WO2011144955A1

WO2011144955A1 - Traction system for parts of anatomy

Info

Publication number: WO2011144955A1
Application number: PCT/IB2010/001202
Authority: WO
Inventors: Mustapha Balsam Ben Rowshan
Original assignee: Mustapha Balsam Ben Rowshan
Priority date: 2010-05-20
Filing date: 2010-05-20
Publication date: 2011-11-24

Abstract

A Traction system of parts of anatomy that comprises at least a traction device able to exert a traction force on a part of anatomy of a patient, at least a retaining device able to exert an opposite force to the traction force to prevent the change of at least the partial position of the patient in the direction of the traction, the at least one traction device and the at least one retaining device being coupled to a reference device able to identify the position of the traction device and/or the retaining device with respect to a support equipment of at least a part of the patient.

Description

TRACTION SYSTEM FOR PARTS OF ANATOMY

DESCRIPTION

The present invention concerns in general traction system for parts of anatomy, particularly of a live being. The present invention is particularly useful in medical field for the traction of human limbs during an operation, as surgical operation, plastering or radiological control. More specifically the present invention is useful for performing the traction of superior limbs, even if it doesn't exclude its application to perform the traction of inferior limbs. Moreover we do not exclude an application in veterinary field.

In medical field, and particularly in orthopaedics, it is often necessary to exert a traction force to align, for example, the stumps of a bone fracture. This operation can be done manually but the alignment is usually rather poor, since it is not possible to exert a high traction force or to maintain it properly during all the operating time.

One of the general purposes of the present invention is to make possible the application of a traction force, to a part of anatomy, with a desired intensity and/or maintaining such traction force for a desired time. It is desirable that this result could be applied to reduce bone fractures, especially of forearms wrists and fingers, and preferably also to other types of operation.

A further purpose of the present invention is that to provide a traction system for parts of anatomy effective and reliable.

Another further purpose of the present invention is that to provide a traction system for parts of anatomy easy to use and economic.

Another further purpose of the present invention is that to provide a traction system for parts of anatomy with a

CONFIR ATIpN CQPY limited or inexistent risk of accidents, both for the safety of the operators and of the patients.

According to a first aspect the present invention concerns a traction system according to claim 1, this is to say a traction system for parts of anatomy that comprises at least a traction device able to exert a traction force on an anatomic part of a patient, at least a retaining device able to exert an opposite force to the traction force, the at least one traction device and the at least one retaining device being coupled to at least one reference device able to define the position of the traction device and /or of the retaining device with respect to a support equipment of at least one part of a patient. Preferably the reference device is coupled lockable/unlockable to the support equipment.

Advantageously, the traction systems according to the present invention, thanks to the contrasting action of the traction device and the retaining device, are able to place the part of anatomy in a condition of desired traction and, thanks to the reference device, to maintain such traction for a desired time even if the patient should move other parts of anatomy.

In a first example of realisation, a traction system according to the present invention comprises at least one configuration in which during use at least one reference device is coupled to a support equipment of at least one part of the patient, and the traction force and the retaining force act substantially or principally in a first direction. Preferably, the configuration is in such a way that the at least one traction device is able to exert a traction on a forearm and the at least one retaining device is able to supply a retaining abutment to the arm of that same superior limb when the arm and its forearm are in an orthogonal position one with respect to the other. In a second example of realisation, a traction system according to the present invention comprises at least one configuration in which during use the at least one reference device is coupled to a support equipment of at least one part of the patient, and the traction force and the retaining force act substantially or principally in a second direction.

Preferably, the configuration is in such a way that that the configuration is in such a way that the at least one traction device is able to exert a traction on a superior limb in a direction orthogonal to the patient's body and the at least one retaining device is able to supply a retaining abutment to the underarm of the patient.

According to a third example of realisation, a traction system according to the present invention comprises at least one configuration in which during use the at least one reference device is coupled to a support equipment to support at least one part of the patient, and the traction force and the retaining force act substantially or principally in a third direction.

Preferably, the configuration is in such a way that the at least one traction device is able to exert a traction on a forearm and the at least one retaining device is able to supply a retaining abutment to the arm of that same superior limb when the arm and its forearm are in an orthogonal position one with respect to the other.

Advantageously, the best embodiments provides a traction system that can take at least two of the three configurations, wherein preferably the traction directions are substantially orthogonal to one another.

In this way it is possible to use the system in a plurality of different operation, as for example plastering a limb, positioning for radiographic control, operation of a wrist or hand. For example, when the at least two configurations are those of the first and third example, in one of them the forearm can be put in traction in a direction parallel to the patient's body and in the other it can be put in traction in a direction orthogonal to the patient's body.

Preferably, the support equipment comprises a bed, an operating table or a chair, and the traction system is able to exert a traction of a superior limb of a human being lying on the mentioned bed or operating table, or sitting on said chair, to which the at least one reference device is coupled.

Preferably, the traction system according to the first example has a configuration in such a way that the at least one traction device is able to exert a horizontal traction on a forearm positioned parallel to the patient's body, and the at least one retaining device is able to supply a retaining abutment to the arm of that same superior limb when the arm is positioned in a horizontal and orthogonal direction to the body of the patient. Preferably, the traction system according to the second example has a configuration in such a way that the at least one traction device is able to exert a horizontal traction on an arm and a forearm both positioned orthogonally to the patient's body, and the at least one retaining device is able to supply a retaining abutment to the underarm of the patient .

Preferably, the traction system according to the third example has a configuration in such a way that when the patient is lying on the back, the at least one traction device is able to exert a vertical traction upwards on the forearm positioned in a vertical position, and the at least one retaining device is able to supply a retaining abutment to the arm of that same superior limb when the arm is in a horizontal position. According to a general example particularly preferred, given a first reference position of the at least one reference device with respect to a support equipment of at least one part of a patient, the at least one traction device and the at least one retaining device can be placed at least according to a first and a second configuration with respect to the at least one reference device, in which respectively they act substantially or principally in a first direction and in a second direction different from each other with respect to the at least one reference device .

In particular, preferably when the at least one reference device is in the first reference position, the at least one traction device and the at least retaining device can be placed according to at least a third configuration wherein acting substantially or principally in a third direction different to the first and to the second directions with respect to the reference device.

More preferably, the direction of action in the first and in the second configuration, and eventually in the third configuration, are orthogonal to one another.

According to a preferred feature, the first and the second configurations, and eventually the third configuration, can be assumed in a plurality of reference positions of the at least one reference device.

A particular advantageous example comprises at least one retaining device comprising at least one abutment element with a thin form and shaped in an anatomical manner so as to substantially adhere to human arms. In particular, it is preferable that the at least one abutment element with a thin form has a shape such as to be able to be interposed between an arm, with which it can have a contact, and an over plastering of such arm, as well as it is able to be withdrawn from such plastering. This helps the plastering operation for the operator and reduces the pain of the patient.

To facilitate the extraction from the plaster, preferably, at least one abutment element with a thin form can be coupled to and uncoupled from the reference device and moreover preferably the at least one abutment element with a thin form has an adjustable position with respect to the at least one reference device to be able to adapt to any dimension of the patient. For more security and easy of use it is preferably that the at least one abutment element with a thin form can be locked at a desired height with respect to the at least one reference device.

In some preferred embodiments the at least one abutment element with a thin form slides with respect to a vertical guide of the at least one reference device.

For a matter of simplicity and economy of construction, the more advantageous embodiments are those in which the at least one traction device and the at least one retaining device are coupled to a same reference device.

In general, it should be noted that preferably the reference device should be able to be coupled to an equipment different from the traction system, such as an equipment to support at least partially the patient, or alternatively the traction system comprises a supporting equipment, such as an operating table, a bed (5) or a chair, to which the reference device (30) is coupled.

In general, the embodiments which work better are those in which the reference device has a first guide that can be coupled, can slide and can be locked in a desired position with respect to a corresponding guide of said equipment different from the traction system and/or with respect to a corresponding guide of said supporting equipment comprised in the traction system. Preferably, the first guide comprises a couple of jaws and said corresponding guide comprises a rod with respective grooves wherein said jaws can slide. For example the jaws can tighten together according to a vertical direction. Advantageously in some embodiments when the jaw, that is in a vertically higher position, rests in the respective groove of the rod, prior to tightening of the two jaws, the reference device is supported in equilibrium on the rod.

This ensures a high rate of safety in use, because it avoids that the system falls, with risks of accidents, while it gets assembled, besides this while in use it is more stable and it will reduce the rate of accidents in case the jaws loosens for any reason.

Preferably the jaws, are tightened together with a screw and nut device, of which at least one screw is free to run through the body of a first jaw of the two jaws and it is screwed in a threaded hole in the body of the second jaw of the two jaws or in a portion of the reference device that is fixed with respect to said second jaw, the first jaw is pushed toward the second by tightening the nut on the at least one screw and is able to drag the first jaw, during its movement, the at least one screw comprising, at the end opposite to the end screwed in the second jaw or in the portion of the reference device that is fixed with respect to said second jaw, a stopping head to avoid the separation of the nut from the at least one screw.

In the preferred embodiment the first guide is swallow tail shaped.

Generally, it is preferable that the traction device comprises at least one coupling device to at least one finger or one hand of a patient and at least one support element of the at least one coupling device, the support element can be positioned at a certain distance from the finger or hand with respect to the at least one coupling device, the at least one coupling device having an adjustable position with respect to the at least one support element. This means that the limb is placed in traction through a pulling action instead of a pushing one such as to be well accessible to run on it the necessary operations, allowing the various parts of the system to remain distant from it.

Moreover, preferably the at least one coupling device at the finger or hand can be connected to the at least one support element in a plurality of positions.

In this way, although the substantial or principal traction direction is a predetermined direction, there is a certain freedom of placing the limb for example with a desired degree of rotation. To do this, the at least one support element comprises a plurality of points for coupling the at least one coupling device, the said coupling points being arranged in a trait of length greater than 15,5 cm.

In case it is desired to use at least two coupling devices to a finger, that can be fixed to the support element in a plurality of positions, it is possible to define many positions of the limb corresponding to the same substantial or principal direction of traction, for example it is possible to immobilize the wrist in a partially rotated position. In other words you will have different directions of pulling, with one resulting, or a major component of the resulting that defines the substantial or principal direction of traction.

According to a preferable very practical feature, the at least one support element comprises a series of parallel grooves distributed along a line of predetermined length, the at least one coupling device at the finger or at the hand being fixed to the at least one support element through a chain that can be inserted in any of the grooves 01202

-9- and that is retained therein in the direction of traction.

Again more preferably, the chain comprises a plurality of balls and the grooves comprise a countersink notch to lodge said balls, so that when the chain is inserted in any of the grooves and is pulling in the traction direction, the chain cannot be extracted out of the groove since the ball abuts the countersink notch surface In this way it is guaranteed a security mechanism that avoids that during an operation the limb may suddenly be free. For a major adaptability to the patient measures and to the type of operation, preferably the position of the at least one support element with respect to the reference device is adjustable. For example, the at least one support element comprises an adjustment movement comprising at least one movement of rotation and one movement of translation independent from each other. The movement of rotation and the movement of translation are allowed or are locked through a single lock and release device.

In order to ensure the most accessibility to the limb on which it is necessary to intervene, in general it is preferable that the at least one support element is fixed to the at least one reference device through at least two spacer elements of lengthened form placed orthogonal one to another. Preferably the at least one support element has a lengthened form and, when in use is orthogonal to the two spacer elements.

For example, a first spacer element of the at least two spacer elements is coupled to the reference device and a second spacer element of the at least two spacer elements is coupled to the first spacer element in a distal position with respect to the reference device, the at least one support element being selectively rotatable and selectively slide-able with respect to the second spacer element . In some simple embodiments the first and the second spacer elements and the at least one support element are three rods .

Preferably, the first spacer element and the at least one reference device are coupled and slide one on the other, one of them comprises a first guiding groove in which the other slides, one of them comprises a second groove parallel to the first groove in which slides a locking element sliding jointly with that of the first spacer element and the at least one reference device that is without the second groove, in order that the second locking element prevents the first spacer element or the reference device to come out of the first guide groove in an orthogonal direction to the sliding one. More in particular, the first groove is "U" shaped with a longitudinal opening pointed towards a first direction and allowing at least the partial passage of the first spacer element or of the at least one reference device; also the second groove is "U" shaped with a longitudinal opening pointed in a second orthogonal direction with respect to the opening of the first groove and allowing the passage of the locking element.

Advantageously, the separation of the first spacer element from the at least one reference device in the sliding direction and in an orthogonal direction to it, is prevented by the retaining element inserted in the second guide groove.

For example, the retaining element comprises the end of a locking screw that can be activated to press the first spacer element and the at least one reference device together in order to lock their relative sliding movement.

According to another preferred example, the first spacer rod is coupled to the reference device through at least an adapter device. The at least one adapter device comprises a seat for the first spacer rod that can be locked in a predetermined position with respect to the reference device .

In general it is preferable that the coupling position of the at least one adapter device and the at least one reference device is adjustable. For example the at least one adapter device is coupled with a sliding movement to the at least one reference device in the same way as described for the sliding coupling of claims 40 to 43, mutatis mutandis.

In case it is desired to perform a particular operation it is preferable to provide at least an abutment device to allow the flexion of a wrist of a forearm under traction.

In its preferred embodiments the traction system according to the present invention is designed in the form of a detachable kit. In particular, the at least one traction device, the at least one retaining device and the at least one reference device are separable from each other.

Advantageously, each part of the kit has a maximum dimension inferior to 75.5cm.

For simplicity of construction it can be useful in some embodiments to comprise an operating table, a bed or a chair to which is coupled the reference device.

According to a second aspect, the present invention concerns a traction system according to claim 54, in particular a traction system for parts of anatomy characterized in that it comprises at least one traction device able to exert a traction force on a part of anatomy of a patient, at least one retaining device able to exert a force opposite to the traction force in order to prevent the change in the position even partially of the patient in the direction of traction, the at least one traction device and the at least one retaining device being coupled to a same reference device and being able to assume a plurality of configurations with respect to said reference device.

Preferably, this plurality of configurations corresponds to as many substantial or principal directions of traction orthogonal one to another. Even more preferably, the reference device comprises a coupling portion to be coupled to a support equipment of at least one part of a patient.

According to a third aspect, the present invention concerns a traction system according to claim 55, in particular a traction system for parts of anatomy characterized in that it comprises at least one traction device able to exert a certain traction force on a part of the body of a patient, at least one abutment device able to abut on a part of the body of a patient in order to contrast the action of the traction device, the traction device and the abutment device being coupled to each other through a connecting portion placed in an area outside the area between the traction device and the abutment device. Advantageously, when performing an operation of a radiography on the part of anatomy under traction, the connecting portion is not an obstacle .

According to a forth aspect, the present invention concerns a traction system according to claim 56, in particular a traction system for parts of anatomy characterized in that it comprises at least one traction device having a movement in a traction direction in order to exert a certain traction force on a part of the body of a patient, at least one abutment device able to abut on a part of the body as a consequence of the application of the traction force, a reference device coupled to the traction device and to the abutment device and able to be solidly locked to another equipment .

According to a fifth aspect the present invention concerns a medical device according to claim 57, in particular it comprises at least a first and a second part destined to be tightened together, characterized in that at least one screw is coupled to the first part and comprises a stopping head in a distal position with respect to the first part, the second part comprises at least a hole in which an at least one screw passes through in a sliding way, the second part being placed between the stopping head and the first part; a nut being coupled to the screw, in a way that when tightened or un-tightened it brings closer or further apart the second part and the first part, the nut locked to the stopping head prevents its separation from the screw.

According to a sixth aspect, the present invention concerns a medical device according to claim 58, in particular a medical device comprising a first and a second part designed to be coupled so as to slide one with the other, characterized in that the first element comprises a first guide groove in which slides the second element, the first or the second element comprises a second groove parallel to the first groove in which slides a retaining element sliding jointly with that of the first and second element which is without the second groove, so that the retaining element prevents the second element to slide out of the first guide groove. Preferably, the first groove has a "U" shaped longitudinal opening directed in a first direction to allow the passage or at least a partial passage of the second element; the second groove also has a "U" shaped longitudinal opening directed in a second direction orthogonal to the longitudinal opening of the first groove allowing the passage of the retaining element.

According to a preferred embodiment, the separation of the first and the second element in the sliding direction is prevented by the locking element inserted in the second guiding groove. For example, the retaining element comprises at its end a locking screw that can be activated to press the first element and the second element together to lock any relative sliding.

Further characteristics and advantages of the present invention shall become clearer from some preferred embodiments thereof, made with reference to the attached drawings and given for indicating and not limiting purposes .

These drawings show:

-figure 1 is a scheme showing the working principle of a traction system according to the present invention;

-figure 2 is a schematic perspective view of an embodiment of the invention;

-figure 3 is a schematic view showing a first operative configuration of the embodiment of figure 2 in use for the traction of a human upper limb;

-figures 4 and 5 are schematic views showing the reference device of the embodiment of figure 2, figure 5 is in partial section;

- figure 4a is a schematic side view of a detail of the reference device of figures 4 and 5;

- figure 5a is a schematic view showing the disposition scheme of two elements in a hypothetical section according to plan V of figure 5;

-figures 6 and 7 are schematic views showing the assembly of the embodiment of figure 2 in order to obtain the configuration of figure 3;

-figure 8 is a schematic view in partial section of the reference device of figures 6 and 7;

-figure 9 is a schematic view showing a component of a traction device of the traction system of figure 2, and figure 9a is its detail in a larger scale;

-figure 10 is a schematic perspective view showing a traction system according to the present invention coupled to an operation room bed in a configuration that allows a traction in a direction different from that of figure 3;

-figures 11 and 12 are schematic front elevation views of only the traction system in the configuration of figure 10 according to two possible way of assembly;

-figure 13 is a schematic perspective view of an

alternative retaining device that allows the assembly of the traction system in accordance with the configuration of figure 10;

-figures 14 and 15 are schematic perspective views of the respective adapters for the coupling of the traction device and the retaining device of the traction system of figure 10;

-figure 16 is a schematic perspective view showing a traction system according to the present invention coupled to an operating room bed according to a configuration allowing a traction in a direction different to the one of figure 3 and of figure 4;

- figure 16a is a schematic perspective view of the

traction system alone in the configuration of figure 16 and with an additional wrist abutment device; -figures 17, 18 and 19, are respectively schematic front, side, and rear views of the traction system in the

configuration of figure 16;

-figure 20 is a schematic perspective view of the adapter for the coupling of the reference device and the traction device of the traction system in the configuration of figure 16;

-figure 21 is a schematic perspective view showing the components of a kit that allows to obtain all the three assembly configurations illustrated respectively in figure 3, figure 10 and figure 16;

- figures 22 and 23 are schematic perspective views of an alternative embodiment of a traction system according to the present invention showed in a configuration

corresponding to the first configuration of figure 3.

In the following of the present description we will refer, for simplicity of illustration, to the use of the invention for the traction of a superior limb of a human being, nevertheless other uses cannot be excluded, e.g. the traction on an inferior limb, or for veterinary purposes.

Again, for more simplicity of illustration we will refer to a traction system that can be transformed in order to assume a plurality of configurations, nevertheless we do not exclude traction systems according to the present invention having a single configuration, preferably one of the three described. This could be, for example, obtained using non detachable parts or not providing replacement parts of some of the components to obtain other configurations, as it will be made clear hereinafter.

Referring to the figures, we will describe a traction system according to the present invention able to assume at least three operative configurations in which it is able to exert a traction force according to different directions. The shifting from one configuration to another is possible thanks to the fact that some components are detachable and preferably can be reassembled in different combinations.

However, preferably, when changing between some or all the configurations, some components can be replaced by others in such a manner that the traction system in a determined configuration can be obtained at least in part by different components with respect to the traction system in another configuration. The assembly of all the components necessary to realise the different configurations is in kit form, an example of which is illustrated in figure 21.

Figure 1 shows the functional scheme of a traction system 1 according to the present invention. In particular, the traction system 1 includes a traction device 10, a retaining device 20 and a reference device 30.

The traction device 10 exerts on an part of anatomy, not illustrated, a traction force in a predetermined direction Tl, while the retaining device 20 exerts on the same part of anatomy, or on a different part of anatomy, a retaining force Rl in opposition to the traction force Tl.

The reference device 30 is able to be coupled to a support equipment of the patient, as for example a bed, an operating table, or a chair to provide a fixed position to the part of the anatomy. For example, in case of a traction of a superior limb, the traction device 10 can be coupled to a finger or to a hand, while the retaining device 20 is able to supply a retaining abutment to the arm in traction or to the underarm of the patient, so that the traction can be of a great intensity if so required, while the reference device 30 prevents the change of position during the intervention that could alter the condition of traction.

Figure 2, illustrates a specific example of the traction system 1 according to the present invention. In particular, the traction device 10 and the retaining device 20 are connected to a single reference device 30 in a manner so as to form a single device that can be coupled to a bed.

Naturally, the possibility that the traction device 10 and the retaining device 20 be connected to respectively different reference devices, is not excluded, in order to form for example separate objects, each one able to be applied to a bed independently from each other.

Figure 2, shows the traction system 1 in a first assembled configuration . Figure 3, illustrates the use of the system 1 for the traction of a human being' s superior limb 2 in a first predetermined direction. The patient 3 is lying on the back on a support equipment 5, in particular a bed, at the edge 31 of which is coupled the reference device 30.

The traction device 10 exerts a traction on the forearm 4 in a direction parallel to the body of the patient 3 and towards the patient's feet. The limb 2 is placed with the elbow 6 folded in such a manner that the arm 7 is retained in abutment by the retaining device 20. The reference device 30 in this case is coupled to the bed 5 in such a manner as to be locked/unlocked, so that its position can be fixed in the most appropriate point.

To facilitate the holding of the body of the patient, the traction device 10 includes at least one coupling device 11 to at least a finger or a hand, for example a wire cage suitable to be tightened around a finger when put in traction.

The cage ends in a chain 14 connected to a support element 15 that will be better illustrated hereinafter.

The skilled man will note that within the same configuration of the traction system 1, and depending on the number of cages 12 used and of the direction of traction of the chain 14 it is possible to exert a traction in a wide range of directions, to maintain, for example, the wrist in a straight or turned position. In any case it will be also noted that in each configuration the traction system 1 identifies a principal and ideal direction of traction Tl, to which as a matter of simplicity we refer, and that in figure 3 is parallel to the body of the patient 3, and that in general is parallel or orthogonal to the direction of sliding XI of the traction system 1 in respect to the bed, the operating table 5 or the chair.

In the following it is described in detail the traction system 1 with specific reference to its configuration of figure 2.

Figures 4 and 5 illustrate part of the traction system 1 including the reference device 30 and the retaining device 20.

The reference device 30 includes a couple of jaws 33 and 35 supported by a plate 36. The jaws can be fixed in a removable way on the edge of the bed, operating table or chair, preferably by sliding along a straight guide 32 placed on the edge (shown in figure 4a) .

The sliding straight guide 32 generally has the form of a rod with a swallow tail shaped section, therefore also the jaws 33 and 35 form preferably in their complex a guide with a swallow tail shaped section 34 that defines a reference direction XI, which in turn coincides with the sliding direction parallel to the bed or the table 5 and therefore to the floor - as shown in figure 3.

Thanks to the internal inclined surface 33a of the jaw 33, forming a hook profile able to rest on a corresponding inclined side 32a of the straight sliding guide of the bed or operating table 5, the reference device is able to remain hooked to the bed or table 5 even before the jaws 33 and 35 are tightened together.

The jaw 33 is preferably fixed to the plate 36, while the jaw 35 has the form of a rod with a U shaped groove in which the plate 36 slides.

As it is better shown in the section of figure 8, where the U shaped jaw 35 is partially removed, a couple of screws 38 are inserted in a threaded hole 34 of the plate 36 and in corresponding holes 37 of the U shaped jaw 35. The holes 37 have a greater diameter than the screws 38 and are aligned with the threaded hole 32. A nut 39 is screwed on each screw 38 to push the U shaped jaw 35 against the jaw 33. Preferably, the end 40 of the screw 38 at the opposite side of the threaded end of the plate 36 comprises an enlarged head, in such a manner as to avoid the loosening of the nut 39. Putting into action the nut 39 makes it possible to allow, or lock, the sliding of the reference device 30 with respect to the edge 31 of the bed, operating table 5 or chair .

With reference to figure 5, on the plate 36, preferably on a side opposite to that of the jaws 33 and 35, it is provided a U shaped groove 42 for coupling to the traction device 10, preferably disposed according to the direction XI. In particular, inside the coupling groove 42, slides in direction XI a first spacer element 45 that is part of the traction device 10.

Said spacer element 45 comprises in turn a U shaped groove 47, parallel to the coupling groove 42. Each of the two U shaped grooves includes a bottom 49a, 49b, two opposite sides 48a, 48b and an open top 50a, 50b, orthogonal to one another and parallel to the sliding direction XI, as shown in the schematic section of figure 5a. One of the opposite sides 48b of the groove 42 includes at least a threaded hole 52 (illustrated in the partial section of figure 5) in which is inserted a screw 54 in such a manner as to press against the bottom 49a of the groove 47 and therefore pressing the spacer element 45 against the second side 48b of the groove 47.

The head 54a of the screw 54 acts as an abutment element for both opposite sides 48a of the groove 47, preventing the spacer element 45 to go out of the open top 50b of the groove 42, that is to say in a direction orthogonal to the direction XI. The screw 54 is therefore a locking element of the spacer element 45 in the groove 42.

It will be noted that when the screw 54 is tightened, it prevents the separation of the spacer element 45 from the reference device 30 both in the sliding direction XI and in the direction orthogonal to it. With reference again to figure 4 and 5, the plate 36 includes one, preferably two, coupling seats 55 for the retaining device 20. Preferably the coupling seats 55 are straight slots that also serve as vertical guides for adjusting the position of the retaining device 20.

The retaining device includes a plate 60 - also called abutment element - preferably curved shaped, for example with a concave section, thin, and able to abut against the arm of a patient in need of plastering, to remain in a first phase of plastering between the arm and the plaster, and finally to be slipped out from the plaster.

The applicant has discovered that the best results are obtained when the plate 60 has a thickness comprised between 1mm and 20mm and even preferably between 1mm and 10mm.

The plate 60 is coupled to a stem 62 for coupling in turn to the plate 36, where said stem 62 can be inserted in one of the slots 55 and held therein by way of a clamp 56 (figure 4) . The clamp 56 includes a tightening nut 57 with a series of holes suitable for inserting a lever 58.

The lever 58 allows a faster tightening or un-tightening of the nut 57.

Naturally we do not exclude other systems of prolongation of the nut 57 and/or multiplication of the force. To prevent loosing the lever 58, it is coupled to the retaining device 20 by a chain 59.

Thanks to the sliding possibility in the slots 55, the position of the retaining device 20 can be adjusted in the direction Y orthogonal to the direction XI, in order to be adaptable to the dimensions of the patient.

Referring now to figures 6 and 7 it should be noted that the traction device 10 includes a support element 15, for example a rod, to which the cages 12 illustrated in figure 2 can be hooked. The support rod 15 extends preferably substantially according in a direction Z orthogonal both to the direction XI and to the direction Y, in particular when in use it is parallel to the ground and orthogonal to the body of the patient. Moreover, it is connected to the reference device 30 through a couple of spacer elements 45 and 65, preferably two rods, the first of which has been already described with reference to figures 5 and 5a.

Both spacer elements 45 and 65 are coupled together in such a manner as to avoid rotation between them, achieved for example by way of a shaped interlocking system 68.

The supporting rod 15 and the second spacer rod 65 have preferably one relative adjustable position, for example with a curved profile coupling 70 that allows a translation and a rotation movement both independent from each another and that can be locked thanks to a single locking clamp 72, even if the direction of the support rod 15 is substantially in the direction Z.

With reference to figure 9, the support rod 15 includes a comb shaped portion 75, extending preferably for a length greater than 15,5 cm, and more preferably substantially for the entire length of the rod 15.

The comb portion 75, better shown in the detail in larger scale of figure 9a, includes a plurality of notches 77 to insert the chain 14 according to a direction different to that of the direction of traction and to hold it in the direction of traction XI. In particular, the chain links comprise balls 14a, while the bottom of the notches 77 comprises a curved edge 78 with a countersink notch 79. Such a countersink notch 79 defines a spherical seat able to hold a ball 14a in the direction of extraction when the chain 14 is under traction, and to allow the extraction of the ball 14a when the chain is left slack.

Referring to figure 10, we will now describe a second configuration of the traction system 1. In particular, the configuration of figure 10 differs from that of figure 3 because the substantial or principal direction of traction X2 instead than being coincident with the sliding direction XI of the reference device 30 is orthogonal to it, even if it remains parallel to the ground.

This configuration can be used to advantage for wrist surgery, since the traction system 1 can be coupled to an operating room bed 5 with an extension 5a on to which can lean a superior limb stretching laterally out from the edge 31 of the table.

The traction device 10 is able to assume a position in which the first spacer rod 45 extends parallel to the extension of the table 5a and for a distance HI from the floor equal or inferior to the distance H2 of such extension 5a.

In this manner the rod 45 is not an obstacle during operation.

In more detail, the first spacer rod 45 is directed in the direction X2 of traction, the second spacer rod 65 is directed in the direction Y orthogonal to the traction direction X2 and orthogonal to the floor, and the support rod 15 is in the sliding direction XI of the reference device 30. The support rod 15 has an adjustable position in the Y direction thanks to the clamp 72 that allows or locks its sliding movement on the spacer rod 65.

The assembly of the traction system 1 according to the configuration in figure 10 is made possible by the use for example of two adapters 80 and 85, the position of which could be well seen in figures 11 and 12, and by the use of a retaining device 320 shown in figure 13.

As it can be noted in figures 11 and 12 the adapter 80 permits the hooking of the retaining device 320 to the plate 36. Referring to figure 13, the retaining device includes a rod 345 for coupling to the plate 36, and a telescopic rod 365 coupled at one of its ends to the coupling rod 345 and at its opposite end to an abutment shaped plate 360. The telescopic rod 365 is connected, in a rotating and orthogonal manner, both to the coupling rod 345 and to the abutment shaped plate 360.

This can be achieved, for example, through respectively curved coupling profiles 370a and 370b with a vertical rotation axis, and locking clamps 372a ad 372b that allow or lock the relative rotation.

The telescopic rod 365 can instead be realized by means of two telescopic components 365a and 365b and a clamp 372c able to allow or lock their relative sliding. In this manner, when the alternative retaining device 320 is coupled to the reference plate 36, the position of the abutment shaped plate 360 can be adjusted in a plane parallel to the bed or operating table 5 so as to be able to abut any desired part of anatomy of a patient of any dimension, such as for example an underarm.

Referring to figure 14, the adapter 80 is composed of a hook shaped portion 81 that includes a slot 82 for inserting the plate 36, a clamp 83 for locking to the plate and a seat 84 to insert the coupling rod 345 of the retaining device 320.

As to the assembling of the traction device 10 to the reference plate 36, there are at least two possible modalities, illustrated in figure 11 and figure 12. Referring to figure 11, the first modality - also called the fixed modality - comprises the insertion of the adapter 85 in the U shaped groove 42, its locking in such a groove by means of the screws 54 and its fixed coupling to the traction device 10. Referring to figure 12, the second modality, also called adjustable modality - comprises the coupling of the adapter

85 to the couple of slots 55 of the plate 36 in a vertical sliding manner that can be locked by the clamps 355a. In this way, the vertical position of the traction device 10 with respect to the reference plate 36 and consequently to the bed, operating table or chair 5 can be adjusted.

As can be noted in figure 15, the adapter 85 includes a tube shaped seat 86 for the insertion of the first spacer rod 45 of the traction device 10. It can be locked inside the tube 86 thanks to a clamp 86a. At one end of the tube

86 is fixed a coupling rod 87 to the plate 36 in such a manner as to form a T.

The coupling rod 87 is in a form such that it can be inserted in the U shaped groove 42 of the plate 36, and includes a series of holes 88 for the insertion of the clamps 355a.

With reference to figure 16 it is described in the following a third configuration of the traction system 1 - also called tower configuration. In particular, the configuration in figure 16 differs from the one of figure 3 by the fact that the principal or essential direction of traction X3 instead of being coincident with the sliding direction XI of the reference device 30 it is orthogonal to it and directed upwards when the traction system 1 is coupled to a bed, an operating table 5 or a chair.

Such a configuration is particularly useful to put in an upward traction the forearm of a patient laying down on his back on a bed or operating table 5 with the elbow of the superior limb being in a position that is substantially at 90°, the forearm disposed according to the direction X3 and hooked to the traction device 10, for example through the cages 12 described above, and the arm disposed parallel to the floor and hold through an abutment action by the retaining device 20. W

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In more detail, the traction device 10 and the retaining device 20 are coupled to the reference device 30 through relative adapters 90 and 100, as shown in figures 17 to 19.

The support rod 15 is directed in the direction XI of sliding of the reference device 30, while the first and the second spacer rods 45 e 65 are directed respectively vertically and horizontally and are substantially orthogonal to the support rod 15 and to one another.

With reference to figure 20, the adapter 90 has a T shape, with a seat 92 able to receive the first spacer rod 45, and a portion 94 to be placed and locked in the U shaped groove 42 of the plate 36.

Between the seat 92 and the portion 94 is provided a channel 96 for the passage of one of the two sides 48b of the U shaped groove, in this manner the adapter 90 can remain adherent to the plate 36 and therefore contributing to limiting the bulk of the system 1.

As shown in figures 17 to 19, to assemble the traction device 10, the adapter 90 is inserted in the U shaped groove 42 of the plate 36 with the seat 92 directed upward. To increase the stability of the first spacer rod 45, it is possible to use also the adapter 80, already described for the second configuration, in addition to the adapter 90, positioned on the plate 36 with the seat 84 aligned with the seat 92. In this manner the first spacer rod 45 can run through the first adapter 80 and be inserted in the second adapter 90.

Alternatively, the first spacer rod 45 can be coupled to the plate 36 without the adapter 90 by providing a channel on one side of the U shaped groove 42 for the passage of one end of the first spacer rod 45 and by locking said end to the plate 36 through a screw. The adapter 80 can optionally be used also in this case.

Another alternative is to provide a hole on one side of the ϋ shaped groove 42 wherein can be fitted an end made thin of the first spacer rod 45. The first spacer rod 45 preferably passes through the adapter 80.

The retaining device 20 is the same as described for the first configuration, but to allow its orientation the stem 62 is coupled to one of the slots 55 of the plate 36 through the interposition of an adapter 100. The latter comprises two rods sliding one with respect to the other, which are able to be maintained orthogonal to one another and in a parallel plane to the sliding direction XI and to the traction direction X3. The adapter 100 comprises a slot 102 for the insertion and the sliding in direction XI of the stem 62. The latter can be locked by the clamp 56. In this way it is possible to adjust the position of the shaped plate 60 in the direction XI. The adapter 100 in turn, has an adjustable position in the direction X3 thanks to its possibility to slide with respect to the slot 55, and can be locked thanks to the clamp 104.

In this configuration, it could be useful to place the wrist of the patient in a flexed manner. To obtain this it is possible to place an additional abutment device 61 - shown in figure 16a - able to provide an abutment surface for the wrist.

The wrist abutment device 61 can be coupled to any one of the other parts of the traction system 1, and it is preferable that it has an adjustable position. In the embodiment shown in figure 16a, by way of example, it is coupled to the first spacer rod 45, on which it can slide or be locked. Moreover its distance from said first spacer rod 45 is also adjustable.

Figure 21, shows a kit 400 that includes all the components described above necessary for the assembly of the traction system 1 in all the three configurations described. The dimensions of each element of the kit are less than 75.5cm enabling their insertion in a standard sterilizer. It is preferable that all or most of the elements of the said kit 400 be in metal, and preferably aluminium.

Please note that often in the present description we have made reference to generic clamps, so intending that any locking device can be used, such as for example a bolt.

We will describe now a preferred plastering procedure made possible by the traction system 1, especially when it is in the first configuration.

Such a procedure comprises the phase of putting the superior limb in traction through the traction system 1 assembled according to the configuration of figure 2 or 16, applying the plaster around the arm and the shaped plate 60, then extract the shaped plate 60 from the plaster when the limb is not any more in traction. Preferably the plaster is extended both to the arm and the forearm.

With reference to figures 22 and 23 it is now described an alternative embodiment 501 of a traction system according to the present invention. It should be noted that in figures 22 and 23 the retaining device 520 comprising the abutment element 560 can slide in the direction of traction XI with respect to the plate 536, while the traction device 510 comprising the support element 515 has a fixed position with respect to the plate 536. Therefore the role of the retaining device 520 is not only that of abutment device but it can also be used to adjust the traction force.

The movement of the retaining device 520 is made possible by applying a sliding guide 595 to the plate 536, within which can slide or be locked an adapter bar 596. The stem 562 of the retaining device 520 is coupled to one edge of the adapter bar 596 in an orthogonal relation. The position of the sliding guide 595 with respect to the plate 536 can in turn be adjusted by way of bolts and screws 558 coupled to the slots 555. Alternatively or in addition also the position of the stem 562 with respect to the adapter bar can be adjusted for example by way or a slot a screw and a bolt.

The traction device 510 can have a single position with respect to the plate 536 or a plurality of positions. In the example of figures 22 and 23 there are two possible positions given by a couple of shaped seats 568 provided on the first spacer element 545 to which can be coupled the second spacer element 565. One of the two positions being nearest to the plate 536 than the other. The first spacer rod 545 has abutment shoulders 545a and 545b that prevent its movement with respect to the U-shaped groove 542 of the plate 536.

Naturally, the embodiments and variants so far described and illustrated are given purely by way of example. A skilled person, shall be able to apply several modifications, in order to meet specific and contingent needs, among which for example the use exclusively of the same elements in any configuration, a traction system with configurations with different traction directions or with a number of configurations different than three, for example one or two configurations, a traction system that comprises a bed, an operating table, a chair or any other type of support of the patient, that for example are inseparable from it. Moreover, other examples can be generated by crossing the embodiments, variants and aspects so far disclosed, these and all the other embodiments, variants and aspects being contained within the scope of protection of this invention as defined by the following claims.

Claims

TRACTION SYSTEM FOR PARTS OF ANATOMY CLAIMS

1. Traction system for parts of anatomy characterized in that it comprises at least one traction device (10, 510) able to exert a certain traction force on a part of the body (2) of a patient (3), at least one retaining device (20, 320, 520) able to exert a retaining force opposing the force of traction; the at least one traction device (10, 510) and the at least one retaining device (20, 320, 520) being coupled to at least one reference device (30) able to define the position of the traction device (10) and /or of the retaining device (20,320, 520) with respect to a support equipment (5) of at least one part of a patient (3) .

2. A traction system according to claim 1, characterized in that it comprises at least one configuration in which during use at least one reference device (30) is coupled to a support equipment (5) of at least one part of the patient (3), and the traction force (Tl) and the retaining force (Rl) act substantially or principally in a first direction (XI) .

3. A traction system according to claim 2, characterized in that the configuration is in such a way that the at least one traction device (10, 510) is able to exert a traction on a forearm (4) and the at least one retaining device (20, 520) is able to supply a retaining abutment to the arm of that same superior limb when the arm and its forearm are in an orthogonal position one with respect to the other.

4. A traction system according to claim 1 characterized in that it comprises at least one configuration in which during use the at least one reference device (30) is coupled to a support equipment (5) of at least one part of the patient (3), and the traction force (Tl) and the retaining force (Rl) act substantially or principally in a second direction (X2) .

5. A traction system according to claim 4, characterized in that the configuration is in such a way that the at least one traction device (10, 510) is able to exert a traction on a superior limb (4) in a direction orthogonal to the patient's body and the at least one retaining device (20, 520) is able to supply a retaining abutment to the underarm of the patient.

6. A traction system according to claim 1 characterized in that it comprises at least one configuration in which during use at least one reference device (30) is coupled to a support equipment (5) to support at least one part of the patient (3) , and the traction force (Tl) and the retaining force (Rl) act substantially or principally in a third direction (X3) .

7. A traction system according to claim 6, characterized in that the configuration is in such a way that the at least one traction device (10, 510) is able to exert a traction on a forearm (4) and the at least one retaining device (20, 520) is able to supply a retaining abutment to the arm of that same superior limb when the arm and its forearm are in an orthogonal position one with respect to the other.

8. A traction system characterized in that it can take at least two of the configurations of claims 2 to 7.

9. A traction system according to claim 8, characterized in that in the at least two configurations the traction directions are substantially orthogonal to one another.

10. A traction system according to claim 8 or 9, characterized in that the at least two configurations comprises the configurations of claims 3 and 7 wherein in one of them the forearm is put in traction in a direction parallel to the patient' s body and in the other in a direction orthogonal to the patient's body.

11. A traction system according to any of the preceding claims, characterized in that the support equipment (5) comprises a bed, an operating table or a chair, and the traction system (10, 510) is able to exert a traction of a superior limbs (2) of a human being lying on the mentioned operating table (5) or bed, or sitting on said chair, to which the at least one reference device (30) is coupled.

12. A traction system according to claim 1, characterized in that the at least one traction device (10) and the at least one retaining device (20, 320) can be placed at least according to a first and a second configuration with respect to the at least one reference device (30) , in which respectively they act substantially or principally in a first direction (XI, X2, X3) and in a second direction (XI, X2, X3) different from each other with respect to the at least one reference device (30) .

13. A traction system according to claim 12, characterized in that the first and the second configurations, and eventually the third configuration, can be assumed in a plurality of reference positions (XI) of the at least one reference device (30) .

14. A traction system according to any one of the preceding claims, characterized in that the at least one retaining device (20,320, 520) comprises at least one abutment element (60, 360, 560) with a thin form and shaped in an anatomical manner so as to substantially adhere to human arms (4) .

15. A traction system according to claim 14, characterized in that the at least one abutment element (60, 360, 560) with a thin form has a shape such that it is able to be interposed between an arm (4) , with which it can have a contact, and an over plastering of such arm, as well as it is able to be withdrawn from such plastering.

16. A traction system according to claim 15, characterized in that the at least one abutment element (60, 360, 560) with a thin form can be coupled to and uncoupled from the reference device (30).

17. A traction system according to claim 16, characterized in that the at least one abutment element (60, 360, 560) with a thin form has an adjustable position with respect to the at least one reference device (30, 536) .

18. A traction system according to claim 17, characterized in that the at least one abutment element (60, 360, 560) with a thin form can be locked at a desired height with respect to the at least one reference device (30, 536).

19. A traction system according to claim 18, characterized in that the at least one abutment element (60, 560) with a thin form slides with respect to a vertical guide (55) of the at least one reference device (30, 536) .

20. A traction system according to any one of the preceding claims, characterized in that the at least one traction device (10, 510) and the at least one retaining device (20,320, 520) are coupled to a same reference device (30).

21. A traction system according to any one of the preceding claims, characterized in that it comprises a supporting equipment, such as an operating table, a bed (5) or a chair, to which the reference device (30) is coupled.

22. A traction system according to any one of the claims from 1 to 20, characterized in that the reference device (30) is able to be coupled to an equipment (5) different from the traction system.

23. A traction system according to claim 21 or 22, characterized in that it has a first guide (34) that can be coupled, can slide and can be locked in a desired position with respect to a corresponding guide of said equipment (5) different from the traction system and/or with respect to a corresponding guide of said supporting equipment (5) comprised in the traction system.

24. A traction system according to claim 23, characterized in that the first guide (34) comprises a couple of jaws (33 35) and said corresponding guide comprises a rod with respective grooves wherein said jaws can slide.

25. A traction system according to claim 24 characterized in that the jaws (33 35) can tighten together according to a vertical direction.

26. A traction system according to claim 25, characterized in that when the jaw (33) , that is in a vertically higher position, rests in the respective groove of the rod, prior to tightening of the two jaws (33 35), the reference device (30) is supported in equilibrium on the rod.

27. A traction system according to any one of the claims 24 to 26, characterized in that the jaws (33 35), are tightened together with a screw and nut device (39) , of which at least one screw (38) is free to run through the body (37) of a first jaw of the two jaws (35) and it is screwed in a threaded hole (32) in the body of the second jaw (33) of the two jaws or in a portion (36) of the reference device (30) that is fixed with respect to said second jaw (33) , the first jaw (35) is pushed toward the second (33) by tightening the nut (39) on the at least one screw (38) and is able to drag the first jaw (35), during its movement, the at least one screw (38) comprising, at the end opposite to the end screwed in the second jaw (33) or in the portion (36) of the reference device (30) that is fixed with respect to said second jaw (33) , a stopping head (40) to avoid the separation of the nut (39) from the at least one screw (38) .

28. A traction system according to any one of the claims 23 to 27, characterized in that the first guide (34) is swallow tail shaped.

29. A traction system according to any one of the preceding claims, characterized in that the traction device

(10) comprises at least one coupling device (11) to at least one finger or one hand of a patient and at least one support element (15) of the at least one coupling device

(11) , the support element (15) can be positioned at a certain distance from the finger or hand with respect to the at least one coupling device (11) , the at least one coupling device (11) having an adjustable position with respect to the at least one support element (15) .

30. A traction system according to claim 29 characterized in that the at least one coupling device (11) at the finger or hand can be connected to the at least one support element (15) in a plurality of positions.

31. A traction system according to claim 30 characterized in that the at least one support element (15) comprises a plurality of points (77) for connecting the at least one coupling device (12, 14), the said points being arranged in a trait of length greater than 15,5 cm

32. A traction system according to claim 31 characterized in that it comprises at least two coupling devices (12,14) for corresponding fingers, that can be fixed to the at least one support element (15) in a plurality of positions (77) .

33. A traction system according to any one of the claim 29 to 32 characterized in that the at least one support element (15) comprises a series of parallel grooves (77) distributed along a line of predetermined length, the at least one coupling device (11) at the finger or at the hand being fixed to the at least one support element (15) through a chain (14) that can be inserted in any of the grooves (77) and that is retained therein in the direction of traction.

34. A traction system according to claim 33, characterized in that the chain (14) comprises a plurality of balls (14a) and the grooves (77) comprise a countersink notch (79) to lodge said balls (14A), so that when the chain (14) is inserted in any of the grooves (77) and is pulling in the traction direction, the chain (74) cannot be extracted out of the groove (77) since the ball (14a) abuts the countersink notch surface (79) .

35. A traction system according to any one of the claims 29 to 34 characterized in that the position of the at least one support element (15) with respect to the reference device (30) is adjustable.

36. A traction system according to claim 35 characterized in that the at least one support element (15) comprises an adjustment movement comprising at least one movement of rotation and one movement of translation independent from each other.

37. A traction system according to claim 36 characterized in that the movement of rotation and the movement of translation are possible or are locked through a single lock and release device (72) .

38. A traction system according to any one of the claims 29 to 37 characterized in that the at least one support element (15) is fixed to the at least one reference device (30) through at least two spacer elements (45, 65) of lengthened form placed orthogonal one to another.

39. A traction system according to claim 37 characterized in that the at least one support element (15) has a lengthened form and, when in use is orthogonal to the two spacer elements (45, 65) .

40. A traction system according to any one of the claims 38 or 39 characterized in that a first spacer element (45) of the at least two spacer elements (45, 65) is coupled to the reference device (30) and a second spacer element (65) of the at least two spacer elements (45, 65) is coupled to the first spacer element (45) in a distal position with respect to the reference device (30) , the at least one support element (15) being selectively rotatable and selectively slide-able with respect to the second spacer element (65).

41. A traction system according to claim 40 characterized in that the first and the second spacer elements (45, 65) and the at least one support element (15) are three rods.

42. A traction system according to any one of the claims 38 to 41 characterized in that the first spacer element (45) and the at least one reference device (30) are coupled and slide one on the other, one of them comprises a first guiding groove (42) in which the other slides, one of them comprises a second groove (47) parallel to the first groove (42) in which slides a locking element (54) sliding jointly with that of the first spacer element (45) and the at least one reference device (30) that is without the second groove (42) , in order that the second locking element (54) prevents the first spacer element (45) or the reference device (30) to come out of the first guide groove (42) .

43. A traction system according to claim 42 characterized in that the first groove (42) is "U" shaped with a longitudinal opening (50b) pointed towards a first direction and allowing for at least the partial passage of the first spacer element (45) or of the at least one reference device (30); also the second groove (47) is "U" shaped with a longitudinal opening (50a) pointed in an orthogonal direction with respect to the opening of the first groove and allowing for the passage of the locking element (54 ) .

44. A traction system according to claims 42 or 43 characterized in that the separation of the first spacer element (45) from the at least one reference device (30) in the sliding direction (XI) and in an orthogonal direction to it, is prevented by the retaining element (54) inserted in the second guide groove (47) .

45. A traction system according to any one of the claims 42 to 44 characterized in that the retaining element (54) comprises the end (54a) of a locking screw (54) that can be activated to press the first spacer element (45) and the at least one reference device (30) together in order to lock their relative sliding movement.

46. A traction system according to claim 41 characterized in that the first spacer rod (45) is coupled to the reference device (30) through at least an adapter device (80, 85, 90) .

47. A traction system according to claim 46 characterized in that the at least one adapter device (85, 90) comprises a seat (84, 86, 92) for the first spacer rod (45) that can be locked in a predetermined position with respect to the reference device (30) .

48. A traction system according to claim 46 characterized in that the position of the at least one adapter device (85, 90) and the at least one reference device (30) is adjustable.

49. A traction system according to claim 48 characterized in that the at least one adapter device (85, 90) is coupled with a sliding movement to the at least one reference device (30) in the same way as described for the sliding coupling of claims 41 to 44, mutatis mutandis.

50. A traction system according to any one of the preceding claims, characterized in that it comprises at least an abutment device to allow the flexion of a wrist of a forearm under traction.

51. A traction system according to any one of the preceding claims, characterized in that it is designed in the form of a detachable kit (400) .

52. A traction system according to claim 51 characterized in that the at least one traction device (10, 510), the at least one retaining device (20, 320, 520) and the at least one reference device (30) are separable from each other.

53. A traction system according to claim 51 or 52 characterized in that each part of the kit (400) has a maximum dimension smaller than 75.5cm.

54. Traction system for parts of anatomy characterized in that it comprises at least one traction device (10, 510) able to exert a traction force on a part of anatomy (2) of a patient (3), at least one retaining device (20, 320, 520) able to exert a force opposite to the traction force in order to prevent the change in the position even partially of the patient in the direction of traction, the at least one traction device (10, 510) and the at least one retaining device (20, 320, 520) being coupled to a same reference device (30) and being able to assume a plurality of configurations with respect to said reference device (30) .

55. Traction system for parts of anatomy characterized in that it comprises at least one traction device (11, 15) able to exert a certain traction force on a part of the body (2) of a patient (3) , at least one abutment device (60, 360, 560) able to abut on a part of the body (7) of a patient in order to contrast the action of the traction device (11, 15), the traction device (11, 15) and the abutment device (60, 360, 560) being coupled to each other through a connecting portion (36, 45, 65, 536) placed in an area outside the area between the traction device (11, 15) and the abutment device (60, 360, 560) .

56. Traction system for parts of anatomy characterized in that it comprises at least one traction device (10, 510) having a movement in a traction direction (XI, X2, X3) in order to exert a certain traction force on a part of the body (2) of a patient (3), at least one abutment device (20, 320, 520) able to abut on a part of the body (7) as a consequence of the application of the traction force, a reference device (30) coupled to the traction device (10, 510) and to the abutment device (20, 320, 520) and able to be solidly locked to another equipment (5) .

57. A medical device comprising at least a first and a second part (35, 36) destined to be tightened together, characterized in that at least one screw (38) is coupled to the first part (36) and comprises a stopping head (40) in a distal position with respect to the first part (36) , the second part (35) comprises at least a hole (37) in which an at least one screw passes through in a sliding way (38), the second part (35) being placed between the stopping head (40) and the first part (36); a nut (39) being coupled to the screw (38), in a way that when tightened or un- tightened it brings closer or further apart the second part

(35) and the first part (36) , the nut locked to the stopping head (40) prevents its separation from the screw (38) .

58. A medical device comprising a first and a second element (36, 45) designed to be coupled so as to slide one with the other, characterized in that the first element

(36) comprises a first guide groove (42) in which slides the second element (45), the first or the second element (36, 45) comprises a second groove (47) parallel to the first groove (42) in which slides a retaining element (54) sliding jointly with that of the first and second element (36, 45) which is without the second groove (47), so that the retaining element (54) prevents the second element to slide out of the first guide groove (42) .

59. A medical device according to claim 58 characterized in that the first groove (42) has a "U" shaped longitudinal opening (50b) directed in a first direction to allow the passage or at least a partial passage of the second element (45); the second groove (47) also has a "U" shaped longitudinal opening (50a) directed in a second direction orthogonal to the longitudinal opening (50b) of the first groove (42) allowing for the passage of the retaining element (54) .

60. A medical device according to the claims 57 or 58 characterized in that the separation of the first and the second element (36, 45) in the sliding direction is prevented by the locking element (54) inserted in the second guiding groove (42) .

61. A medical device according to any one of the claims 57 to 60 characterized in that the retaining element (54) comprises at its end a locking screw (54a) that can be activated to press the first element and the second element (36, 45) together to lock any relative sliding.