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WO1998036699A2 - Clou a fracture pour l'enclouage medullaire d'os diaphysaires longs - Google Patents

Clou a fracture pour l'enclouage medullaire d'os diaphysaires longs Download PDF

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Publication number
WO1998036699A2
WO1998036699A2 PCT/EP1998/001018 EP9801018W WO9836699A2 WO 1998036699 A2 WO1998036699 A2 WO 1998036699A2 EP 9801018 W EP9801018 W EP 9801018W WO 9836699 A2 WO9836699 A2 WO 9836699A2
Authority
WO
WIPO (PCT)
Prior art keywords
bone
bone nail
nail
body temperature
deflections
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/EP1998/001018
Other languages
German (de)
English (en)
Other versions
WO1998036699A3 (fr
Inventor
Manfred Hinze
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to AU63994/98A priority Critical patent/AU6399498A/en
Publication of WO1998036699A2 publication Critical patent/WO1998036699A2/fr
Publication of WO1998036699A3 publication Critical patent/WO1998036699A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • A61B17/7208—Flexible pins, e.g. ENDER pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • A61B17/7233—Intramedullary devices, e.g. pins or nails with special means of locking the nail to the bone
    • A61B17/7258—Intramedullary devices, e.g. pins or nails with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone

Definitions

  • the invention relates to a bone nail for the intramedullary nailing of long long bones.
  • Bone nailing is used in trauma surgery for shaft fractures of the lower or upper extremities.
  • the bone nails serve to stabilize the bone during the healing process.
  • it is known to drill out the differently dimensioned medullary space in the middle shaft area of the bone so that the nail is firmly jammed there over a longer distance.
  • Medullary canals destroy nourishing bone vessels, they reduce the blood flow to the bone and thus have a negative effect on the healing process.
  • a bone nail made of a nickel-titanium alloy, which is plastically deformable at a temperature which is lower than the human body temperature and takes on the original shape again at body temperature, the bone nail at body temperature at least one Deflection from the straight central axis and can be brought into an essentially straight course at the lower temperature.
  • the use of a titanium alloy with a thermomechanical memory effect and this design of the bone nail have the advantage that the nail can be driven into the medullary cavity in a straightforward, frozen form in a simple manner. As soon as the nail takes on the body temperature, it gets its original shape and can become tense within the medullary canal.
  • Such a nickel-titanium alloy is known for example from DE 42 10 801 AI.
  • the nickel-titanium alloy described there contains 0.017% 0 2 , 0.0005% H 2 , 0.015% N 2 and 0.13% C as an admixture.
  • This nickel-titanium alloy is compatible with the human body and can be healed after it has been healed remain in the body.
  • This publication describes implants made of the alloy for the treatment of fractions in the facial area.
  • the nail can be held evenly in the medullary canal without the need for additional cross locks. It is also no longer necessary to drill out the bone marrow space. The damage to the bone by the bone nail to be used is thus reduced to a minimum, namely the insertion opening for the nail, so that the healing process is not additionally hindered.
  • the bone nail has a deflection at body temperature at least in the upper and / or in the lower area, so that the bone nail is braced in the enlarged upper and lower area of the medullary cavity of the diaphysis. In this area, the bone nail can easily clamp against the bone wall, so that any fracture in between can be well supported.
  • the bone nail has at least two deflections, each bent in a different direction, at body temperature. It can also be provided that the bone nail is wavy at body temperature. It can also be expedient if at least one free end of the bone nail has a curved course at body temperature, so that the nail is supported in the region of the epiphysis. Through these additional measures, the bone nail can be clamped well in the medullary canal without an area being stressed too much.
  • the deflections are almost matched to the course of the medullary cavity of the bone to be nailed.
  • the course of the medullary can be determined, for example, on the basis of the x-ray to be performed anyway, and nails with the appropriate dimensions can be selected from a standard range.
  • the orientation and / or the position of the deflections can also be adapted to the position of the fracture. This has the advantage that an arrangement of a deflection in the immediate fracture area can be avoided.
  • the bone nail in the area of the nail head is provided with an area which is asymmetrical with respect to a rotation about the central axis, so that a clear orientation of the nail in the inserted Location is possible.
  • This has the advantage that the surgeon can twist the nail in the driven position in order to adapt the orientation of the deflections to the course of the medullary cavity. This is particularly advantageous if the nail has deflections of different degrees of curvature.
  • this area of the nail has a notch which can be brought into engagement with a turning tool in order to enable the bone nail to be twisted and aligned.
  • This area can also be designed as a unidirectional hook, which can also serve as a traction device for later removal of the nail.
  • the hold of the nail is brought about by the interaction of the deflections with the inner wall of the medullary canal. It is no longer necessary for the diameter to be dimensioned in the middle of the bone shaft in accordance with the medullary cavity, if necessary, and consequently to be relatively heavy. Rather, it can be provided that the bone nail has a diameter that is smaller than the smallest clear dimension of the medullary cavity. On the one hand, this has the advantage that the nail can be inserted relatively easily in the straight, frozen form. On the other hand, there is an advantage that the nail is relatively light and requires less material. This means that any additional costs can be compensated for by the more complex alloy.
  • the distance between the maxima of at least two deflections that bend in opposite directions perpendicular to the central axis is greater than the smallest clear dimension of the medullary cavity. This results in a secure and firm tightening of the bone nail in the medullary canal.
  • bone nails are used.
  • the individual nails can then do so be twisted into each other so that optimal support can be achieved.
  • a straight nail is additionally used, on which the other curved nails can be supported.
  • the straight nail is first removed, so that the remaining, curved nails are relaxed and can be more easily removed.
  • a curved nail can be removed anyway due to the elasticity of the alloy.
  • the nickel-titanium alloy is compatible with the body, the bone nails only need to be removed in exceptional cases.
  • FIG. 3 shows an upper arm bone which is nailed with bone nails according to the invention
  • Fig. 4 shows a bone nail for an upper arm bone
  • FIG. 5 shows bone marrow nailing of a forearm.
  • the bone nail 10 for the intramedullary nailing of long long bones, such as. B. those of the upper and lower extremities of humans, shown schematically.
  • the bone nail 10 consists of a nickel-titanium alloy with a thermomechanical memory effect, that is to say of a metal alloy which, at a low temperature, which is lower than human body temperature, is plastically deformable and regains its original shape at body temperature.
  • the low temperature can be, for example, -10 ° C to -20 ° C.
  • FIG. 1 b shows the bone nail 10 in its original shape at body temperature.
  • the bone nail has several deflections 12, 13, 14 curved in different directions perpendicular to the central axis 11.
  • the lower free end 15 is also bent outwards.
  • the individual deflections are approximately wavy in relation to the central axis, so that the entire bone nail runs in a wavy manner along the central axis 11.
  • the bone nail is frozen in preparation for nailing and brought into the straight shape shown in Fig. 1 a.
  • the bone nail can be easily inserted into the medullary canal. Over time, the bone nail will warm up to body temperature and deform back into the original shape shown in FIG. 1b.
  • FIGS. 2 and 3 show a nailing of a thigh bone 16.
  • the femur 16 is broken in the middle shaft area 17.
  • the intramedullary nailing shown is carried out with two bone nails corresponding to FIGS. 1 a, b, in that the straight bone nail 10 (FIG. 1 a) is inserted into the medullary canal 19 from above in the region of the joint ball 18 in a conventional manner.
  • the original curved course of the bone nails is established in accordance with FIG. 1b. Due to the deflected areas 12, 14, the bone nail 10 can be in the upper enlarged shaft area 20 and in the lower enlarged shaft area Support 21 of the medullary canal 19.
  • the middle deflection 13 is somewhat weaker and is located in the immediate vicinity of the fracture 22 and can offer good hold to the individual fragments there.
  • the curved free end 15 also anchors the bone nail in the region of the epiphysis 23 of the bone 16.
  • the bone nail is accordingly supported in the areas 20, 21 of the diaphysis, in the lower epiphysis 23 and in the upper opening 24. This ensures a secure hold of the nail 10.
  • FIG. 3 shows bone nailing of an upper arm bone 25.
  • the corresponding bone nail 26 is shown in FIG. 4.
  • the course of the bone nail 26 is adapted to the course of the medullary cavity 27 of the humerus 25 and has a greater deflection 28 in the upper region.
  • the upper arm nail 26 is also first brought deep-frozen into the straight shape and driven into the medullary cavity 27.
  • Another advantage of this bone nail becomes clear here. With conventional bone nails, it was always necessary to insert the nail in the shoulder area 29 and fix it by at least one cross lock. This bone nailing is very complex and has after-effects for the patient. Since the bone nail 26 is now automatically braced in the medullary cavity, it is possible to insert the bone nail from the elbow side 30. This significantly reduces the surgical effort and the after-effects of the nailing on the patient.
  • FIG. 5 shows the medullary nailing of a broken forearm.
  • Both the ulna 31 and the spoke 32 are nailed here with two relatively thin bone nails 33, 34 each.
  • the bone nails have a variety of at body temperature wave-shaped deflections to evenly tense in the relatively thin medullary cavity of the forearm bones.
  • the bone nailings have always been carried out with two bone nails. It goes without saying that, depending on the size of the bone and the internal dimensions of the medullary cavity, three or more bone nails are required or only one bone nail may be sufficient. It is also possible to adapt the curved course of the bone nail to the course of the medullary cavity and the position of the fracture in advance. All that is required for this is the X-ray image, which is usually taken anyway with every broken bone treatment. The nail can thus find an optimal hold in the medullary canal without placing excessive strain on the fracture site.
  • the nail 10, 26 described above makes it easy to nail the bone.
  • the bone nail 10, 26 tightens itself in the medullary canal, so that additional transverse locking and / or drilling of the medullary canal in the central shaft area is not necessary.
  • no further damage is caused to the bone in addition to the actual fracture, so that the healing process is not delayed.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

Clou à fracture (10) pour l'enclouage médullaire d'os diaphysaires longs (16). Afin d'éviter des boulonnages ou l'alésage de la cavité médullaire (19) dans la zone diaphysaire, on utilise selon l'invention un clou à fracture en un alliage de nickel et de titane qui est plastiquement déformable à une température inférieure à la température du corps humain et qui reprend sa forme originelle à la température du corps. A la température du corps, le clou à fracture présente au moins une déviation (12, 13, 14) par rapport à son axe médian droit et à une température inférieure on peut lui donner une forme sensiblement rectiligne. Le clou à fracture peut ainsi se caler fermement à l'intérieur de la cavité médullaire et bien stabiliser l'os.
PCT/EP1998/001018 1997-02-25 1998-02-23 Clou a fracture pour l'enclouage medullaire d'os diaphysaires longs Ceased WO1998036699A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU63994/98A AU6399498A (en) 1997-02-25 1998-02-23 Fracture nail for intramedullary nailing of long shaft bones

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19707420.0 1997-02-25
DE1997107420 DE19707420A1 (de) 1997-02-25 1997-02-25 Knochennagel für die Markraumnagelung langer Röhrenknochen

Publications (2)

Publication Number Publication Date
WO1998036699A2 true WO1998036699A2 (fr) 1998-08-27
WO1998036699A3 WO1998036699A3 (fr) 1998-11-19

Family

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Family Applications (1)

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PCT/EP1998/001018 Ceased WO1998036699A2 (fr) 1997-02-25 1998-02-23 Clou a fracture pour l'enclouage medullaire d'os diaphysaires longs

Country Status (3)

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AU (1) AU6399498A (fr)
DE (1) DE19707420A1 (fr)
WO (1) WO1998036699A2 (fr)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040111090A1 (en) * 2002-10-03 2004-06-10 The University Of North Carolina At Chapel Hill Modification of percutaneous intrafocal plate system
US7052498B2 (en) 1998-10-26 2006-05-30 Expanding Orthopedics, Inc. Expandable orthopedic device
US8663224B2 (en) 2010-09-09 2014-03-04 DePuy Synthes Products, LLC Surgical nail
US8979846B2 (en) 2004-04-12 2015-03-17 Navin N Thakkar Flexible nail assembly for fractures of long bones

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IT1292085B1 (it) * 1997-06-05 1999-01-25 Bartolomei Claudio Di Dispositivo per la sintesi endomidollare elastica delle fratture di ossa
ATE332105T1 (de) 1999-08-30 2006-07-15 Zimmer Gmbh Marknagel für den humerus
DE10349571A1 (de) * 2003-10-24 2005-06-02 Friedrich-Alexander-Universität Erlangen-Nürnberg Knochennagel aus einer Formgedächtnislegierung

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0251583A2 (fr) 1986-06-23 1988-01-07 Howmedica Inc. Système modulaire de fixation fémorale
DE4210801A1 (de) 1992-04-01 1992-11-05 Rossar Ingeneering Gbr Ges Fue Verfahren zur herstellung einer nickel-titanum (niti)-legierung mit dem effekt der formenwiederherstellung zur herstellung von reparaturteilen und prothesen fuer den menschlichen koerper

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2703529A1 (de) * 1977-01-28 1978-08-03 Krupp Gmbh Implantat zur verbindung von trennstellen in lebendem gewebe
DE3201056C1 (de) * 1982-01-15 1983-08-11 Fried. Krupp Gmbh, 4300 Essen Marknagel
SU1147378A1 (ru) * 1982-07-19 1985-03-30 Новокузнецкий Государственный Ордена Трудового Красного Знамени Институт Усовершенствования Врачей Внутрикостный фиксатор дл остеосинтеза
SU1175460A1 (ru) * 1983-10-19 1985-08-30 Новокузнецкий институт усовершенствования врачей Устройство дл интрамедулл рного остеосинтеза
JP3013384B2 (ja) * 1990-04-13 2000-02-28 大同特殊鋼株式会社 生体用形状記憶合金
FR2727304A1 (fr) * 1994-11-28 1996-05-31 Felman Daniel Dispositif de verrouillage d'un implant intra-osseux par effet memoire de forme

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0251583A2 (fr) 1986-06-23 1988-01-07 Howmedica Inc. Système modulaire de fixation fémorale
DE4210801A1 (de) 1992-04-01 1992-11-05 Rossar Ingeneering Gbr Ges Fue Verfahren zur herstellung einer nickel-titanum (niti)-legierung mit dem effekt der formenwiederherstellung zur herstellung von reparaturteilen und prothesen fuer den menschlichen koerper

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7052498B2 (en) 1998-10-26 2006-05-30 Expanding Orthopedics, Inc. Expandable orthopedic device
US20040111090A1 (en) * 2002-10-03 2004-06-10 The University Of North Carolina At Chapel Hill Modification of percutaneous intrafocal plate system
US8979846B2 (en) 2004-04-12 2015-03-17 Navin N Thakkar Flexible nail assembly for fractures of long bones
US8663224B2 (en) 2010-09-09 2014-03-04 DePuy Synthes Products, LLC Surgical nail

Also Published As

Publication number Publication date
DE19707420A1 (de) 1998-08-27
WO1998036699A3 (fr) 1998-11-19
AU6399498A (en) 1998-09-09

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