GB2231799A - Countertraction and traction bars - Google Patents

Abstract

A surgical apparatus for fracture surgery of the forearm bones comprises a countertraction bar(1) having an arm piece (5) at one end and a handle (3) at the distal end. The handle (3) is adjustably attached to a bar (7) which is adjustably attached to an operating table (9). The apparatus also includes a traction bar (11) adjustably secured to the operating table (9), and a traction bar (13) rotatably attached to the traction bar (11). <IMAGE>

Description

The Countertraction and Traction Bars The invention relates to fracture surgery of the forearm bones. It helps achieving a good closed reduction of the fracture and, so, the resort to operative fixation is kept to a minimum.

According to the present invention there is provided (Fig. 1) a wooden countertraction bar 1 - a metal countertraction bar 7, a long metal traction bar 11 and a small metal traction bar 13.

The Wooden Countertraction Bar 1 (Fig. 1, 2 and 3): comprises a handle 3 at the distal end and an arm piece 5 at the opposite end.

The handle 3 (Fig. 2) has two tunnels 19 and 21, through which pass the stabilising rods 41 and 43 of the metal countertraction bar 7 (Fig. 5).

on the distal side of the handle 3 (Fig. 2) is a rounded slot at its centre to receive the pressure of the countertraction screw 37 (Fig. 5) The arm piece 5 rests just proximal to the flexor surface of the elbow.

The Metal Countertraction Bar 7 (Fig. 1, 4 and 5): is fixed at the inner end on a rod 31 by a screw 29. It lies horizontally parallel to the upper arm and the handle 3, and just distal to the handle 3 of the wooden countertraction bar 1 . The holding rod 31, is fixed to the side of the operation table 9, by a clamp 33.

A countertraction screw 37 passes through a threaded tunnel 27 near the middle of the countertraction bar 7. When the handle 39 of the screw 37 is turned, the tip of the screw engages in the slot 23 of the handle 3 of the wooden bar 1 and applies pressure on the handle 3. This means countertraction applied on the arm above the elbow by the arm piece S. At the same time, the stabilising rods 41 and 43 pass in their respective tunnels 19 and 21 of the handle 3 and prevent its rotation or displacement. The handle 3 is allowed to move only in a proximal direction when pressed by the screw 37.

The Metal Traction Bars 11 and 13 (Fig. 1, 6 and 7): the long traction bar 11 lies distal and parallel to the countertraction bar 7, so that its outer part is distal to the fingertips and keeps 2 inches distance from them.

It is fixed at its inner end to the side of the operation table in the same way as the metal countertraction bar 7 (Fig. 4). So, it is fixed on a rod 59, by a screw 61. The holding rod 59 is fixed to the side of the operation table 15 by a clamp.

The outer part of the long traction bar 11 has 5 tunnels, 45, 47, 49, 51 and 53; all are threaded for the passage of the traction screw 55 in one of them. The tunnel chosen depends on the length of the upper arm. The small traction bar 13 fits over the screw 55, which passes through a tunnel 63 at its middle. A nut 65, when tightened, holds the two traction bars 11 and 13 fixed to each other, with the small traction bar 13 at the desired position of rotation. Two small rods 67 and 69, protrude from the anterior or front side of the small traction bar 13 at each end.

Method of Use: (Fig. 1) Position of the arm and the four bars 1, 7, 11 and 13 is shown.

Countertraction Bar 1 can be used on its own by hand in displaced or angulated fractures of the forearm bones, the radius and the ulna, specially in children. The surgeon, after manipulating the fracture with an assistant doing countertraction , quickly holds the countertraction bar 1 by its handle 3, with one hand to press above the elbow in a proximal direction and with the other hand he holds the fingers of the patient's hand and pulls distally, so applying traction.

It may be necessary that an assistant, with his finger tips below the elbow, stops it from dropping down. An assistant applies a dorsal plaster of Paris (P.O.P.) slab from the knuckles to the upper arm i.e. above the elbow P.O.P. slab while traction and countertraction are maintained (Watson Jones principle); then he applies P.O.P. below the elbow, leaves the elbow part and applies P.O.P. above the elbow. So, avoiding P.O.P. over the arm end 5 of the countertraction bar 1, Traction and Countertraction are maintained for a few minutes until P.O.P. hardens. The countertraction bar 1 is then removed, leaving no pressure at all at the elbow and its place is filled with few rounds of P.O.P. Leaving no pressure at all at the elbow is a great advantage over Watson-Jones method.In adults, especially in displaced fractures, the surgeon may not be strong enough to succeed using the wooden countertraction bar 1 only.

A stronger and more steady traction and countertraction is achieved using the four bars 1, 7, 11 and 13. The elbow point is rested on the edge of a small table, the shoulder is steadied by a shoulder support 17. The metal countertraction bar 7 is fixed to its holding rod and assembled to the handle 3 of the wooden countertraction bar 1.

Traction can be applied as follows :- Each of the four fingers (index, middle, ring and little fingers) is tied with an obstetric knot by nonstretch cloth strips long enough to be plaited around the finger then tied around the small traction bar 13. The more traction on the finger the more the tied strips tighten and do not slip. The small bar 13 is rotated as desired according to the position required for the forearm (pronation/supination) for the reduction of fracture, then assembled to the long bar 11 and fixed to it by tightening the nut 65 over the screw 55. More traction is applied by pulling distally the long bar 11 by hand while the clamp holding its rod 59 is loose then tightened at the end of traction.

Countertraction is applied by pushing the countertraction bar 7 proximally by hand while the clamp 33 holding its rod 31 is loose then tightened at the end of countertraction. Considerable extra countertraction can be achieved by turning the screw 37 while the bars 7 and 11 are kept in a fixed position by their holding rods 31 and 59 well clamped to tne side of the table.

If still the fracture ends are not in satisfactory position, cortical hold of each fracture end by the specific cortical fixator designed by the same inventor is resorted to. The fracture ends are directly manipulated by each arm of the caliper till a satisfactory reduction is achieved as checked by the image intensifier,and the two halves of the caliper are then fixed to each other by narrow P.O.P. strips, making sure there is no distraction and bone contact is adequate at the fracture site.

The fracture is now reduced and stable. The traction and countertraction are released. Special P.O.P. slabs are necessary on the volar or dorsal side. Above elbow P.O.P. is applied leaving the part where the calipers hold the radial and ulnar fractures.

Referring to the drawings FIG. 1 An assembly drawing showing the position of the arm, the counter traction and traction bars in the clinical application, while the patient is lying in supine position on the operation table.

The wooden countertraction bar 1, its handle 3 and its arm end 5.

The metal countertraction bar 7 is fixed to the side of the table 9.

The long traction bar 11 is fixed to the side of the table 15.

The small traction bar 13 fixed to the long traction bar 11 by bolt screw and nut.

A shoulder support 17 steadies the shoulder.

FIG. 2 The handle 3 of the wooden countertraction bar 1 in section showing two tunnels 19 and 21, each on one side of the handle 3.

A slot 23 at the centre of the distal side.

FIG. 3 The arm piece 5 of the countertraction bar 1. Its concave surface 25 is the contact surface with the arm.

FIG. 4 Metal countertraction bar 7 (distal view) shows the hole of the tunnel 27 which is threaded for the passage of the screw (not shown for clarity).

The countertraction bar 7 is fixed on a holding rod 31 by a screw 29. The holding rod 31 is fixed to the side of the table by a clamp 33.

FIG. 5 The metal countertraction bar 7 in section (anterior or front view) showing its inner end fixed by a screw 29 to a holding rod 31 which passes through a hole 35.

A threaded tunnel 27 passes across the width of the bar 7 near its middle.

The tunnel 27 lodges the countertraction screw 37 which has a handle 39.

From the proximal side of the bar 7 two stabilising rods 41 and 43 protrude proximally parallel to the screw 37 and engage the reciprocal tunnels 19 and 21 in the handle 3 (Fig. 2). When the screw is turned its tip engages the slot 23 of the handle 3 (Fig. 2) and presses the handle and the wooden bar in a proximal direction, thus, applying countertraction.

FIG. 6 The long metal traction bar 11 (front or anterior view) in section to show its inner end fixed by a screw 61 on its holding rod 59, which passes through a hole 57. The outer part of the long bar 11 has 5 threaded tunnels, 45, 47, 49, 51 and 53 across its width. A screw 55 passes through the chosen threaded tunnel 49, then through an unthreaded tunnel 63 at the centre of the small traction bar 13.

When a nut 65 is tightened it fixes the small traction bar 13 to the long bar 11, whatever the rotation of the small bar 13.

FIG. 7 Another projection of the small bar 13 (distal view) to show the two small rods 67 and 69 at each end and protruding anteriorly (towards the ceiling). At the centre of the distal side lies the hole of the tunnel 63.

Claims (9)

1 A surgical apparatus comprising a countertraction arm having an arm piece at one end arranged to support the human upper arm, the countertraction arm being adjustably attached at its other distal end by attachment means to a support arm, the support arm being arranged to be adjustably attached to a base structure.

2 An apparatus as claimed in claim l in which the attachment means comprises a handle attached to the distal end of the countertraction arm, at least two guides attached to the support arm, and a threaded member arranged between the handle and the support arm to vary the distance between the handle and the support arm.

3 An apparatus as claimed in claim 1 or claim 2 in which the base structure is an operating table.

4 An apparatus as claimed in claim 3 in which the support arm is attachable to the operating table by means of a clamp on the support arm engaging a rod adjustably securable to the operating table.

5 An apparatus as claimed in any one of the preceding claims including a traction bar comprising a first traction arm adjustably securable to the base structure, and a second traction arm rotatably mounted on the first traction arm and securable to the first traction arm.

6 An apparatus as claimed in claim 5 in which the second traction arm is securable to the first traction arm by means of a threaded member passing through one of a number of holes in the first traction arm, and through a hole in the second traction arm, and a nut attached to the threaded member.

7 An apparatus as claimed in claim 6 in which the second traction arm includes two projections located on opposite sides of the second traction arm.

8 A surgical apparatus constructed and arranged for use and operation substantially as herein described, and with reference to the accompanying drawings.

9 A method of setting fractures of the forearm bones substantially as herein described.