| Title of Invention | "DEVICE FOR THE TREATMENT OF FEMORAL FRACTIONS" |
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| Abstract | A device for the treatment of femoral fractions with A) an intramedullary pin (1) with a central axis (2), and a passage (5) with a non- circular cross-section (6) that passes through the rear portion (4) obliquely to the longitudinal axis (2), B) a sliding sleeve (10), that can pass through the non-circular passage (5), C) a longitudinal bone fixing element (20) with a head portion (22) with fixing means (23) that can engage the femoral head during use, as well as a shaft (24) that can be coaxially introduced into the sliding sleeve (10), wherein D) the external jacket surface (14) of the sliding sleeve (10) has a non-circular cross-section (17) at least in a partial section, E) the internal jacket surface (15) of the sliding sleeve (10) has a non-circular cross-section (38) at least in a partial section, F) the shaft (24) is rotatably mounted in the longitudinal bore (13) of the sliding sleeve (10), and G) at the free end (27) of the shaft (24) locking means (30) are provided, so that the rotation of the longitudinal bone fixing element (20) relative to the sliding sleeve (10) can be optionally locked or released. |
| Full Text | English translation of the specification of the International Patent Application No. PCT/CH03/00630 "Device for the treatment of femoral fractions" in the name of Mathys Medizinaltechnik AG Device for the treatment of femoral fractions The invention concerns a device for the treatment of femoral fractions according to the preamble of patent claim 1. Devices, whereby a securing of the femoral head against rotation is attempted by a single hip screw, i.e. a longitudinal bone fixing means, are already known. From EP-B 0 441 577, for example, a device is known, that has a sleeve accommodating the hip screw in a sliding manner, while the sleeve can be secured against rotation in the intramedullary pin by a locking screw proximally introduced into the intramedullary pin. The shaft of the hip screw and the bore of the sleeve are, however, not circular, so that the hip screw cannot rotate in the sleeve. However, during the introduction into the head of the femur the hip screw has to be able to rotate. For this reason during implantation the hip screw has to be inserted first and the sliding sleeve only afterwards. There is further the danger, that the hip screw moves medially when a compression screw is not additionally employed. A further disadvantage is, that the locking screw has to introduced from above (cranially) into the intramedullary pin, representing a further operating procedure. Finally, in the case of a potential subsequent removal of the hip screw a relatively great intervention is required to release the locking screw, screwed proximally into the intramedullary pin, in one step prior to removing the hip screw.Furthermore, from US-A 5,454,813 Lawes, an intramedullary pin with a hip screw and a sliding sleeve is known, wherein the transition in the intramedullary pin, the 30 external and internal profile of the sliding sleeve and the shaft of the hip screw have a non-circular construction. Consequently, the sliding sleeve acts as an anti-rotational means between the hip screw and the intramedullary pin. This known device has the disadvantage, that the prior introduced hip screw has to be rotated again one way or another during the assembly of the sliding sleeve, until it is so aligned that the non-circular cross-sections of the shaft, the external and internal profiles of the sliding sleeve and of the passage allow the introduction of the sliding sleeve. This means a time-consuming adjustment for the surgeon. A further disadvantage of this device is that a medial movement can be prevented 5 only with an additional component (tension adjuster). The purpose of the preceding discussion of the state-of-the-art is merely to explain the field of the invention and does not mean that the state-of-the-art quoted has actually been published or is public knowledge at the time of this 10 application. This is where the invention wants to provide remedy. The invention is based on the problem to produce a device for the treatment of bone fractures, particularly of proximal femoral fractures, that does not require elaborate adjusting steps by 15 the surgeon during the implanting and allows a simply lockable and releasable form-locking locking of the rotation between the longitudinal bone fixing element (e.g. the hip screw) and the intramedullary pin. The invention achieves the objective set by a device for the treatment of femoral fractures having the features of claim 1. The advantages achieved by the invention are essentially that as a result of the device according to the invention • by means of the locking means the bone fixing element can be optionally locked and released relative to the intramedullary pin with regard to rotation about the longitudinal axis of the bone fixing element, • the locking means can be locked and released laterally, • due to the rotatability of the sliding sleeve on the shaft of the bone fixing element, the introduction of the sliding sleeve after the implanting of the bone fixing element is possible prior to the assembly without long adjustment of the sliding sleeve and consequently the operation will be simplified and shortened, • the lateral sliding of the longitudinal bone fixing element is not limited by the locking means, • the front portion of the longitudinal bone fixing element, preferably constructed as a screw or a helical blade, can be optimally anchored in the spongiosa of the femoral head, because during its introduction the shaft of the longitudinal bone fixing element remains rotationally freely displaceable in the surrounding sleeve, • during its introduction into the femoral head the longitudinal bone fixing element does not need to be specially aligned and can rotate helically on impact in the femoral head. At this stage the longitudinal bone fixing element is not yet secured against rotation. Thus the surgeon can rotationally correct the femoral head, before he locks the rotation of the longitudinal bone fixing element in the longitudinal bore of the sliding sleeve. Further advantageous developments of the invention are characterised in the dependent claims. In a preferred embodiment the locking means comprise a tightening screw, that is axially firmly yet rotatably connected with the shaft, by means of a bush that can be axially displaced in the longitudinal bore of the sliding sleeve and can rotate relative to the sliding sleeve. At the front end of the bush and at the free end of the shaft there are preferably means provided which can be engaged by rotation with one another in a form-locking manner. In another embodiment the means at the front end of the bush and at the free end of the shaft are constructed as complementary spur gears. The following advantages are achieved by this: • the spur gears allow an engagement between the bone fixing element and the sliding sleeve at various angles of rotation, so that a simple adjustment between the bone fixing element and the intramedullary pin is possible during the implantation, and • by virtue of the spur gears a reliable securing against rotation can be achieved. In yet another embodiment at its front end the tightening screw has an annular bead, while the shaft has a coaxial bore with an undercut accommodating the bead, so that the tightening screw is rotatably but axially firmly connected with the shaft. The bore and the undercut preferably contain a radial opening, so that the tightening screw can be assembled transversely to the longitudinal axis of the bone fixing element. In a further embodiment the non-circular passage is complementary to the non-circular cross-section of the external jacket surface of the sliding sleeve, while the cross-section of the passage, for example, is so constructed that the non-circular cross-section of the passage has circumferential partial sections in the form of partial circular arcs.The fixing means of the longitudinal bone fixing element are preferably a helical blade, preferably a double helical blade. Other embodiments of the fixing means are a screw thread with a relatively fine pitch, a chisel, a pin, a T-section or a double T-section.In another embodiment the head portion of the longitudinal bone fixing element is constructed as a multi-start thread, preferably as a four-start thread. Due to this configuration the positioning of the bone fixing element is of no consequence. At the same time the thread of the head portion can have a pitch of at least 50 mm, preferably at least 80 mm. The advantage of this relatively coarse pitch is the higher resistance against the rotation of the bone fixing element. In addition, the bone fixing element, constructed as a helical blade, causes less damage to the bony substance than a conventional hip screw with a relatively fine pitch of the thread. The bone is more compacted than cut by the helical surfaces of the helical blade. The locking means are preferably so dimensioned, that they act as an axial stop with regard to the passing through of the intramedullary pin. This stop prevents a too wide a medial movement of the bone fixing element. In another embodiment the longitudinal bone fixing element is a hip screw. In yet another embodiment the longitudinal bone fixing element is a helical screw. The invention and developments of the invention are explained in detail in the following based on partly schematic illustrations of several embodiments. They show in: Fig.1 - a side view through the device according to the invention, Fig.2 - a partial section through an intramedullary pin in the region of its oblique passing through with the hip screw and sliding sleeve inserted, Fig.3 - a partial section through a modified intramedullary pin in the region of its oblique passing through with the hip screw and sliding sleeve inserted, Fig.4 - a partial section through another modified intramedullary pin in the region of its oblique passing through with the hip screw and sliding sleeve inserted, Fig.5 - a partial section through the device according to Fig.1, Fig.6 - an enlarged detail of the circle VI of Fig.5, Fig.7 - a section along the line VII-VII of Fig.5,Fig.8 - a longitudinal section through the sliding sleeve with the bone fixing element pre-assembled therein,Fig.Qa - an enlarged detail of the circle VI of Fig.5 with the locking means locked,Fig.Qb - an enlarged detail of the circle VI of Fig.5 with the locking means released,Fig.10 - a longitudinal section through the embodiment of the sliding sleeve illustrated in Fig.2,Fig. 11 -a rear view on the embodiment of the sliding sleeve illustrated in Fig. 10, Fig.12 - a longitudinal section through the embodiment of the sliding sleeve illustrated in Fig.2 with the shaft of the bone fixing element introduced, and 5 Fig.13 - a section along line XIII-XIII of Fig.12. In Figs.1 to 2 as well as 5 to 8 a device for the treatment of femoral fractures is illustrated, that comprises an intramedullary pin 1, a sliding sleeve 10, a longitudinal bone fixing element 20 in the form of a hip screw or a helical screw, and a locking means 30. The intramedullar pin 1 has a central longitudinal axis 2, a front portion 3 that can be introduced into the medullary canal, a rear portion 4, as well as a passage 5 with a non-circular cross-section 6 (Figs.2-4) that passes through the rear portion 4 obliquely to the longitudinal axis 2. The sliding sleeve 10, that can pass through the non-circular passage 5, has a front end 11, a rear end 12, a central longitudinal bore 13, an external jacket surface 14, an internal jacket surface 15, as well as a longitudinal axis 16.The longitudinal bone fixing element 20 in the form of a hip screw or helical screw has a longitudinal axis 21, a head portion 22 with fixing means 23 in the form of a multi-start thread of relatively coarse pitch, that can engage the femoral head during use, as well as a shaft 24 that can be coaxially introduced into the sliding sleeve 10. The external jacket surface 14 of the sliding sleeve 10 has a non-circular cross-section 17, while the internal jacket surface 15 of the sliding sleeve 10 has a non-circular cross-section 38 only on its rear segment 36 adjoining its rear end 12, and a circular cross-section 18 on a front segment 37 (Figs. 10, 11). The circular cross-section 18 of the front segment 37 (Figs. 10, 11) has the same diameter as the shaft 24 of the bone fixing element 20, so that the bone fixing element 20 is mounted in the sliding sleeve 10 in an axially displaceable and rotatable manner about the longitudinal axis 16. A segment at the transition between this segment of the shaft 24, that can be introduced into the longitudinal bore 13, and the head portion 22 of the bone fixing element 20 has a larger diameter, so that by virtue of this a shoulder 39 is formed that can be brought to rest at the front end 11 of the sliding sleeve 10. The possibility of axial displacement of the bone fixing element 20 relative to the rear end 11 of the sliding sleeve 10 is limited by virtue of this shoulder 39. Finally locking means 30 are provided to enable the optional locking of the rotation of the hip screw in the sliding sleeve 10.As it is illustrated in Fig.2, the sliding sleeve 10 with a non-circular cross-section 17 of its external jacket surface 14 is secured against rotation in the passage 5 of the intramedullary pin 1 with equally non-circular cross-section 6. As it is illustrated in Fig.2, the non-circular cross-section 6 of the passage 5 is constructed essentially as a circle with two diametrally opposing ribs 7, which are parallel to the longitudinal axis 16 of the sliding sleeve 10. The sliding sleeve 10 is secured in the passage 5 against rotation relative to the intramedullary pin 1 by the complementary construction of the external jacket surface 14 of the sliding sleeve 10 with two protrusions 35. By virtue of this design the intramedullary pin 1 can be also used with a conventional hip screw having a cylindrical shaft, i.e. without a sliding sleeve.Fig.3 illustrates a version of the non-circular cross-section 6 of the passage 5. The cylindrical shaft 24 of the longitudinal bone fixing element 20, constructed as a hip screw, is mounted in a rotatable manner in the interior of the sliding sleeve 10 with a cylindrical internal jacket surface 15 in the front segment 37. In contrast to that the external jacket surface 14 of the sliding sleeve 10, having an essentially quadratic, i.e. non-circular, cross-section 17 is secured against rotation in the passage 5 of the intramedullary pin 1 also having a non-circular cross-section 6. As Fig.3 illustrates, the non-circular cross-section 6 of the passage 5 has also an approximately quadratic construction, but has additional peripheral part-sections in the form of partial circular arcs. Due to this construction the intramedullary pin 1 can be also used with a conventional hip screw with a cylindrical shaft, i.e. also without a sleeve. Fig.4 illustrates a further version of a non-circular cross-section 6 of the passage 5, wherein two small partial circular arcs and a larger partial circular arc are present. The non-circular cross-section 17 of the external jacket surface 14 of the sliding sleeve 10 is correspondingly constructed.As it is illustrated in Figs.Qa and 9b, the locking means 30 comprise a bush 60 that is displaceable parallel to the longitudinal axis 21 of the bone fixing element 20 as well as a tightening screw 70. At the rear end 12 of the sliding sleeve 10 the bush 60 is axially displaceably mounted in the longitudinal bore 13 of the sleeve.As Figs. 10 and 12 illustrate, the longitudinal bore 13 in the sliding sleeve 10 comprises two axially adjacent segments 36, 37, of which the front segment 37 has a circular cross-section 18. Therefore, when the locking means 30 (Fig.9b) are released, the shaft 24 of the bone fixing element 20 is mounted in the sliding sleeve 10 rotatable about its longitudinal axis 16.As Fig.7 illustrates, the fixing means 23 of the longitudinal bone fixing element 20 are constructed as a four-start helical screw, wherein the thread has a pitch of approx. 120 mm.As Figs.9a and 9b illustrate, between the front end 62 of the bush 60 and the free end 27 of the shaft 24 means 50 are provided, which can be engaged by rotation with one another in a form-locking manner, said means can be engaged by axially displacing the bush 60. When the means 50 are engaged, i.e. locked (Fig.9a), a relative rotation between the bush 60 and the shaft 24 about the longitudinal axis 21 of the bone fixing element 20 is prevented, whereas when the means are released (Fig.9b) a rotation of the bone fixing element 20 relative to the sliding sleeve 10 is possible. The means 50 are constructed in this case as spur gears 51, 52, wherein on the front end 62 of the bush 60 an annular, first spur gear 51 is provided and the second spur gear 52 is also annular and is provided on the free end 27 of the shaft 24. The bush 60 has a central bore 65 with a coaxial inside thread 64, that can be screwed onto the outside thread 71 of the tightening screw 70. When the tightening screw 70 is tightened, the bush 60 is axially displaced towards the free end 27 of the shaft 24 until the two spur gears 51, 52 on the front end 62 of the bush 60 and on the free end 27 of the shaft 24 become engaged (Fig.9a). By virtue of this a relative rotation between the bush 60 and the shaft 24 about the longitudinal axis 21 of the bone fixing element 20 will be prevented. In the region of its rear segment 36 the longitudinal bore 13 has a non-circular cross-section 38 also with two flattenings 41 (Fig.11). By virtue of the complementary non-circular cross-sections of the bush 60 and of the longitudinal bore 13 in the sliding sleeve 10 a rotation between the bush 60 and the sliding sleeve 10 is prevented.When the locking means 30 (Fig.9a) are locked, the bone fixing element 20 is secured against rotation relative to the sliding sleeve 10 on the one hand, and on the other due to the non-circular cross-sections 6, 17 of the passage 5 and of the external jacket surface 14 the sliding sleeve 10 is secured against rotation relative to the intramedullar pin 1.The tightening screw 70 is axially firmly yet rotatably connected with the free end 27 of the shaft 24. As it is shown in Figs.9a and 9b, this axial connection is realised by a bead 72 at the front end 73 of the tightening screw 70, this bead engaging the undercut 66 in the bore 25 in the shaft 24. Since the undercut 66 extends over the entire circumference of the bore 25, the rotation of the tightening screw 70 relative to the shaft 24 about the longitudinal axis 21 of the bone fixing element 20 is not prevented. The tightening screw 70 has a coaxial bore passing through it and has at its rear end 74 means 75 to accept a screwdriver (not illustrated). By virtue of the axial fixing of the tightening screw 70 on the shaft 24, when the tightening screw 70 is tightened the bush 60 is displaced towards the free end 27 of the shaft 24 until the two spur gears 51, 52 engage one another, whereas when the tightening screw 70 is released the bush 60 is displaced in the opposite direction until the two spur gears 51, 52 become disengaged.As it can be seen from Figs. 12 and 13, in the region of the free end 27 of the shaft 24 the wall of the shaft 24 has a radial opening 42; as a matter of fact in such a manner, that the tightening screw 70 can be laterally introduced with the bead 72 into the undercut 66. This lateral introduction of the tightening screw 70 into the radial opening 42 is carried out before sliding the sliding sleeve 10 over the shaft 24. Finally, the tightening screw 70 is screwed into the inside thread 64 of the central bore 65 in the bush 60. Patent claims 1. A device for the treatment of femoral fractions with A) an intramedullary pin (1) with a central axis (2), a front portion (3) that can be introduced into the medullary canal of the femur, a rear portion (4), a passage (5) with a non-circular cross-section (6) that passes through the rear portion (4) obliquely to the longitudinal axis (2), B) a sliding sleeve (10), that can pass through the non-circular passage (5), with a front end (11), a rear end (12), a central longitudinal bore (13), an external jacket surface (14), an internal jacket surface (15) and a longitudinal axis (16), C) a longitudinal bone fixing element (20) with a longitudinal axis (21), a head portion (22) with fixing means (23) that can engage the femoral head during use, as well as a shaft (24) that can be coaxially introduced into the sliding sleeve (10), wherein D) the external jacket surface (14) of the sliding sleeve (10) has a non-circular cross-section (17) at least in a partial section, and E) the internal jacket surface (15) of the sliding sleeve (10) has a non-circular cross-section (38) at least in a partial section, characterised in that F) the shaft (24) is rotatably mounted in the longitudinal bore (13) of the sliding sleeve (10), and G) at the free end (27) of the shaft (24) locking means (30) are provided, by means of which the shaft (24) can be optionally connected rotatably with the sliding sleeve (10) in a form-locking manner, so that the rotation of the longitudinal bone fixing element (20) relative to the sliding sleeve (10) can be optionally locked or released. 2. A device according to claim 1, characterised in that the locking means (30) comprise a tightening screw (70), that is axially firmly yet rotatably connected with the shaft (24), and a bush (60) that can be axially displaced by the tightening screw (70) and is rotatably firm in the longitudinal bore (13) of the sliding sleeve (10). 3. A device according to claim 2, characterised in that the bush (60) has a front end (62) and the shaft (24) a free end (27) and that on the front end (62) of the bush (60) and on the free end (27) of the shaft (24) means (50) are provided which can be engaged by rotation with one another in a form-locking manner. 4. A device according to claim 3, characterised in that the means (5) comprise a first spur gear (51) on the front end (62) of the bush (60) and a second spur gear (52) on the free end (27) of the shaft (24). 5. A device according to any one of claims 2 to 4, characterised in that the front end (73) of the tightening screw (70) has an annular bead (72) and that the shaft (24) has a coaxial bore (25) with an undercut (66) rotatably accommodating the bead (72). 6. A device according to claim 5, characterised in that the bore (25) and the undercut (66) have a radial opening (42), so that the tightening screw (70) can be assembled transversely to the longitudinal axis (21) of the bone fixing element (20). 7. A device according to any one of claims 1 to 6, characterised in that the non- circular passage (5) is complementary to the non-circular cross-section (17) of the external jacket surface (14) of the sliding sleeve. 8. A device according to claim 7, characterised in that the non-circular cross- section (6) of the passage (5) has circumferential partial sections in the form of partial circular arcs. 9. A device according to claim 7 or 8, characterised in that the fixing means (23) of the longitudinal bone fixing element (20) are a helical blade, preferably a double helical blade. 10. A device according to claim 7 or 8, characterised in that the fixing means (23) are a screw thread, a chisel, a pin, a T-section or a double T-section. 11. A device according to any one of claims 1 to 10, characterised in that the head portion (22) of the longitudinal bone fixing element (20) is constructed as a multi-start thread, preferably as a four-start thread. 12. A device according to claim 11, characterised in that the thread of the head portion (22) has a pitch of at least 50 mm, preferably at least 80 mm. 13. A device according to any one of claims 7 to 11, characterised in that the locking means (30) act as an axial stop with regard to the passage (50). 14. A device according to any one of claims 1 to 13, characterised in that the longitudinal bone fixing element (20) is a hip screw. 15. A device according to any one of claims 1 to 13, characterised in that the longitudinal bone fixing element (20) is a helical screw. |
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| Patent Number | 269682 | ||||||||||||||||||
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| Indian Patent Application Number | 976/DELNP/2006 | ||||||||||||||||||
| PG Journal Number | 45/2015 | ||||||||||||||||||
| Publication Date | 06-Nov-2015 | ||||||||||||||||||
| Grant Date | 30-Oct-2015 | ||||||||||||||||||
| Date of Filing | 24-Feb-2006 | ||||||||||||||||||
| Name of Patentee | SYNTHES GMBH | ||||||||||||||||||
| Applicant Address | EIMATTSTRASSE 3, CH-4436 OBERDORF, SWITZERLAND | ||||||||||||||||||
Inventors:
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| PCT International Classification Number | A61B 17/74 | ||||||||||||||||||
| PCT International Application Number | PCT/CH2003/000630 | ||||||||||||||||||
| PCT International Filing date | 2003-09-18 | ||||||||||||||||||
PCT Conventions:
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