CN1604758A - Orthopedic stabilization apparatus and methods - Google Patents

Abstract

An orthopedic stabilization structure includes a threaded fastener that can articulate to accommodate a wide variety of skeletal geometries, a rod, and a cup that supports the threaded fastener and the rod which is then held in a fixed position relative to the skeletal structure.

Description

Orthopedic stabilization apparatus and methods

technical field

The present invention relates generally to instruments used by orthopedic surgeons to stabilize and align skeletal structures. More specifically, the present invention includes a fastener capable of pivoting about an axis within a support cup and the cup is contoured to receive a rod internally, and means for making the rod and rotationally oriented fasteners are secured in a fixed position. In addition, the present invention includes a fastener that utilizes radial and axial forces to hold itself in place without the use of rods or rotatable fasteners.

Background technique

Various orthopedic procedures involving stabilizing skeletal structures currently share two common weaknesses: first, the inability to orient a stable structure for a wide variety of common angles, and second, the inability to provide a reliable threaded portion that engages the patient's bone.

Contents of the invention

The present invention provides the ability to correlate different bone parts with relative methods that allow the instrument to articulate in a variety of angles and is secured to the skeleton to provide greater stability by means of an improved threaded form that provides Both axial compressive force along the length of the fastener and radially inward pulling force.

Industrial Applicability

The industrial applicability of the invention will be illustrated by discussing the following objects of the invention.

Accordingly, it is a primary object of the present invention to provide an orthopedic stabilizing structure.

To this end, another object of the present invention is to provide an improved threaded portion.

It is yet another object of the present invention to be able to adjust multiple angles when correcting the skeletal structure.

Viewed from a first advantageous aspect, the object of the present invention is to provide an orthopedic surgical instrument comprising in combination: a threaded shaft having an end with a turning means; a cup having a turning means receiving area, the a receiving area dimensioned to allow rotation of the threaded shaft about said end, the cup having a transverse slot; a rod passing through the slot; and for securing the rod and threaded shaft relative to the cup A device in a fixed position.

Viewed from a second advantageous aspect, it is an object of the present invention to provide a method for supporting a skeletal structure comprising the steps of: using a fastener with a support cup; using a support rod; orienting the cup such that The rod abuts the fastener; and securing the rod and fastener together.

Viewed from a third advantageous aspect, the object of the present invention is to provide an orthopedic surgical instrument comprising in combination: a fastener having a threaded body and a top equipped with a saddle; the saddle has an upper surface and a lower surface; the upper surface is contoured to receive a rod thereon; and the lower surface includes a seating area for receipt within the cup whereby the fastener is articulated within the cup.

Viewed from a fourth advantageous aspect, it is an object of the present invention to provide an orthopedic fastener comprising in combination a shaft having a first thread form at one end and a second thread form at the other end, the thread forms having a It is a device that pulls the bones radially inwards buried inside.

Viewed in a fifth advantageous aspect, it is an object of the present invention to provide a method of using an orthopedic fastener comprising the steps of: embedding the fastener so as to generate an axial compressive force and a radial force relative to the fastener. Inwardly directed force.

Viewed from a sixth advantageous aspect, it is an object of the present invention to provide an orthopedic surgical instrument comprising in combination: a support rod; a plurality of fastener supports connected to the support rod; A plurality of fasteners connected by a fastener support, wherein the fastener includes a threaded body and means for cooperating with the fastener support in a fixed orientation, and subsequent movement of the fasteners is controlled by the fastener Interaction of the fastener support and the means for cooperating with the fastener support is prevented.

Viewed from a seventh advantageous aspect, it is an object of the present invention to provide an orthopedic surgical instrument comprising in combination a clamping member having means for receiving and securing a support member and for engaging and securing a fastener The fastener has a threaded body and complementary means for engaging and being secured by the clamping member, and wherein the fastener includes means for engaging the clamping member in a limited number of orientations.

Viewed from an eighth advantageous aspect, it is an object of the present invention to provide an orthopedic surgical instrument comprising in combination a clamping member having means for receiving and securing a first support member and for receiving a second support member member, wherein the second support member includes a support cup containing a fastener and means for allowing rotational movement of the fastener within the support cup.

Viewed from a ninth advantageous aspect, it is an object of the present invention to provide an orthopedic surgical instrument comprising in combination a clamping member having means for receiving a support member and means for engaging a fastener, wherein the means for cooperating with the fastener comprises an open shaft which is an extension of the means for receiving the support member, the fastener having a threaded body and complementary means for cooperating with the clamp , and the fastener includes means for cooperating with the clamp in a limited number of orientations; and securing means for cooperating with the fastener to secure the support member in the clamp and The split shaft secures the fastener to the clamp.

These and other objects of the invention will become apparent from a study of the following detailed description in conjunction with the accompanying drawings.

Description of drawings

Figure 1 is a top view of the fastener;

Figure 2 is a side view of the fastener;

Figure 3 is a cross-sectional view of the fastener geometry;

Figure 3A represents Figure 3 with a slope;

Fig. 4 represents this fastener and stabilizing structure;

Fig. 5 is another view of Fig. 4;

Fig. 6 represents the inclination of Fig. 4 structure;

Figure 7 details the screws used in this structure;

Figure 8 details the receiving area of the screw;

Figure 9 shows a side of the goblet;

Figure 10 shows the adjoining side (90 degrees) relative to Figure 9, thereby showing the diametral slot;

Figure 11 is a top view of Figures 9 and 10;

Figure 12 is a bottom view of Figures 9 to 11;

Fig. 13 is a sectional view of Fig. 9 along line 13-13;

Figure 14 is a sectional view similar to Figure 4;

Figure 15 adds fasteners and rods to Figure 14;

Figure 16 adds fixing screws to Figure 15;

Figure 17 shows the instrument used as an example;

Figure 18 shows an alternative thread form;

Figures 19A and B show the screw of the earlier figures deformed to include a rod;

Figure 20 is a perspective view of a clamp to be used with the rod of Figure 19;

Figure 21 shows the clamping member installed on the bar;

Figure 22 shows the two clamps on the bar from one side;

Figure 23 shows the two clamps on the bar from the other side;

Fig. 24 represents a kind of usage mode of Fig. 18 to 23;

Figure 25 depicts the angles of Figures 22 and 23;

Figure 26 is an alternative fastener to the fastener shown in Figure 1;

Figure 27 is a perspective view of Figure 26;

Figure 28 is a side sectional view of the cup used in Figures 26 and 27;

Fig. 29 is another side sectional view of Fig. 28;

Fig. 30 shows the fastener of Fig. 26 used in the cup of Fig. 28 together with the retaining rod;

Figure 31 is a second view of Figure 30;

Figure 32 is a side view of Figure 26;

Fig. 33 is the view of Fig. 30, wherein adopted screw;

Figure 34 shows Figure 33 from the side;

Figure 35 represents Figure 34 at an angle;

Figure 36 is a fastener with a driving head;

Figure 36A is a top view of another fastener driving device;

Figure 36B is a top view of a third fastener driving device;

Figure 37 is a view of a longer fastener with an unthreaded intermediate shaft section;

Figure 38 is an example of use of the fastener in Figure 36;

Figure 39 is an alternative to Figure 36;

Figure 40 is an alternative to Figure 37;

Figure 41 is an example of use of the fasteners of Figures 39 and 40;

42A and 42B are side views of an alternative embodiment of a fastener having a hollow top;

Figure 43A is a side view of the rod holder mated with the fastener of Figure 42;

Figure 43B is an end view of the rod holder mated with the fastener of Figure 42;

Figure 44 shows the Figure 42 fastener cooperating with the Figure 43 retainer;

45A and 45B are side views of another embodiment of a fastener having a hollow top;

Figure 46A is a side view of the rod holder mated with the fastener of Figure 45;

Figure 46B is an end view of the rod holder mated with the fastener of Figure 45;

Figure 47 shows the Figure 45 fastener cooperating with the Figure 46 holder;

Figure 48 is a view of an embodiment of a fastener having an elongated hexagonal top mating with a corresponding retainer;

Figure 49A is a top view of the assembly of Figure 48, now mounted on the threaded rod with fine-tuned stabilizers;

Fig. 49B is a side view of another fastener embodiment when the assembly is installed on the threaded rod with micro-adjustable stabilizers;

Figure 50 is another embodiment of the threaded fastener;

Figure 51 is a rod holder mated with the fastener of Figure 50;

Figure 52 shows the fastener of Figure 50 mated with the holder of Figure 51; and

Figures 53A and 53B illustrate the use of Figures 50 to 52 with a rod.

Detailed ways

With regard to the drawings, like reference numerals refer to like parts throughout the different drawings, and reference numeral 100 designates the orthopedic stabilization device of the present invention.

Instrument 100 allows threaded fastener 10 to move about arrow C shown in FIG. ,As shown in Figure 6. The rotating device 120 embodied as a disc has a cylindrical outer surface 122 and planar top 124 and bottom 126 surfaces. Thus, a rotation about arrow C occurs about geometric center 128 . The disk 120 is integrally fixed on the fastener 10 . The turning device 120 is constrained in a cup-shaped body 130 having a central hole 132 , the upper part of which is equipped with a thread 111 . In addition, a transverse slot 134 is cut along the diameter of the cup which allows for the slidable insertion therein of both the fastener 10 and the integral disc 120 as well as the rod 136 transverse to the long axis of the cup 130 . 9 to 16, the rod may have any of various cross-sectional profiles (eg, square, circular, oval, etc.). The cup 130 is sized such that the rotating device 120 is in tangential registration with the rod 136 along the cylindrical surface 122 . The threaded holes 132 receive the set screws 110 therein so that the compression rods 136 abut against the rotation means 120, thereby securing their relative relationship once the proper orientation is achieved.

In general, fastener 10 includes a threaded shaft 32 having a first thread form 12 at one end and a second thread form 14 at an opposite end. As shown in FIGS. 1 and 2 , the first end thread form 12 terminates at the tip 12 and the thread diameter increases to form a thread form that increases in helicity as it extends away from the tip 16 .

The second thread form 14 has a larger diameter but a similar thread profile, as will be discussed in detail below. Preferably, the shaft 32 has a variable length and taper and tapers from the end 18 to the tip 16 . Please see Figures 1 and 2.

Another slight difference between the first and second thread forms is that the first thread form 12 has a thicker thread than the second thread form 14 which has a finer thread. Tip 16 is the starting point for insertion into bone during orthopedic procedures. For this, a pilot hole can be drilled in the bone, but after that this section is self-tapping due to the tapered character of the first thread 12 . It should be noted that the tops 70 of both the first and second thread forms are sharp. This allows cutting into bone which is usually harder on the outside than inside. By providing the first thread 12 with a thicker thread, this thread will insert into the bone faster than the second thread form 14 . As a consequence, when the bone starts to be engaged by the second thread form 14, the bone is axially compressed in the direction of the two arrows A. Furthermore, due to the thread geometry, the thread exerts a radially inwardly directed force in the direction of the double-ended arrow B. The present invention provides a radially inward or pulling force B and a compressive force A, whereas conventional fasteners in the prior art cause radially outward expansion (opposite direction of arrow B).

As with threads 12 and 14 , thread 60 of fastener 10 is actually a continuous helically wound thread that begins at the end and spirals toward the middle section of shaft 32 as it transitions from the end. Please see Figure 3.

The thread 60 includes a sharp crest 70 that defines an outer diameter 62 of the thread and a root 80 that defines an inner diameter 64 of the thread 60 . As shown in detail in FIG. 3 , the thread 60 has an upper surface 66 that extends from a bottom edge 84 of a root 80 to a sharp top 70 . Thread 60 also includes a lower surface 68 that extends from top edge 82 of root 80 to sharp tip 70 . As the surfaces 66, 68 extend from the root 80 to the top 70, both the upper surface 66 and the lower surface 68 are angled towards the middle section of the fastener.

In cross-section, the surfaces 66 , 68 extend linearly from the root 80 to the sharp top 70 . However, due to this profile as the threads 60 helically turn about the thread axis 32, both the upper surface 66 and the lower surface 68 take on a curved appearance. This appearance resembles a shape that might be formed by a straight segment of the surface of a cone with the apex pointing down and the cone rotating and moving upward along its central axis. The upper surface 66 and the lower surface 68 thus have a three-dimensional curved surface similar to the curved surface of a cone, but have a rectilinear character when viewed in cross-section.

Upper surface 66 extends from root 80 to sharp top 70 at an upper surface angle α offset from a reference plane perpendicular to the central long axis of the fastener. The upper surface angle a is preferably 20°, but may be any angle between 0° and 90°. Instead, the lower surface 68 extends from the root 80 to the sharp top 70 at a lower surface angle β relative to the reference plane. The lower surface angle β is preferably 40°, but may vary between 0° and 90°.

The upper surface angle α is preferably smaller than the lower surface angle β. In this way, the threads 60 have a greater thickness and thus greater strength adjacent the inner diameter 64 than at the outer diameter 62, thereby being more able to withstand the loads experienced within the bone.

It is the angle of these surfaces, especially upper surface 66, that contributes to the radially inward force. When the upper and lower thread forms are combined, it can exhibit axial compression force. Note the flat wall 54 in FIG. 3 . This could possibly replace the tip 16 and would require a deeper pilot hole.

The second threaded portion 14 has the same geometry as in FIG. 3 except that the threads 60a are reversed and as mentioned above are finer threads (more threads per inch axially). In other words, FIG. 3 can be viewed upside down for the thread 14 .

Figure 3A shows a section of thread with a significant slope, for thread form 14, Figure 3A can be viewed upside down and has a slope opposite to that shown.

The bottom 129 ( FIG. 4 ) of the cup 130 has a void 22 which extends within an arc contained preferably approximately 90° to allow a wide range of rotation of the fastener 10 about arrow C. Rotation beyond this clearance 22 is prevented by the cup's wall structure 24 which keeps intact both the clearance hole 22 and the slots 134 extending radially to either side of the generally cylindrical cup 130 . The free end 138 of the cup 130 needs to support the screw 110 in order to: (first) press the rod 136 into place by (second) applying pressure to the disc 120 and by (third) merging the free end 138 to hold the disk.

The thread 60 of the screw 110 ( FIGS. 7 and 16 ) is actually a continuous helically wound thread that starts at the bottom 54 and spirals up to the top 52 . While this single flight configuration is preferred, other configurations including a series of mixed flights that helically wind together from the bottom 54 to the top 52 may also be used.

The thread 60 includes a crest 170 defining an outer thread diameter 62 and a root 80 defining an inner diameter 64 of the thread 60 . As shown in detail in FIG. 7 , the thread 60 has an upper surface 66 that extends from a bottom edge 84 of the root 80 to an upper edge 72 of the top 170 . Thread 60 also includes a lower surface 68 that extends from top edge 82 of root 80 to lower edge 74 of top 170 . As the surfaces 66, 68 extend from the root 80 to the top 170, both the upper surface 66 and the lower surface 68 are angled upwardly. Both the top 170 and the root 80 present a constant distance from the central axis 2 between the top edge 82 and the bottom edge 84 . Compared to FIG. 3, the top 170 is blunt, while the top 70 is pointed. The screw 110 and its threads 60 could also have a sharp profile like the tip 70 (instead of the tip 170) and vice versa.

In cross-section, the surfaces 66 , 68 extend linearly from the root 80 to the top 170 . However, when this profile is turned helically around the screw 110 as the threads 60, the upper surface 66 and the lower surface 68 take on a curved appearance. This appearance resembles a shape that might be formed by a straight segment of the surface of a cone with the apex pointing down and the cone rotating and moving upward along its central axis. The upper surface 66 and the lower surface 68 thus have three-dimensional curved surfaces similar to the curved surfaces of a cone, but have rectilinear characteristics when viewed in cross-section.

The upper surface 66 extends from the root 80 to the top 170 at an upper surface angle α deviating from the reference plane 4 perpendicular to the central axis 2 . The upper surface angle a is preferably 20°, but may be any angle between 0° and 90°. In contrast, the lower surface 68 extends from the root 80 to the sharp top 70 at a lower surface angle β with respect to the reference plane 4 . The lower surface angle β is preferably 40°, but may vary between 0° and 90°.

The upper surface angle α is preferably smaller than the lower surface angle β such that the thickness of the thread 60 at the crest 170 is less than the thickness of the thread between adjacent root portions 80 . In this way, the threads 60 have a greater thickness and thus greater strength adjacent the inner diameter 64 than at the outer diameter 62, thereby being more able to withstand the loads experienced within the bone.

Referring now to FIG. 8 , this figure shows details of the screw holes 132 on the free end 138 . The hole is preferably substantially complementary in shape to the threaded shaft of screw 110 . The hole includes a thread T. The thread geometry of the screw 110 and the threads T cause the free ends 138 of the cups 130 to be drawn together along the arrows D .

Figure 17 shows the fractured bone and the instrument 100 applied. Fastener 10 with disk 120 and cup 130 is positioned such that fastener 10 is seated inside the bone but the disk can rotate in void 22 as already described. The rod 136 is then placed within the slot 134 of the cup 130 .

The rod is shown with a bend 165 to demonstrate the versatility of the system. The screw 110 is then screwed into the thread 111 in the free end 138 of the cup. When the screw is pressed against the rod 136, the rod 136, disc 120 and fastener 10 become rigid. The free ends 138 are also pulled tightly together.

Figure 18 is a view similar to Figure 4 showing an embodiment where the first and second thread forms have conventional geometry but the second thread form has a greater pitch density thereby defining a finer thread than the first thread form. thread.

19A and B are similar to FIG. 16 except that the screw 110 includes an elongated rod 112 extending from the top of the screw and thus from the cup 130 . Rod 112 may include a necked region 113 adjacent screw 110 . The rod is preferably cylindrical and the constriction 113 may be faceted to allow rotation of the rod 112 with a tool.

FIG. 20 is a perspective view of rod clamp 210 secured to rod 112 . Clamp 210 includes a cylindrical bore 212 sized to receive rod 112, and includes a slot 214 in the outer wall radially aligned with a channel 216 extending into the body of the clamp. Together with the groove, this slot cooperates with a hole 218 which passes through the clamp and is perpendicular to the groove 216 . When the slot 214 and groove 216 are pulled together in the direction of arrow D, the rod 112 is held in place. Clamp 210 is generally box-shaped and includes a top surface 222 that is planar except for two outer raised side walls that are oriented parallel to clamp aperture 212 . Side walls 224 together with top surface 222 define receiving recesses sized to receive projections 226 similar to projections 226 shown on the bottom surface of FIG. 20 . The protrusion 226 thus comprises a raised wall 228 leading to the body of the clamping member 210 such that the overall length between the side walls 224 is equal to the overall length of the protrusion between the raised walls 228 . Note that protrusion 226 is offset by 90° from top surface 222 (and its notch defined by side wall 224). This allows the clamping blocks 210 to overlap in a stable manner, as shown in FIGS. 22 and 23 . A bolt 230 passing through the hole 218 holds the clamp in place with a nut 232 . The corners 203 of the clip 210 may be chamfered.

FIG. 24 shows how this alternative embodiment uses the rod as an extension to receive the rod 136 depicted in FIG. 17 . The rod 136 is not inserted between the disc 120 and the screw 110, but is received through the hole 218 of the clamping member 210 which cooperates as shown in FIG. 23, while the second hole receives the rod 112. This embodiment facilitates the use of the rod 136 on the outside of the patient's body. To use the Figure 24 instrument, the fastener 10 (with disc 120 and cup 130) is threaded along the hole. The rod 112 with the integral screw 110 is then screwed into the cup 130 . The rod 112 has not been tightened so the cup is allowed to tilt (as in Figure 25) to conform to the bone contour. Clamps 210 are then positioned in pairs on rod 112 along with rod 136 . A plurality of rods 112 are then tightened against the disc 120 to secure the cup 130 by pressing the screws 110 against the cylindrical outer surface 122 of the disc 120 . It should be noted that the geometry of the disc 120 and its location within the slot 134, especially with the thread geometry 12, 14 discussed above, prevents working loosening of the fastener within the bone. Bolt 230 and nut 232 are then used to secure rod 136, clamp 210 and rod 112 in place. At this point, the fracture (or other orthopedic deformity) has been stabilized. While the necked section 113 could be made faceted, the end 114 of the rod 112 has a drive head on the rod 112 instead of a facet or in addition to the facet.

Figures 26, 27 and 32 show front, perspective and side views, respectively, of an alternative fastener 310 as compared to Figure 1 . Points similar to the previous embodiments will not be described too much. Most notably, the turning device 120 of FIG. 1 has been replaced by a saddle 320 . Saddle 320 has a radiused top surface 336 sized to receive rod 136 in tangential registration about half its circumference ( FIGS. 30 and 33 ). Thus, the radius of curvature of the saddle top surface 336 matches the radius of curvature of the rod 136 . Saddle 20 has greater surface contact with rod 136 than in the FIG. 4 configuration. This results in fewer manipulations required to hold the rod 136 and fastener 310 in a fixed position due to the larger contact area. Also, the overall length of the fastener is reduced, resulting in a shorter and thus more compact overall height of the instrument, such as shown in Figure 33 (compared to Figure 6), since the major part of the disc 120 has been reduced in profile. The saddle 320 is replaced by the saddle, which is actually the outer arc of the disk of FIG. 6 . Therefore, the cup-shaped body 130' can also be made shorter accordingly. Figures 27 and 32 show the outer shoulders 338 of the saddle, which have a complementary curvature to its seat 340 (Figure 33) within the cup 130'. As before, gap 22 allows relative rotation about arrow C between fastener 310, stem 136 and cup 130'.

Threaded fastener 10 may appear in different embodiments. The threaded fastener turning device 120 shown in Figures 1 and 2 can be replaced so that the distal end 18 close to the second thread form 14 comprises a driving head 18, which is shown as a hexagon in the drawings, but also It can be formed as a hex head wrench notch 21 (FIG. 36B), an oval drive head 20 that is also concave (FIG. 36A), or any other profile for securely driving a fastener. Thus, the threaded fasteners of Figures 36, 37 have no rotating means. Such threaded fasteners 10 may be embedded directly into the bone instead of or in conjunction with other threaded fasteners 10 (FIG. 38).

Figures 39 to 41 show a variation where the tapered shaft 32 uses the thread 12 specified for the embodiment of Figure 1, but uses a conventional thread 114 on the second threaded section. The drive head 18 may be that of Figure 36, 36A, 36B or others.

Conventional threads 114 cooperate with screw holes 116 of member 118, which may be contoured to follow the bone tissue to be supported. Component 118 may thus have a blending profile as exemplified by angle 119 . As shown, the threads 12 are embedded in the patient's bone. In this embodiment, the threads 12 cooperate with the threads 114 to provide the axial compression A, and the threads 12 also provide the radially inward force B described in the earlier figures.

Alternatively, the rotating means 120 embodied as a solid disc in Figs. 1, 2 may be replaced by a hollow disc, as shown in Figs. 42A-B, 45A-B. The hollow may have a faceted profile, such as an octagonal profile 402A, another profile such as a circular profile 404A peripherally defined by teeth 406A, or any other profile that allows the threaded fastener 10 to be secured. The fastener 10 of Figures 42A-B, 45A-B slides over a stem holder having a complementary profile 402B, 404B to the hollow 402A, 404A. The fastener 10 of FIGS. 45A-B in turn engages the teeth 406B on the end 420 of the rod holder. The stem 422 within the stem retainer slot 424 is held adjacent to the fastener 10 . Threaded section 426 of slot 424 cooperates with an externally threaded shaft 428 securing the assembly.

The fastener 10 of FIG. 48 has an elongated hexagonal rod segment 408A that mates with a hexagonal channel 408B in a complementary formed corresponding rod holder. The rod holder includes a slot 424 for a screw 430 and threads 426 for engaging a shaft 428 . The assembly depicted in FIG. 48 may be configured such that one of the tops 410 of the hexagonal rod 408A engages the screw 430 and allows positioning adjustments along the screw 430 .

Referring to Figures 49A-B, adjustment and stabilization devices 432A, 432B are present in pairs, and each device abuts a respective side of the fastener 10 and retainer assembly. Any of the fastener and retainer assemblies depicted in Figures 4, 21-23, 33, 44, 47, 48 may be used with the screw 430 and adjustment and positioning means 432A, 432B.

FIG. 50 is a threaded fastener 10 embodiment having a recess 450 representing a facet profile 452 and terminating inside threads 466 . A corresponding socket ( FIG. 51 ) has a lumen to accommodate a rod 462 , with a lumen 456 extending from rod end 458 to socket end 460 . Accordingly, lumen 456 is not solid but defines an open axis 464 . The socket end 460 is connected to the rod end 456 by means of a clamping section 454 having a profile that matches the profile of the facet profile 452 of the threaded fastener 10 . The socket is seated within a recess 450 of the fastener 10 (FIG. 52). The screw 110 mates with the threads 466 at the top of the fastener. The pressure of screw 110 on clamping section 454 and split shaft 464 secures rod end 458 to rod 462 in addition to securing fastener 10 to clamping section 454 . Figures 53A and 53B show the embodiment of Figures 50 to 52 already deployed on a rod 462. FIG. 53B shows the inclinations relative to stem 462 that are possible using the combination of facet profile 452 and gripping section 454 of fastener 10 .

Having thus described the invention, however, it will be apparent that various structural changes and modifications may be employed without departing from the scope and full meaning of the invention as set forth above and described in the following claims.

claims

(Amended in accordance with Article 19 of the Treaty)

1. An orthopedic instrument comprising comprehensively:

a threaded shaft having one end equipped with means for rotation about a single axis transverse to the long axis of said threaded shaft and means for preventing all other rotations,

a cup having an internally threaded upper end and having a lower swivel receiving area dimensioned to allow the threaded shaft to surround said one end and to traverse across said threaded shaft long axis rotation of a single axis of the cup, said cup also having means to prevent all other rotations,

The cup has transverse slots,

a rod passing through the slot and adjoining the turning means in approximately tangential registration, and

screw means threaded on the internal threads of said cup to position said rod and said threaded shaft in a fixed position relative to said cup.

2. The instrument of claim 1, wherein said threaded shaft has first and second thread forms thereon.

3. A method for supporting a skeleton structure, the steps comprising:

Using multiple fasteners with multiple bearing cups;

screwing the fastener into the bone to be repaired such that the bone is subjected to both an axial compressive force and a radially inward force relative to the fastener;

using support rods inside said support cup;

orienting the cup relative to the stem such that the stem abuts the fastener; and

The rod and fastener are secured together by creating a radially inward force on the cup.

4. The apparatus of claim 2, wherein the first and second thread forms of the threaded shaft have different pitches such that the second thread form has a finer pitch than the first thread form. of thread.

5. The instrument of claim 4, wherein said thread forms have crests axially offset from their respective roots so as to create a radially inwardly directed force.

6. The instrument of claim 5, wherein the first and second thread crests face each other to create an axial compressive force.

7. An orthopedic surgical instrument comprising in combination:

Fasteners having a threaded body and a top equipped with a saddle;

the saddle has an upper surface and a continuous lower surface;

said upper surface is contoured to receive a cylindrical rod thereon;

the upper surface is in tangential registration with approximately half of the shaft circumference; and

said lower surface includes a seating area for receipt within a cup whereby a shoulder of said fastener is in tangential registration with said cup and is articulated within said cup, The cup has a seat complementary to the shoulder, and the cup has a free end protruding upwards, internally threaded and equipped with an oblique thread, and a screw with an oblique thread is placed in the The cup is internally threaded to provide a radially inward force thereby eliminating the need for a retaining ring.

8. An orthopedic fastener comprising in combination:

a bone engaging shaft having a first thread form at one end and a second thread form at the other end,

The threaded form engages the bone and has the means to draw radially inward on the bone that embeds it.

9. A method of using an orthopedic fastener in bone, the steps comprising: embedding said fastener in said bone so as to generate an axial compressive force and a radially inwardly directed force.

10. An orthopedic surgical instrument comprising in combination:

support rod;

a plurality of fastener supports connected to the support rod; and

a plurality of fasteners coupled to the plurality of fastener supports, wherein the fasteners include a threaded body and means for engaging the fastener supports in a fixed orientation, and the fasteners Subsequent movement of the fastener is prevented by the interaction of said fastener support and said means for cooperating with said fastener support.

11. An orthopedic surgical instrument comprising in combination:

Clamping member having means for receiving and securing a support member and means for engaging and securing a fastener having a threaded body and a threaded body for engaging and being secured by said clamping member Complementary means, and wherein said fastener includes means for cooperating with said clamping member in a limited number of orientations.

12. An orthopedic surgical instrument comprising in combination:

Clamping member having means for receiving and securing a first support member and means for receiving a second support member, wherein the second support member includes a support cup containing a fastener and permits the fastener to means for the rotational movement of the fixture within said support cup.

13. An orthopedic surgical instrument comprising in combination:

Clamping member having means for receiving a support member and means for cooperating with a fastener, wherein said means for cooperating with said fastener comprises a split shaft, and said split shaft is for an extension of said means for receiving a support member, said fastener having a threaded body and complementary means for cooperating with said clamping means, and said fastener includes means for engaging said clamping means in a limited number of orientations means of tight fitting; and

and securing means cooperating with the fastener to secure the support member in the clamp and secure the fastener to the clamp by compressing the open shaft.

14. The fastener of claim 8, wherein said thread form includes a sharp crest having an outer diameter and a root defining an inner diameter, said thread has an upper surface and a lower surface, said upper surface Extending from the root bottom edge to the sharp top and the lower surface extending from the root top edge to the sharp top, the surfaces are angled relative to the fastener central portion.

15. The fastener of claim 14, wherein said upper surface defines a smaller angle of inclination than said lower surface.

16. An orthopedic stabilization device comprising in combination:

threaded shaft, which has both axial and radial bone engaging compression threads,

The shaft has a free end terminating inside a disc that is constrained in a cup having a recess complementary to the disc so as to allow the cup and shaft to surround the The relative rotation of the geometric center of the disk,

a rod received inside said cup and disposed tangentially to said disc, and

Means for maintaining said rod, cup and disc in fixed relation.

17. An orthopedic stabilization device comprising in combination:

a cup having a recess for receiving a threaded shaft, said cup recess and said shaft including means for permitting rotation of said shaft in only one plane, said cup at a length of said recess has an internal thread on the mouth and the internal thread does not contact the threaded shaft,

The internal thread has a complementary thread form to the screw such that when the screw is threadedly engaged within the internal thread and the screw reaches its limit of travel, a radially inward force is applied to the on the internal thread.

18. The apparatus of claim 17, wherein said screw comprises a rod extending away from said cup, said rod being adjustable by adjusting the position of said clamping member along said rod. operatively connected to the clamp, and

A rod is adjustably positioned within the clamp.

19. The instrument of claim 17, wherein said threaded shaft includes two thread forms similar to said screw and internal thread, said two thread forms facing each other and one thread form having a ratio Another thread form with a finer pitch.

20. The instrument of claim 18, wherein said threaded shaft includes two thread forms similar to said screw and internal thread, said two thread forms facing each other and one thread form having a ratio Another thread form with a finer pitch.

21. An orthopedic stabilization device comprising in combination:

a cup having a recess for receiving a threaded shaft having a saddle within the cup, the cup recess and the shaft including seating means to allow the shaft Rotating in a plane only, the cup has an internal thread on a section of the recess, and the internal thread does not contact the threaded shaft.

The internal thread has a complementary thread form to the screw such that when the screw is threadedly engaged within the internal thread and the screw reaches its limit of travel, a radially inward force is applied to the on the internal thread.

22. The apparatus of claim 21 comprising:

A rod is adjustably positioned inside the cup and seats within the saddle.

23. The instrument of claim 21, wherein said threaded shaft includes two thread forms similar to said screw and internal thread, said two thread forms facing each other and one thread form having a ratio Another thread form with a finer pitch.

24. The instrument of claim 22, wherein said threaded shaft includes two thread forms similar to said screw and internal thread, said two thread forms facing each other and one thread form having a ratio Another thread form with a finer pitch.

25. An orthopedic stabilization device comprising in combination:

threaded shaft, which has both axial and radial bone engaging compression threads,

The shaft has a free end terminating inside a saddle which is constrained in a cup having a recess complementary to the saddle so as to allow the cup and shaft to relative rotation around the geometric center of the saddle,

a rod received inside said cup and disposed tangentially to said saddle,

and means for maintaining said stem, cup and saddle in fixed relation.

26. An orthopedic surgical instrument comprising in combination:

A threaded shaft having one end equipped with means for rotation about a single axis transverse to the long axis of the threaded shaft and means for preventing all other rotation, said shaft also having on the thread engaging the bone radially inward force puller,

a cup having an internally threaded upper end and having a lower swivel receiving area dimensioned to allow the threaded shaft to pass around said one end and around the long axis of the threaded shaft a single axis of rotation, the cup also has means to prevent all other rotations,

The cup has transverse slots,

a rod passing through the slot and adjoining the turning means in approximately tangential registration, and

screw means threaded on the internal threads of said cup to position said rod and said threaded shaft in a fixed position relative to said cup.

27. An orthopedic stabilization device comprising in combination:

a cup having a recess for receiving a bone-engaging threaded shaft having bone-engaging threads containing a radially inward force, the cup recess and the shaft including only allowing the shaft to means for in-plane rotation, said cup having an internal thread on a section of said recess and said internal thread does not contact said threaded shaft,

The internal thread has a thread form complementary to the screw such that when the screw is threadedly engaged within the internal thread and the screw reaches its advanced limit, a radially inward force is applied to the on the internal thread.

28. The instrument of claim 27, wherein said threaded shaft includes two thread forms similar to said screw and internal thread, said two thread forms facing each other and one thread form having a ratio Another thread form with a finer pitch.

29. An orthopedic stabilization device comprising in combination:

threaded shaft, which has both axial and radial bone engaging compression threads,

The shaft has a free end terminating inside a disc that is constrained in a cup having a recess complementary to the disc so as to allow the cup and shaft to surround the relative rotation of a single axis of rotation defined by the geometric center of the disc,

a rod received inside said cup and disposed tangentially to said disc, and

Means for maintaining said rod, cup and disc in fixed relation.

Claims (13)

1. orthopaedic instruments, it synthetically comprises:

Thread spindle, described axle has an end that has tumbler,

Have tumbler and admit the goblet in district, described admittance district is sized so that allow described thread spindle around described terminal a rotation,

Described goblet has horizontal stria,

Pass the bar of described stria,

And be used for described bar and described thread spindle are fixed on device in the fixed position with respect to described goblet.

2. apparatus as claimed in claim 1 is characterized in that, has first and second thread forms on the described thread spindle.

3. one kind is used for the method for support framework structure, and its step comprises:

Use has the hypanthial securing member of supporting;

Use cramp bar;

Directed described goblet causes described bar in abutting connection with described securing member;

And described bar and securing member be fixed together.

4. apparatus as claimed in claim 2 is characterized in that, first and second thread forms of described thread spindle have different spiral shell squares, so that described second thread forms has than the thin screw thread of described first thread forms.

5. apparatus as claimed in claim 4 is characterized in that, described thread forms has from they root tops of axially departing from separately, thereby forms the power of radially inwardly pointing to.

6. apparatus as claimed in claim 5 is characterized in that, described first and second threaded top are faced mutually, thereby produces axial compressive force.

7. orthopaedic instruments, it synthetically comprises:

Securing member, it has threaded body and is equipping the top of saddleback;

Described saddleback has upper surface and lower surface;

Described upper surface is made certain profile so that admit bar in the above; And

Described lower surface comprises that being used for being received in the intravital seat of cup-shaped puts the zone, and described whereby securing member can be movably connected in the described goblet.

8. orthopedics's securing member, it synthetically comprises:

Axle, one end have first thread forms and its other end has second thread forms,

Described thread forms has to make it is embedded in the radially inside device of tractive of inner skeleton.

9. method of using orthopedics's securing member, its step comprises: embed described securing member so that produce the axial compressive force and the inside power of sensing radially with respect to described securing member.

10. orthopaedic instruments, it synthetically comprises:

Cramp bar;

A plurality of securing member supporting members that are connected on the described cramp bar; And

The a plurality of securing members that are connected with described a plurality of securing member supporting members, the device that wherein said securing member comprises threaded body and is used for cooperating with described securing member supporting member on fixed orientation, and the follow-up motion of described securing member is stoped by the interaction of described securing member supporting member and the described device that is used for cooperating with described securing member supporting member.

11. an orthopaedic instruments, it synthetically comprises:

Clamping element, it has and is used for admitting with the device of fixed bearing member and is used for cooperating and the device of fixation fastener, described securing member has threaded body and is used for cooperating with described clamping element and by its fixed compensation device, and wherein said securing member comprises and is used for being orientated the device that cooperates with described clamping element with limited quantity.

12. an orthopaedic instruments, it synthetically comprises:

Clamping element, it has and is used for the device admitting and fix the device of first supporting member and be used for admitting second supporting member, and wherein said second supporting member comprises the supporting goblet that contains securing member and allows the device of described securing member in described supporting goblet internal rotation motion.

13. an orthopaedic instruments, it synthetically comprises:

Clamping element, it has and is used for the device admitting the device of supporting member and be used for cooperating with securing member, the described device that wherein is used for cooperating with described securing member comprises opening shaft, and described opening shaft is the extension that is used for admitting the described device of supporting member, the compensation device that described securing member has threaded body and is used for cooperating with described clamping element, and described securing member comprises and is used for the device that cooperates with described clamping element with limited quantity orientation; And

Fixture, described fixture cooperate with described securing member so that described supporting member is fixed in the described clamping element and by compressing described opening shaft described securing member are fixed on the described clamping element.

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