WO1995024871A1 - Removable, orthopedic fracture-stabilizing nail - Google Patents

Removable, orthopedic fracture-stabilizing nail Download PDF

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Publication number
WO1995024871A1
WO1995024871A1 PCT/NO1995/000054 NO9500054W WO9524871A1 WO 1995024871 A1 WO1995024871 A1 WO 1995024871A1 NO 9500054 W NO9500054 W NO 9500054W WO 9524871 A1 WO9524871 A1 WO 9524871A1
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WO
WIPO (PCT)
Prior art keywords
fracture
pin
head
stabiliser
nail
Prior art date
Application number
PCT/NO1995/000054
Other languages
French (fr)
Inventor
Espen Haukeland
Original Assignee
Espen Haukeland
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Espen Haukeland filed Critical Espen Haukeland
Priority to AU20866/95A priority Critical patent/AU2086695A/en
Publication of WO1995024871A1 publication Critical patent/WO1995024871A1/en

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Classifications

    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • 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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor

Definitions

  • the present invention relates to a removeable, orthopaedic fracture stabiliser, or to be more explicit a fracture stabiliser in the form of an elongated pin (intramedullar pin) threaded only over a limited area at one end.
  • the present invention has been especially developed for the stabilisation of fractures at the upper end of the humerus, a fracture of frequent occurrence.
  • the inventive object may also be used in the treatment of various other types of fracture, optionally when using other techniques simultaneously.
  • An additional area of application for the inventive object is in the field of veterinary medicine.
  • Fractures in the upper part of the humerus often occur in elderly, brittle-boned (osteoporotic) persons.
  • fractures are not treated by means of surgery, but some are treated operatively such as, e.g., fractures where the displacement of the ends of the fracture is more than 45% or a dislocation of approx. one bone width, which are usually reset and optionally fixed by means of an operation.
  • Common practice includes plastic osteosynthesis and steel wire fixation, optionally in combination with pinning or medullary nails.
  • US-A-3, 118, 444 which describes a rod or nail for stabilising a fracture of the lower arm and where the nail is pointed at both ends, and is equipped over a not insignifant part of one end with threads having a diameter just slightly greater than the diameter of the nail .
  • the nail is designed to be knocked into place or screwed into place with both ends as possible leading ends. Above all, this nail is not designed to be removed, should this be necessary;
  • US-A-5, 100, 405 which describes a two or three part nail having one part designed to be knocked into place through bone and a head part designed to be screwed onto the first part, and where the head part can optionally be secured to the first part by means of a locking screw;
  • NO-B-124 291 which teaches a hip nail equipped with radical projecting fins.
  • the end of the nail which shall be guided into the bone is designed to have projecting protrusions, the free ends of which are pointed and such that there is an open field of vision between the fin extensions;
  • NO-B-167 957 which teaches a bone pin for securing bone fragments
  • DE-C-2 807 364, US-A-5, 019, 079, US-A-Re. 33-348, and US-A-3 , 892, 232 teach different screws for use in the treatment of bone fractures
  • US-A-5, 112,333 which describes a two-part nail where the parts are screwed into one another to draw a fracture tight, optionally without the use of transversal aids although the device according to this document is equipped for an attachment of this kind.
  • the present invention aims to enhance/supplement the prior art and thus relates to a removeable, one-piece orthopaedic intramedullar fracture stabiliser in the form of an elongated pin, equipped in the proximal end thereof with grooves or holes for interaction with a suitable tool, and the fracture stabiliser according to the invention is characterised is that the pin, at the same end, is equipped with an externally threaded head having an end surface, the diameter of said head being greater than the diameter of the smooth, substantially circular portion of the pin.
  • Figure 1 shows a stabilising method according to prior art
  • FIG. 1 illustrates another known technique
  • Figure 3 is an illustration of the inventive object; and - Figure 4 shows the inventive object in use.
  • a fracture is stabilised in that the pointed end of a substantially right-angled member is knocked into the bone and that through holes in the portion extending along the bone, nails are knocked into place, alternatively screws are screwed into place.
  • FIG. 2 A further known technique is shown in Fig. 2 where so-called Rush pins, i.e. , long pins where the end remaining outside the bone is flanged and knocked in through the head of, e.g., the humerus and into the medullary cavity.
  • Rush pins i.e. , long pins where the end remaining outside the bone is flanged and knocked in through the head of, e.g., the humerus and into the medullary cavity.
  • the Rush pins illustrated in Fig. 2 are useful per se for holding a good axis in the fracture until it has healed, when they are put through the head of the humerus and into the upper part of the medullary cavity of the humerus.
  • many local problems occur around the point of entry and also the particularly pernicious migration of the pins upwards and out which often necessitates a second operation to remove the pins. This last-mentioned is, of course, often undesirable and troublesome.
  • the present invention aims to enhance known intramedullar fixation by means of pins and to rectify the defects associated with the prior art, and relates therefore to an orthopaedic fracture stabiliser of the type described above.
  • the pin consists of an elongated body 1 which at the posterior end thereof is equipped with a cylindrical, threaded head 2 in which there is also provided a groove or a hole 3 for interaction with a suitable tool.
  • a suitable tool In the illustrated case, this is a hexagonal hole of a known type per se.
  • the previously used Rush pins as shown in Fig. 2 are in the illustrated case knocked down through the head of the humerus and into the medullary cavity. Good stabilisation of the axis at the site of the fracture is usually obtained. However, these pinsoften migrate proximally and it is this proximal migration the present invention aims to remedy as the last portion of the fracture stabiliser according to the invention is screwed into the head of the bone to a desired depth in the bone and/or cartilage.
  • Pretapping is not necessary as the threads are preferably designed to be self-tapping and as the material is not so hard as to necessitate pretapping.
  • the head of the pin may be recessed below the cartilage on the surface of the joint or also below the bone, i.e., sub-c ⁇ rtically, away from the joint surface of the head of the bone.
  • the object according to the invention is preferably made of stainless steel with a head in the form of a self-tapping screw.
  • a normal length for such a pin will be from 50 to 200 mm where the end opposite the screw head is somewhat pointed for ease of penetration into the bone.
  • the thickness is preferably about 3 mm homogenous thickness .
  • the threaded head is preferably about 15 mm and the threads in the preferred embodiment are sharp-edged and self-tapping.
  • the diameter of the threaded head will be slightly larger than the outside diameter of the actual pin and will be 6 mm +/- 2 mm.
  • An embodiment is conceivable wherein a stop washer is provided at the end of the screw head.
  • the use of the inventive object is outlined in Figure 4 where the use of three pins to stabilise a fracture of the upper arm is indicated. The fixation of this fracture has been effected in that three pins have been inserted operatively into the head of the humerus from the uppermost end.
  • the inventive object makes possible a simple technique which gives better attachment in the often brittle or osteoporotic and relatively small upper fragment (s) of the fracture.
  • the inventive fracture stabiliser is primarily intended for use as an alternative fixation method in the case of fractures of the upper end of the humerus, the proximal humerus, in patients where there is an indication that surgical treatment is required.
  • inventive object may be used in connection with other fractures such as, e.g., a fracture of the proximal ulna (forearm) and distal radius (forearm at the wrist) .
  • fractures such as, e.g., a fracture of the proximal ulna (forearm) and distal radius (forearm at the wrist) .
  • Paediatric orthopaedics and veterinary medicine are also suitable fields of application for the inventive object.
  • the inventive fracture stabiliser having a steel pin with a threaded posterior portion enables one to pin fractures in a simple manner with several pins and at the same time anchor the pins so that the surrounding soft tissues are not significantly affected. The previous frequently occurring pin migration is counteracted owing to the threading.
  • the narrow diameter of the pins obviates the problems which usually accompany thicker medullary nails, and it is possible to use two or more pins to obtain sufficient stability both above and below the fracture.
  • the inventive object thus represents a new and valuable contribution to orthopaedic surgery which to a great extent rectifies the defects of the techniques used until now.

Abstract

A removable, orthopedic intramedullar fracture stabiliser in the form of an elongated pin (1), where said pin (1) at the posterior portion thereof is equipped with an externally threaded head (2) having a groove or hole (3) for interaction with a suitable screwdriver or similar, the diameter of the threaded portion being greater than the diameter of the outer circle of the pin (1).

Description

Removable, orthopedic fracture-stabilizing nail
The present invention relates to a removeable, orthopaedic fracture stabiliser, or to be more explicit a fracture stabiliser in the form of an elongated pin (intramedullar pin) threaded only over a limited area at one end.
The present invention has been especially developed for the stabilisation of fractures at the upper end of the humerus, a fracture of frequent occurrence. The inventive object may also be used in the treatment of various other types of fracture, optionally when using other techniques simultaneously. An additional area of application for the inventive object is in the field of veterinary medicine.
Fractures in the upper part of the humerus (proximal humerus) often occur in elderly, brittle-boned (osteoporotic) persons.
Most of these fractures are not treated by means of surgery, but some are treated operatively such as, e.g., fractures where the displacement of the ends of the fracture is more than 45% or a dislocation of approx. one bone width, which are usually reset and optionally fixed by means of an operation.
Common practice includes plastic osteosynthesis and steel wire fixation, optionally in combination with pinning or medullary nails.
As examples of prior art in this field, we shall refer to the following publications:
US-A-3, 118, 444 which describes a rod or nail for stabilising a fracture of the lower arm and where the nail is pointed at both ends, and is equipped over a not insignifant part of one end with threads having a diameter just slightly greater than the diameter of the nail . The nail is designed to be knocked into place or screwed into place with both ends as possible leading ends. Above all, this nail is not designed to be removed, should this be necessary;
US-A-5, 100, 405 which describes a two or three part nail having one part designed to be knocked into place through bone and a head part designed to be screwed onto the first part, and where the head part can optionally be secured to the first part by means of a locking screw;
US-A-5, 112, 333 which teaches an intramedullar nail comprising two parts. The parts are secured to one another to obviate rotation therebetween. One part exhibits threads (11) for attachment to the broken bone;
US-A-5, 281, 225, EP-A-550 814 and US-A-4, 875, 474, all of which teach different embodiments of an intramedullar nail. These publications teach the fixing of the nail by means of screws which are placed transverse thereto;
NO-B-124 291 which teaches a hip nail equipped with radical projecting fins. The end of the nail which shall be guided into the bone is designed to have projecting protrusions, the free ends of which are pointed and such that there is an open field of vision between the fin extensions;
NO-B-167 957 which teaches a bone pin for securing bone fragments; DE-C-2 807 364, US-A-5, 019, 079, US-A-Re. 33-348, and US-A-3 , 892, 232 teach different screws for use in the treatment of bone fractures; and finally
US-A-5, 112,333 which describes a two-part nail where the parts are screwed into one another to draw a fracture tight, optionally without the use of transversal aids although the device according to this document is equipped for an attachment of this kind. The present invention aims to enhance/supplement the prior art and thus relates to a removeable, one-piece orthopaedic intramedullar fracture stabiliser in the form of an elongated pin, equipped in the proximal end thereof with grooves or holes for interaction with a suitable tool, and the fracture stabiliser according to the invention is characterised is that the pin, at the same end, is equipped with an externally threaded head having an end surface, the diameter of said head being greater than the diameter of the smooth, substantially circular portion of the pin.
The invention and the advantages thereof shall be described in more detail with reference to the accompanying drawings where:
Figure 1 shows a stabilising method according to prior art;
Figure 2 illustrates another known technique;
Figure 3 is an illustration of the inventive object; and - Figure 4 shows the inventive object in use.
As shown in Fig. 1, a fracture is stabilised in that the pointed end of a substantially right-angled member is knocked into the bone and that through holes in the portion extending along the bone, nails are knocked into place, alternatively screws are screwed into place.
This is a complex and elaborate method which requires a relatively large surgical operation.
A further known technique is shown in Fig. 2 where so-called Rush pins, i.e. , long pins where the end remaining outside the bone is flanged and knocked in through the head of, e.g., the humerus and into the medullary cavity.
As indicated above, there are also other methods such as medullary nailing. What these known methods have in common is that they are subject to a high frequency of fracture healing complications, the disintegration of the head of the humerus (caput necrosis) , failure of the osteosynthesis or migration of osteosynthetic material so that this eventually protrudes into the soft tissues, i.e., a so-called proximal pin migration, with secondary soft tissue problems in the muscles and the joint capsule, in the case described around the shoulder.
The Rush pins illustrated in Fig. 2 are useful per se for holding a good axis in the fracture until it has healed, when they are put through the head of the humerus and into the upper part of the medullary cavity of the humerus. However, many local problems occur around the point of entry and also the particularly pernicious migration of the pins upwards and out which often necessitates a second operation to remove the pins. This last-mentioned is, of course, often undesirable and troublesome.
As mentioned above, the present invention aims to enhance known intramedullar fixation by means of pins and to rectify the defects associated with the prior art, and relates therefore to an orthopaedic fracture stabiliser of the type described above.
The pin consists of an elongated body 1 which at the posterior end thereof is equipped with a cylindrical, threaded head 2 in which there is also provided a groove or a hole 3 for interaction with a suitable tool. In the illustrated case, this is a hexagonal hole of a known type per se.
The previously used Rush pins as shown in Fig. 2 are in the illustrated case knocked down through the head of the humerus and into the medullary cavity. Good stabilisation of the axis at the site of the fracture is usually obtained. However, these pinsoften migrate proximally and it is this proximal migration the present invention aims to remedy as the last portion of the fracture stabiliser according to the invention is screwed into the head of the bone to a desired depth in the bone and/or cartilage.
Pretapping is not necessary as the threads are preferably designed to be self-tapping and as the material is not so hard as to necessitate pretapping. The head of the pin may be recessed below the cartilage on the surface of the joint or also below the bone, i.e., sub-cσrtically, away from the joint surface of the head of the bone.
These pins are put through the skin by means of nothing more than a small incision, e.g., of 0.5 to 1 cm, the so-called percutaneous technique, and it is therefore not necessary to open the joint capsule thus encountering the problems normally entailed thereby if the fracture has to be reset in a "bloody" manner.
The object according to the invention is preferably made of stainless steel with a head in the form of a self-tapping screw.
The material of manufacture must, of course, satisfy the usual medical requirements for such objects.
A normal length for such a pin will be from 50 to 200 mm where the end opposite the screw head is somewhat pointed for ease of penetration into the bone.
The thickness is preferably about 3 mm homogenous thickness .
The threaded head is preferably about 15 mm and the threads in the preferred embodiment are sharp-edged and self-tapping. The diameter of the threaded head will be slightly larger than the outside diameter of the actual pin and will be 6 mm +/- 2 mm. An embodiment is conceivable wherein a stop washer is provided at the end of the screw head. The use of the inventive object is outlined in Figure 4 where the use of three pins to stabilise a fracture of the upper arm is indicated. The fixation of this fracture has been effected in that three pins have been inserted operatively into the head of the humerus from the uppermost end.
The inventive object makes possible a simple technique which gives better attachment in the often brittle or osteoporotic and relatively small upper fragment (s) of the fracture.
Because it is possible to recess and anchor the pins, they will stay in place to a far greater extent than previously without proximal migration even after the fracture has healed, and they will therefore not necessitate a second surgical operation for removal as is the practice in other "safe" osteosynthesis methods.
The inventive fracture stabiliser is primarily intended for use as an alternative fixation method in the case of fractures of the upper end of the humerus, the proximal humerus, in patients where there is an indication that surgical treatment is required.
However, it is also conceivable that the inventive object may be used in connection with other fractures such as, e.g., a fracture of the proximal ulna (forearm) and distal radius (forearm at the wrist) . Paediatric orthopaedics and veterinary medicine are also suitable fields of application for the inventive object.
The inventive fracture stabiliser having a steel pin with a threaded posterior portion enables one to pin fractures in a simple manner with several pins and at the same time anchor the pins so that the surrounding soft tissues are not significantly affected. The previous frequently occurring pin migration is counteracted owing to the threading.
The narrow diameter of the pins obviates the problems which usually accompany thicker medullary nails, and it is possible to use two or more pins to obtain sufficient stability both above and below the fracture.
The inventive object thus represents a new and valuable contribution to orthopaedic surgery which to a great extent rectifies the defects of the techniques used until now.

Claims

P a t e n t c l a i m s
1.
A removeable, one-piece orthopaedic intramedullar fracture stabiliser in the form of an elongated pin (1) , equipped at one end (1') with members (3) for interaction with a suitable screwdriver or similar, characterised in that the pin (1) at the same end (1') thereof is equipped with an externally threaded head (2) having an end surface, the diameter of said head being greater than the diameter of the smooth, substantially circular portion of the pin (1) .
2.
A stabiliser according to Claim 1, characterised in that the pin is made of stainless steel of a surgical quality.
3.
A stabiliser according to Claim 1, characterised in that the hole (3) is designed for interaction with a hexagonal key that is known per se.
4.
A stabiliser according to any one of the preceding Claims 1 to 3, characterised in that the end of the screw head (2) is equipped with a flange or stop washer (4) .
PCT/NO1995/000054 1994-03-14 1995-03-13 Removable, orthopedic fracture-stabilizing nail WO1995024871A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU20866/95A AU2086695A (en) 1994-03-14 1995-03-13 Removable, orthopedic fracture-stabilizing nail

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
NO940896 1994-03-14
NO940896A NO179773C (en) 1994-03-14 1994-03-14 Removable orthopedic fracture stabilizer

Publications (1)

Publication Number Publication Date
WO1995024871A1 true WO1995024871A1 (en) 1995-09-21

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Country Status (3)

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AU (1) AU2086695A (en)
NO (1) NO179773C (en)
WO (1) WO1995024871A1 (en)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2749157A1 (en) * 1996-05-28 1997-12-05 Delponte Patrick Medullary nail implant for surgery

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3118444A (en) * 1961-11-20 1964-01-21 Jr Jose C Serrato Forearm rod for fractures
US4175555A (en) * 1977-02-24 1979-11-27 Interfix Limited Bone screw
US4723541A (en) * 1986-05-19 1988-02-09 Reese Hewitt W Bone screw and method
US5019079A (en) * 1989-11-20 1991-05-28 Zimmer, Inc. Bone screw
WO1992003979A1 (en) * 1990-09-07 1992-03-19 Mclaren Alexander C Locking cap for medical implants
WO1994020039A1 (en) * 1993-03-11 1994-09-15 Dietmar Pennig Screw for securing an intramedullary nail

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3118444A (en) * 1961-11-20 1964-01-21 Jr Jose C Serrato Forearm rod for fractures
US4175555A (en) * 1977-02-24 1979-11-27 Interfix Limited Bone screw
US4723541A (en) * 1986-05-19 1988-02-09 Reese Hewitt W Bone screw and method
US5019079A (en) * 1989-11-20 1991-05-28 Zimmer, Inc. Bone screw
WO1992003979A1 (en) * 1990-09-07 1992-03-19 Mclaren Alexander C Locking cap for medical implants
WO1994020039A1 (en) * 1993-03-11 1994-09-15 Dietmar Pennig Screw for securing an intramedullary nail

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2749157A1 (en) * 1996-05-28 1997-12-05 Delponte Patrick Medullary nail implant for surgery

Also Published As

Publication number Publication date
NO940896D0 (en) 1994-03-14
AU2086695A (en) 1995-10-03
NO179773C (en) 1996-12-18
NO940896L (en) 1995-09-15
NO179773B (en) 1996-09-09

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