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WO2010062379A1 - Vis de fixation de fracture osseuse, systèmes et procédés d'utilisation - Google Patents

Vis de fixation de fracture osseuse, systèmes et procédés d'utilisation Download PDF

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Publication number
WO2010062379A1
WO2010062379A1 PCT/US2009/006142 US2009006142W WO2010062379A1 WO 2010062379 A1 WO2010062379 A1 WO 2010062379A1 US 2009006142 W US2009006142 W US 2009006142W WO 2010062379 A1 WO2010062379 A1 WO 2010062379A1
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WO
WIPO (PCT)
Prior art keywords
bone
screw
head
holes
shaft
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/US2009/006142
Other languages
English (en)
Inventor
Kai U. Mazur
Stephen Gunther
Stephen R. Mcdaniel
Heber Saravia
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.)
Sonoma Orthopedic Products Inc
Original Assignee
Sonoma Orthopedic Products Inc
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 Sonoma Orthopedic Products Inc filed Critical Sonoma Orthopedic Products Inc
Publication of WO2010062379A1 publication Critical patent/WO2010062379A1/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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8695—Washers
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842—Flexible wires, bands or straps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws

Definitions

  • the present invention relates to devices and methods for providing reinforcement of bones. More specifically, the present invention relates to devices and methods for providing reconstruction and reinforcement of fractured bones.
  • Bone fractures are a common medical condition of the population. Sports and work-related accidents account for a significant number of fractures among all age groups. The incidence of fracture in the general population increases with age as osteoporosis and osteoarthritis, common in the elderly, are a significant underlying cause of fracture as well.
  • One current treatment method of bone fractures includes surgically resetting the fractured bone and then setting the bone containing body part in an external cast to immobilize the section of the body containing the fracture until the bone can mend. Casts however are uncomfortable for the wearer as they are heavy and hot and interfere with the wearing of clothes during the healing process. They also provide no internal fixation of the fracture for reinforcement purposes and rely exclusively on the immobilization of the body part to ensure that the fractured bone segments remain aligned during the healing process.
  • External fixation is another technique employed to repair fractures.
  • the fracture may be set and a rod or brace may traverse the fracture site external to the epidermis where the rod is attached to the bone with trans-dermal screws.
  • This requires multiple incisions and fixation screws and presents the opportunity for multiple infection paths.
  • the external fixation is cosmetically intrusive, bulky and prone to painful inadvertent manipulation by bumping or brushing against objects, lntermedullary nails or rods are another technique which are particularly well suited for fractures of longer, slender bones where the fracture occurs somewhere near the midpoint of the bone.
  • a metal rod is placed inside a canal of a bone and fixed in place by means of integrated or ancillary anchoring mechanisms.
  • the anchoring mechanisms attach from the inside of the canal to the compact or denser cortical bone situated at the outside surface of the bone as well as to the softer, cancellous bone located in the center of the bone.
  • the rod can be left in place or subsequently removed after the fracture has healed. While useful in situations where the fracture is situated closer to the midpoint of long, slender bones, intermedullary rods are not optimally-suited for situations where the fracture is closer to the end of the bone, especially if the smaller segment of bone is also connected to a ligament. Bone screws by themselves have long been available as a means for repairing fractures and are particularly well suited for fractures which occur close to the end of longer, slender bones where the use of an IM rod may not be well suited.
  • the fracture often results in a smaller segment of bone requiring fixation to the longitudinal axis of the longer, slender segment
  • a screw can be inserted through the smaller segment and then threaded into the longitudinal axis of the longer segment.
  • the threads and head of the screw provide compressive force along the longitudinal axis which serve to mend the fracture.
  • this compressive, longitudinal force is not sufficient to promote rapid mending because the smaller segment of bone is often attached to ligaments which provide a torsional rotating and tipping force to that segment.
  • This torsional force cannot be completely counteracted by the compressive force of the bone screw no matter how tightly it is threaded across the fracture, and as a consequence the fracture does not heal properly because of repeated disturbance of the fracture from the force applied by the ligament.
  • Suturing of small fractured segments has long been an alternative to the use of rods, nails and screws and is particularly well suited to situations where the fracture may not be completely transverse to the longitudinal access.
  • an anchor often in the form of a short screw with a through-hole in the distal portion of the shaft, may be inserted in the bone on one side of the fracture. Additional anchors may be inserted on the other side of the fracture if there is sufficient mass of bone to support an anchor at a second location. The suture is then arrayed between the anchors and across the fracture to provide compressive force across the fracture and resistance to torsional rotating and tipping forces about the smaller bone segment.
  • the suture method described also requires the creation of at least two anchor points which is not required when using just the bone screw approach.
  • fixation strength fixation stiffness
  • incision size reduction ability to treat comminuted fractures
  • treating more end of shaft fractures treating more end of shaft fractures and resistance to torsional 75 rotation and lifting forces in bone segments attached to ligaments.
  • a device and method which does not require the use of large incisions, casts or bulky eternal fixation devices for approximation and immobilization of fractures, while providing sufficient lateral stiffness and compressive fracture fixation force. Furthermore the device must not suffer from the inability to 80 counter the disruptive torsional forces exerted by ligaments on the proximal segments of fractured bones that occurs where intermedullary rods or bone screws are used by themselves. What is needed is a device and method which combines the features of a bone screw and a suture to fixate bone fractures with lateral rigidity across the fracture, compressive force along the axis, and resistance to ligament-induced torsion on the 85 proximal fractured segment.
  • the present disclosure advantageously addresses one or more of the 90 aforementioned deficiencies in the field of bone fracture fixation by providing a bone screw and suture anchoring device, and associated method, for the fixation of fractured bones.
  • the device includes a threaded shaft, a head and a plurality of suture receiving holes in the shaft and head.
  • the device may be inserted across the fracture of a bone so that the threads of the shaft can exert a compressive force upon the fractured bone 95 segments in order to fixate them and allow them to heal.
  • Sutures may then be threaded through the receiving holes in the device and also through holes drilled into the bone segments requiring fixation, then tightened and tied to provide additional fixation force to the bone segments.
  • the device and method provide longitudinal rigidity as well as resistance to rotational and
  • An embodiment of the present disclosure comprises a bone screw with a shaft
  • the head has a diameter greater than that of the shaft in order to capture the proximal bone fragment which the underside of the head contacts when advanced against the fragment. This puts the proximal fragment into compression with the opposing, main bone fragment by virtue of the force exerted on the main fragment by the threaded section of the screw
  • Suture receiving holes may be configured transversely through the unthreaded shank of the screw at a point below the head to allow for the threading of sutures through the screw. Additional suture receiving holes may be configured in the head along transverse and longitudinal axes, with those along the longitudinal axes being offset from the central axis of the screw.
  • 115 like those in the shank, may be used to receive sutures and wires which may be anchored at locations on the main fragment on the distal side of the fracture.
  • the screw head has an inner section connected to the shaft with a socket in this inner section for receiving a driving tool to rotate the screw during insertion and removal.
  • Surrounding this inner section of the head is an outer
  • the outer head is configured to rotate freely about the inner head without being capable of sliding passed the inner head along the longitudinal axis of the shaft. This configuration allows sutures to be threaded through the holes in the outer
  • the disclosure also includes a method for employing the device whereby the screw is inserted across the fracture along the longitudinal axis of the bone. This is
  • a small through hole may be drilled laterally through the bone of the main bone fragment.
  • the sutures threaded through the holes in the screw are then threaded through the lateral hole of the main bone fragment and drawn tight and tied.
  • the sutures may be configured in a cross pattern to provide additional stability and resistance to torsional forces on the proximal fragment.
  • the screws and sutures 150 may be left in place permanently or may be removed once the fracture is healed.
  • a novel and non obvious feature of the device and associated method is its combination of cross fracture fixation with suture anchoring in a single piece of hardware. This allows a single device to provide rigid resistance to opposing transverse forces on
  • Another novel feature is the freely rotating outer head, in the form or an annular ring, which surrounds the main, inner head and contains suture receiving holes.
  • the rotating outer head has teeth on the underside to aid in maintaining a fixed orientation
  • the device affords the user one or more of the following advantages.
  • FIG. 1 illustrates a side elevation of an embodiment of the device where the tip is modified to include a self tapping and threading feature.
  • FIG. 2 illustrates a bottom perspective of the device depicted in FIG. 1.
  • FIG. 3 illustrates a plan view of the device depicted in FIG. 1.
  • FIG. 4 illustrates a top perspective view of the device depicted in FIG. 1.
  • FIG. 5 illustrates a side elevation of an embodiment of the device where the tip has a blunt profile and suture through holes are located in the shaft and head.
  • FIG. 6 illustrates a plan view of the device of FIG. 5.
  • FIG. 7 illustrates a bottom plan view of the device FIG. 5.
  • FIG. 8 illustrates a side elevation of an alternate embodiment where axial bores and radial suture through holes intersect at the outer circumference of the head.
  • FIG. 9 illustrates a side perspective of the alternate embodiment of FIG. 8.
  • FIG. 10 illustrates a cross section of the head of the alternate embodiment of FIG. 8.
  • FIG. 11 illustrates a top perspective of an embodiment with freely rotating outer head section and the attached inner head with suture receiving holes in the in the outer head section.
  • FIG. 12 illustrates a bottom perspective of the alternate embodiment of FIG. 11.
  • FIG. 13 illustrates a cross section of the device illustrated in FIG. 11 along the 220 longitudinal axis.
  • FIG. 14 illustrates an exploded view of the head from the embodiment illustrated in FIG. 11 with rotating outer head separated from the inner, attached head.
  • FIG. 15 illustrates a top perspective of an alternate embodiment of the device with a self countersinking head.
  • FIG. 16 illustrates a bottom perspective of an alternate embodiment of the device with a self countersinking head.
  • FIG. 17 illustrates a top plan view of the device depicted in FIG. 15.
  • FIG. 18 illustrates a bottom plan view of the device depicted in FIG. 15.
  • FIG. 19 illustrates an embodiment of the device and an associated method of 230 use in which the device is inserted into a bone and threaded with sutures that also run through a lateral hole in the bone.
  • FIG. 20 illustrates top perspective view of the device and associated method depicted in FIG. 19.
  • FIG. 21 illustrates top down view of the device and method illustrated in FIGS. 19 235 -20.
  • FIG. 22 illustrates an embodiment of the device and associated method of use where the device is inserted across multiple fractures.
  • FIG. 23 illustrates and embodiment of the device and associated method of use where the device is inserted across multiple fractures and a suture is threaded through 240 the head of the device and lateral through holes in the in two bone fragments.
  • FIG. 24 illustrates an alternate method of use where the screws are inserted through bone into a curved hub of an intermedullary rod.
  • bone is often described as a specialized connective tissue that serves three major anatomical functions.
  • bone provides a mechanical function by providing structure and muscular attachment for movement
  • bone provides a metabolic function by
  • Bones ca be categorized as long bones (e.g. radius, femur, tibia and humerous) and flat bones (e.g. skull, scapula and mandible). Each bone type has a different embryological template. Each bone type contains cortical and trabecular bone in varying proportions. The devices of this
  • 255 invention can be adapted for use in any of the bones of the body as will be appreciated by those skilled in the art.
  • Cortical bone forms the shaft, or diaphysis, of long bones and the outer shell of flat bones.
  • the cortical bone provides the main mechanical and protective function.
  • the trabecular bone is found a the end of the long bones, or the
  • the trabecular bone consists of a network of interconnecting trabecular plates and rods and is the major site of bone remodeling and resorption for mineral homeostasis and is typically less dense than cortical bone.
  • the bone segments are positioned in proximity to each other, called approximation, in a manner that enables woven bone to be laid down on the
  • This finely woven bone lacks the organized structure of either cortical (dense) or cancellous (spongy) bone.
  • fracture fixation devices such as the screws described in this disclosure are used to repair the fracture, access to the surface of the bone fragments is accomplished through surgical techniques. The segment or fragment of bone on the side of the fracture through which the fixation device
  • proximal segment segment of bone on the opposing side of the fracture is regarded as the distal segment.
  • the present disclosure is directed to a bone fracture fixation screw and method
  • an embodiment of the device 340 can comprise a shaft with a threaded section 350 and an unthreaded shank section 352, a tip 353, and a head 346.
  • Suture and wire receiving holes may be arrayed in a variety of configurations in the head 346 and shank 352 to accommodate various techniques for threading and tying sutures.
  • the head 346 further comprises a
  • the head 346 of the screw 340 can be configured in a plurality of shapes and equipped with cutting surfaces on the underside of the head to aid in countersinking the screw into the bone.
  • the tip 353 of the screw may be configured in a plurality of profiles and can be configured with a self tapping and threading feature 354 to aid in insertion.
  • the shaft comprises a cylindrical column extending 295 between a tip 353 and a head 346 of the screw 340. It comprises a threaded section
  • the shaft 350 which may extend the entire length of the shaft, and an unthreaded section 352, the shank, in the case where the threaded section extends only from the tip to some intermediate point along the shaft.
  • the shaft may be configured in a plurality of lengths and diameters depending on the size of the bone the device is intended for and the
  • the threads may be configured in a variety of pitches and thread depths to accommodate bones of different hardness and may be further configured to have an outside diameter greater than, equal to or lesser than the shank of the shaft.
  • the shaft may further comprise suture receiving holes
  • the tip 353 of the screw is located at the distal end of the shaft and may be configured with a blunt profile as in FIG. 5, or a pointed profile as in FIG.16, or an intermediate profile as in FIG. 1 where the tip 353 is partially conical but the end is nonetheless blunted.
  • the tip 353 may also be configured with a self-tapping and self threading cutting element 354 as depicted in FIGS. 1,2. This element is formed by the
  • the head 346 is connected to the proximal end of the shaft and as depicted in
  • FIG. 3 and comprises a socket 348 for accepting a driving tool, and a plurality of suture receiving holes 342, 344 for threading sutures or wires.
  • the suture receiving holes 344 may be arrayed axially and offset from the center axis, laterally and offset from the center axis 342, or as in FIGS. 8-10, radially and intersecting 396.
  • the axial, lateral and radial holes may be configured singularly or in multiples.
  • the head may comprise two parts, a fixed inner head 376 attached to the proximal end of the shaft, and freely rotating outer head 374 in the form of an annular ring that can rotate about the inner head 376 and can translate axially toward the tip 354 of the screw but cannot translate axially past the inner head 376.
  • the inner head 376 further comprises a socket for receiving a driver 335 and an outside axial surface 380 that is angled so that the circumference of the top of the inner head 376 is greater than the circumference of the bottom of the inner head 376.
  • the inside surface 389 of the outer head is sized and angled to mate with the sloping outside surface 380 of the inner head so that the inner head can rotate freely passed the outer head but not pass through the outer head.
  • the outer head 376 may further include
  • 340 a plurality of suture receiving holes 342, 344 oriented axially and laterally through the outer head for the purpose of receiving sutures and wires.
  • the head 212 may also include one or more cutting surfaces 214 on the underside of the head to aid in creating a countersink in the bone so that the screw may not protrude above the surface of the bone after it is inserted.
  • cutting surfaces 214 comprise conical surfaces 218 that form a 65 degree angle with the top of the head 212. These same features form a 50 degree included angle with each other. In other embodiments not shown, the conical surface 218 may form a 30, 45, 60 or 75 degree with the top surface. In other embodiments, the angle may be between 0 and 90 degrees, inclusive.
  • the cutting surfaces 218 may be ground, sheared, milled,
  • leading surfaces 220 may form a compound angle with the longitudinal axis of the screw 210.
  • the longitudinal component of the compound angle may be equivalent to the conical angle of head 212 (i.e. 65 degrees in the embodiment shown), as best seen in FIG 18.
  • each leading surface 220 forms an angle ⁇ of about 30 degrees with a tangent line at the outer circumference of the head 212 when viewed axially, as shown in FIG. 18.
  • the wide section of each cutting surface 214 is 1/8 of the radius of the maximum circumference of the head 212.
  • the device is intended to be self tapping 365 and self countersinking and thus comprises a threaded shaft, a pointed tip with self tapping element 216, a flat profile head 212 which further comprises a socket 206 and a plurality of cutting surfaces 218.
  • This embodiment contains no suture receiving holes in either the shaft or the head.
  • FIG. 1 An alternate embodiment is depicted in FIG. 1 , where the device 340 includes a 370 shaft with a threaded section 350 and an unthreaded shank section 352, a partially pointed tip with self threading cutting surface 354, a head 346 with laterally offset suture receiving holes 342, and axial wire receiving holes 344.
  • the head 346 further comprises a socket for receiving a driving tool.
  • FIGS. 11 -14 another embodiment of the present invention will be described.
  • screw 372 similar in construction to screw 340 described above is provided.
  • screw 372 includes two suture receiving holes 342 formed laterally through the head and two wire holes 344 formed axially through the screw head as described above.
  • screw 372 is provided with a two-part head, a fixed inner head 376 attached to the proximal end of
  • the inner head 376 further comprises a socket 348 for receiving a driver and an outside axial surface 380 that is angled so that the circumference of the top of the inner head 376 is greater than the circumference of
  • the inside surface 389 of the outer head 374 is sized and angled to mate with the sloping outside surface 380 of inner head 376 so that the inner head 376 can rotate freely passed the outer head 374 but not pass through the outer head 374.
  • the outer head 374 may further include a plurality of suture and wire receiving holes 342, 344 oriented axially and laterally through the outer head 374 for the
  • the underside of the outer head 374 may also be provided with one or more spikes 382 for engaging with the bone so that its orientation with respect to the bone that it contacts remains fixed when pressure is applied to it by the advancing and rotating inner head 376. In this manner the two part head of screw 372 allows the screw to be loosened and tightened without changing the
  • suture and wire receiving holes 342, 344 to be oriented as desired and remain independent from screw tightening or loosening.
  • the device 384 includes a shaft with a threaded and an unthreaded shank section, and a tip 353 with a blunted
  • the shaft is configured with six radial holes 388 at the top of the shank.
  • the holes are arranged in two rows of three and extend transversely through the shank of the screw 384, with the holes of each row intersecting with each other at the center axis of the screw.
  • the head 390 is configured with six axial holes 386 which are parallel to, offset from and equally spaced around a central longitudinal axis of the screw 384.
  • Holes 386 and 388 may each be configured to receive sutures or wires.
  • the abundance of holes provided in screw 384 allows a surgeon to choose from a variety of hole orientations to suit each particular situation and/or allows many sutures and wires to be anchored to each screw 384 where fixation of multiple bone fragments may be required.
  • FIGS. 8 -10 another embodiment of the invention is shown.
  • Screw 392 is provided with four axial holes 394 and two radial holes 396.
  • axial holes 394 are parallel to, offset from, and equally spaced around a central longitudinal axis of screw 391, and extend through head 398.
  • Radial holes 396 extend transversely through the head 398, intersecting each other at the central axis of screw 392.
  • Holes 386 and 388 may each be configured to receive sutures or wires.
  • Axial bores 400 may be provided at each circumferential exit point of radial holes 396 to provide clearance for sutures or wires extending through radial holes 396, so that the sutures or wires do not get pinched between the screw head and bone as the screw head 398 is tightened against the bone.
  • the device may be made from a variety of materials such as metal, composite,
  • plastic or amorphous materials which include, but are not limited to, steel, stainless steel, cobalt chromium plated steel, titanium, nickel titanium alloy (nitinol), superelastic alloy, and polymethylmethacrylate (PMMA).
  • the device may also include other polymeric materials that are biocompatible and provide mechanical strength, that include polymeric material with ability to carry and deliver therapeutic agents, that include bioabsorbable
  • the device may further be coated with
  • proteins from synthetic or animal source or include collagen coated structures, and radioactive or brachytherapy materials.
  • the construction of the supporting framework or device may include radio-opaque markers or components that assist in the location during and after placement in the bone.
  • Implantable bone screw 320 is provided with transverse holes 322, each formed through
  • Screw 320 is driven through the proximal end 326 of the ulna 316 towards the distal bone segment, generally along the longitudinal axis of the bone. Screw 320 may bridge fracture 314 and engage with the main portion 328 of the ulna 316. A hole may first be prepared through the proximal bone portion 326 having a diameter larger than the maximum thread diameter of screw
  • screw 320 may be slidably received through the screw hole in proximal bone segment 326 and threadably engage the main bone portion 328.
  • screw 320 is tightened, fracture 314 is approximated and screw 320 provides compressive fixation to keep proximal bone segment 326 from moving away from the main bone portion 328. This same result may be achieved be eliminating screw threads,
  • screw 320 may threadably engage both bone portions 326 and 328.
  • Screw 320 may then provide compressive fixation to keep proximal bone segment 326 from moving away from main bone segment 328, and also provide tensile force to keep proximal bone segment 326 from moving closer to main bone segment 328. This latter arrangement may be desirable for fixating comminuted fractures.
  • a suture 330 may be placed
  • a hole 332 may be drilled laterally through the main bone portion 328, as shown, to provide an anchor point for the other end of suture 330.
  • Suture 330 may be threaded in a figure-eight pattern and tightly tied to provide additional fixation and resistance to rotational and lifting torque.
  • Screw 320 may be left with its head protruding from the bone 316 as shown, or it may be
  • sutures 330 may be omitted, with screw 320 providing all of the bone fixation. When no suture is used, the incision size may be reduced since no suture hole
  • screw 320 may be provided with 0, 1, 2, 3, 4 or more cross holes for receiving sutures.
  • screw 340 may be inserted in a generally axial direction through a long bone, such as an ulna 316.
  • a long bone such as an ulna 316.
  • the screw 340 traverses fractures 356 and 358.
  • bone segments 360 and 362 are captured and secured to the main segment 364 of ulna 316.
  • Bone segments 360 and 362 may be further secured by using sutures 330, shown in FIG. 23.
  • transverse holes 366 and 368 may be formed in bone segment 362 and the main bone segment 364, respectively.
  • a rigid wire 308 may be inserted through one or both of the wire receiving holes 344 and into the bone segment 370, as shown in FIG 23.
  • screw 340, suture 330 and rigid wire 308 cooperate to fully fixate the comminuted fracture.
  • FIG. 24 This method is shown in FIG. 24.
  • the fractured bone is approximated and the intermedullary fixator positioned across the fracture. Lateral holes are then drilled through the bone so as to intersect with preexisting holes in the hub 112 of the rod 100 that have been positioned so as to receive
  • the fixating screws of the present disclosure are then inserted through the bone holes and the receiving holes in the hub of the rod.
  • the cutting surfaces on the underside of the head serve to create a countersink cavity in the surface of the bone so that the screw may be positioned flush or recessed in the bone.
  • the cutting surfaces may also seat into the hub 112 of the rod 100 thereby creating a locking

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Abstract

L'invention concerne une vis osseuse (372) et un dispositif d'ancrage de suture ainsi qu'un procédé associé, pour la fixation d'os fracturés. Le dispositif comprend une tige filetée (377), une tête (376) et plusieurs trous (342, 344) de réception de suture prévus dans la tige et dans la tête. Le dispositif peut être inséré à travers la fracture d'un os de telle sorte que les filets de la tige (377) exercent une force de compression sur les segments de l'os fracturé de manière à les fixer et leur permettre de cicatriser. Les sutures peuvent alors être passées dans les trous de réception (342, 344) du dispositif et également dans des trous forés dans les segments de l'os qui doivent être fixés, pour ensuite être serrées et liées de manière à exercer une force de fixation supplémentaire sur les segments de l'os. La combinaison des fonctions des vis osseuses et de l'ancrage de sutures dans le même dispositif et le procédé de filetage des sutures minimisent l'équipement nécessaire pour réaliser la fixation et réduisent l'invasivité de la procédure.
PCT/US2009/006142 2008-11-25 2009-11-17 Vis de fixation de fracture osseuse, systèmes et procédés d'utilisation Ceased WO2010062379A1 (fr)

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US11790108P 2008-11-25 2008-11-25
US61/117,901 2008-11-25

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WO2010062379A1 true WO2010062379A1 (fr) 2010-06-03

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Cited By (25)

* Cited by examiner, † Cited by third party
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US8961518B2 (en) 2010-01-20 2015-02-24 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
GB2518545A (en) * 2012-11-14 2015-03-25 Harold M Wotton Iii Bone anchor
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WO2016044053A1 (fr) * 2014-09-19 2016-03-24 Crossroads Extremity Systems, Llc Implant de fixation osseux et moyens de fixation
US9517093B2 (en) 2008-01-14 2016-12-13 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US9730739B2 (en) 2010-01-15 2017-08-15 Conventus Orthopaedics, Inc. Rotary-rigid orthopaedic rod
US9757173B2 (en) 2009-11-23 2017-09-12 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
US9820777B2 (en) 2014-07-09 2017-11-21 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
US10022132B2 (en) 2013-12-12 2018-07-17 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
US10136929B2 (en) 2015-07-13 2018-11-27 IntraFuse, LLC Flexible bone implant
US10154863B2 (en) 2015-07-13 2018-12-18 IntraFuse, LLC Flexible bone screw
CN109091218A (zh) * 2018-09-05 2018-12-28 陕西创信金属科技有限公司 一种具有内螺纹头部的医用钛合金固定螺钉
CN109906056A (zh) * 2016-10-25 2019-06-18 德普伊新特斯产品公司 用于骨板的缝合连接系统
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US10499960B2 (en) 2015-07-13 2019-12-10 IntraFuse, LLC Method of bone fixation
US10918426B2 (en) 2017-07-04 2021-02-16 Conventus Orthopaedics, Inc. Apparatus and methods for treatment of a bone
WO2021137824A1 (fr) * 2019-12-31 2021-07-08 Selcuk Universitesi Vis canulée supportée par câbles
CN114601515A (zh) * 2020-12-04 2022-06-10 镱钛科技股份有限公司 缝合锚钉与其系统及植入方法
CN115317161A (zh) * 2022-06-29 2022-11-11 山东大学 一种用于角化组织增宽的手术缝合固定装置及使用方法
US20240261009A1 (en) * 2021-06-22 2024-08-08 Smith & Nephew, Inc. Self-countersinking bone fastener and method for countersinking a bone fastener used in connection with an orthopedic implant
WO2025003070A1 (fr) * 2023-06-26 2025-01-02 Naviswiss Ag Dispositif de fixation pour fixer une aide à la navigation à un os

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US10603087B2 (en) 2008-01-14 2020-03-31 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US9788870B2 (en) 2008-01-14 2017-10-17 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US9517093B2 (en) 2008-01-14 2016-12-13 Conventus Orthopaedics, Inc. Apparatus and methods for fracture repair
US10130404B2 (en) 2009-11-23 2018-11-20 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
US9757173B2 (en) 2009-11-23 2017-09-12 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
US9730739B2 (en) 2010-01-15 2017-08-15 Conventus Orthopaedics, Inc. Rotary-rigid orthopaedic rod
US9848889B2 (en) 2010-01-20 2017-12-26 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
US8961518B2 (en) 2010-01-20 2015-02-24 Conventus Orthopaedics, Inc. Apparatus and methods for bone access and cavity preparation
US9993277B2 (en) 2010-03-08 2018-06-12 Conventus Orthopaedics, Inc. Apparatus and methods for securing a bone implant
US8906022B2 (en) 2010-03-08 2014-12-09 Conventus Orthopaedics, Inc. Apparatus and methods for securing a bone implant
CN104080416A (zh) * 2012-01-24 2014-10-01 新特斯有限责任公司 压紧螺钉系统
US11197667B2 (en) 2012-01-24 2021-12-14 DePuy Synthes Products, Inc. Compression screw system
GB2518545A (en) * 2012-11-14 2015-03-25 Harold M Wotton Iii Bone anchor
US9962208B2 (en) 2012-11-14 2018-05-08 Steris Instrument Management Services, Inc. Bone anchor
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US10285746B2 (en) 2012-11-14 2019-05-14 Steris Instrument Management Services, Inc. Bone anchor
CN103169512A (zh) * 2013-03-26 2013-06-26 雷青 一种用于软组织修复固定的多线孔锚钉
US10022132B2 (en) 2013-12-12 2018-07-17 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
US10076342B2 (en) 2013-12-12 2018-09-18 Conventus Orthopaedics, Inc. Tissue displacement tools and methods
CN104027140A (zh) * 2014-05-09 2014-09-10 苏州瑞华医院有限公司 一种三孔带线锚钉
JP2017524447A (ja) * 2014-07-09 2017-08-31 デピュイ・シンセス・プロダクツ・インコーポレイテッド 可撓性上下顎固定デバイス
CN110559068A (zh) * 2014-07-09 2019-12-13 德普伊新特斯产品公司 柔性上下颌骨固定装置
CN110559068B (zh) * 2014-07-09 2022-05-10 德普伊新特斯产品公司 柔性上下颌骨固定装置
WO2016007415A3 (fr) * 2014-07-09 2016-03-17 DePuy Synthes Products, Inc. Dispositif flexible pour une fixation maxillo-mandibulaire
US10064654B2 (en) 2014-07-09 2018-09-04 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
US9820777B2 (en) 2014-07-09 2017-11-21 DePuy Synthes Products, Inc. Flexible maxillo-mandibular fixation device
JP2019213924A (ja) * 2014-07-09 2019-12-19 デピュイ・シンセス・プロダクツ・インコーポレイテッド 可撓性上下顎固定デバイス
WO2016044053A1 (fr) * 2014-09-19 2016-03-24 Crossroads Extremity Systems, Llc Implant de fixation osseux et moyens de fixation
US10582957B2 (en) 2014-09-19 2020-03-10 Crossroads Extremity Systems, Llc Bone fixation implant and means of fixation
US10136929B2 (en) 2015-07-13 2018-11-27 IntraFuse, LLC Flexible bone implant
US10499960B2 (en) 2015-07-13 2019-12-10 IntraFuse, LLC Method of bone fixation
US10492838B2 (en) 2015-07-13 2019-12-03 IntraFuse, LLC Flexible bone implant
US10485595B2 (en) 2015-07-13 2019-11-26 IntraFuse, LLC Flexible bone screw
US10154863B2 (en) 2015-07-13 2018-12-18 IntraFuse, LLC Flexible bone screw
CN109906056A (zh) * 2016-10-25 2019-06-18 德普伊新特斯产品公司 用于骨板的缝合连接系统
US11039825B2 (en) 2016-10-25 2021-06-22 DePuy Synthes Products, Inc. Plate holes suture connection
CN109906056B (zh) * 2016-10-25 2021-09-07 德普伊新特斯产品公司 用于骨板的缝合连接系统
US10918426B2 (en) 2017-07-04 2021-02-16 Conventus Orthopaedics, Inc. Apparatus and methods for treatment of a bone
CN109091218A (zh) * 2018-09-05 2018-12-28 陕西创信金属科技有限公司 一种具有内螺纹头部的医用钛合金固定螺钉
WO2021137824A1 (fr) * 2019-12-31 2021-07-08 Selcuk Universitesi Vis canulée supportée par câbles
CN114601515A (zh) * 2020-12-04 2022-06-10 镱钛科技股份有限公司 缝合锚钉与其系统及植入方法
US20240261009A1 (en) * 2021-06-22 2024-08-08 Smith & Nephew, Inc. Self-countersinking bone fastener and method for countersinking a bone fastener used in connection with an orthopedic implant
US12453589B2 (en) * 2021-06-22 2025-10-28 Smith & Nephew, Inc. Self-countersinking bone fastener and method for countersinking a bone fastener used in connection with an orthopedic implant
CN115317161A (zh) * 2022-06-29 2022-11-11 山东大学 一种用于角化组织增宽的手术缝合固定装置及使用方法
WO2025003070A1 (fr) * 2023-06-26 2025-01-02 Naviswiss Ag Dispositif de fixation pour fixer une aide à la navigation à un os

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