Title:
Bone splint
United States Patent 2393831


Abstract:
IThis invention relates to new and useful im"provemerts In bone splints and more particularly to splints for -effecting the reduction and fixation of fractures of the os calcis or heel bone. Fractures :of the:os calcis are difficult properly to effect:reduction ;and fixation chiefly because...



Inventors:
Otto, Stader
Application Number:
US47047542A
Publication Date:
01/29/1946
Filing Date:
12/29/1942
Assignee:
Otto, Stader
Primary Class:
Other Classes:
606/59
International Classes:
A61B17/64
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Description:

IThis invention relates to new and useful im"provemerts In bone splints and more particularly to splints for -effecting the reduction and fixation of fractures of the os calcis or heel bone.

Fractures :of the:os calcis are difficult properly to effect:reduction ;and fixation chiefly because of the strong upward pull of the Achilles tendon which tends to displace .the :os calcis: fragment .upward and also because the muscles and tendons underneath the foot tendi:to displace the fragment forward, these tendencies :combining to cause a shortening-of the, fractured os calcis.

Previous attempts to treat fractures of the os ,calcis have:all recognized the importance of preventing contraction of.the Achilles tendon in the reduction of: such ifractures, and the fact that counteracting restraint -must be maintained throughout :the healing process. However, no .particular attention: has been paid to the equally important problem of preventing contraction of the plantar muscles in the sole of the foot to prevent shortening of the os calcis.

.Prior to the-present invention the practice employed in.the reduction and fixation of os calcis fractures generally-has-been as follows: A single pin is:passed through the lower extremity of the -tibia, and another pin:is similarly passed through the upper:outermost area of the os calcis. These two:pins are then secured in-a suitable mechanical reduction apparatus or frame. After reduction of the fracture by this apparatus, a plaster cast is applied and then the apparatus is removed, the opposite end portions of said pins being embedded in the plaster cast.

.Certain -substantial difficulties and objections ┬Ľare presented by this treatment of os calcis fractures. In the first place, the plaster cast is not a rigid structure: and following its application and the embedding-of-the pin ends therein, disintegration of the cast occurs with the result that the pins become loosened in the cast, and it is impossible to maintain the degree of reduction of the fracture originally obtained in the reduction frame. Secondly, with;a plaster cast applied as aforesaid, ifitt is not possible in the first instance to obtain a, satisfactory reduction, which is 'the rule rather than the exception in fractures of the os calcis, then -at each treatment that is made until a satisfactory reduction -is obtained, the plaster cast must be removed and. the entire reduction treatment repeated.

Furthermore, one of the most important considerations attendant upon the- treatment of os calcis fractures is the desirability of maintaining adequate sub-astragaloid joint space, in order to better insure-that the.patient will be free from pain in this joint:after the os calcis fracture has completely healed. The conventional plaster cast treatment.df os calcis fractures is not, sufficiently strong -to prevent ,contraction of ,the Achilles tendon and-maintain :this .proper joint space or the normal .tuber-joint angle which is an angle normally of about 400 formed by the bisection of -a line. drawn: from the edge of the posterior subastragaloid articulation anteriorly-to the anterior rim of the anterior subastragaloid articulation and a line drawn posteriorly over the superior surface of the tuberosity. This tuberjoint angle has been greatly: distorted by the fracture -as the result of a shortening of -the Achilles tendon and plantar muscles thereby producing subsequent 'deformity. Nor does this treatment serve to prevent shortening of the-os calcis through contraction of the plantar muscles. With the foregoing in mind, the principal object of the. present invention is to provide an os calcis 'fracture reduction and fixation splint which effectively prevents contraction of both the Achilles tendon and plantar muscles and affords absolute:rigidity to the fractured bone fragments while at the same time allowing for necessary inspection -and :secondary adjustments thereof 'during- knitting.

Another object of the invention is to provide a splint of the character set forth which does not require fixation or immobilization of the fracture by the usual plaster or other cast.

Another object of the present invention is to provide a. splint of the type _described which is sufficiently. strong to- prevent contraction of the Achilles tendon, and plantar muscles and maintain the proper sub-astragaloid joint spacing and restore tuber-joint angle during healing of fractures of the. os. calcis.

. A further .object of the invention is- to provide a splint, of the. stated .character which is constructed.and arranged to,,permit positive lateral displacement with respect to the vertical anterior-posterior plane to effect complete anatomical correction of the, os calcis thereby,.affording complete anatomical reduction of the fracture. -A still, further object of the invention is to provide a splint of the type described which may be used, in conjunction with a conventional .os calcis clamp without interfering with application .and use of such-a 'clamp.

These and other objects of the invention and the- various -features and details of the construction and operation thereof are hereinafter, fully set forth and described, and shown in the accompanying drawing, in which: Figure 1 is a view in perspective of the lower leg and foot of a person showing the splint of the present invention positioned for reduction and fixation of a fracture of the os calcis or heel bone.

Figure 2 is a view in side elevation of the disclosure in Figure 1.

Figure 3 is an enlarged fragmentary view in section taken on line 3-3, Figure 2; and Figure 4 is an enlarged fragmentary view in section taken on line 4-4, Figure 1.

Referring now more particularly to the drawing, an os calcis splint made according to the present invention comprises a pair of spindles or bars I, I which have the major portion of their length threaded as indicated at 2, 2, respectively.

These threads 2, 2 extend along each of the spindles I from one end thereof to an enlarged portion 3 provided or formed inwardly adjacent the opposite end of each spindle I. Beyond this enlarged portion 3 each spindle I terminates in a reduced spindle portion 4 having threads at the extremity thereof. The enlarged portion 3 of each spindle I provides a stop or shoulder 6 adjacent the portion 4, the purpose of which will be set forth hereinafter, and the surface of said portion 3 is made hexagonal or similar shape to provide a nut-like portion to enable rotation of the spindles by any suitable means such as a wrench or the like.

Upon the threaded portions 2 of each of the spindles I is threaded a support or block T and the construction and arrangement of these supports or blocks 7 and spindles I is such that, if the said supports 7 are held against rotation, the spindles I may be rotated to adjust said support 7 axially with respect to said spindles. The supports 7 may be positively locked in a predetermined position axially with respect to the spindles I by means of lock nuts 8 or the like threaded thereon.

As shown in the drawing, each of the supports 7 is slotted as indicated at 9 to receive the lug or like portion 10 of a stud 11. This lug portion is Provided with a suitably located aperture 12 therein through which freely extends a retaining screw or the like 13 threaded into the supports 7 and passing through the slots 9, the construction and arrangement being such that said stud II may pivot within the slot 9 about said screw 13 relative to the supports 7 in a plane parallel to the axis of the associated spindle I.

A pin bar or holder 14 is mounted at or adjacent its midpoint upon each stud II and secured thereon by a nut or the like 15 for rotation with said stud II.

A pair of screws 16 are threaded in each support 7 at opposite sides of the slots 9 therein and stud .i and these screws 16 extend in the direction of the pin bars 14 and engage the adjacent face thereof thereby making it possible by adjustment of said screws 16 to effect positive mechanical adjustment of said pin bars 14 and stud Il about its retaining screw 13 relative to the support 7, after which the said screws IS may be tightened to securely lock the pin bars 14 and stud II in the position to which adjusted thereby, thus providing the desired degree of traction.

The splint of the present invention comprises also a strong, rigid yoke member 17, of substantially semi-circular configuration, which is provided in the opposite end portions thereof with suitable openings 18 to receive the respective portions 4 of the two spindles I. These openings 18 in the terminal portions of the yoke member 17 have their axes substantially perpendicular to the plane of said yoke member T1 so that when the yoke member is mounted on the portions 4 of the spindles 1, as aforesaid, and in abutting relation against the shoulders '6 provided by the portions 4, the said yoke member 17 will reside in a plane substantially at right angles to the plane of the two spindles. The yoke member 17 may be fixedly secured in place upon the spindles I by means of nuts or the like 19 threaded on the threads 5 at the extremity of the spindle portions 4.

As shown, each of the pin bars 14, previously described, is provided with a plurality of bores Sor openings 20 which extend therethrough and are arranged to receive the end portions of a skeletal pin or other bone-penetrating element 21. -Similarly, the terminal end portions of the yoke member 17 are each provided with a bore or opening 22 which extends therethrough and are arranged to receive the end portions of a like skeletal pin or other bone-penetrating element 23. The skeletal pins or elements 21 and 23 are each adapted to penetrate or extend entirely through the flesh and bone of the limb with the end portions of said pins projecting from opposite sides of the limb and extending through the correspondingly positioned bores 20 and 22 in the pin bars 14 and the terminal end portions of the yoke member 17, respectively, as shown in Figure 1 of the drawing. The pin bars 14 and the yoke member 17 are each provided with set screws or the like 24 and 25, respectively, disposed normal to the axis of the bores 20 and 22, by means of which the pins 21 and 23 may be locked or secured relative to the pin bars 14 and the yoke 17.

The pins 21 and 23 are provided with sharply tapered points or ends as indicated at 26 to facilitate penetration into and through the bone and surrounding flesh. This is accomplished by forcing the pins through the flesh and bones at the several places shown in the drawing. The pins may be forced through the bone with comparatively easy effort: due to the sharply pointed ends 26 thereof merely by applying pressure axially of said pins and at the same time rotating the same in alternately opposite directions in the manner of a hand drill.

For strength and rigidity the pins 21 and 23 employed are composed generally of metal such as, for example, stainless steel, and the like, and in the course of application and use of the splint, it has been found that the contact of these metal pins with the tissue and flesh through which inserted causes a bio-chemical reaction to take place which sets up a galvanic-like current through the pins, the flesh and tissue in which embedded, and the externally connected pin bars 14 and their supporting structure: This galvanic-like current manifests itself by an ammoniacal odor definitely indicative of tissue (protein) breakdown, causes also irritation of the adjacent bone structure, and attributes generally to the discomfort of the patient.

Elimination of the occurrence of such a galvanic' current may e accomplished by electrically insulating or segregating each pin from the others.

For example, this may be done, as described in my United States Patent No. 2,251,209, either by constructing the pin bars 14 of suitable di-electric material such as, for example, hard rubber, '"~akelith," $'paltic o'r ithe like, or ,by iiserting "inibfob'hepn ~iiertures or bores 20 and 22, a sleeve ir lile strfuctiure of such a di-electric material in fiiiiemanner indicated at 27 in the drawing. By 'stidh an a'rrangement 'each of the pins 21 and 423 is'electrically insulated from the others iand, by either such arrangement, the occurrence of a gaiavfiic-like current is .entirely 'eliminated toither -wit-h til-e objectionable manifestations thereof.

Tih apilying the splint, the skeletal pin 23is-in'srted through the opening 22 in one end of the yoke iriember "i and then is passed entirely throriigh the heel -of the foot so as to pierce the s 'calcis :in the upper posterior 'area. thereof.

The other end 'f the pin23 'projecting froim the ipppidsite -side of the heel is next passed through the openiing 22 in the other end of said -yoke Member I: Iand the pin is then securely locked in the yoke member 17 by means of the lock nuts or screws -25.

The first of the skeletal pins 21 is now inserted through the tibia a short distance above the angle joint so as to project laterally from opposite sides of the leg as shown in Figure 1 of the drawing. The pin bars 14 are next placed on the first inserted pin 21 with the ends of the latter passing through corresponding bores 20 in the respective pin bars 14. The second skeletal pin 21 is now inserted, in a manner similar to that just described, with its projecting opposite end portions inserted through other corresponding bores 20 in said pin bars 14, the said pins 21 being locked or secured in the pin bars 14 by means of the set screws 24.

It is pointed out that the two skeletal pins 21 are passed through the tibia in such relative positions that when inserted they are substantially parallel to one another and reside substantially in the plane of the axis of the tibia. This latter is essential for it is important to the most advantageous use of the splint that the pin bars 14 when mounted on the pins 21 at opposite sides of the leg, have their long axis substantially parallel to the axis of the tibia so that accurate traction may be obtained.

With the pins 21 and pin bars 14 properly positioned, the bars or spindles 1, 1, each of which has threaded thereon a support 7, are connected to the yoke member 17 by inserting the portions 4 of said spindles through the openings 18 in the terminal end portions of said yoke member where they are secured by the nuts or like elements 19.

Finally, the studs II of the respective supports 7 on the bars or spindles I are inserted through the central opening in the pin bars 14 which are then secured on said studs 11 by means of the nuts or like elements 15, the said supports 7 being arranged posteriorly of the pin bars 14 with the screw elements 16 disposed for engagement of the anteriorly adjacent surface of said pin bars 14.

In reducing the fracture, the desired degree of traction against the pull or contraction of the plantar muscles in the sole of the foot is first obtained by adjusting the screw elements 16 of each support 7 relative to its associated pin bar 14 thus rotating the axis of each bar or spindle I in an anterior-posterior plane with respect to the leg, and in a counterclockwise direction with respect to Figure 2, to the proper angular position with respect to the axis of the tibia which lies parallel to the long axes of the pin bars 14, thereby adjusting the pin 23 rearwardly with respect to pins 2-1 arid lengthe ingtheg os-'calis' in aiposte'iidr direction to its ibnrnial position. When this adjustment has been tmade or during the making thereof the spindles I are rotated to effedt a relative separation of the yoke member I and supports 7 and provide the necessary countertraction against the pull of the Achilles itendon.

Too, if it is not possible initially to obtain a domplete or final reduction of the fracture duie to extreme contraction of the -Achilles tendon aid plantar muscles, adjustments may be made from time to time until such a reduction has been made, ainddifferential adjustments of the'spindies I relative to one another also may be nmade to effect lateral rotational displacement correction of the os- calcis with respect to the ahteriorposterior-plane.

The foregoing treatment produces accurately controlled traction against shortening 'of the Achiliesi-tenidn and plantar muscles to'the -tegree required to restore the normal -tuber-joint angle as well as the degree of separation of the sub-astragaloid joint space. Also, any required shortening or lengthening of the os calcis in the anterior-posterior direction may be accomplished by further adjustments of the angular relation between the spindles I and the pin bars 14 through operation of screws 16, the long axes of which bars lie substantially parallel to the axis of the tibia.

The splint of the present invention affords a reduction of the fracture that is positive and fixation thereof which is completely rigid and, in addition to the treatment of fractures of the os calcis, may be employed effectively in the treatment of other fractures in the general ankle joint area, including the lower tibia.

In the drawing and foregoing description of the present invention the pin bars 14 have been referred to and illustrated as provided with but one pair, or two, of the pin holes 20, but it will be obvious that these pin brackets may be provided with holes or openings for a greater number of pins as desired. The splint herein described may be applied in various ways and methods which must be determined by the practitioner or surgeon according to the particular case, although where the nature of the fracture permits, the methods of application and treatment herein set forth are preferred.

While a particular embodiment of the invention has been set forth and described, it is not intended that said invention shall be limited to such disclosure, but that changes and modifications may be made and incorporated therein within the scope of the claims.

I claim: 1. An os calcis fracture reduction-fixation splint comprising a substantially U-shaped heel yoke, a pin for connecting the opposite end portions of said heel yoke to the fractured bone, a pair of spaced pin bars respectively spaced from the end portions of the heel yoke, a pair of pins for connecting said pin bars to bone structure therebetween with the axes of said pins extending substantially parallel to the plane of the heel yoke and operable to prevent rotation of said pin bars relative to said bone structure, a pair of support members pivotally connected respectively to each of said pin bars and arranged for rotational movement in planes substantially at right angles to the axes of the pin bar pins, a pair of rigid elements connected respectively between each of the support members and the corresponding end portion of the heel yoke and securing the latter in spaced relation with respect to the pin bars, said rigid elements being adjustable at will to position the heel yoke and its pin in variously spaced relation with respect to the pin bar pins, and means associated with the support members and cooperable with the associated pin bars to rotationally adjust the support members, rigid elements and heel yoke relative to the pin bars to adjustably position said heel yoke pin laterally with respect to the axes of the pin bar pins.

2. An os calcis fracture reduction-fixation splint comprising a substantially U-shaped heel yoke, a pin for connecting the opposite end portions of said heel yoke to the fractured bone, a pair of spaced pin bars respectively spaced from the end portions of the heel yoke, a pair of pins for connecting said pin bars to bone structure therebetween with the axes of said pins extending substantially parallel to the plane of the heel yoke and operable to prevent rotation of said pin bars relative to said bone structure, a pair of spindles having one end thereof respectively mounted in the opposite end portions of said heel yoke and extending therefrom substantially at right angles to points adjacent said pin bars, a support member threaded on each of said spindles and pivotally connected to the adjacent pin bar for rotational movement with respect thereto in a plane substantially at right angles to the axes of the pin bar pins, said spindles being rotatable at will to position the heel yoke in variously spaced relation with respect to said support members and pin bars, and means associated with the support members and mechanically cooperable with the associated pin bars positively to rotationally adjust the support members, spindles and heel yoke relative to the pin bars to adjustably position and secure said heel yoke pin laterally with respect to the axes of the pin bar pins.

OTTO STADER.