US20070011814A1

US20070011814A1 - Surgical table attachment

Info

Publication number: US20070011814A1
Application number: US11/181,140
Authority: US
Inventors: Jeremy Rotert
Original assignee: Individual
Current assignee: Individual
Priority date: 2005-07-14
Filing date: 2005-07-14
Publication date: 2007-01-18

Abstract

The present invention provides an armboard attachment for supporting a humerus of a patient placed on a surgical table. The armboard attachment comprises a humerus support board for horizontally and laterally positioning the humerus of a patient on an upper surface thereof. The humerus support board has a central cut-out at the outboard edge that is sized to receive the lower arm of a patient when the upper arm is supported on the board. The armboard attachment includes a pair of bars extending downward from the support board that are configured to be clamped to an accessory rail of a surgical table. The attachment also includes a reinforcing bar extending along each side of the support board to prevent bending or buckling of the armboard attachment when in use.

Description

BACKGROUND OF THE INVENTION

The present invention generally relates to surgical attachments which are removably mounted to a main surgical table. Particularly, the present invention relates to surgical attachments for supporting and positioning a patient's humerus during radiographic and surgical procedures.
Humeral fractures are among the most common traumatic injuries that a primary clinician will see in the office or emergency room. The fractures are usually the result of a fall on the upper limb, or high-energy trauma as may occur in industrial or motor vehicle accidents or with gunshot injury. Most humeral fractures can be treated non-operatively. However, there are some situations in which surgical intervention is recommended. These include open fractures, fractures associated with vascular injuries, and multiple fractures of the same limb. These types of fractures are frequently the result of high-energy traumas.
When performing surgical procedures on fractures it is necessary to perform radiographic imaging. This imaging must be done from a variety of angles in order to correctly diagnose the injury and determine the extent of the damage. Radiographic imaging is often performed before, during and after surgical procedures.
Radiographic and surgical procedures on the humerus of a patient are usually performed under general anesthesia, with the patient positioned on a surgical table. Typically, for fractures of the humerus, a patient is placed in the lateral decubitus position. The lateral decubitus position facilitates the use of the posterior approach to fractures of the humerus. The posterior approach provides exposure of the lower three fourths of the humerus, and is used for fractures of the midshaft and distal humerus. The lateral decubitus position requires that the operating table be essentially flat and horizontal. The patient is rolled on one side with the affected arm or shoulder being uppermost and with the patient's back essentially perpendicular to the table.
However, there are a number of disadvantages in placing the patient in the lateral decubitus position for radiographic and surgical access to the patient's humerus. Because the patient's arm is elevated relative to the surgical table, an additional assistant is required whose central role is to stabilize the patient's arm during treatment. The use of operating room personnel to support a patient during a surgical procedure is unsatisfactory in that the assistant supporting the extremity may tire and find it necessary to change position at some critical or otherwise inconvenient time.
Another disadvantage in the use of the lateral decubitus position for access to the humerus lies in cases of multiple fractures to the same extremity. A patient suffering multiple fractures will often have to be repositioned during treatment in order to facilitate radiographic or surgical access at different angles and to different areas of the arm. However, this can pose an increased risk of complications to the patient. These complications can include additional fractures and neurological damage to the affected areas during movement. Repositioning also increases the duration of the procedure. The increase in duration of the procedure translates to increased operating room costs as well as increased time the patient spends under the general anesthesia.
An alternative to the lateral decubitus position is the prone position. The prone position also allows access to the fractures via the posterior approach. In the prone position, the patient's arm is often positioned horizontally and laterally extended to facilitate access to the fractures. This can be accomplished by the use of an auxiliary device, such as a hand table or armboard.
Prior hand tables and armboards have generally tended to be a table which is removably mounted to the main surgical table. Prior surgical tables are typically constructed with siderails permanently attached along opposing edges of the table. Armboards and other accessories may be clamped onto the rails at desired locations along the table, depending on the requirement of the surgical procedure.
The armboards which are removably mounted to the main table have evolved into two general types. The first type of armboard is typically provided with rail engaging means to attach the armboard to the main surgical table and includes a main support leg or post. The support post bears a substantial portion of the weight of the armboard and the patient's arm, and thereby maintains the armboard in a generally constant position relative to the main table. Although the support leg helps to provide a stable platform for the surgeon, it also limits radiographic access to the patients arm and represents an unnecessary obstacle or hazard to the surgeon and associated surgical staff during performance of surgery. Also, tables of this type tend to be rather bulky and ungainly during setup and removal, further lessening their desirability.
The second type of removably mounted armboard is vertically supported by means which engage the main surgical table, such as a support truss, eliminating the necessity of an extra support leg. In armboards of this sort, one end of armboard is releasably attached to the rail provided by the main surgical table. The armboard includes an integral support structure, such as a support truss, extending between the main table and the hand table. These armboards allow limited radiographic access to the arm at certain angles. However, these armboards tend to be rather flimsy and unstable during use due to the lack of a solid support system, and have a tendency to wobble on the rail due, in part, to the manner in which they are attached to the main table.
In addition to the inherent limitations of the prior armboards described above, these armboards are typically designed for use with a patient placed in the supine position on a surgical table and are generally unsatisfactory for use with a patient in the prone position. Prior armboards support the entire arm extended laterally and horizontally from the surgical table. When face down, a patient's arm will be in an unnatural position. This position can put high pressure on the ulnar nerve of the elbow resulting in neurological injury.
Therefore, what is needed is an armboard for removable attachment to a surgical table that facilitates radiographic and surgical access to a patient's upper arm while the patient is placed in the lateral decubitus or prone position on a surgical table and overcomes the limitations of prior armboards.

SUMMARY OF THE INVENTION

In order to address this need, the present invention provides a surgical table attachment for supporting a humerus of a patient placed in a lateral decubitus or prone position on a surgical table. The surgical table attachment comprises a humerus support board for horizontally and laterally positioning the humerus of a patient on an upper surface thereof. The humerus support board has an inboard and outboard edge with a dimension from edge to edge sized to receive the upper arm of a patient. The apparatus also includes an attachment means for removably attaching the humerus support board to a surgical table. The attachment means is affixed on the inboard edge of the humerus support board.
The surgical table attachment is removably attached to the surgical table on a side proximate the end of the table where a patient's head is placed. When the patient is positioned in the prone position, the attachment is positioned so that the upper surface of the humerus support board is parallel and generally on the same plane as the upper surface of the surgical table. This allows the upper arm of the patient to be extended horizontally and laterally from the body of the patient in order to allow the surgeon and assistants easier access.
When the patient is placed in the lateral decubitus position, the surgical table attachment is positioned so that the upper surface of the humerus support board is parallel to the upper surface of the surgical table and vertically displaced. The vertical displacement of the humerus support board should be such that the arm of the patient that is farthest from the surgical table can be horizontally and laterally extended from the surgical table.
In a preferred embodiment, the dimension of the humerus support board from inboard edge to outboard edge is approximately seven inches. This dimension allows the humeral portion of the patient's arm to be placed on the upper surface of the humerus support board while the lower portion of the patients arm, from the elbow down, extends beyond the outboard edge of the support board. This allows the lower portion of the arm to be draped over the outboard edge to hang downward comfortably at approximately a 90 degree angle relative to the upper arm.
In another embodiment of the present invention, the outboard edge includes a concave cut-out. The concave cut-out is in the horizontal plane of the humerus support board, extending toward the inboard edge. When the humeral portion of the patient's arm is placed on the upper surface of the humerus support board, the concave cut-out facilitates the bending of the elbow downward and comfortably allows the positioning of the lower arm at a downward angle relative to the upper arm.
In a further embodiment of the invention, the surgical table attachment is radiolucent. When used in conjunction with a radiolucent surgical table, it allows metal free imaging at all angles necessary to properly diagnose and treat a humeral fracture.
According to another aspect of the invention, there is described a method for prone positioning of a patient on a surgical table. The method comprises providing a surgical table and a surgical table attachment of the present invention and attaching the surgical table attachment at a portion of the surgical table proximate an end of the table. The method also includes placing the patient on the surgical table in the prone position with an upper arm extended horizontally and laterally away from the patient's body then placing the upper portion of the extended arm on the upper surface of the surgical table attachment with the lower portion of the arm free and draped over the outboard edge of the support board and hanging downward at approximately a ninety degree angle relative to the upper arm.
It is, therefore, an object of the present invention to provide a novel, efficient, and economical apparatus for supporting the humerus of a patient positioned in the on a surgical table. It is a further object of the invention to provide an armboard for supporting the humerus of a patient that allows the patient to be safely and comfortably positioned in the prone position for radiographic and surgical access to the patient's upper arm.
It is yet another object to provide an armboard that overcomes the problems associated with prior armboards. For instance, by providing an armboard that supports the upper arm while allowing letting the forearm swing free alleviates the pressure on the ulnar nerve that can lead to neurological damage. These and other objects and benefits of the invention will be readily discerned from the following written description, taken together with the accompanying figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective view of a surgical table attachment according to the present invention.
FIG. 2 is a top plan view of the humerus support attachment of FIG. 1 according to the present invention.
FIG. 3 is a side elevational view of the humerus support attachment of FIG. 1 according to the present invention.
FIG. 4 is a front elevational view of the humerus support attachment of FIG. 1 according to the present invention.
FIG. 5 is a perspective view of the humerus support attachment of FIG. 1 attached to a surgical table for prone or supine positioning of a patient.

DESCRIPTION OF THE PREFERRED EMBODIMENT

For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and described in the following written specification. It is understood that no limitation to the scope of the invention is thereby intended. It is further understood that the present invention includes any alterations and modifications to the illustrated embodiments and includes further applications of the principles of the invention as would normally occur to one skilled in the art to which this invention pertains.
With reference to FIGS. 1-4, there is shown a surgical table attachment 10 of one embodiment of the present invention. The surgical table attachment comprises a humerus support board 12 for horizontally and laterally positioning the humerus of a patient on an upper surface 14 thereof. The surgical table attachment also includes an attachment means 26 for removably attaching the humerus support board 12 to a surgical table. The attachment means 26 is affixed on the inboard edge 16 of the humerus support board 12.
The humerus support board 12 has a generally rectangular shape with an inboard edge 16 and an outboard edge 18, a first lateral edge 20 and a second lateral edge 22, and an upper surface 14 and opposite lower surface 28. The upper surface 14 of the board 12 is preferably relatively smooth and free from surface irregularities that might irritate the patient's arm or that may make cleaning the surface difficult. The humerus support board 12 may be composed of any suitable material that is light yet sufficiently rigid to resist flexing and vibration during use. Moreover, the support board 12 must be radiolucent so as not to interfere with imaging of the injured limb. In a preferred embodiment, the board is formed of a radiolucent material, such as plastic or carbon fiber.
In the preferred embodiment, the humerus support board has a dimension W from inboard edge 16 to outboard edge 18 sized to receive the upper arm of a patient. In a most preferred embodiment, the dimension W is approximately seven inches from inboard edge 16 to outboard edge 18. The humerus support board 12 also has a dimension L from first edge 20 to second edge 22. In the preferred embodiment, the dimension L is approximately eighteen inches. The dimension W allows the humeral portion of the patient's arm to be placed on the upper surface 14 of the humerus support board 12 while the lower portion of the patients arm, from the elbow down, extends beyond the outboard edge 18 of the support board 12. The dimension L provides the surgical table attachment 10 with enough of a surface area to allow the placement of surgical instruments and provides a place for physicians and assistants to rest their elbows or hands as necessary during the procedure.
The outboard edge 18 of the humerus support board 12 preferably has a generally circular cut-out 24 that extends toward the inboard edge 16 in the horizontal plane. The cut-out 24 is positioned essentially in a central portion of the outboard edge 18 and has a width from edge to edge that is substantially wider at its greatest dimension than a typical human arm. As shown in FIGS. 5 and 6, when the humeral portion of the patient's arm is placed on the upper surface 14 of the humerus support board 12, the cut-out 24 allows natural bending of the elbow so that the lower arm can hang down below the horizontal plane of the humerus support board at approximately ninety degrees relative to the upper arm.
The attachment means 26 is operably affixed to the inboard edge 16 of the humerus support board 12 for facilitating engagement of the surgical table attachment 10 with a surgical table. As shown in FIG. 5, when the surgical table attachment 10 is attached to the surgical table T, the upper surface 14 of the humerus support board 12 is preferably co-planar with the upper surface S of the surgical table and extended out from a side of the surgical table. It can be appreciated that in the arrangement shown in FIG. 5, the patient's forearm can be positioned within the cut-out 24 when the patient is supine.
Prior surgical tables 30 are typically constructed with accessory rails R permanently attached along opposing edges of the table as shown in FIGS. 5 and 6. Thus, surgical accessories may be clamped onto the rails R at desired locations along the table using a variety of known clamps C. In the preferred embodiment of the present invention, the attachment means 26 is configured to be removably attached to an accessory rail 32 of a surgical table 30. It can be appreciated that the specific rail R and clamp C may vary with the surgical table, but that the attachment means 26 of the present armboard may be modified accordingly.
In one embodiment, the attachment means 26 includes a pair of elongated bars 27 extending from the bottom surface of the humerus support board proximate the inboard edge 16. In the illustrated embodiment, the bars 27 are generally rectangular to be accepted within the clamp C depicted in FIG. 5. It is understood, however, that the configuration of the bars may be modified in accordance with the requirements of the particular clamp and accessory rail R. In the illustrated embodiment, the rail clamps C are typical of the finger-tightenable screw-type clamps which may be mounted at any point on the accessory rail of a typical surgical table.
In accordance with one aspect of the invention, the bars 27 have a length sufficient to slidably engage the clamps C to adjust the vertical position of the support board 12 relative to the upper surface S of the surgical table T shown in FIG. 5. In some procedures, it is typical to use pillows to adjust the position of the upper body of the patient on the table and to accordingly adjust the position of the patient's arm. The board 10 can be moved up or down as necessary for optimum positioning once the patient is on the surgical table T.
The humerus support board 12 may also be configured to facilitate placing the patient in the lateral decubitus position. As mentioned above, a patient in the lateral decubitus position is placed on his/her side on the surgical table with the injured arm uppermost. Accordingly, the elongated bars may be longer, as depicted by the dashed lines for modified bars 27′ in FIG. 5, than the spine/prone position bars 27. This added length allows the support board 12 to be elevated higher above the surface S of the surgical table T to a height necessary for the comfortable placement of the uppermost arm of the patient.
In another feature of the present invention, the surgical table attachment is provided with a bracing means 40. The bracing means 40 comprise at least one beam 42 affixed to the bottom surface 28 of the humerus support board 12 at each side 20, 22. Preferably, the beams 42 extend from inboard edge 16 to outboard edge 18, spanning the width W of the board. The beams 42 reinforce the humerus support board 12 to make the board 12 more stable and to prevent vibrations. In the illustrated embodiment, the beams are right angle beams, although other configurations may be used, such as I-beam, T-beam or box beam constructions. As with the support board 12, the beams 42 are formed of a radiolucent material, such as plastic or carbon fiber.
In one embodiment, the entire attachment 10 is integrally formed as a unitary structure. In this embodiment, the attachment may be molded from plastic, with the support plate 12 integral with the bars 27 and the beams 42. For the molded construction, it is preferable that the beams 42 be angle beams, as depicted in FIG. 4 to facilitate manufacture.
It should be appreciated from the foregoing description of the surgical table attachment 10 that the attachment 10 provides numerous benefits. The surgical table attachment 10 is ideally suited for facilitating access to humeral fractures of a patient. The attachment 10 permits safe and comfortable positioning of the patient in the lateral decubitus or the prone position and allows the surgeon and assistants to remain close to the injured extremity. The attachment also provides a sturdy surface for supporting the humeral portion of the patient's arm with additional space for placing medical instruments. The attachment stabilizes the upper arm of the patient while allowing the lower arm to bend at the elbow and remain mobile. This positioning can prevent neurological damage to the ulnar nerve by preventing pressure points on the elbow. Moreover, the use of the attachment 10 eliminates the need of an extra assistant whose primary job is positioning and stabilizing the patient's arm.
A particular advantage associated with the present invention is the ability of operating room personnel to perform radiographic procedures on the upper arm of a patient. As mentioned above, the surgical table attachment 10 is preferably formed of a radiolucent material. When used in conjunction with a radiolucent surgical table, it allows metal free imaging at all angles necessary to properly diagnose and treat injuries to a patient's upper arm. Radiographic machines used most frequently are fluoroscopy or CT systems. Mobile C-arm machines are an example of these types of systems. A C-arm machine is a real-time fluoroscope. The C-arm machine derives its name from the arcuate main arm that supports the imaging components. An x-ray tube is positioned at one end of the arm, and an image receiver is positioned at the opposite end of the arm. The entire imaging apparatus is mounted on a mobile base which allows the imager to be moved to the patient for imaging procedures. It will be appreciated that the surgical table attachment 10 facilitates the use of a C-arm machine. The attachment 10 is integrally supported and does not require a leg for support. Therefore, the main arm of the C-arm machine can rotate completely around a patient's arm positioned on the attachment 10 providing imaging from all angles.
Another advantage is that the surgical table attachment 10 permits prone positioning of a patient for radiographic and surgical access to midshaft (diaphyseal) fractures of the humerus as well as surgical and radiographic access to the distal humerus, the elbow joint and proximal ulna without having to reposition the patient. The attachment 10 also provides benefits for use in supine positioning of a patient. The attachment 10 permits supine positioning for radiographic access to the proximal humerus, shoulder joint, and neck. The attachment 10 also permits supine positioning for soft tissue repairs of the shoulder.
In either the prone or supine position, it is often beneficial to allow the lower arm of the patient to remain mobile for the procedure. For instance, in the supine position, the shoulder joint may have to be rotated to obtain certain radiographic views. The attachment 10 is ideally suited for these types of procedures because the lower arm remains unrestrained permitting nearly a full range of motion.
While the invention has been illustrated and described in detail in the drawings and foregoing description, the same should be considered as illustrative and not restrictive in character. It is understood that only the preferred embodiments have been presented and that all changes, modifications and further applications that come within the spirit of the invention are desired to be protected.
Thus, while the present invention contemplates a surgical table attachment for supporting a patient's humerus, other uses requiring a sturdy flat surface are contemplated. By way of non-limiting examples, the surgical table attachment could be used as a safe and stable bed widening device for patients who are too adequately fit on a standard surgical table.

Claims

1. In combination:

a surgical table to support a patient lying prone or supine thereon; and

an armboard attachment for positioning a humerus of a patient lying on a said surgical table, the armboard attachment including:

a humerus support board having an upper surface for supporting the upper arm of a patient thereon when the patient is lying prone or supine on said surgical table, said humerus support board including an inboard edge and an outboard edge and a dimension therebetween sized to support a portion of only the upper arm of a patient;

at least one reinforcing beam affixed to a bottom surface of said humerus support board extending substantially from said inboard edge to said outboard edge; and

attachment means for removably attaching said humerus support board to said surgical table, said attachment means affixed to said support board at said inboard edge thereof.

2. The combination of claim 1, wherein said support board includes opposite side edges and said at least one reinforcing beam includes a reinforcing beam extending along each of said side edges.

3. The combination of claim 1, wherein said humerus support board has a width dimension from said inboard edge to said outboard edge of approximately seven inches.

4. The combination of claim 1, wherein said outboard edge of said support board includes a cut-out extending towards said inboard edge and configured to accept the lower arm of the patient when the upper arm is supported on said upper surface.

5. The combination of claim 1, wherein:

said surgical table includes an accessory rail and a number of clamps each configured to mount a surgical table attachment to said rail; and

said attachment means includes a pair of bars extending from a bottom surface of said humerus support board proximate said inboard edge, said pair of bars each configured to be slidably engaged by one of the clamps and connected to the accessory rail.

6. The combination of claim 1, wherein said humerus support board further includes opposite lateral edges defining a length therebetween that is approximately eighteen inches.

7. The combination of claim 1, wherein said humerus support board is formed of a radiolucent material.

8. The combination of claim 1, wherein said humerus support board, said at least one reinforcing beam and said attachment means are integrally formed.

9. The combination of claim 8, wherein said humerus support board, said at least one reinforcing beam and said attachment means are integrally molded.

10. The combination of claim 1, wherein said humerus support board, said at least one reinforcing beam and said attachment means are formed of a radiolucent material.