US2381050A - Fracture reducing device - Google Patents

Description

Aug- 7, 1945. M. G. HARDINGE 2,381,050

FRACTURE REDUCING DEVICE Filed Dec. 4, i943 6111/1llllllllllllflll/lllr/I ./EQw/v @e0/NGE,

l N V E N TO R In 11111111' (I,

HMH

ATTORN EY.

Patented Aug. 7, 1945 UNITED STATES PATENT vOFFICE My invention relates to fracture reducing devices and has particular reference to a means for reducing fractures of the neck of the femur or similarfractures wherein it is desirable to employ a fracture reducing element capable of drawing the bone fragments together and to render them sufiiciently rigid to permit use of the bones for supporting weight.

In the treatment of many of the bone fractures, it has been the practice in the past to employ various devices to draw the bone fragments together and then the entire limb has been immobilized by means of casts extending beyond the joint at opposite ends of the bone. ment of fractures of the neck of the femur, for example, it has long been -the'practice to attempt to draw the bone fragments into reasonably close juxtaposition with each other by means of nails driven through the bone fragments longitudinally of the neck of the femur. This lends some rigide ity to the reassembled bone fragments but it has been essential that the patient maintain the en-` tire leg substantially immobilized for a relativelyv long period of time extending between two to ve months before it was possible to permit the patient to walkor otherwise exert force upon the into the bone through the distal fragmentV and thence into the proximal fragment, the driving fragment into abutting relation with each other and in which the device will provide a suiilcient support between the fragments as to permit the In the treat-` l patient to immediately exert weight upon the.

fractured bone.

Another object of my invention is to. provide a device of the character described wherein the device is readily removable from the healed bone after the termination vof the -healing period.

Other objects and advantages of my invention will be apparent from a study of the following specications, read-in connection with the accompanying drawing, wherein Fig. 1 is an elevational vieW of a typical femur having a fracture at the neck thereof and -illustrating the manner in which my fracture reducing device may be employed therein; i

Fig. 2 is a vertical vsectional view taken through the fracture reducing device shown in forces being exerted in a direction which tends to separate the bone fragmentsrather than to draw them' together; the reaction forces of the driving of the nail or pin into the proximal fragment being depended upon for compounding the meeting ends of the fragments into close .relation with each other.Av This method does not' assure the tight engagement of thejaggedends of the bone fragments and frequently requires. that. the healing processes must bridge a considerable'gap between the bone'ends during the healing period.

It is therefore an object otmy invention to provide a fracture reducing device which may Fig. 1 and illustrating the same in its initial position;

Fig. 3 is a vertical sectional view similar to Fig. 1 and illustrating the position of the parts when the inner end of the device has been expanded to grip the proximal fragment of the bone;

Fig. 4 is a transverse sectional view of the device illustrated in Fig. 2,.taken along line IV-IV of Fig. 2; y

Fig. 5 is 'a vertical sectional View taken through a modified form o f fracture reducing device which may be substituted for the device shown in Figs. 2, 3 and 4 and illustrating the position of the parts prior tothe expansion of the inner end of the device; l

Fig. 6 is a fragmentary sectional view similar to Fig. 5 and illustrating the position of `the parts when the inner end of the device has. been expanded; and

Fig. 7. is a fragmentary sectional view similar.

to Fig. 6 but illustrating a still further modied form of my invention.

vReferring to the drawing, I have illustrated vin Fig. 1 a typical femur bonel l having a neck indicated at 4. The fracture of the type illusbe successfully employedto actually exert' forces trated in Fig. lis a common type of fracture and for proper treatment requires that the head portion 3 be drawn intosnug engagement with the main or distal fragment I to permit the knit,- i'fing together of the bone fragments across the break 4.

into the proximal fragment and there to grip the To accomplish this result, a'bore indicated by the dotted line 5 is drilled through the main or distal bone fragment and-through the neck 2 into the head 3 of the bone after the head fragment has been accurately aligned with and moved into reasonably close juxtaposition to the distal fragment I. Into the bore 5 is inserted my fracture reducing device, which comprises a body member 6 preferably formed as a hollow bolt of any suitable material, such as stainless steel, provided upon its exterior surface with threads 'I which preferably extend continuously from one end to the other of the body 6. lThe body 6 is provided with an internal bore 8 through which extends a threaded rod or bolt 9 for the purpose of expanding or enlarging the inner end I of the body member 6.

In the form of the device illustrated in Figs. 1 through 4, the bolt 9 is illustrated as having threaded upon its inner end an expanding wedge nut II normally seated in a tapered recess I2 formed inthe inner end of the body 6 so that as the screw or bolt 9 is turned relative to the body 6 the wedge II will be drawn into the body to such position that the split inner ends I0 of the body 6 will be bent or expanded radially into an enlarged head which will grip the sides of the bore with suiicient pressure to effectively anchor the inner end I0 of the body in the head or proximal fragment 3 of the bone.

'Ihe body 6 now being anchored in the head 3, a nut structure I3 may then be screwed down upon the body 6 to draw the distal and proximal fragments into tight abutment with each other, interlacing any jagged edges of the fragments and positioning the two fragments in sufiiciently close abutment as to permit the healing or knit ting of the bone sections together with a mini-V mum of healing time.

The nut structure I3 is preferably constructe as a tubular sleeve, the inner end of which is provided, as indicated at I4, with female threads engaging the external threads 1 of the body 6 while the outer end of the nut I3 is provided with an enlarged head or radially projecting flange I5 adapted to abut against the outer surface of the distal bone fragment I so that by turning the nut I3 relative to the body 6, the bone fragments may be drawn together with any desired pressure. The nut I3 is preferably constructed of any suitable material, such as stainless steel or other material which will not react chemically with the body processes during the time it is within the body, and may be provided with slots I 6 upon its outer end for the purpose of receiving a suitable wrench, screwdriver or other instrumentfacilitating the turning of the nut on the body.

Wih the fracture reducing device just described' inserted and the bone fragments drawn together., the device will not only hold the bone fragments together but will provide suflicient rigidity between the bone fragments as to resist displacement thereof by the exertion of the weight of over the nailf methods of reducing fractures of this character lies in the fact that there is substantially no bruising or other injury to the hip joint by the manipulation necessary to insert and fix the device in place, with the result that, except for the minor pain and soreness resulting from the incision through -the muscles necessary to exposeV the bone for the drilling of the fracy CFI ture reducing device, there is no unfavorable reaction upon the Patient. r

By referring particularly to Figs. 2, 3 and 4,

it will be observed that the inner bolt 9 and its wedge exert relatively great expandingforces, permitting the anchoring of the body 6 within the'head 3 of the bone by reason of the relatively great mechanical advantage achieved between the wedge surfaces of the nut II and the split ends of the body 6, the bolt 9 being preferably formed with an enlarged head Il upon its outer end provided with a screwdriver or wrench slot I8 by which the bolt may be manipulated from the exterior of the bone. If desired, the expansion of the inner end I0 of the body 6 may be facilitated by reducing the cross sectional area of the body 6 at some point spaced inwardly from the inner end I0 thereof as by forming a recess or laterally extending bore I9 at the end of the split in the end of the body 6. While this weakening of the expanding end of the body facilitates the ready expansion of the body into gripping relation with the head 3 of the bone, it also serves additionally topermit the ready contraction of the4 expanded end of the body 6 when it is desired t0 remove the entire device at the end of the healing period.

Removal of the device is accomplished by rev leasing the wedge nut I I as by reversing the rotation of the inner bolt 9 to thread the nut toward the inner end of the bolt 8|. While if desired the bolt 9 may be merely turned until it has threaded itself to some extent out of the nut II and then the head I1 of the bolt 9 may be struck to drive the wedge inwardly, I prefer to provide means for resisting the outward movement of the bolt 9 as by providing an annular groove 20 in the bolt 9 and an annular groove 2| on the interior of the bore 8 of the body 6; between which grooves may be interposed a snap ring 22 of the construction commonly employed for interconnectingtwo telescopically assembled machine elements. Thus reverse rotation of the bolt 9 will positively drive the wedge I I inwardly of the bone head 3 and relieve the expanding forces from the split end I0 of the body 6, permitting the split expanded end to collapse to its normal diameter and thus releasing engagement thereof with the now healed bone fragment .3. However, if for any reason the split end I0 failed to contract as the wedge II is removed therefrom, the removal of the entire device from the bone is by no means prevented since all that is necessary is to rotate the body 6 in a'direction to unscrew it from the bone, the

Athreads 1 which have engaged the bon surface on the interior of the drilled bore 5 acting like a screw and nut assembly to thread the device outof the bone cavity. To facilitate the unscrewing of the body 6 wherever i1; is necessary, I provide a cross slot 23 in the outer end of the body 6 to permit th'e insertion therein of a wrench or screwdriver or other suitable instrument required to rotate the body 6.

The nut structure I3 is preferably formed with a length suflicient to provide considerable, longitudinal movement thereof on the body 6 before the outer end of the body 6 is exposed through the open end of the nut structure I3. Thus a single device may be employed for bones of different size, the adjustment of the device to bones of smaller size being accomplished merely by screwing the nut structure I3 further inwardly upon the body 6 or the device may be adapted to larger bones by merely screwing the nut structure I3 outwardly with respect to the body l Ili or otherwise fforming an "enlarged head against `which VLthe nut II may bear vwhen the nut is in its :innermost position. AlsoI may provide ithe outer 'end of afthebody `6 `with an enlarged unlthreaded section 6a which constitutes -an Yabut- 'mentfagainst which the nutstructure I 3 'may engage when the nut is completely unscrewed toits outermostposition.

"Referring to `Fig. l, it will be observed that -while v'the device' is particularly adapted 'for the reduction of fractures of the neck of the femur, `thesame may be employed also to draw together threeor more bone fragments in the event a multiple :fracture has occurred, a second line of fracture being indicated at 24 and the drilled bore or cavity being illustrated as extending through fall three pieces of the bone.

Also lI 'have illustrated the adaptation of my lfracture reducing device to the `reduction of intercondylar fractures of the lower end of the femur. Thus Vit will lbe apparent that the device is equally adaptable for the reduction of various types of fractures yin which boththe exertion of 'tensile forces drawing the vbone fragments `together and also the provision of lateral rigidity during the healing period is required.

IWhile in Figs. 1 through 4 I have illustrated one form of expanding body member `6, it will be apparent that the body may be provided with other types `of expanding devices; for example, in Figs. 5 and 6 I `have illustrated a modified form of expanding apparatus which includes the body member ll constructedY substantially as described in theforms shown in Figs. 1 through 4 with the exception that the tapered split 25 is provided with a reverse taperv from that shown 26 is provided with a tapered end 28 conforrning with the reverse taper 25 and arranged in such manner that by screwing the screw'26 inwardly the tapered end 28 acts as an expanding mandrel forcing the split ends of the body 6 to their expanded bone gripping position as illustrated in Fig. 6.

In Fig. 7 I have illustrated a still further modified form of my invention wherein the inner split end of the body 6 is formed by constructing a pair of jaws Illa and IOb separate from the body member, each of the jaws having a hemi-spherical head 3l adapted to be received in a spherical socket 332 formed in the end of the body 6. The

bore 8 through the body extends through the loose ends IIJa and Ib in such fashion that when the bolt or screw 9 is inserted the ends Illa and I0b will be prevented from vinadvertent disengagement with the end of the body member 6. Thus the ends Illa and Ib form a pair of loose jaws which may readily be removed from their normally retracted position as shown in Fig. 7 to an expanded position corresponding to the position of the jaws I0 shown in Fig. 3 by the inward threading of the wedge II upon the screw 9 in the same manner as was described with ref- .erenee to Figs. Al1ft`hrcmgi1 4, theprimaryldiirerence beinginuthe-ifaet that `Wh'entne wedge `H :is

again screwed outwardly the "jaws Illa and 10b 'are freeto collapse `and are not restrained by the normal Ainlfierent `stiffness of the material -of the bodyf.

"Again the removal or retraction of'thescrew -26iwi1l permit the contraction orcollapse ofthe expandedend of thebody 6 tofacilitate removal thereof lfro'm the'bone `after the lhealing process is complete, the Afailure of the 'ends to contract permitting the unscrewing of the body member B from the bone'cavity in 'the same manner'as wasdescribedfwithfreference'to Figs. lthrough 4. In the'eventthat'the particular position along the distal'b'one fragment at which the bore 5 Iis to `bemadeiis not at right angles to the surface of 1the bone, it may-be desirable 'to interpo'se between the head lI5 and the distal bone fragment anfang'ular washer such as is illustrated at 30 in Fig. `1, `thus providing for a distribution of the pressure `'exerted Aby the head I5 over a greater area-'of the bone surface.

While "I yhave shown and vdescribed the pre-- ferred embodiment of my'invention, I do not desire `to be limited to any ofthe details of con-- struction shown or described herein, except as defined in the'appended claims.

rI'clainfu f1. In fa' fracture reducing device,` a body member `'adapted y'to be inserted into a bore Iformed in the bone .'fragments, comprising an elongated cylindrical member -having its inner end 'laterally expandable 'to engage Ithe walls of ythe bone bore and having ritsexteri'or surface at said inner end provided with screw threads, means extending through said body member and adapted tobe a`ccessiblefrorn the exterior of the distal bone fragment for expanding said inner end into anchored relation in the proximal fragment, a nut member comprising a sleeve extending along and threaded upon Said body member, a nut member comprising a sleeveextending along and threaded upon said'body member and having a head at its outer end `ladapted to bear against the exterior of fs'ai'd 'distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, and means interengaging said body member and said nut member when said nut member is unscrevved Ia predetermined distance along said body member -tol prevent further unscrewing of said nut member, whereby further turning of said nut member will unscrew the members from the bone as a unit.

2. In a fracture reducing device, a body member adapted to be inserted into a bore formed in the bone fragments, comprising an elongated cylindrical member having its inner end laterally expandable and having its exterior surface at said inner end provided with screw threads, means extending through said body member and adapted to be accessible from the interior of the distal bone fragment for expanding saidinner end into anchored relation with the proximal fragment, a nut member comprising a. sleeve ex- .tending along and threaded upon said body member and having a head at its outer end adapted to bear against the exterior of said distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, shoulder means formed on said body member adjacent the outer end thereof to engage the threads of said sleeve when said nut member is unscrewecl to a predetermined distance along fthe body member to prevent further unscrewing of said nut member, whereby further turning of said nut member will unscrew the members from the bone as a unit. 7

3. In a fracture reducing device, a body mem!- ber adapted to be inserted into a bore formed in the bone fragments, comprising an elongated cylindrical member having its inner end split and having the exterior surface thereof at said inner end provided with screw threads, means extending through said body member and adapted -to be accessible from the exterior of the distal bone fragment for expanding said split end into anchored relation in the proximal fragment, a nut member comprising a sleeve extending along and threaded upon said body member and having a head at its outer end adapted to bear against the exterior f said distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, and means interengaging said nut member and said body member when said nut member is unscrewed to a predetermined distance along said body member to prevent unscrewing of said nut member, whereby further turning of said nut member will unscrew the members from Kthe bone as a unit.

4. In a fracture reducing device, a body member adapted to be inserted into a bore formed in the bone fragments, comprising an elongated cylindrical member having its inner end split and having lthe exterior surface thereof at said inner end provided with screw threads, wedge means in said split end, a screw adapted .to be accessible from the exterior of the distal bone fragment for drawing said wedge toward the outer end of said body member to expand said split end into anchored relation in the proximal fragment, a nut member comprising a sleeve extending along and threaded upon said body member and having a head at its outer end adapted to bear against the exterior of said distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, and means interengaging said nut member and said body member when said nut member is unscrewed to a predetermined distance along said body member to prevent unscrewing of said nut member, whereby further turning of said nut member will unscrew the members from the bone as a unit.

5. In a fracture reducing device, a body mem-- ber adapted to be inserted into a bore formed in l.the bone fragments, comprising an elongated cylindrical member having its inner end split and be accessible from the exterior of the distal bone fragment, said screw having a tapered end disposed in the tapered portion of said bore to expand the split end of said body member when said screw is turned inwardly of said body member, a nut member comprising a sleeve extending along and threaded upon said body member and having a head at its outer end adapted to bear against the exterior of said distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, and means interengaging said nut member and said body member when said nut member is unscrewed to a predetermined distance along said body member .to prevent unscrewing of said nut member, 'whereby further `turning of said nut member will unscrew the members from the bone as a unit.

6. In a fracture reducing device, a body member adapted to be inserted into a bore formed in the bone fragments, comprising an elongated cylindrical member, a pair of semi-cylindrical members hingedly secured to the inner end of said body member and constituting an extension of said body member having screw .threads thereon, a bore extending through said body member, a screw extending through said bore and adapted to be accessible from the exterior of the distal bone fragment, a Wedge nut on said screw disposed between said semi-cylindrical members comprising the extension of said body member to expand said semi-cylindrical members into anchored relation in the proximal fragment, a nut member comprising a sleeve extending along and threaded upon said body member and having a head at its outer end adapted to bear against the exterior of said distal fragment for drawing said anchored proximal fragment into abutment with said distal fragment, and means interengaging said nut member and said body member when said nut member is unscrewed to a. predetermined distance along said body member to prevent unscrewing of said nut member, whereby fur-ther turning of said nut member will unscrew the members from the bone as a unit.

MERVYN G. HARDINGE.

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