Title:
Surgical apparatus
United States Patent 2393694


Abstract:
My invention relates to fracture reduction and fixation apparatus of the general type known as "pin fixation splints" and relates more specifically to certain new and useful improvements, among which are: an extension bar assembly, a superior pin bar assembly, a distal pin bar assembly, an...



Inventors:
Kirschner, Otto S.
Application Number:
US58754545A
Publication Date:
01/29/1946
Filing Date:
04/10/1945
Assignee:
Kirschner, Otto S.
Primary Class:
International Classes:
A61B17/60; A61B17/66
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Description:

My invention relates to fracture reduction and fixation apparatus of the general type known as "pin fixation splints" and relates more specifically to certain new and useful improvements, among which are: an extension bar assembly, a superior pin bar assembly, a distal pin bar assembly, an angulation bracket, a rotational arc assembly, and self-drilling and anchoring pins to provide maximum rigidity and stiffness between the cortex of the bone and the pin bar. 1 1. Permits anatomical manipulation of the bone fragments through three planes of motion, including rotation through the anatomical axis; 2. Enables a firm grip on the bone fragments even though the pins be inserted parallel to e'ach I other; 3. Allows for the most rigid possible fixation of the fragments due to the fact that the pins may be inserted at right angles to the shaft of the bone, providing the shortest possible pin length from the bone to the attached pin bar, thereby reducing the spring in the pins to the minimum (firm fixation promotes rapid union); 4. Permits extension or impaction of the fragments without placing the patient on a fracture table or employing other means of traction and without disturbing the alignment of the fragments; and 5. Permits reducing the fracture, in most cases, without the use of auxiliary means of traction.

A further object is to provide an improved splint having the following characteristics: 1. Each pin, because of its unique design, is self retaining, permitting the insertion of the pins in any desired plane or angle.

2. Each adjusting movement of either bone fragment is under control of a separate bolt or nut, Movement of the fragment through one plane does not disturb the alignment in the other plane.

3. Rotation of the fragments through their axial center is provided by the rotating arc.

4. Adjustment in extension or impaction is effected at any time without disturbing the alignment of the fragments.

5. Adjustment of the fragments is manual instead of mechanical, permitting the surgeon to feel the crepitus of the ends of the fragments as he brings them into alignment.

Other objects will in part be obvious and in part be pointed out hereinafter.

To the attainment of the aforesaid objects and ends the invention still further resides in the novel details of construction, combination and arrangement of parts, all of which will be first fully described in the following detailed description, and then be particularly pointed out in the appended claims, reference being had to the accompanying drawing, in which: S Fig. 1 is a side elevation and part longitudinal section of my invention in use.

Fig. 2 is a top plan view of the apparatus, the bone being indicated in dotted lines.

Fig. 3 is an enlarged detail section on the line 0 3-3 of Fig. 2.

Fig. 4 is an enlarged detail section on the line 4-4 of Fig. 2.

Fig. 5 is an enlarged detail section on the line 5-5 of Fig. 1.

In the drawing, in which like numerals and letters of reference indicate like parts in all the figures, it will be seen that I and 2 indicate the two parts of an extension bar which is lapjointed as shown in Fig. 1. The section I of the 20 extension bar has a longitudinal slot 3 through which a clamping screw 4 passes and is threaded at 9 into the bar section 2. A threaded traction rod 5 is anchored at 6 to the extension bar section I and passes freely through an ear 1 and Z freely into a bore 10 in the extension bar section 2, a nut 8 being provided for moving the section 2 toward and from the section 1.

The extension bar section I has its free end slotted as at II to receive one leg of an angle 30 bracket 13. It also has holes 12 for the passage of a clamping bolt 15 that passes through the holes 12 and a hole 14 in bracket 13 and carries a washer 52 and nut 53 for clamping the bracket to the extension bar for angular adjustment 35 about the axis of the bolt 12. The bracket 13 also has a bolt hole 18 for the passage of a clamping bolt 19 that passes through the furcations of a superior pin-bar holder 16 and carries a washer 54 and nut 55.

40 The superior pin-bar holder 16 is provided with a bore 20 to receive the superior pin bar 21 and is slotted, as at 58, the furcations thus provided having bolt holes 57 through which pass the clamping bolt 58. The bolt 58 carries a 45 washer 59 and nut 60 as best shown in Fig. 5.

Pin carriers 22 having holes 24 for the pin-bars are split, as at 23, to form clamps, there being bolt holes 25 provided through which pin-clamping bolts 26 pass. The bolts 26 have transverse 50 holes 27 through which the pins pass. The bolt 26 carries a washer 61 and nut 64 as best shown in Fig. 4. When nut 64 is tightened pin 28 (Fig. 4) will be tightly clamped against pin carrier 22 and pin carrier 22 will be tightly clamped to Its 5n pin bar, Each traction pin comprises a rigid body 28, a chuck, wrench or handle receiving end 29, a threaded portion 30, a reduced portion 31 and a drill point 32. The thread 30 is such as will cut its own thread in the bone into which it is to be inserted.

The section 2 of the extension bar has its free and slotted as at 33, the slot 33 lying in a plane at right angles to that of the slot I . The same end of the section 2 has a bolt hole 63 to receive the clamping bolt 62 which also passes through a hole 36 in the ear 35 of the rotational arc 34.

The rotational arc 34 is longitudinally slotted, as at 37, and grooved, as at 38, Figs. 1, 2 and 3.

One threaded end 43 of a stud 42 passes through a hole 41 in a rotational slide 39 and through the slot 37. The end 43 carries a washer 44 and a nut 45.

The slide 39 has a tongue 40 to ride in the groove 38 and slot 37 (see Fig. 3). The stud 42 passes through a hole 51 in a distal pin bar base 50 and has a threaded end 46 that carries a washer 47 and a clamping nut 48.

The distal pin bar is made in two co-axial sections 49, the adjacent ends of which are rigidly carried in recesses in the base 50. The rods 49 and the base 50 may be made integral if desired.

Each section 49 of the pin bar has a pin carrier 22 mounted on it to hold the distal pins.

The rotational arc and the parts carried thereby may be adjusted about the axis of bolt 62; the rotational slide 39 and its carried parts may be adjusted about the axis of the rotational arc; the pin-bar base 50 may be adjusted about the axis of the stud 50; the pin carriers on the bar 49 may be independently adjusted about the axis of the pin bar; and the pins carried by the pin carriers may be adjusted about the axis of their respective pin-clamping bolts. This gives a wide range of adjustments which will enable efficient manipulation and securing the parts of the bone in position.

The superior pin bar 21 and the parts which it carries may be adjusted as a unit about the axis of the pin bar or the pins carried by that pin bar may be severally adjusted independently about said axis. The superior pin-bar holder IS and the parts carried thereby may be adjusted about the axis of bolt 19 and the bracket 13 and parts carried by it may be adjusted about the axis of the bolt 15. This too gives a wide range of adjustments.

From the foregoing it will be seen that the apparatus permits adjustments in every possible direction with each adjustment independently controlled by a separate bolt.

In use, the bone fragments having been transfixed by the pairs of pins arranged, preferably, in a perpendicular position to the long axis of the ( bone, (they may be applied angularly if desired), the pins are secured to the respective pin bars.

The parts are then manipulated to reduce the fracture and angulate the fragments in proper position for mending. By adjusting the nut 8 ( extension may be applied while retaining alignment of the fragments due to the extensibility of the extension bar and the engagement of the connecting bolt in the slot 3 and the passage of the rod 5 through the ear 7 into the bore 10. 1 The provision of the slot II and bolt holes 12 enable the apparatus to be used on patients of different sizes.

The Kirschner splint is specially helpful in the treatment of such difficult fractures as;. Crossed or locked shaft fractures Oblique shaft fractures Spiral shaft fractures Subtrochanteric fractures Super condillar fractures T fractures into joints Crush fractures Multiple fractures Compound fractures Fractures of surgical neck of humerus.

The success of this splint is due largely to several unusual features.

1. Firm fixation pins. Pins require no previous drilling of holes, no tapping of threads. Each pin is self sufficient: will stay firmly fixed where placed: no slipping or sliding in the bone. Thin section and drilling point make only small hole in bone; threaded section assures firm fixation in cortex with no movement or slipping; heavy section from bone to splint assures maximum rigidity and firm immobilization of fragments.

The design of this pin allows the surgeon to place the pins in any desired position or angle in the bone. Where possible it is best to place the pin perpendicular to the long axis of the bone as this provides the shortest distance from bone to the splint, hence minimum spring in the pin.

Also, insertion of pin perpendicular to the cortex of the bone greatly facilitates the labor of insertion of the pin.

2. Three plane manipulation of each fragment, Each movement is controlled by separate bolt.

Adjustment in one plane does not displace alignment in other planes.

3. Longitudinal rotation through central axis of bone provided by special arc and sliding assembly. Rotation provided without disturbing other alignments.

4. Extension or impaction provided by sliding sections and threaded rod and nut without disturbing alignment while making adjustments.

Adjustments in extension are made anytime without returning the patient to the operating table.

5. Manipulating handles, engaging the pin bars, facilitate adjustment of fragments.

With fully relaxed muscles, under proper anesthesia, most fractures may be satisfactorily reduced with no traction other than that provided by the extension bar and nut. In cases of much overriding or displacement some auxiliary means of traction is recommended before inserting pins.

This assures proper relative position of pins in the skin, muscles and bone, avoiding undue skin and muscle stretch around the pin.

5 From the foregoing description taken with the accompanying drawing, it is thought the complete construction, operation and advantages of my invention will be clear to those skilled in the art to which it appertains.

O0 What I claim is: 1. An ambulatory splint including; an extension bar having means for applying traction, said bar being longitudinally slotted at each end, the slot at one end of the bar lying in a plane at right 5 angles to the slot in the other end of the bar; an angle bracket pivotally-adjustable mounted in the slot at one end of said bar; a rotational arc disposed transversely of said bar at its other end and pivotally-adjustably mounted in the slot 0 at said other end; a pin-bar holder pivotally-adjustable mounted on said angle bracket on an axis normal, to the pivotal axis of said angle bracket on said extension bar; a pin bar carried by said pin-bar holder and lying at right angles '5 to the pivotal axis of said pin-lbar holder on said angle bracket; pin carriers mounted on said pin bar; a rotational slide adjustably mounted on said rotational arc; a pin-bar base carried by said rotational slide; a pin bar carried by said pin-bar base; and pin carriers on the last named pin bars.

2. In an ambulatory splint wherein is provided an extension bar carrying at its ends superior and distal pins; the improvement which comprises: a bifurcated end of the extension bar; an angle bracket one leg of which lies between the furcations of said end; a clamp bolt with nut passing through said furcations and said leg for pivotally-adjustably securing said angle bracket to said extension bar; a pin-bar holder having one end bifurcated to receive, between the furcations of the same, the other leg of said angle bracket; a clamp bolt with nut passing through the last named furcations and said other leg; said pin-bar holder having a pin-bar-receiving hole and being split from said hole to the free end of the pin-bar holder; a clamp bolt with nut passing through the split part of said pinbar holder for clamping the pin bar in place, the pin bar being adjustable longitudinally and rotationally in said holder; and pin carriers slidably and rotatably adjustably mounted on said pin bar.

3. In an ambulatory splint wherein is provided an extension bar carrying at its ends superior and distal pins; the improvement which comprises: a bifurcated end of the extension bar; an angle bracket one leg of which lies between the furcations of said end; a clamp bolt with nut passing through said furcations and said leg for pivotally-adjustably securing said angle bracket to said extension bar; a pin-bar holder having one end bifurcated to receive, between the furcations of the same, the other leg of said angle bracket; a clamp bolt with nut passing through the last named furcations and said other leg; said pinbar holder having a pin-bar-receiving hole and being split from said hole to the free end of the pin-bar holder; a clamp bolt with nut passing through the split part of said pin-bar holder for clamping the pin bar in place, the pin bar being adjustable longitudinally and rotationally in said holder; and pin carriers slidably and rotatably adjustably mounted on said pin bar, said pin carriers each comprising a split clamp and a clamping bolt with nut, said clamping bolt having a pin-receiving hole by virtue of which when said clamping bolt nut is tightened a pin held in said pin-receiving hole will be rigidly held to said pin carrier and said pin carrier will be securely clamped to said pin bar.

4. In an ambulatory splint wherein is provided an extension bar carrying at its ends superior and distal pins; the improvement which comprises: a bifurcated end of the extension bar; a longitudinally slotted rotational arc disposed crosswise of the extension bar and having an ear pivotallyadjustably secured between the furcations of said end; a rotational slide on said rotational arc; a pivot stud having a threaded extension with a nut for adjustably securing said rotational slide to said rotational arc; a pin-bar base pivotally adjustably mounted on said stud; a pin bar carried by said pin-bar base; and pin carriers adjustably mounted on said pin-bar.

OTTO S. KIRSCHNER.