Compression brace
A surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener, such as a screw or pin. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to form a compression opening. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings. In some embodiments, the fasteners are maintained in a substantially fixed relation with the fastener retaining portion. The brace is installed on adjacent bones such that a fastener engages each bone. The compression opening is spread apart to draw the fasteners toward one another, and thereby compress the adjacent bones together.
Not applicable
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENTNot applicable
REFERENCE TO A MICROFICHE APPENDIXNot applicable
FIELD OF THE INVENTIONThe present invention relates generally to orthopedic surgery, and more particularly to devices and methods for reduction of fractures and osteotomies by drawing bones together.
BACKGROUND OF THE INVENTIONU.S. Pat. No. 2,597,342 (Lang) discloses the use of a compressible fastener for joining boards together. The Lang fastener includes a central loop portion and claw members that extend from diametrically opposed sides of the central loop. The loop is preferably a parallelogram. Each claw member has two claws. Each claw has downwardly turned ends with inwardly turned portions which are configured to penetrate and engage boards. In operation, the claw members are set astraddle adjacent board members. The central loop is then expanded outward to draw the opposing arms toward one another and thereby fasten the adjacent boards together.
The earliest use of a compression opening in a surgical application appears to be U.S. Pat. No. 4,887,601 (Richards). Richards discloses an adjustable surgical staple having a slotted spine and downwardly depending legs on opposing ends of the spine. The legs are bent toward or away from the spine. However, a straight leg embodiment is discussed with reference to
The use of a compressible bone staples for fracture reduction is disclosed in U.S. Pat. No. 5,449,359 (Groiso); U.S. Pat. No. 5,660,188 (Groiso); U.S. Pat. No. 5,853,414 (Groiso); U.S. Pat. No. 5,947,999 (Groiso); and U.S. Pat. No. 5,993,476 (Groiso) (collectively, “the Groiso patents”). However, the Groiso patents, which are incorporated herein by reference, disclose the use of staples having downwardly depending legs for engaging adjacent bones. The Groiso compression bone staples suffer from several drawbacks. Staples having opposing spaced-apart bridges can be difficult and therefore expensive to manufacture. See e.g. U.S. Pat. No. 5,947,999 (Col. 1, lines 48-52). Positioning holes in the bones such that they align with the legs of the staple can be challenging, and typically requires specialized instrumentation. Additionally, staple legs tend to splay outward during use in vivo, which may reduce the compressive force of the staple. Staples can pull out of the bones. The configuration of staples also reduces intra-operative choices. In order to accommodate varying inter-axis and leg length requirements, it is necessary to provide a wide array of staple sizes, which requires extra inventory. A staple conventionally has legs of the same length and diameter/cross-section, which may make the staple unsuitable for situations in which it is desirable to have a longer or larger leg on one side of the staple. Thus, even with a large inventory of staple sizes, intra-operative choices may be limited.
One of the Groiso patents, U.S. Pat. No. 5,947,999, discloses a compressible bone staple that has a pair of wing members extending from opposing ends of the staple, each wing member having apertures therein for receiving a screw for fastening the clip member to a bio-organic tissue member. However, the '999 patent does not teach elimination of the downwardly depending leg portions of the staple. In fact, Groiso teaches away from elimination of the leg portions by noting “the aim of attaining a desired spacing between bone fragments could be obtained with connecting elements such as plates and screws, but these are much bulkier, require major surgical procedures for the placing thereof and the possibility of trauma is increased.” U.S. Pat. No. 5,947,999 (Col. 2, lines 55-59). Additionally, the '999 patent is direct toward connecting soft tissues (tendons and ligaments) to bone.
U.S. Pat. No. 4,444,181 (Wevers et al.) discloses a bone clip for repair of bones in vivo including a body having a slot in a central portion thereof and a pair of downwardly depending legs on either end of the body. After the clip is inserted in opposing bones, opposing bridges are compressed toward one another (rather than expanded) to shorten the clip and thereby draw the bones together.
The use of bone screws and bone plates to reduce fractures is well known in the art. However, as far as the applicant is aware, no attempt has been made to provide a brace and screw combination that has the ability to pull bone fragments together in the efficient and highly effective manner described herein. There is thus a need for a surgical device having the following characteristics and advantages over the prior art.
OBJECTS AND SUMMARY OF THE INVENTIONIt is an object of the invention to provide an improved means of compressing adjacent bones together in surgical applications.
It is an object of the invention to provide a substitute for surgical compression staples that has superior anchorage in bone.
It is an object of the invention to increase intra-operative choices by allowing a surgeon to select desired lengths and diameters of fasteners.
It is an object of the invention to reduce inventory by allowing a surgeon to mix and match between braces and fasteners.
The foregoing objects and advantages are achieved by providing a surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to thereby form a compression opening between the fastener retaining portions. Each bridge member is preferably substantially V-shaped. The fasteners are sized and configured to pass through the fastener hole and retain the compression bracket on bones. The fasteners preferably have a lengthwise shaft sized to pass through the fastener hole and an upper retainer portion sized and configured to retain the fastener in the fastener hole. In one embodiment, the fasteners are screws having a lower thread positioned to engage bone. In an alternative embodiment, the fasteners are pins. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings.
The device is preferably provided with a means for selectively locking the fasteners in the fastener holes to maintain the fasteners in a substantially fixed relation with the fastener retaining portion. Alternatively, the fastener hole of the brace member may be substantially smooth. The shaft of at least one of the fasteners can be sized to provide play between the shaft and the fastener hole, such that the fastener can be selectively angled into bone during use of the device.
The foregoing and other objects, features, aspects and advantages of the invention will become more apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIGS. 8A-C show views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end.
In the following detailed description of the preferred embodiments, reference is made to the accompanying drawings which form a part hereof, and in which are shown by way of illustration specific embodiments in which the invention may be practiced. It is to be understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present invention.
As shown in
As shown in
A pair of bridge members 50A, 50B are positioned between the fastener retaining portions 10. The bridge members 50A, SOB preferably extend directly from the fastener retaining portions 10, but may be spaced from one or both of the fastener retaining portions, such as by a shared extension portion disposed between the bridge members 50A, SOB and fastener retainer portions 10. The bridge members 50A, 50B are spaced apart from one another to form a compression opening 70 between the fastener retaining portions 10. The bridge members SOA, SOB and the compression opening 70 are used to compress the fastener retaining portions 10 and fasteners 100 toward one another, in a manner described in further detail below.
In the preferred embodiment shown in
Bridge members 50A, 50B may alternatively have curved, arcuate, straight, or other deformable configurations, provided that bridges 50A, 50B are configured to form a deformable compression opening 70. In
As shown in
As shown in
As shown in
In a preferred embodiment shown in
The invention may be provided with a means 130 for selectively locking the fastener 100 in the fastener hole 20. In the preferred embodiment shown in
As shown in
Snap-off screws, such as the type shown in
As shown in
One of the advantages of the invention over the prior art is that it enables a surgeon to intra-operatively select various combinations of brace and fastener sizes and configurations to accommodate the operative condition of a particular surgical site, thus providing greater options while decreasing staple inventory. To further enhance options, compression braces 1 can be provided with a combination of threaded and unthreaded holes. Such a configuration could be used, for example, in situations where it is desirable to provide a perpendicularly locked fastener on one end of the brace 1, while providing selective angulation of the fastener 100 on the opposing end of the brace. The same effect can be obtained by selecting a fastener 100 sized to permit angulation through a relatively larger threaded hole 20, such that the threads of the hole 20 do not substantially impinge on the selected degree of angulation. Similarly, a combination of locking and non-locking threads can be used.
The compression brace 1 is used primarily for fixation of arthrodeses and osteotomies. The compression brace 1 can also be used in place of conventional plates, such as cuboid plates, hind or mid-foot plates, or calcaneal plates.
In operation, the compression brace 1 is used as follows. After preparation of the surgical site, the compression brace 1 is placed on adjacent bones 301, 302 such that one of the fastener holes is on the first bone or bone fragment 301 and one of the fastener holes 302 is on the second bone or bone fragment (see
The compression bracket 1 can also be used as a distraction plate, such as for opening osteotomies (e.g. HTO or spine distraction). By applying a force to bridge members 50A, 50B, a space can be created or widened, thus forcing the fasteners 100 apart. The device 1 can be used to open a space to allow insertion of a spacer, and then used to close the space in order to sandwich the spacer between adjacent bones.
The compression bracket 1 can be installed with or without specialized instrumentation.
A first drill guide 301 is fixedly mounted on the stationary guide base 318, while a second drill guide 302 is fixedly mounted on the adjustable guide base 328. The drill guides 301, 302 are preferably removable from the drill guide instrument in order to accommodate selected sizes and configurations of fasteners 100 and compression braces 1. A distal end of the drill guide 301, 302 is provided with a counter bore having a side slot 304 therethrough for accommodating a compression brace 1, in the manner shown in
As indicated in
As indicated in
Spreading of the bridge members 50A, 50B is preferably accomplished using a spreader, such as the type shown in FIG. 10 of U.S. Pat. No. 5,660,188 (Groiso). If crimping of the bridge members 50A, 50B is desired, pliers can be used.
The device and method can be used to join, fix and maintain bones in various procedures, including: LisFranc arthrodesis; mono or bi-cortical osteotomies in the forefoot; first m etatarsophalangeal arthrodesis; Akin osteotomy; midfoot and hindfoot arthrodeses or osteotomies; fixation of osteotomies for hallux valgus treatment (Scarf and Chevron); and arthrodeses of the metatarsocuneiform joint to reposition and stabilize the metatarsus primus varus; carpal bone fusion; wrist fusion; elbow fracture; and metacarpal fractures.
The compression brace 1 and fasteners 100 are preferably made of suitable biocompatible materials having sufficient mechanical strength and elasticity for the desired applications of the invention 1. Suitable materials include medical grade titanium alloys, medical grade stainless steel, and cobalt chrome. A memory metal, such as nitinol, can be incorporated into the invention. Suitable non-metallic biocompatible materials can also be used. Further, the brace 1 or fasteners 100 can be made of a suitable bio-absorbable material, such that the components are eventually absorbed by the body after healing of the bone parts.
Unless the context indicates otherwise, the term “bone” as used herein includes whole bones as well as bone fragments (i.e. the two or more fragments of a particular bone that remain after the bone has been fractured, either completely or incompletely).
Although the present invention has been described in terms of specific embodiments, it is anticipated that alterations and modifications thereof will no doubt become apparent to those skilled in the art. It is therefore intended that the following claims be interpreted as covering all alterations and modifications that fall within the true spirit and scope of the invention.
Claims
1-15. (canceled)
16. A surgical device for pressing and retaining adjacent bones against one another, such as to reduce a fracture, comprising:
- a compression brace, said compression brace having at least two fastener retaining portions, each said fastener retaining portion having a fastener hole therethrough for receiving a fastener, said fastener hole having an internal thread, a pair of bridge members positioned between said fastener retaining portions, said bridge members spaced apart from one another to thereby form a compression opening between said fastener retaining portions, and
- at least two fasteners, each said fastener having a lengthwise shaft sized to pass through said fastener hole and a head portion sized and configured to retain said fastener in said fastener hole, an upper thread on said shaft adjacent said head of said fastener for engaging said internal thread in said fastener hole to thereby maintain said fastener in a substantially fixed relation to said fastener retaining portion.
17. The device of claim 16, wherein said substantially fixed relation between said fastener and said fastener retaining portion is substantially perpendicular.
18. The device of claim 16, wherein said upper thread comprises double lead threads, said double-lead threads providing selective locking of said fastener in said fastener hole
19. The device of claim 16, wherein at least one of said fasteners is a screw, said shaft of said screw having a lower thread positioned to engage bone.
20. The device of claim 19, wherein said lower thread is self-drilling in bone.
21. The device of claim 20, further comprising a cutting means along said tip of said screw for facilitating initial engagement of bone by said lower thread.
22. The device of claim 16, wherein at least one of said fasteners is a pin.
23. The device of claim 16, further comprising each said fastener retaining portion having a counterbore formed in an upper surface thereof, said counterbore substantially in axial alignment with said fastener hole, said counterbore sized and configured to provide countersinking of said upper retainer portion of said fastener in said fastener retaining portion.
24. The device of claim 16, wherein each said bridge member is substantially V-shaped.
25. The device of claim 16, wherein said compression brace includes a plurality of fastener retaining portions and a plurality of compression openings.
26. A method of compressing and retaining first and second adjacent bones together, such as to reduce a fracture, comprising:
- providing a compression brace, said compression brace having at least two fastener retaining portions, each said fastener retaining portion having a fastener hole therethrough for receiving a fastener, said fastener hole having an internal thread, a pair of bridge members positioned between said fastener retaining portions, said bridge members spaced apart from one another to thereby form a compression opening between said fastener retaining portions;
- providing at least two fasteners, each said fastener having a lengthwise shaft sized to pass fastener hole, and an upper thread on said shaft adjacent said head of said fastener for engaging said internal thread in said fastener hole to thereby maintain said fastener in a substantially fixed relation to said fastener retaining portion;
- placing the compression brace on the bones such that one of said fastener holes is on the first bone and one of said fastener holes is on the second bone;
- securing the compression brace on the first bone by threading one of said fasteners into one of said fastener holes and into the first bone;
- securing the compression brace on the second bone by threading one of said fasteners into a second one of said fastener holes and into the second bone; and
- spreading the bridge members of the compression brace apart to thereby draw said fasteners and said bones toward one another.
27. The method of claim 1, further comprising, prior to said step of securing the compression bracket on the bones, forming a hole in each of the bones for receiving the fasteners.
28. The method of claim 1, wherein said bridge members are spread until said bones contact one another.
Type: Application
Filed: Sep 14, 2004
Publication Date: Mar 16, 2006
Inventors: Vernon Hartdegen (Collierville, TN), Kevin Wong (Cordova, TN), Robert Fencl (Cordova, TN)
Application Number: 10/940,396
International Classification: A61F 2/30 (20060101);