WO2008034844A1 - Bipolar expansion dowel for osteosynthesis of fractures of long bones - Google Patents

Bipolar expansion dowel for osteosynthesis of fractures of long bones Download PDF

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Publication number
WO2008034844A1
WO2008034844A1 PCT/EP2007/059898 EP2007059898W WO2008034844A1 WO 2008034844 A1 WO2008034844 A1 WO 2008034844A1 EP 2007059898 W EP2007059898 W EP 2007059898W WO 2008034844 A1 WO2008034844 A1 WO 2008034844A1
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WO
WIPO (PCT)
Prior art keywords
implant
expansion
bipolar
conical element
bone
Prior art date
Application number
PCT/EP2007/059898
Other languages
French (fr)
Inventor
Levon Doursounian
Original Assignee
Levon Doursounian
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 Levon Doursounian filed Critical Levon Doursounian
Publication of WO2008034844A1 publication Critical patent/WO2008034844A1/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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7258—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone
    • A61B17/7266—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone with fingers moving radially outwardly

Definitions

  • Osteosynthesis of bone diaphysis fractures can be done in different ways. Its goal is to restore the anatomy of a fractured bone, that is to say to maintain the bone in its shape and its natural dimension in a stable and lasting way during the period of consolidation.
  • the common methods of osteosynthesis of closed fractures are: the screwed plate, the intramedullary nail or the bundle of flexible pins.
  • the screwed plate requires for its implementation an extensive dissection with in particular the disinsertion of the soft parts over a large bone surface. But it has the advantage of allowing an anatomical reduction under control of the eye, to stabilize the bone effectively and to avoid to the surgeon exposure to X-rays.
  • the intramedullary nail allows osteosynthesis without the fracture focus, but requires perforation of one end of the bone, which is often close to a joint.
  • intramedullary nailing There are several methods of intramedullary nailing. Simple nailing does not prevent axial rotation movements at the fracture focus and often requires supplementation with a rotation locking system.
  • the most commonly used is locking by screws that pass through the bone and the nail under radiological control.
  • Another method is to expand the distal end of the nail and place screws through the nail only in the proximal portion.
  • the locked intramedullary nail avoids the opening of the fracture site but makes the anatomical reduction of the fracture difficult and requires some exposure of the surgeon to X-rays.
  • the present invention proposes to fix the fractured bone anatomically and rigidly but without extensive dissection, without perforation of one of the ends of the bone, or exposure of the surgeon to X-rays.
  • the implant according to the invention is characterized in that it consists of a piece of cylindrical or polygonal section configured to be inserted into the medullary canal of the long bones (O) by a fracture focus without perforation and whose ends are provided with expandable means to form a bipolar expansion pin.
  • the implant according to the invention is very advantageous because it allows a simple, rapid and atraumatic implementation, since it does not require any perforation of the fractured bone for its introduction.
  • its fixation is internal, fast and implemented by the fracture center without creating a new perforation.
  • the implant is such that:
  • the expansible means comprise at each end of the part one or more slots,
  • bone fixation means capable of cooperating with the expandable means
  • the fastening means comprise at least one conical element intended to be engaged in at least one slot
  • the insertion of the conical element into the slot causes the end of the piece to expand;
  • the conical element comprises traction means configured to cause it to be inserted into the split zone of each end, the traction means comprise a link,
  • the piece is composed of several segments assembled by means of assembly.
  • the implant which is the subject of this invention is part of the overall framework of centromedullary nails locked by expansion.
  • This implant (I) consists of a piece of cylindrical or polygonal section split at each of its ends.
  • a wedge (C) which in the initial position does not change the diameter of the cylinder.
  • Each of these corners is crossed by a cord (Cr) or any axial traction means. The pull of the cord in the direction of the middle of the implant causes the penetration of the wedge into the slot and increases the diameter of the implant at the level of the penetration of the wedge.
  • Figures 1 and 2 show more explicitly the device relating to the invention.
  • the implant (I) When the implant (I) is introduced into the medullary canal of a bone (O) fractured in two and is placed so that its ends are located on either side of the fracture, the expansion of the ends of the implant by penetration of the corners in the slots causes osteosynthesis of the fracture.
  • FIGS. 3, 4 and 5 The fracture is surgically treated by a small incision so as to expose only the zone of rupture of the bone.
  • Figure 3 shows the implant (I) introduced into one of the fragments of the bone (O) so as to be flush with the level of the fracture.
  • the implant is moved to penetrate the other bone fragment.
  • the implant is arranged so that the cords (Cr) exit through the fracture site and the middle of the implant is at the fracture site.
  • the body of the implant of cylindrical or polygonal section may consist of several segments integral. These segments can be solidified in many ways: pin, screw, clip. Moreover, the slit ends of the implant may have one or more slots. The removable traction device on the corners that constitute the cords can be replaced by any link such as a flexible rod or a cable.

Abstract

The invention relates to an implant (I) for treatment of diaphyseal fractures, characterized in that it is formed by a component of cylindrical or polygonal cross section which is designed to be inserted into the medullary canal of long bones (O) through a fracture site without perforation and whose ends are provided with expandable means in order to form a bipolar expansion dowel. The expansion is achieved by a conical element provided with traction means such as a cord. Pulling the cord through the fracture site inserts the conical element into the expandable means, resulting in their expansion and in the fixation of the implant.

Description

"Cheville à expansion bipolaire pour l'ostéosynthèse de fractures des os longs" "Bipolar Expansion Ankle for Osteosynthesis of Long Bone Fractures"
L'ostéosynthèse des fractures de la diaphyse des os peut se faire de différentes manières. Son objectif est de restaurer l'anatomie d'un os fracturé, c'est-à-dire de maintenir l'os dans sa forme et sa dimension naturelle de façon stable et durable pendant la période de consolidation. Les méthodes courantes d'ostéosynthèse des fractures fermées sont : la plaque vissée, le clou centromédullaire ou le faisceau de broches souples. La plaque vissée nécessite pour sa mise en place une dissection extensive avec en particulier la désinsertion des parties molles sur une large surface osseuse. Mais elle a l'avantage de permettre une réduction anatomique sous contrôle de la vue, de stabiliser efficacement l'os et d'éviter au chirurgien l'exposition aux rayons X.Osteosynthesis of bone diaphysis fractures can be done in different ways. Its goal is to restore the anatomy of a fractured bone, that is to say to maintain the bone in its shape and its natural dimension in a stable and lasting way during the period of consolidation. The common methods of osteosynthesis of closed fractures are: the screwed plate, the intramedullary nail or the bundle of flexible pins. The screwed plate requires for its implementation an extensive dissection with in particular the disinsertion of the soft parts over a large bone surface. But it has the advantage of allowing an anatomical reduction under control of the eye, to stabilize the bone effectively and to avoid to the surgeon exposure to X-rays.
Le clou centromédullaire permet une ostéosynthèse sans abord du foyer de fracture, mais nécessite une perforation d'une des extrémités de l'os qui souvent est proche d'une articulation. Il existe plusieurs modalités d'enclouage centro-médullaire. L'enclouage simple ne permet pas d'empêcher les mouvements de rotation axiale au niveau du foyer de fracture et nécessite souvent d'être complété par un système de verrouillage de la rotation. Parmi les différentes méthodes proposées pour le verrouillage du clou, le plus couramment utilisé est le verrouillage par des vis qui traversent l'os et le clou sous contrôle radiologique.The intramedullary nail allows osteosynthesis without the fracture focus, but requires perforation of one end of the bone, which is often close to a joint. There are several methods of intramedullary nailing. Simple nailing does not prevent axial rotation movements at the fracture focus and often requires supplementation with a rotation locking system. Among the various methods proposed for locking the nail, the most commonly used is locking by screws that pass through the bone and the nail under radiological control.
Une autre méthode consiste à réaliser une expansion de l'extrémité distale du clou et de ne placer de vis à travers le clou que dans la portion proximale. D'une manière générale, le clou centromédullaire verrouillé permet d'éviter l'ouverture du foyer de fracture mais rend difficile la réduction anatomique de la fracture et nécessite une certaine exposition du chirurgien aux rayons X.Another method is to expand the distal end of the nail and place screws through the nail only in the proximal portion. In general, the locked intramedullary nail avoids the opening of the fracture site but makes the anatomical reduction of the fracture difficult and requires some exposure of the surgeon to X-rays.
Le brochage à foyer fermé ou ouvert est une solution intermédiaire qui évite certains désavantages des méthodes précédentes mais au prix de fixation peu rigide et du risque de migration des broches.Closed or open broaching is an intermediate solution that avoids certain disadvantages of the previous methods but at the cost of rigid fixation and the risk of migration of the pins.
La présente invention propose de fixer l'os fracturé de façon anatomique et rigide mais sans dissection extensive, sans perforation d'une des extrémités de l'os, ni exposition du chirurgien aux rayons X. A cet effet, l'implant selon l'invention est caractérisé par le fait qu'il est constitué d'une pièce de section cylindrique ou polygonale configurée pour être insérée dans le canal médullaire des os longs (O) par un foyer de fracture sans perforation et dont les extrémités sont munies de moyens expansibles afin de constituer une cheville à expansion bipolaire.The present invention proposes to fix the fractured bone anatomically and rigidly but without extensive dissection, without perforation of one of the ends of the bone, or exposure of the surgeon to X-rays. For this purpose, the implant according to the invention. The invention is characterized in that it consists of a piece of cylindrical or polygonal section configured to be inserted into the medullary canal of the long bones (O) by a fracture focus without perforation and whose ends are provided with expandable means to form a bipolar expansion pin.
L'implant selon l'invention est très avantageux car il permet une mise en place simple, rapide et atraumatique, puisqu'il ne nécessite aucune perforation de l'os fracturé pour son introduction. De plus, sa fixation est interne, rapide et mise en œuvre par le foyer de fracture sans créer de nouvelle perforation. Selon des variantes préférées mais non limitatives de l'invention, l'implant est tel que :The implant according to the invention is very advantageous because it allows a simple, rapid and atraumatic implementation, since it does not require any perforation of the fractured bone for its introduction. In addition, its fixation is internal, fast and implemented by the fracture center without creating a new perforation. According to preferred but non-limiting variants of the invention, the implant is such that:
- les moyens expansibles comprennent à chaque extrémité de la pièce une ou plusieurs fente(s),the expansible means comprise at each end of the part one or more slots,
- il comprend des moyens de fixation à l'os aptes à coopérer avec les moyens expansibles,it comprises bone fixation means capable of cooperating with the expandable means,
- les moyens de fixation comprennent au moins un élément conique destiné à être engagé dans au moins une fente,the fastening means comprise at least one conical element intended to be engaged in at least one slot,
- l'insertion de l'élément conique dans la fente provoque l'expansion de l'extrémité de la pièce, - l'élément conique comprend des moyens de traction configurés pour provoquer son insertion dans la zone fendue de chaque extrémité, - les moyens de traction comprennent un lien,the insertion of the conical element into the slot causes the end of the piece to expand; the conical element comprises traction means configured to cause it to be inserted into the split zone of each end, the traction means comprise a link,
- la pièce est composée de plusieurs segments assemblés par des moyens d'assemblage.the piece is composed of several segments assembled by means of assembly.
L'implant qui fait l'objet de cette invention entre dans le cadre global des clous centromédullaires verrouillés par expansion. Cet implant (I) est constitué d'une pièce de section cylindrique ou polygonale fendu à chacune de ses extrémités. Dans chacune des fentes (F) aux deux extrémités est engagé un coin (C) qui en position initiale ne modifie pas le diamètre du cylindre. Chacun de ces coins est traversé par une cordelette (Cr) ou un quelconque moyen de traction axiale. La traction de la cordelette dans le sens du milieu de l'implant, provoque la pénétration du coin dans la fente et augmente d'autant le diamètre de l'implant au niveau de la pénétration du coin.The implant which is the subject of this invention is part of the overall framework of centromedullary nails locked by expansion. This implant (I) consists of a piece of cylindrical or polygonal section split at each of its ends. In each of the slots (F) at both ends is engaged a wedge (C) which in the initial position does not change the diameter of the cylinder. Each of these corners is crossed by a cord (Cr) or any axial traction means. The pull of the cord in the direction of the middle of the implant causes the penetration of the wedge into the slot and increases the diameter of the implant at the level of the penetration of the wedge.
Les figures 1 et 2 montrent plus explicitement le dispositif relatif à l'invention.Figures 1 and 2 show more explicitly the device relating to the invention.
Lorsque l'implant (I) est introduit dans le canal médullaire d'un os (O) fracturé en deux et qu'il est placé de façon à ce que ses extrémités soient situées de part et d'autre de la fracture, l'expansion des extrémités de l'implant par pénétration des coins dans les fentes provoque l'ostéosynthèse de la fracture.When the implant (I) is introduced into the medullary canal of a bone (O) fractured in two and is placed so that its ends are located on either side of the fracture, the expansion of the ends of the implant by penetration of the corners in the slots causes osteosynthesis of the fracture.
En pratique, l'intervention peut se dérouler de la façon suivante qui est illustrée par les figures 3, 4 et 5.La fracture est abordée chirurgicalement par une petite incision de façon à n'exposer que la zone de rupture de l'os. La figure 3 montre l'implant (I) introduit dans un des fragments de l'os (O) de manière à affleurer le niveau de la fracture.In practice, the procedure can be carried out in the following manner which is illustrated by FIGS. 3, 4 and 5. The fracture is surgically treated by a small incision so as to expose only the zone of rupture of the bone. Figure 3 shows the implant (I) introduced into one of the fragments of the bone (O) so as to be flush with the level of the fracture.
Puis comme le montre la figure 4, l'implant est déplacé de façon à pénétrer dans l'autre fragment de l'os. L'implant est disposé de façon à ce que les cordelettes (Cr) sortent par le foyer de fracture et que le milieu de l'implant se situe au niveau du foyer de fracture.Then as shown in Figure 4, the implant is moved to penetrate the other bone fragment. The implant is arranged so that the cords (Cr) exit through the fracture site and the middle of the implant is at the fracture site.
Ensuite comme le montre la figure 5, une traction est exercée sur l'une des cordelettes, provoquant l'expansion d'une des extrémités de l'implant et sa fixation à l'os. Cette cordelette utilisée est retirée et la fracture réduite. Enfin, comme le montre la figure 6, une traction est exercée sur l'autre fil ce qui provoque la fixation de l'autre extrémité de l'implant. De cette manière, la fracture est solidaire de l'implant. En d'autre terme, elle est ostéosynthésée grâce à une cheville à expansion bipolaire.Then, as shown in Figure 5, traction is exerted on one of the cords, causing the expansion of one end of the implant and its attachment to the bone. This cord used is removed and the fracture reduced. Finally, as shown in Figure 6, a pull is exerted on the other wire which causes the fixing of the other end of the implant. In this way, the fracture is integral with the implant. In other words, it is osteosynthesized thanks to a bipolar expansion pin.
Afin de s'adapter aux multiples variantes possibles en fonction du matériau de l'implant et du type de fracture, le corps de l'implant de section cylindrique ou polygonale peut être constitué de plusieurs segments solidaires. Ces segments peuvent se solidariser de multiples façons : goupille, vis, clip. Par ailleurs les extrémités fendues de l'implant peuvent présenter une ou plusieurs fentes. Le dispositif de traction amovible sur les coins que constituent les cordelettes peut être remplacé par un quelconque lien comme une tige souple ou un câble. In order to adapt to the multiple possible variants depending on the material of the implant and the type of fracture, the body of the implant of cylindrical or polygonal section may consist of several segments integral. These segments can be solidified in many ways: pin, screw, clip. Moreover, the slit ends of the implant may have one or more slots. The removable traction device on the corners that constitute the cords can be replaced by any link such as a flexible rod or a cable.

Claims

REVENDICATIONS
1. Implant (I) pour le traitement des fractures diaphysaires caractérisé par le fait qu'il est constitué d'une pièce de section cylindrique ou polygonale configurée pour être insérée dans le canal médullaire des os longs (O) par un foyer de fracture sans perforation et dont les extrémités sont munies de moyens expansibles afin de constituer une cheville à expansion bipolaire.1. Implant (I) for the treatment of diaphyseal fractures, characterized in that it consists of a piece of cylindrical or polygonal section configured to be inserted into the medullary canal of the long bones (O) by a fracture site without perforation and whose ends are provided with expandable means to form a bipolar expansion pin.
2. Implant (I) selon la revendication 1 dans lequel les moyens expansibles comprennent à chaque extrémité de la pièce une ou plusieurs fente(s) (F). 2. Implant (I) according to claim 1 wherein the expandable means comprise at each end of the piece one or more slot (s) (F).
3. Implant (I) selon la revendication 1 ou 2 comprenant des moyens de fixation à l'os aptes à coopérer avec les moyens expansibles.3. Implant (I) according to claim 1 or 2 comprising means for attachment to the bone adapted to cooperate with the expandable means.
4. Implant (I) selon la revendication 2 en combinaison de la revendication 3 dans lequel les moyens de fixation comprennent au moins un élément conique (C) destiné à être engagé dans au moins une fente (F). 4. Implant (I) according to claim 2 in combination of claim 3 wherein the fixing means comprise at least one conical element (C) intended to be engaged in at least one slot (F).
5. Implant (I) selon la revendication 4 dans lequel l'insertion de l'élément conique (C) dans la fente (F) provoque l'expansion de l'extrémité de la pièce.5. Implant (I) according to claim 4 wherein the insertion of the conical element (C) in the slot (F) causes the expansion of the end of the piece.
6. Implant (I) selon la revendication 4 ou 5 dans lequel l'élément conique (C) comprend des moyens de traction configurés pour provoquer son insertion dans la zone fendue (F) de chaque extrémité. 6. Implant (I) according to claim 4 or 5 wherein the conical element (C) comprises traction means configured to cause its insertion into the slotted zone (F) of each end.
7. Implant (I) selon la revendication 6 dans lequel les moyens de traction comprennent un lien (Cr).7. Implant (I) according to claim 6 wherein the traction means comprise a link (Cr).
8. Implant (I) selon une quelconque des revendications précédentes dans lequel la pièce est composée de plusieurs segments assemblés par des moyens d'assemblage. 8. Implant (I) according to any one of the preceding claims wherein the part is composed of several segments assembled by means of assembly.
PCT/EP2007/059898 2006-09-19 2007-09-19 Bipolar expansion dowel for osteosynthesis of fractures of long bones WO2008034844A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR0608302 2006-09-19
FR0608302A FR2901993A1 (en) 2006-06-12 2006-09-19 Implant for surgical treatment of diaphyseal fracture, has part of cylindrical or polygonal section expanded at its two ends to constitute bipolar expansion bolt, where end of implant has grooves admitting expansion wedges

Publications (1)

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WO2008034844A1 true WO2008034844A1 (en) 2008-03-27

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Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4522200A (en) * 1983-06-10 1985-06-11 Ace Orthopedic Company Adjustable intramedullar rod
FR2653006A1 (en) * 1989-10-12 1991-04-19 Dorange Arnaud Centromedullary nail with a multiplicity of internal fixators
DE3221835C2 (en) * 1982-06-09 1995-02-09 Diem Wolf Juergen Dr Bone marrow splint for fixing and compressing fractures of long long bones
US5437674A (en) * 1992-08-25 1995-08-01 Alexandre Worcel Osteosynthesis device
US5713904A (en) * 1997-02-12 1998-02-03 Third Millennium Engineering, Llc Selectively expandable sacral fixation screw-sleeve device
JPH1057398A (en) * 1996-08-15 1998-03-03 Mitsuru Monma Turn preventive device for operation of femur and humerus fracture
EP0922437A1 (en) * 1997-12-11 1999-06-16 ORTOMEDICAL S.p.A. Intramedullary nail for the osteosynthesis of bone fractures
FR2783699A1 (en) * 1998-09-29 2000-03-31 Maurice Bertholet Intra osseal connector for bone fracture
WO2001028443A1 (en) * 1999-10-22 2001-04-26 Mark Levy Expandable orthopedic device
US20030124488A1 (en) * 2001-12-28 2003-07-03 Gittleman Neal B. Expandable dental implant apparatus
WO2005112804A1 (en) * 2004-05-21 2005-12-01 Myers Surgical Solutions, Llc Fracture fixation and site stabilization system

Patent Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3221835C2 (en) * 1982-06-09 1995-02-09 Diem Wolf Juergen Dr Bone marrow splint for fixing and compressing fractures of long long bones
US4522200A (en) * 1983-06-10 1985-06-11 Ace Orthopedic Company Adjustable intramedullar rod
FR2653006A1 (en) * 1989-10-12 1991-04-19 Dorange Arnaud Centromedullary nail with a multiplicity of internal fixators
US5437674A (en) * 1992-08-25 1995-08-01 Alexandre Worcel Osteosynthesis device
JPH1057398A (en) * 1996-08-15 1998-03-03 Mitsuru Monma Turn preventive device for operation of femur and humerus fracture
US5713904A (en) * 1997-02-12 1998-02-03 Third Millennium Engineering, Llc Selectively expandable sacral fixation screw-sleeve device
EP0922437A1 (en) * 1997-12-11 1999-06-16 ORTOMEDICAL S.p.A. Intramedullary nail for the osteosynthesis of bone fractures
FR2783699A1 (en) * 1998-09-29 2000-03-31 Maurice Bertholet Intra osseal connector for bone fracture
WO2001028443A1 (en) * 1999-10-22 2001-04-26 Mark Levy Expandable orthopedic device
US20030124488A1 (en) * 2001-12-28 2003-07-03 Gittleman Neal B. Expandable dental implant apparatus
WO2005112804A1 (en) * 2004-05-21 2005-12-01 Myers Surgical Solutions, Llc Fracture fixation and site stabilization system

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