Fracture splint
United States Patent 2406987

This invention relates to fracture reducing and immobilizing devices, and it has reference more particularly to means or devices for that purpose which employ transfixion pins, half-pins, or wires in connection with the means for holding the" fracture fragments during the reduction operation...

Roger, Anderson
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Roger, Anderson
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This invention relates to fracture reducing and immobilizing devices, and it has reference more particularly to means or devices for that purpose which employ transfixion pins, half-pins, or wires in connection with the means for holding the" fracture fragments during the reduction operation and during the healing period; the present invention being in the nature of an improvement upon the equipment that has been illustrated and described in my copending application filed January 21, 1941, under Ser. No. 375,278.

It is the principal object of this invention to provide fracture reducing and immobilizing means employing standardized parts, adapted to be associated or assembled in various numbers and in different combinations and ways to accommodate fractures of many kinds and at various locations. Furthermore, it is an object of the invention to provide fracture treating equipment having universal application; that, in its various adaptations, is exceptionally light in weight; that may be easily and readily assembled for use, and is strong and rigid and effective when properly applied.

Another object of the invention is, by the provision of the above mentioned standardized parts designed to be selected and assembled, to provide the type of device desired to meet requirements for the treating of any particular kind. of fracture, to make it possible and practical to provide kits or cases that will hold sufficient equipment for the treating of many fractures and which will be light in weight, easily transported and adapted to be used to great advantage by doctors, particularly those serving with the army and navy in such places as field hospitals in battle zones, or on naval vessels.

The invention also has as an object to provide equipment of the kind above stated for the reduction of fractures and for their immobilization during the healing period employing skeletal transfixions, which in this art are known as transfixion pins, half-pins or wires, and which equipment includes a frame structure made up of one or more transfixion units, fixation rods and clamps, later fully described, including pin clamps for mounting the transfixions that may be adjusted on their rods to accommodate them to the location of the transfixions after the latter have been applied rather than requiring that the transfixions be arranged to accommodate themselves to the position of clamps in the frame structure.

More specifically stated, the present invention resides in the provision of fracture reducing and immobilizing equipment of universal application and comprising a frame, made up of an assembly of adjustably united parts whereby it is adapted to be shaped or adjusted to best accommodate '5 it to the requirements of the particular fracture to be treated, and including in the assembly of parts, one or more straight, round rods that are rigidly joined and secured in the relationship required to accommodate the particular fracture to be treated by means of fixation rod clamps of novel kind that, when loosened, provide for the assembling of rods therewith and their adjustment to any of the required relationships, anrd when tightened, will operate to so secure the assembly as to form a rigid frame structure.

Also, the equipment includes as a part thereof, special pin clamps for fixing the transfixion members to the frame structure; these clamps being slidably and rotatably adjusted on their mounting rods to accommodate themselves to the required disposition of transfixion members and which, after being functionally associated with rods and transfixion members, may be tightened to secure their position on the rods and to render the associated transfixions and frame relatively rigid.

Other objects of the invention are to be found in the novel details of construction of the vari0 ous standardized parts, and in their combination and mode of use as will hereinafter be fully described.

In accomplishing these and other objects of the invention, which will be disclosed in the specification to follow, I have provided the improved details of construction, the preferred forms of which are illustrated in the accompanying drawings, whereinFig. 1 is a side view of a fracture reducing and immobilizing equipment embodied by the present invention, illustrating it as applied for the immobilization of a fracture of the femur.

Fig. 2 is a view illustrating an arrangement of equipment according to this invention for the immobilization of a fracture of the tibia using transfixion pins and wires for holding the fracture fragments.

Fig. 3 is a view illustrating use of equipment embodied by the present invention for immobilizing femoral neck or intertrochanteric fractures. Fig. 4 is a view showing another arrangement of the present standardized parts as applied for immobilizing a fracture of the femur.

Fig. 5 is an enlarged, sectional detail of one of the fixation rod clamps.

Fig. 6 is a side view of the parts shown in Fig. 5.

Fig. 7 is a side view of one of the pin clamps.

Fig. 8 is a sectional view on line 8-8 in Fig. 7.

Fig. 9 is a view of a transfixion wire holding yoke and a wire as functionally mounted therein.

Fig. 9a is a detail showing an end view of the yoke of Fig. 9, and a sectional detail of a pin mounting clamp with a yoke stud as applied thereto.

Fig. 10 is a view of fixation rods of different standardized lengths as provided for the construction of devices embodied by the invention.

Fig. 11 is a view of an assortment of standardized transfixions as provided for use with this equipment.

Fig. 12 is a view illustrating a means for and manner of applying a half-pin.

Fig. 13 is a view of one of the stop collars used on a transfixion pin.

Fig. 14 is a sectional detail of a wire tightener.

Fig. 15 is a top view of the tightener as applied to a yoke for tightening a wire.

Referring more in detail to the drawingsThe present invention is based upon the provision of a fracture reducing and immobilizing equipment that may be made applicable to many and various kinds of fractures, regardless of their particular location. It further provides for the treatment and immobilization of any of these fractures through the use of transfixion pins or wires that are applied to the fracture fragments and are then assembled with and fixed to an adjustable frame structure which may be made rigid, after the fracture has been reduced, so as to hold the fragments in a desired or in proper relationship for and during the healing period.

Novelty of the present equipment resides in the provisions made for accommodating fractures of many kinds by the selection and assembly of parts of standardized dimensions and of such character that they may be made into frames to best suit the particular fractures to be treated thereby, and it is not anticipated that the devices shall all be in the same form or employ the same number of parts for the various types of fractures, but that standardized parts shall be used in the combination and to the number required to provide an equipment that will meet the special requirements of any particular fracture.

In the make-up of any device or equipment according to this invention, there are certain standardized parts to be used. First, there is provided a plurality of straight, round rods 10, referred to as "fixation rods," and which are of the kind shown in Fig. 10 and made in the most practical assortment of lengths. All rods in any particular set are preferably straight and. of the same uniform diameter, and at present it has been found practical and adequate to provide these rods in graduated lengths; for example, rods may be five inches, seven inches and nine inches long. Different sets may be provided, all to comprise the -same number of parts, but using rods of -a different diameter, and to accommodate fixations of another diameter.

For the joining of fixation rods together in the building up of any required frame structure, I employ a 'clamp assembly comprising a pair of rod holding clamps such as illustrated in Figs. and 6. Each clamp assembly comprises two split, U-shaped collars 12 and 12; each collar being formed within its base portion with a bore 13 having a diameter corresponding to that of the fixation rods 10. The two legs of the Ushaped collar are separate and somewhat.spaced by the division or split 14 at one side of the bore which permits the opposite side portions of the collar to be sprung together for gripping the rod that may be inserted in the bore 13. When a collar 12 is applied to a rod 10 and is not under clamping pressure, it may be easily rotated on the rod or slipped along the rod.

In a clamp assembly, two of the split collars 12 are placed side to side as shown in Fig. 5 and are held functionally assembled by a single clamping bolt 15. This bolt is extended directly through the divided portion of each collar at one side of the bore and at a right angle to the axial line of the bore. Preferably such a bolt will have a rounded head 15a and is fixed in the leg of the clamp against which the head engages, by a pin .15x, as noted in Fig. 5. This one bolt, as thus applied, serves as a clamping means for both clamp collars 12-12 which are rotatable thereon, and also, it operates as a pivot axis about which the collars may rotate, thus to provide that they may assume various angular positions relative to each other as has been indicated in Fig. 6.

In the assembly of parts for treating any fracture, I employ transfixion mounting devices which I call "pin clamps," each of these being in the form of a U-shaped, split collar 18 as has been shown in Figs. 7 and 8; each collar being formed through its base portion with a bore -19 to slidably receive any of the fixation rods 10 slidably therein. The collar 18 is longitudinally divided along one side of the bore 19 by the split or division indicated at 20 in Fig. 8, and the leg portions at opposite side of the split 20 are spaced apart to permit the collar to be sprung inwardly to grip the rod to which it may be applied to hold it secure thereon at any set position. Projected through the two legs of the clamp collar separated by the split 20 at a right angle to the bore, and at one side thereof, is a clamping bolt 21, formed at one end with a relatively wide and flat head 22 and with threads 23 along its other end portion for mounting a tightening nut 25 thereon. Formed diametrically through the bolt 21, is a hole 26 designed to loosely receive a transfixion pin, rod or wire therein. This hole is flush with or may slightly overlap with the flat inside surface of the bolt head 22. Thus, when the end portion of a transfixion pin has been inserted through the bolt hole, it is thereby located between and flatly engages the bolt head, and the side of the clamp, as in Fig. 8, and the tightening of the nut 25 against the opposite side of the clamp collar not only rigidly anchors the transfixion pin in the clamp, but will .at the same time render the pin, clamp and rod relatively rigid.

Then, when the nut is loosened, all parts become relatively adjustable.

The transfixions adapted for use with this equipment may be of the full length pin for completely transfixing a limb, or the half-pin type for partial transfixion, or it may comprise a length of small diameter steel wire 32. When pins 30 or half-pins 3.1 are employed, they are applied to and are held functionally in place by the pin clamps as illustrated in Fig. 8. When wires are used, they are more practically held in U-shaped yokes 33 of that kind shown in Fig. 9, which yokes, in turn, are functionally mounted on the fixation rods by use of pin clamps 18. Each yoke 33, for the purpose of mounting it, is equipped at the ends of its opposite legs, with extension pins or studs 34 rigidly fixed therein. These studs are 7. of such length and diameter that they may be inserted in the holes 26 of any clamp bolt 21 as has been illustrated in Fig. 9a.

Also, each yoke is formed at the ends of its two legs with alined slots 35-35 opening laterally as in Fig. 9a, and designed to seat the opposite end portions of a wire 32 therein. In each leg, there is threaded a set screw 36 adapted to be tightened against the end of the wire when seated against the base of a slot to hold the wire secure.

Various means might be employed to draw the wire taut after it has been passed through a bone fragment and its ends applied to the yoke. In Figs. 14 and 15, I have shown a preferred wire tightener, designated in its entirety by numeral 40. This clamp 40 comprises a block 40' formed with a longitudinal slot 41 and a base end bore 42 in which a tube 43 is located; a head 43' of the bolt being located and held against rotation in the slot and the bolt shank being slidable in the bore and extended from the outer end of the block, where it has a nut 44 threaded thereon. Formed axially through the bolt from end to end is a hole 45 designed to receive the end of the traction wire. and in the bolt head is a set screw 46 to engage the wire in the hole. To tighten a wire 32 after it has been applied through a bone, as in Fig. 2, one end is first fixed by a set screw 36 in one of the yoke arms. Then the clamp 40 is applied to the other end of the wire, as in Fig. 14, and is seated against the other yoke arm, and the set screw 46 is tightened against the wire. Then the nut 44 is tightened on tube 43 to draw the latter outwardly, thus to place the wire under the required tension. Finally the set screw 36 of the other arm of the yoke is tightened and then the set screw 46 is loosened, the clamp withdrawn and the wire end clipped off to the desired length.

Assuming that the above described parts have been provided in size and assorted lengths required, one arrangement of the equipment, suitable for reducing and immobilizing a common fracture of the femur, has been illustrated in Fig.

1. In use of this appliance, two transfixion halfpins 31 are applied in non-parallel relationship to each of the bone fragments at opposite sides of the fracture. Preferably, the pins inserted in the same fragment would be in the converging relationship illustrated, or in other non-parallel relationship, and the extent of their insertion would be limited to just through or nearly through the bone. This might be insured by fixing a clamp collar 50 of suitable kind, as indicated at 50 in Fig. 1, on the pin at a definite location to engage the flesh of the limb. The exact required location of such a collar would be determined by measurements taken in an X-ray inspection of the fractured limb before work thereon, and the collar would be fixed on the pin in the proper place before the pin was inserted. Such a collar would preferably be round and as shown in Fig. 13, would be longitudinally slotted, as at 52, to receive the pin therein and equipped with a set screw 53 to engage and hold the stop at a set location on the pin. Preferably, the end of the collar that is adjacent the limb is conically tapered to avoid injury to the flesh when the pin is rotated.

In the assembling and applying of the parts constituting the apparatus of Fig. 1, and after the diverging sets of half-pins have been applied to the two fracture fragments, a rod 10 of a suitable length, somewhat greater than the distance between the outer ends of the paired pins as applied to the same fragment, is selected. Then two of the pin clamps 18 are loosely applied to the rod. Then, the outer end portions of the paired pins are applied through the holes 26 of the bolts 21 of the pin clamps and when the rod has been located in a desired position which will best accommodate it to the complete assembly, the clamp nuts 25 are drawn tight, thus to render the transfixion unit as applied to the fragment, perfectly rigid. A fixation rod clamp is then applied to each of the rods 10 as associated with the fracture fragments, by applying one collar 12 of each clamp to the rod end. Then a fixation rod 10 is extended between the two transfixion units and its ends are applied to the other collars of the fixation clamps. Then, after the fracture has been reduced, the bolts 15 are tightened, by turning the nuts thereon, to rigidly join all parts together. It is to be understood, of course, that prior to the tightening of the bolts 15, the fracture fragments would be brought into proper relationship; that is, the fracture would be reduced and held so that upon tightening the bolts, the whole unit would be rendered rigid, and the fracture fragments thereby held in a relatively fixed, definite relationship.

For purpose of better understanding, particularly in the claims which will terminate this specification, an assembly of transfixion pins or half-pins in a fracture fragment and their mounting rod and pin clamps, will be referred to as a transfixion unit, and the rod 10 which joints units will be referred to as a fixation rod.

The reduction of any fracture, after the securing of a transfixion unit to the fracture fragments, might be accomplished in various ways, either manually or by mechanical means. However, while this has no particular bearing on the present invention, it will be explained that the present means lends itself to mechanical reduction of the fracture by use of apparatus like that of my Patent No. 2,185,322.

In the arrangement of parts shown in Fig. 2 for the reduction and immobilization of a fractured tibia, I employ both a pin 30 and a wire 32 through the extreme portion of each fracture i5j fragment, and I mount these transfixions in side frames that are extended along opposite sides of the leg approximately from knee to angle.

Each side frame, as here shown, includes three rods 10, of selected lengths, and assembled somewhat as the assembly of rods shown in Fig. 1.

The pins 30 as applied through the extreme portions of the fractured bone are carried at their ends in pin clamps 18. The clamps 18 are applied to the rods 10 at the outer ends of the side frames, while the wires 32 which are applied through the bone fragments nearer the fracture, are held at their ends each in the arms of a yoke 33 which is mounted by pin clamps 18 on the end rods 10; the said clamps 18 mounting 6o the yoke 34 as was previously explained, by application of the extension studs 34 to the bolt holes 26 and then tightening the bolts to hold the yoke and to render the parts rigid. In this frame, rods 10 join the transfixion units as was previously described, and in this assembly, fixation rod clamps 12 join and render the parts rigid after reduction of the fracture.

In this particular application of parts, as noted in Fig. 2, the rod clamps 12-12 are left free and loose until the fractured parts are brought into proper reduction, then they are tightened to render the entire unit rigid and to hold the fracture immobilized.

It will here be explained that in some instances, it might be desirable to connect the upper and lower transfixion units by rods 10 with a turn buckle connection, as indicated in dotted lines in Fig. 2, so that extension might be effected.

In Fig. 3, I have shown use of the present standardized parts to make up a transfixion unit for the immobilization of an intertrochantric fracture. In this arrangement and application of apparatus, preferably two half-pins 31 are inserted through the trochanter and into the ball of the head through the femur neck. Likewise, a half pin 31 is inserted in the upper end of the shaft below the fracture. The pins applied to the same fragment preferably are non-parallel and each pin is applied at its outer end through the hole 28 of a bolt 21 of a pin clamp 18; all clamps being loosely applied to a rod 10 of a proper selected length. After reduction of the fracture, all clamps are tightened, and thus the unit is rendered rigid for immobilization of the fracture.

In Fig. 4, I have shown a special assembly of parts for immobilizing a fracture adjacent the upper end of the femur. In this particular equipment, a transfixion pin 30 and wire 32 are applied through the lower end of the femur and are mounted by means of the pin clamps 18 and through use of a yoke 33, on rods 10, as was explained in the device of Fig. 2. Half pins 31 are projected through the upper end of the femur above the fracture, one passing vertically downwardly and the other horizontally at the trochanter and substantially perpendicular to the first half pin. The vertical half pin is fixed by a pin clamp 18 on a relatively long fixation rod I0x that diagonally crosses the femur above the fracture and which is carried at its upper and lower ends by the frames that are located along the outside and inside of the limb; being attached to these frames by a combination of rod clamps 12 and short rods 10, as shown.

This illustration, in consideration of the arrangements shown in Figs. 1, 2 and 3, discloses that the standardized parts provided make possible many different assemblies and the adaptation of the equipment to fractures of many kinds and at various locations.

The means for and technique of inserting a pin or half pin has been illustrated in Fig. 12, wherein 75 designates a hand drill equipped with a chuck 76 applied to the outer end of the pin to rigidly mount the pin. On the pin, at a specific location, a stop collar or limiting collar 50 is fixed. This pin, after being properly located and directed, may be pushed into place by hand pressure applied through the drill handle with an incident axial turning of the pin. After the pin has been inserted, the handle is removed and the pin may be cut off at the proper length.

This equipment has been designed to meet the particular requirements of the most exacting fracture service and is particularly suited to the uses of military units, to meet the various demands in camps, at theatres of military operations and in actual combat. It is made to handle all major fractures of the extremities, comminuted, compound or simple. As a temporary emergency measure, pins can be inserted and the fracture firmly immobilized.

Furthermore, the equipment lends itself to compact, convenient storage in easily transported kits.

Having thus described my invention, what I claim as new therein and desire to secure by Letters Patent is: 1. In fracture treating equipment of the character described; in combination, a rigid transfixion member, a frame extension rod, and a transfixion mounting clamp member applied to the rod for rotation thereon and for sliding adjustment along the rod to accommodate it to the particular disposition of the transfixion member; said clamp member having a tightening means adjustably applied thereto equipped to engage the transfixion for its functional securement to the rod and whereby, upon tightening of the said means, the extension rod and transfixion member will be rendered relatively rigid and whereby, upon loosening of the clamp member, the rod, clamp and transfixion will be rendered relatively adjustable.

2. In fracture treating equipment of the character disclosed; in combination, a rigid transfixion member, an extension rod and a transfixion holding clamp comprising a split collar formed with a bore within which said rod is received for relative rotation and longitudinal adjustment, a tightening bolt for the split collar, holding means at one end of the bolt to receive the transfixion member for functional securement to the extension rod and a nut on the bolt adapted to be tightened thereon against the collar thus to clamp it on the rod and by the same action to cause the said holding means to render the transfixion member and rod relatively rigid at the selected position of relative adjustment.

3. A fracture immobilization splint comprising a rigid rod, a plurality of transfixion pins adapted to be applied to the fracture fragments and to have end portions thereof extended to the rod, transfixion mounting clamps applied to the rod, each for rotation and axial sliding thereon to adapt it to the position of the individual transfixion which it is to mount, and a tightening bolt for each clamp; said tightening bolt having a hole therethrough to receive the transfixion adjustably therein, and a nut on the bolt whereby it may be tightened to secure the clamp in fixed position on the rod and the transfixion rigidly mounted in the clamp.

4. In a fracture treating equipment, in combination, a frame rod, a clamp collar applied to the rod for rotation and sliding adjustment therealong, a clamping bolt rotatably mounted in the clamp collar and having a hole therethrough at one side of the collar, a transfixion mounting yoke having a mounting stud extending from one arm thereof, and rotatably applied to the hole of said clamping bolt, and a nut applied to said bolt at the other side of the collar and adapted to be tightened against the collar to fix the clamp on the rod and to secure the yoke rigidly with reference to the clamp.

5. In fracture treating equipment, a frame comprising rods to be extended along the sides of a limb containing a fracture, clamp collars rotatably applied to the rods and adjustable to different positions therealong, each clamp collar having a tightening bolt extended rotatably through the collar and formed with a hole therethrough at one side of the collar, and having a tightening nut applied thereto at the other side of the collar, and transfixion pins applicable to the fracture fragments and applied at their opposite ends to holes of bolts of the clamp collars; said parts all being relatively adjustable and rendered relatively rigid at any position of adjustment by the tightening of said nuts whereby to fixedly secure the collars on said rods.

6. In a fracture treating equipment, a frame comprising rods that are applicable along a limb containing a fracture, clamp collars rotatably and slidably mounted on said rods, each collar having a clamping bolt extended therethrough formed with a transverse hole at one side of the collar and having a tightening nut applied thereto at the other side of the collar, a yoke adapted to span the rods across the limb, and a fracture transfixion member mounted between the arms of the yoke; said yoke having mounting studs extended from its legs and adjustably applied to holes of clamp bolts of said collars; said parts being rendered relatively rigid at any set position of relative adjustment by the tightening of the nuts on said clamp bolts.

7. In a splint of the character described, a round frame rod, a clamp collar rotatably and slidably adjustable on the rod, a tightening bolt for the collar, a head on one end of the bolt, and a nut threaded on the other end of the bolt; said bolt having a hole therethrough flush with the under surface of the bolt head for the reception of a transfixion whereby, upon tightening the nut to secure the clamp collar, the transfixion will be gripped between the collar and bolt head.