingelement 46. Theopening 68 is a slot having an oval shape and therefore allows for limited movement of the receivingelement 46 relative to theupper guide bolt 60 along the axis A. The relative displaceability of the receiving sleeve is necessary in order to transmit the striking force introduced into the receivingsleeve 46 to the implant accommodated by the receivingelement 46 and not illustrated inFIG. 5 . The striking force is introduced into the receivingelement 46 by means of theupper carriage 58 arranged coaxial to the receivingelement 46. - Arranged within the
housing 50 somewhat below theupper guide bolt 60 is acentral guide bolt 70. Thecentral guide bolt 70 is secured in a stationary manner in thehousing 50 and extends parallel to theupper guide bolt 60. Alower carriage 72 is displaceably guided by aball implant 74 along thecentral guide bolt 70, which penetrates thelower carriage 72. Thecentral guide bolt 70 is enclosed radially on its outside by ahelical spring 76, which is supported at one end against thehousing 50 and at its other end against thelower carriage 72. During a displacement of thelower carriage 72 along thecentral guide bolt 70 to the left inFIG. 5 , thehelical spring 76 is compressed. At the same time, thelower carriage 72 is prestressed to the right inFIG. 5 . - The
lower carriage 72 is rigidly coupled with thegun trigger 54. Upon actuation of thegun trigger 54, i.e. during a displacement of thegun trigger 54 to the left inFIG. 5 , the lower carriage is therefore also displaced to the left. Pressed into thegun trigger 54 is aplastics material plug 82. Upon actuation of thegun trigger 54, theplastics material plug 82 comes to rest against thegun handle 48 and thereby limits the displaceability of thegun trigger 54. - At its lower end in
FIG. 5 , thegun trigger 54 is connected to alower guide bolt 76, which is displaceable relative to thehousing 50. Thelower guide bolt 76 is displaceably guided along an axis B in ablind bore 78 constructed in thepiston handle 48. In order to reduce the frictional resistance, aplastics material sleeve 80 is pressed into the blind bore 78 which lines the blind bore 78 radially on the inside. - Provided within the
housing 50 is acoupling device 84. Thecoupling device 84 allows for the coupling of the operating mechanism, i.e. thegun trigger 54, with the striking element in the form of theupper carriage 58. Thecoupling device 84 comprises adriver 86, which is pivotable in the plane of the drawing, aleaf spring 88 and acoupling element 90. - The
driver 86 is pivotably secured to thelower carriage 72 and is prestressed in the direction of theupper carriage 58 by theleaf spring 88, which is also secured to thelower carriage 72. Arranged on theupper carriage 58 is thecoupling element 90 cooperating with thedriver 86. - Also accommodated within the
housing 50 is adecoupling device 92, which can cooperate with thecoupling device 84 and can release the coupling between thegun trigger 54 and theupper carriage 58. Thedecoupling device 92 comprises apin 94 projecting into thehousing 50. In order to render the decoupling threshold adjustable, thepin 94 is displaceable along its longitudinal axis C. To this end, thepin 94 comprises anexternal thread 96 radially on its outside, which cooperates with a matchinginternal thread 97 in thegun body 42. Acounter nut 98 allows for locking of thepin 94 in a desired, axial position. At its end remote from the pin tip, thepin 94 is provided with an internal polygon allowing for the application of a tool to thepin 94 in order to adjust the decoupling threshold. -
FIG. 6 is a cross section through the driving-indevice 40 shown inFIG. 4 taken along the line IV-IV according toFIG. 5 . As can be seen inFIG. 6 , thehousing 50 is closed laterally by two removable housing covers 52, 52′. Arranged within thehousing 50 is the driving-in mechanism with theupper carriage 58 guided along theupper guide bolt 60 and thelower carriage 72 guided along thecentral guide bolt 70. Thelower carriage 72 is connected by means of ascrew 102 to thegun handle 54. Thescrew 102 comprises aninternal polygon 104. It can be clearly seen inFIG. 6 that thedriver 86 of thecoupling device 84 cooperating with theleaf spring 88 comprises aU-shaped groove 106. By means of thisgroove 106, thecoupling device 84 cooperates with thepin 94 of the decoupling device. Thegroove 106 is arranged relative to the plane of the drawing in such a manner that thedriver 86 can be forced downwards inFIG. 6 by the tip of thepin 94 against the spring force of theleaf spring 88. -
FIGS. 7 a and 7 b show the receivingelement 46 of the driving-indevice 40 illustrated inFIG. 4 . Visible is theoval opening 68, in which thecross bolt 66 illustrated inFIG. 5 is displaceably guided. The receivingelement 46 is partially constructed in the manner of a sleeve and comprises ablind bore 108 for receiving an end region of theupper guide bolt 60 illustrated inFIG. 5 . At its end lying opposite theblind bore 108, the receivingelement 46 comprises asleeve 112, which radially encloses the cylindrical base element of the receivingelement 46 on the outside. Formed between the cylindrical base element of the receivingelement 46 and thesleeve 112 is aflat slot 114, which is used to receive the implant. Theslot 114 can be seen in the sectional view according toFIG. 7 b. - Arranged in the region of the
slot 114 is a self-lockingmechanism 110. The self-lockingmechanism 110 comprises aball 116 and aspring 118 prestressing theball 116 in the direction of theslot 114. Theball 116 cooperates with thescrew hole 26 of theimplant 10 illustrated inFIG. 2 . - The method of operation of the driving-in
device 40 described above with reference to FIGS. 4 to 7 b will be explained in further detail in the following. - In a first step, the
implant 10 illustrated in FIGS. 1 to 3 is introduced with itsleft support arm 22 comprising thescrew hole 26 into theslot 114 of the receivingelement 46. As soon as thescrew hole 26 lies in the region of theball 116 prestressed in the direction of theslot 114, theball 116 engages in thescrew hole 26 and the self-lockingmechanism 110 is actuated. Since theball 116 engages with prestressing in the screw hole of the implant, it is no longer possible for the implant to accidentally slide out of theslot 114. - The implant is preferably directly removed from an implant container by means of the driving-in
device 40. It is therefore unnecessary to introduce the implant into theslot 114 with the aid of the fingers. In this manner, the handling of the implant system according to the invention, comprising implant and driving-indevice 40, is considerably improved. - Once the implant has been introduced into the
slot 114 and has been secured there against falling out by means of the self-lockingmechanism 110, the secured implant is positioned by means of the driving-indevice 40 in the region of the bone cover or bone fragment which is to be fixed in place. The positioning is effected in such a manner that the right-hand support arm 24 of theimplant 10 illustrated inFIG. 1 comes to rest upon the surface of the bone cover or bone fragment and the spike laterally contacts the spongious or cortical region. - Subsequently, the
gun trigger 54 is displaced to the left inFIG. 5 by means of two fingers. This movement of thegun trigger 54 is also transmitted to thelower carriage 52 rigidly coupled with thegun trigger 54. - Consequently, the
lower carriage 52 moves to the left inFIG. 5 against the spring force of thehelical spring 76. - As a result of the displacement of the
lower carriage 72 to the left inFIG. 5 , thedriver 86 contacts thecoupling element 90 of theupper carriage 58. As soon as thedriver 84 contacts thecoupling element 90, theupper carriage 58 is taken along by thedriver 86 and is also displaced to the left inFIG. 5 against the spring force of thehelical spring 64. - The coupling of the
lower carriage 72 with theupper carriage 58 is recognized by the user of the driving-indevice 40 in that the force required for the actuation of thegun trigger 54 increases. This increase in force results from the fact that it is now not only necessary to compress the lowerhelical spring 76, but also the upperhelical spring 84, owing to the coupling of thelower carriage 72 and theupper carriage 58. - After a certain degree of displacement of the two
carriages pin 94 comes into contact with thegroove 108 of thedriver 86 illustrated inFIG. 6 . With a further displacement of the twocarriages FIG. 5 , thedriver 86 is now pivoted downwards by the inclined surface of the tip of thepin 94 about itspivot axis 120 illustrated inFIG. 5 against the spring force of theleaf spring 88. Finally, once a threshold pivoting angle is reached, the coupling between thedriver 86 and thecoupling element 90 of theupper carriage 58 is abruptly released. As a result of the decoupling of thelower carriage 72 andupper carriage 58, theupper carriage 58 prestressed to the right inFIG. 5 by thehelical spring 64 is accelerated to the right inFIG. 5 along theupper guide piston 60. The acceleratedupper carriage 58 comes into striking contact with the end face facing theupper carriage 58 of the receivingelement 46, which has been slightly displaced along the axis A, and exerts a blow to the said end face. - This blow is transmitted to the
implant 10 arranged in theslot 114, thespike 16 of theimplant 10 thereby being laterally driven into the bone cover or bone fragment. During the driving-in, theimplant arm 24 of theimplant 10 resting upon the bone cover or bone fragment acts as a guide. - As soon as the
upper carriage 58 is decoupled from thelower carriage 72, thegun trigger 54 can be released again. Following the release of thegun trigger 54, the compressedhelical spring 76 expands again and thegun trigger 54 is moved by thehelical spring 76 back into the starting position illustrated inFIG. 5 . The driving-in procedure described above can then be repeated, if necessary, to drive thespike 16 of theimplant 10 deeper into position. As soon as theextension 14 rests laterally against the bone cover or bone fragment, the driving-in procedure is complete. Theextension 14 then functions as a mechanical abutment, which prevents thespike 16 from being driven too deeply into the bone cover. - It is usually necessary to position three to four
implants 10 according to FIGS. 1 to 3 in a bone cover in order to reliably fix the bone cover in the skull bone. Once the required number of implants have been driven into the bone cover, the bone cover is positioned in the corresponding opening in the skull bone and is secured to the skull bone by means of a bone screw for each implant. This is illustrated in further detail inFIG. 9 , which will be described in more detail below. -
FIG. 8 shows a second embodiment of a driving-indevice 40 according to the invention for driving an implant laterally into a bone cover or bone fragment. The driving-indevice 40 has an elongated structure and comprises a receivingelement 46 for the implant as well as a knob-like force-receivingstructure 120 having a spherically curved force-receivingsurface 122. The driving-indevice 40 also comprises a substantiallycylindrical body 124, which is arranged in a force-transmitting manner between the force-receivingstructure 120 and the receivingelement 46 for the implant. At its end facing the receivingelement 46, thecylindrical element 124 comprises agrip 126, which radially encloses the outside of thecylindrical body 124. Thegrip 126 is coupled to thebody 124 so as to be immovable in the axial direction. The receivingelement 46 comprises the self-locking mechanism illustrated inFIGS. 7 a and 7 b for the implant. - In order to secure the implant to a bone plate, for example, the implant is firstly fixed in the region of the receiving
element 46 by means of the self-locking mechanism. The implant is then positioned as described above and a striking force is introduced into the force-receivingsurface 122 of the force-receivingstructure 120 by means of a hammer, for example. The striking force is transmitted from the force-receivingstructure 120 via thebody 124 and the receivingelement 46 to theimplant 10, which is thereby driven laterally into the bone cover. -
FIG. 9 shows abone cover 130, which comprises an upper bone plate 132 (first cortical layer), a lower bone plate 134 (second cortical layer) as well as aspongious region 136 arranged between theupper bone plate 132 and thelower bone plate 134. Theimplant 10 has been secured to thebone cover 130 by means of the driving-indevice 40 described with reference to FIGS. 4 to 7 b. Thespike 16 of theimplant 10 has been driven into thespongious region 136 of thebone cover 130 to such a depth that theextension 14 rests laterally against thebone cover 130. - Following the securing of a plurality of
implants 10 to thebone cover 130, thebone cover 130 was positioned in the corresponding opening in theskull bone 140. In this respect, the underside of thesupport arm 22 of theimplant 10 comes to rest against theupper bone plate 142 of theskull bone 140. Theskull bone 140 also comprises aspongious region 146, which is arranged between theupper bone plate 142 and alower bone plate 144. - Following the positioning of the
bone cover 130 provided with theimplant 10 in the opening of theskull bone 140, thebone cover 130 needs to be fixed in position within the opening of theskull bone 140. To this end, theimplants 10 are secured to theskull bone 140 by means of bone screws 150. During this process, thespherical head 152 of eachbone screw 150 is fully recessed within the screw hole of theimplant 10. - In the case of bicortical bones such as the
bone cover 130 illustrated inFIG. 9 , it is expedient to drive thespike 16 of theimplant 10 into the spongious region arranged between the two cortical layers. However, the driving of thespike 16 into a cortical layer is also possible and might even be essential, e.g. in the case of mono-cortical bones.
Claims (16)
1-12. (canceled)
13. A device for securing a self-retaining implant to a bone cover or bone fragment, wherein the implant is of the type having a support element, an extension extending therefrom, and a spike affixed to the extension, the device comprising:
a receiving element defining a slot at one end thereof for receiving at least a portion of the implant; and
a driving-in mechanism coupled to the receiving element for driving the implant, laterally into the bone cover or bone fragment.
14. The device according to claim 13 , wherein the receiving element includes an end such that a striking force can be applied to the end by means of the driving-in mechanism.
15. The device according to claim 14 , wherein the driving-in mechanism comprises a striking element displaceable against a spring force.
16. The device according to claim 15 , wherein the striking element is a first carriage guided coaxial to the receiving element.
17. The device according to claim 13 , wherein the driving-in mechanism further comprises an operating mechanism, for selective coupling and decoupling with the striking element.
18. The device according to claim 17 , wherein the driving-in mechanism further comprises a coupling device interposed between the operating mechanism and the striking element, the coupling device normally biased for coupling the operating mechanism with the striking element.
19. The device according to claim 18 , wherein the driving-in mechanism further comprises a decoupling device for decoupling the coupling device of the operating mechanism from the striking element.
20. The device according to claim 13 , wherein the device is includes a pistol grip.
21. The device according to claim 17 , 18 , wherein the operating mechanism further includes a finger operable trigger.
22. The device according to claim 18 , 21 , wherein the finger operable trigger is coupled with a second carriage displaceable against a spring force, and the coupling device couples and decouples the second carriage with the striking element.
23. The device according to claim 20 , wherein the receiving element extends forwardly from an upper part of the pistol grip in the manner of a gun barrel in relation to a gun body.
24. The device according to claim 13 , wherein the receiving element further comprises a self-locking mechanism in the slot for releasably engaging the support element of the implant.
25. A device for securing a self-retaining implant of the type having a support element, an extension extending therefrom, and a spike affixed to the extension to a bone cover or a bone fragment, the device comprising:
a force-transmitting element for cooperating with the implant; and
a driving-in mechanism for applying a striking force to the force-transmitting element in order to drive the implant into the bone cover or bone fragment.
26. A device for securing a self-retaining implant of the type having a support element, an extension extending therefrom, and a spike affixed to the extension to a bone cover or bone fragment, the device comprising:
a receiving element for releasably receiving the implant; and
a force-receiving surface coupled in a force-transmitting manner with the receiving element for introducing a driving-in force into the implant, in order to drive the spike of the implant, laterally into the bone cover or into the bone fragment.
27. The device according to claim 26 , wherein the receiving element further comprises a self-locking mechanism for releasably receiving the implant.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/253,874 US20060052789A1 (en) | 1999-02-20 | 2005-10-19 | Device for securing an implant |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19907354A DE19907354C2 (en) | 1999-02-20 | 1999-02-20 | Implant to fix a bone plate |
DEDE19907354A1 | 2001-04-24 | ||
DE20107039U DE20107039U1 (en) | 2001-04-24 | 2001-04-24 | Self-holding implant and device for fastening the implant |
DE20107039.1 | 2001-04-24 | ||
US09/921,233 US7682361B2 (en) | 1999-02-20 | 2001-08-01 | System including a self-retaining implant and a device for securing the implant and a method of using the same |
US11/253,874 US20060052789A1 (en) | 1999-02-20 | 2005-10-19 | Device for securing an implant |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/921,233 Division US7682361B2 (en) | 1999-02-20 | 2001-08-01 | System including a self-retaining implant and a device for securing the implant and a method of using the same |
Publications (1)
Publication Number | Publication Date |
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US20060052789A1 true US20060052789A1 (en) | 2006-03-09 |
Family
ID=26051969
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/921,233 Expired - Fee Related US7682361B2 (en) | 1999-02-20 | 2001-08-01 | System including a self-retaining implant and a device for securing the implant and a method of using the same |
US11/253,874 Abandoned US20060052789A1 (en) | 1999-02-20 | 2005-10-19 | Device for securing an implant |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
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US09/921,233 Expired - Fee Related US7682361B2 (en) | 1999-02-20 | 2001-08-01 | System including a self-retaining implant and a device for securing the implant and a method of using the same |
Country Status (1)
Country | Link |
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US (2) | US7682361B2 (en) |
Cited By (1)
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WO2011133397A1 (en) * | 2010-04-23 | 2011-10-27 | Depuy Products, Inc. | Bone plate bender system |
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US6923812B1 (en) * | 2001-07-30 | 2005-08-02 | Bioplate, Inc. | Barbed clip for bone alignment and fixation |
US20060287654A1 (en) * | 2006-08-11 | 2006-12-21 | Jeffrey Posnick | Implant securing device and method |
FR2918262B1 (en) * | 2007-07-03 | 2010-06-11 | Spineart Sa | BRIDGE DEVICE FOR LAMINOPLASTY AND ITS APPLICATIONS |
US9072555B2 (en) * | 2008-07-21 | 2015-07-07 | Arthrex, Inc. | Carbon fiber reinforced peek bone plate with titanium fixation screws |
US8062297B2 (en) * | 2008-07-24 | 2011-11-22 | Biopro, Inc. | Bone fixation apparatus and method of manufacture |
US9566098B2 (en) | 2009-04-23 | 2017-02-14 | University Of Massachusetts | Bone fixture assembly |
WO2010124230A1 (en) * | 2009-04-23 | 2010-10-28 | University Of Massachusetts | Bone fixture assembly |
CN109620379B (en) * | 2018-12-26 | 2021-04-30 | 创美得医疗器械(天津)有限公司 | Bone reduction fixing splint |
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Also Published As
Publication number | Publication date |
---|---|
US20020156477A1 (en) | 2002-10-24 |
US7682361B2 (en) | 2010-03-23 |
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Owner name: STRYKER LEIBINGER GMBH & CO. KG, GERMANY Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KNOPFLE, CHRISTIAN;GREINER, KARL;FRANK, THORSTEN;AND OTHERS;REEL/FRAME:017132/0273;SIGNING DATES FROM 20010613 TO 20010619 |
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