US2150314A - Orthopedic apparatus - Google Patents

Description

March 14, 1939. w. L. BELL ORTHOPEDIC APPARATUS Filed O. 28, 1955- 3 Sheets-Sheet l INVENTOR- WILLIAM L. BELL/ ATTORNEY 'March 14, 1939.

W. L. BELL RTHOPEDIC APPARATUS Filed 0G13. 28, 1935 3 Sheets-Sheetl 2 INVENTOR:

WILLIAM 11.7

ATTOR NEY March 14, 1939. w. L; BELL 2,150,314

ORTHOPEDIC APPARATUS Fned oct. 2s, 1955 s sheets-sheet s- F IG. 3.

I3 e H FIG .T [-1 I l/ M Cl JIL DEE lNvENToR L WILLIAM B E| L ATTORNEY Patented Mar. 14, 1939 UNITED STATES PATENT OFFICE ORTHOPEDIC APPARATUS Application October 28, 1935, Serial No. 47,066

1 claim. l (c1. 12s- 84) This invention relates to improvements in orthopedic apparatus and more particularly to the general construction and arrangement of the frame and the accessories combined therewith.

An object of the invention is to support a human body in such a manner that it may be subjected to X-ray photography at any angle without interposed supporting means impenetrable to the photographic rays.

Another object is to subject the human body to orthopedic stresses for the restoration or correction of fractures or maladjustments, while suspending the body in a manner to permit free access thereto for the purposes of uoroscopic examination photography and/or the application of plaster casts or other corrective means.

Another object is to provide means for subjecting the human anatomy to all the tractive, rotative and compressive stresses that the articulated members of the body will permit and maintain said stresses as long as required.

Another object is to support the human body as long as necessary to perform operations or orthopedic manipulations without undue injurious trauma or pressure.

Anotherl object is to provide an apparatus easily knocked down or assembled for emergencies such as war conditions.

Other objects and advantages will appear as the description progresses.

The X-ray is a very important adjunct in modern orthopedic, surgical and therapeutic practice. Heretofore surgical tables have not given the necessary freedom of access to the body of the patient, with asufcient range of angularity to meet all requirements. In orthopedic practice, especially in reducing skeletal fractures, it is essential that the operator know at all times, by fluoroscope or photography, the exact condition of the bone structure buried within the intervening tissue free from extraneous shadows cast by contiguous apparatus. It is equally important that tractive and other accessories be attached to the table frame in such a manner that corrective stresses can be' appliedV to the limbs of the patient at a full range of angles not limited by any inadequacy of the apparatus. f

For further particulars regarding the tractive accessory particularly adapted vfor use in .this connection, reference is made to my co-pending application. Serial Number'47,065, filed Oct.v 28, 1935, entitled Orthopedic appliances.

In the present invention any articulated member of the human skeletal structure can be sub- 1 jected to traction or compression by placing the patient or the accessories in appropriate relative positions in the apparatus.

In this specification and the accompanying drawings the invention is disclosed in its preferred form. It is to be understood', however, that it is not limited thereto because it may be embodied in modifications within the purview of the claim following the description.

In the three sheets of drawings:

Fig. 1 is a side elevation of an orthopedic apparatus constructed in accordance with this invention.

Fig. 2 is an end View of the same.

Fig. 3 is a plan view from above of the same.

Fig. 4 is an enlarged detail in side elevation of the pivotal spar mounting.

Fig. 5 is a plan View from above of the same.

Fig. 6 is a fragmentary detail in elevation showing the adjustable supports for the transverse boards.

Fig. '7 is a side elevation partly in vertical section of the mounting of the supplementary supporting table.

Fig. 8 is an elevation of the knee rest.

In detail the construction illustrated in the ,d

drawings, referring rst to Fig. 3, comprises a rectangular main frame comprising the side bars I and 2 joined by the cross struts 3 and 4 spaced inward from the ends of the side bars. The opposite ends of these struts are welded or bolted to the side bars I and 2 and suitably reinforced to strengthen the structure. These side bars I and 2 are preferably formed of steel ats either solid or tubular stock about 1/2" x 1%" and 7 feet long. Where saving of weight is desirable suitable aluminum alloys may be substituted.

The several sleeves 5 to 8 have vertical sockets to receive the uprights I0, II, I2 and I3 fixed therein. T'hese` uprights are bent inward and have their upper ends joined by the bolts I5 and I6 respectively. The longitudinal beam Il has its ends fixed between the uprights by the bolts I5fand I6 to form a rigid superstructure above the main frame.

The main frame is supported by the standards I8., I9, 20 and 2|, xed to the end struts 3 and 4 at the top and to the transverse trucks 22 and 23- supported upon the suitable caster rollers 24, 25, 26 and 21. These trucks also have the screwV spindles 28, 29, 30- and 3| at the several corners of the apparatus, so that they may 'be lowered to the floor toV support the apparatus for greater rigidity when portability is undesirable. The standard 2|, the roller 21 and the spindle 3I are obscured by their companion parts inFig. 1. Elevating the frame to accommodate various heights of operators may also be eiected by these screw spindles.

The vertical tube 32 is xed to the bracket 33 adjustably clamped on the beam I1 by the thumb bolts 34 and 35. The tube 36 is slidable in the tube 32 and may be xed by the set screw 31. The perineal post 38 is preferably of wood or any material that will cast the least shadow when penetrated 'by X-ray is fixed in the end of the tube 36 and is adapted to t into the crotch of the patient.

The relatively narrow strip 39 of fabric such as canvas extends between the uprights I U-Il and encircles the windlasses 48 and 4l at its respective ends. Relatively narrow, defines a strip narrower than the human torso. These windlasses -have transverse slots therein to receive the ends of the strip 39 to facilitate engagement of these respective ends to draw the strip tight. The opposite ends of these windlasses extend through bearings in their respective uprights l--IZ and |l-l3. One end of each windlass has a cross pin therethrough such as 40 to turn the windlass. And the opposite ends have a ratchet such as 4l fixed thereon to engage a ratchet pawl 42 pivoted yon-the upright to hold the tension applied to the strip by one or both cf the windlass-es. This strip is elevated above the main frame and is adapted to support the whole weight of the patient reclining thereon. The strip may be slit at 39 to pass the end of the post 38 to hold it in engagement with the rod should thepatient tend to roll oil' the strip.

It is often desirable to vary the hammock like suspension of the patient onthe strip 39. To this end the transverse supports 43, 44 and 45 cooperate with the strip 39 to vary its horizontal plane at the cranial, cervical anddorsal portions of the patient, to change the posture to meet the operative requirements` These supports are alike in structure and the description of one will apply to all. The transverse boards such as 44 have the legs 43 fixed thereto and extending downward and adjustably through sockets in studs such as 48 which are screwed Vinto the side bars l and 2 from the inside at the desired positions, see Fig. 3. One or all of these -supplementary supports 43-45 may be removed or omitted when they would interfere with photographic or operative access to the respective portions of the patient. The several boards 43-45 can be of glass or other photo-penetrable material and may remain in position if necessary. Y y

The fluoroscope may then be employed at anyY time during the progress of the operation without disturbing the position of the patient and apparatus.

The table 5B is of material similar to that of the supports '4S- 45 and Ais adapted to support the buttocks and lower limbs of the patient not shown as in Fig. 1. I ts inner end extends to approximately the center of the length of the main frame. This end has the socket plates Y 5I and 52 engaging the upper ends ofthe legs 53 and 54 which adjustably engage sockets inthe studs 55 and 5E, alike in structure and eifect with the studs 48 and 49. The outer end of the table has hooks such as 5l iixed thereto and adapted to hook over the adjacent windlass itil. Where such procedure is indicated the torso of the patient may rest upon' this table 5B, or the table may be omitted or rev moved when not required. The guide posts 5|' and 5l support the table 58 to facilitate its removal after its having been unhooked'from the windlass 40. The table 5l] has the longitudinal slot 50' therein to receive the lower end of the perineal post 38. This serves to braces the post 38 to increase its transverse stability.

The bracket 52" is adjustably fixed on the beam I1 and has the transverse sleeve 52' therein. The windlass 53 is rotatable in the sleeve 52 and has the opposite ends of the canvas sling 54 wound thereon. The sling 54' may extend below or Vabove the strip 39 as indicated in the technique of the operation to be performed. The hand wheel 53" is provided for turning the windlass to raise the sling 54'. The hand screw 55 in the bracket 52 locks the windlass 53 after the sling has been raised to the desired position.

The transverse bar 5B" has the legs 51 at each end which are vertically adjustable in the brackets 58. The brackets are slidable on the side bars I and 2 and are held in adjusted position thereon by the hand screws 58, see Fig. l. This transverse bar 56" may be raised to support the lumbar region of a patient resting upon the strip 39.

Thus far the combination and arrangement of parts of the apparatus lends itself to the comfortable support of the patient `in a manner best adapted to photography and fluoroscopic examination by X-ray, with minimal interposition of the various parts of the apparatus.

It is of prime importance that the patient be as comfortable as his condition will permit if conscious, so'that he may physically yand mentally relax. If unconscious he must be protected against falling from the strip 39, and against any contact or pressure that will irritate his organism, since he may be confined to the apparatus over a period of hours in extreme instances. It is equal.- ly important that the above conditions be maintained Vduring the period of orthopedic or surgical operations.

The lateral spars 59 and 60 are preferably square in cross section for strength and rigidity. Theyare alike in assembly and the description of one will servefor both. A gudgeon pin 6l is ixed in a socket in the block (53V by the set screws 64, see Fig. 4. The block 63 has the hook flanges 65 and 65V overhanging the side bar l and clearing the studs 48, see Fig. 6, to permit the block to slide freely on the side bar from end to end of the main frame. The block is xed in the desired position by the hand screwsV 6l and 68. Y

The lower protrusion 69 of the gudgeon pin El has the quadrant plate l0 forced thereonto to form a practically integral structure therewith.

The spar 59 or 60 has its end mounted on the gudgeon pin 6I between the quadrant plate 79 and the block 83 and is freelypivotal thereon supported by the quadrant l0. The bolt 'll' screwed into the gudgeon Vpin 6l pivots the end of the clamp bar i l. clamp bar 'H and is threaded into thespar 5 9.

It has the head 'l2 bearing beneath the clamp bar;

The handle 14 passes through the head 'l2 andV provides means for turning the spindle to clamp the spar and the clamp-bar 1| against the immovable quadrant plate l, to x the spar at any desired angletothe side bar of the main frame.

The spars are each provided with encircling sleeves such as 15, see'Fig. l, freely7 slidable thereon andheld in any desired position by the set screw i6. Each sleeve is provided with a lateral vertical socket 'll and a set screw* 18', to receive and adjustably hold the tubular standard 18. The rod 19 telescopes withinthe standard and is held atany adjusted radialangle by the set screw 80, see Fig. 71..; ,Y Y Y f l The spindle i3 passes through theV .mounted on the offset standard This rod has the yoke 8| fixed on its upper end, see Fig. 8. The disk 82 is pivoted in this yoke on the cross pin 83. 'Ihe set screw 84 is threaded through one leg of the yoke and bears against the side of the disk 82 to hold it in adjusted position.

The barrel 81 is slidably connected to the disk 82 by means shown and described in Patent No. 2,124,102 issued to me July 19, 1938. The crank 9| is adapted to advance or retract the barrel 81 with respect to the disk 82.

The heel rest 98 has the split stem 99 pivoted on the fiat portion S6 by transverse bolt |00. When the heel of the patient is placed in the heel rest 98, the foot can be tipped at any desired angle, and the axis of the patients leg can be arranged in alinement or at an angle to the axis of the shank 92-and held in position by means of a suitable hand screw.

The toe stirrup |03 has a slotted shank, adjustably fixed to the standard |02v by the thumb screw |05, for holding the patients foot in adjusted relation to the heel rest 98. The toe stirrup has the lateral extension |03 which engages the side of the patients foot against its natural tendency to turn outward. The patients limb may be supported intermediate its length by the knee rest consisting of the yoke |01, see Figs. 1 and 8, |08 vertically adjustable in the bracket |09 on the side bar I or 2. The fabric strip H traverses the yoke |01 and receives the patients knee.

With the patients foot secured to the heel rest, traction can be applied to the patients leg by turning the hand crank 9| to advance or retract the supporting barrel 81.

The perineal post 38 set in the crotch of the patient takes the stress of the traction applied to the leg of the patient. This post is padded with cotton to relieve the pressure against the patient. If a similar spar and assembly is set upon the opposite side of the table, the patient can thus absorb most of the stress of the traction on the opposite leg and relieve the pressure against the post 38. It is obvious that through the various adjustments of the spar assembly with respect to the main frame, the various adjustments in the support of the tractive elements thereon and the motions possible with the foot support, all the motions provided by the articulations of the human leg can be accomplished and held indefinitely by this apparatus in setting a fracture or applying corrective measures. In

the oase of displaced knee bones, while the leg is under traction the set screw 95 can be released and the patients foot rapidly oscillated with the result that the displaced bones of the knee will return to proper inter-relation without palpation o-f injured tissue. Traction can then be reduced, the screw 95 reset and the knee bandaged or set in plaster for proper healing.

If it is desired to elevate the traction assembly for oblique action from above, the standard 18 can be transferred to the clamp |06 adjustably fixed to the upper beam I1 of the table. If traction is not required from above a rod through this clamp in place of the standard 18 provides means for suspending the patients flexed legs by bandages passed under his knees and over this rod.

In applying traction to the patients vlimb obliquely to the long axis of the strip, the intermediate weight of the limb is supported by the yoke |01 having the stem |08, vertically adjustable in the clamp |09 fixed to the side bar of the main frame. The yoke |01 has the canvas strip ||0 fixed therein and adapted to comfortably support the limb.

`By swinging the spars at the proper angles to the sides of the main frame similar rotative and tractive stresses may be applied to the arms and shoulders of the patient by setting his elbows in the heel rest 98 and his forearm in the toe stirrup |03 and taping them thereto. Or full length arm stresses may be applied by taping the hands to the heel or toe members mentioned.

The uses and possible combinative modes of operation are so extensive that in actual practice over a period of many months this invention has never failed to meet every condition required of it, with mechanical and merciful advantages too numerous to be' set forth herein.

Having thus described this invention what is claimed and desired to secure by Letters Patent An orthopedic apparatus including a main frame; a superstructure supported by said frame; a taut relatively narrow flexible strip supported intermediate said frame and superstructure, an X-ray penetrable perineal post mounted on said superstructure and extending downwardly through said strip; and traction means on said frame in operative relation to said strip and post.

WILLIAM L. BELL.

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