CN1997322A - System for stabilization of fractures of convex articular bone surfaces including subchondral support structure - Google Patents

Abstract

A fracture fixation system is provided for a fracture of a head portion of a long bone which has subchondral bone defining a convex articular surface. The system includes a plate element positionable on the long bone substantially opposite the head portion of the long bone and on a first side of the fracture, and a post coupled to the plate and into the head portion of the bone and across the fracture.

Description

Be used to comprise the stabilisation systems of the convex articular bone surface fracture of cartilage lower support structure

The cross reference of related application

The application requires the priority of following interim U.S. Patent application: submitted January 23 in 2004 60/538,589, submit 60/598/110, the 2005 year January 7 of submitting 60/546,127,2004 year August 2 of submitting February 20 in 2004 _ _ _ _ _ _ _ _ _ _ _ _ (attorney docket HAN-034P).

Technical field

Present invention relates in general to surgical device.More particularly, the present invention relates to bone fracture fixation system, it comprises trim panel and is used for this plate is fixed in associated fasteners on bone and the tendon.

Background technology

Proximal humerus comprises the top of humerus, and promptly the human body upper arm generally is referred to as shoulder regions.Proximal humeral fracture is generally by due to the wound, as the accident that in sports, takes place, and can be with advancing age owing to osteoporosis is easier to take place.The treatment of proximal humeral fracture exposes by fracturing a little and the bone crack is resetted then plate or other device placed and it healed the crack at reset position on the bone to carry out.The crack resetted comprise its original position or similar settling position are proofreaied and correct and be positioned to the breaking portion of bone.The crack fixedly comprised on the bone that plate placed on the breaking portion and be fixed on fracture and the contiguous not fractured bones with bone screw.

There are several shortcomings in conventional fixing head when being used for proximal humerus.In general, their profile is not very to meet human anatomy, and must provide that structural rigidity is difficult when stablize the fissured size of humerus to be formalized by the surgeon being located at.In addition, such fixing head requires large-scale bone screw, and this bone screw can not provide fulcrum on the osteoporotic bone of bottom.

Especially, two kinds of plates that conform to the proximal humerus profile are locking proximal humerus plate (LPHP) and PHILOS of the Synthes company production in Paoli city, Pennsylvania.These plates comprise the nearly head part of holding several fixed angles firmwares, and these fixed angles firmwares stretch into the round end of humerus, and this humerus is perpendicular to articular surface and can be threaded with this plate.Especially, in osteoporotic bone, firmware often pierces through bone and enter the head of humerus and the space, joint between the shoulder joint nest, will cause the injury of great pain and surgery that may be bigger like this.This injury may hinder, prolongs or stop the normal healing of humeral fracture, and can cause bigger misery of patient and the arthritic generation of back wound.

Summary of the invention

Therefore, an object of the present invention is to provide a kind of humeral fracture fixed system that is suitable for humerus automatically.

Another object of the present invention provides a kind of humeral fracture fixed system, and this system provides a kind of stable frame of supporting proximal humeral fracture.

A further object of the present invention provides a kind of humeral fracture fixed system, in this system, passes the firmware of plate extension and can't wear out articular surface.

A further object of the present invention provides a kind of humeral fracture fixed system, and this system helps firmware and aims at the head of humerus.

A further object of the present invention provides a kind of humeral fracture fixed system, this system firmware is correctly implanted humerus the time provide a kind of sense of touch to the surgeon.

These purposes will be described in detail below, according to these purposes, provide a kind of humeral fracture fixed system, and this system comprises that a plurality of os integumentale screws and a plurality of being used for are connected to humerus and the post that fracture is stable with plate.Preferred this system also comprises K line and suture material, and these K lines and suture material will be described below.

This plate is provided with a plurality of posts hole.Each post hole is provided with a post, the head part that post extends and passes plate, and the head of this plate partly is generally perpendicular to the articular surface of shoulder.According to a preferred aspect of the present invention, post can be provided with bracing or strutting arrangement, and this bracing or strutting arrangement is used for the subchondral bone on support joint surface.When being provided with this bracing or strutting arrangement, this post comprises head, and preferably this head can be fixed with the special direction of rotation with respect to the post hole, so that this bracing or strutting arrangement is always with special direction orientation, and preferably aims at front-back with respect to this plate and anatomy.

According to another preferred aspect of the present invention, this head partly comprises a plurality of mating holes, and these mating holes closely hold independent K line with big minispread and according to special direction.When being connected to the head part of plate, passing the direction of axle of these mating holes and the direction of K line that these mating holes are passed in insertion thereafter and closely meet the space that limits by these posts.

After the reduction of the fracture and before being the cylindrical drill hole, the surgeon passes the aligning hole drill K line on the wrench portion part, is temporarily fixed at the head of humerus with the direction with wrench portion.In case will aim at so fixingly, fracture is checked, as carried out fluoroscopic examination, to determine that whether fracture resets in correct mode and whether the K line is correctly aimed at respect to anatomy.Viewed K line shows whether post will be correctly directed with respect to fracture and articular surface in fluoroscopic examination.If arrange correct, so, when giving the cylindrical drill hole K line position of plate will be remained on fracture above.If arrange unsatisfactoryly, so, the K line can be removed, and the surgeon also has an opportunity the K line reorientated and or redirect and can hole once more.Because the diameter of every K line is less relatively, so bone can be owing to boring procedure be subjected to very big damage, and the surgeon is not subjected to initial location and or directed constraint yet.In a single day plate is correctly located with the K line, so just plate, post and bracing or strutting arrangement (if being provided with bracing or strutting arrangement) can be implanted, and the K line can be removed.

According to another preferred aspect of the present invention, this head partly comprises low near-end kerve and a plurality of stitching guider, near a plurality of stitching guiders a plurality of holes is arranged.Low near-end kerve from bone surface, passes suture guides between these stitching guiders and plate and the bone so that the surgeon will have the pin of suture material, with permission tendon and bone fragments is sewn onto on the plate.

After fixed system was implanted, these posts did not penetrate articular surface but do not extend too far with the direction orientation perpendicular to articular surface.

To concrete introduction of the present invention and in conjunction with the accompanying drawings, those of skill in the art can know the advantage of these and others of the present invention by hereinafter.

Description of drawings

Fig. 1 is the perspective view according to the embodiment of proximal humerus fixed system of the present invention.

Fig. 2 is the schematic section of the deployable post of embodiment among Fig. 1, and this figure illustrates with non-deployment configuration;

Fig. 3 is the schematic section of the deployable post of embodiment among Fig. 1, and this figure illustrates with deployment configuration;

Fig. 4 is the schematic section of the deployable post of embodiment among Fig. 1, and this figure illustrates to discharge structure;

Fig. 5 is the longitdinal cross-section diagram of deployable another embodiment of post, in the non-deployment configuration deployable anchors is arranged;

Fig. 6 A is the perspective view of the rear end of deployable post among Fig. 5;

Fig. 6 B is the longitdinal cross-section diagram of the rear end of deployable post among Fig. 5;

Fig. 7 is the perspective view of the central canal of deployable post among Fig. 5;

Fig. 8 is the perspective view at the tip far away of deployable post among Fig. 5;

Fig. 9 is the perspective view of the guide rod of deployable post among Fig. 5;

Figure 10 is the perspective view of the coupling of deployable post among Fig. 5;

Figure 11 is the perspective view of the bone anchors of deployable post among Fig. 5;

Figure 12 is the longitdinal cross-section diagram of deployable post among Fig. 5, and this figure illustrates with the part deployment configuration;

Figure 13 is the longitdinal cross-section diagram of deployable post among Fig. 5, and this figure illustrates with whole deployment configuration;

Figure 14 is the perspective view of another kind of system among the present invention, and this system illustrates to have the deployable post of constructing among Figure 13;

Figure 15 is the perspective view of the cam of system among Figure 14;

Figure 16 is the plane graph of the plate of system among Figure 14;

Figure 17 is along the longitdinal cross-section diagram that is shown in the 17-17 line of Figure 16;

Figure 18 is the perspective view of another kind of system among the present invention, and this system illustrates with the post with deployment configuration;

Figure 19 is the perspective view that is used for the rear end of the expansion post in Figure 18 system;

Figure 20 is the longitdinal cross-section diagram of rear end among Figure 19;

Figure 21 is the rear end of system among Figure 18 and the incomplete partial section of amplification of dog screw;

Figure 22 is the incomplete partial cross section perspective view of system among Figure 18;

Figure 23 is the lateral perspective view that is illustrated in another embodiment of the proximal humeral fracture fixed system of the present invention on the appropriate location of bone;

Figure 24 is the perspective view of the plate of system among Figure 23;

Figure 25 is the vertical view of fixed system among Figure 23, and shown fixed system is implanted;

Figure 26 is the medial view of the bone of fixed system from Figure 23;

Figure 27 is another view of implanting fixed system among Figure 23;

Figure 28 is similar to the view that illustrating of Figure 25 has the system that launches anchor;

Figure 29 is similar to the view that illustrating of Figure 26 has the system that launches anchor;

Figure 30 is the perspective view that another embodiment of proximal humeral fracture fixed system of the present invention is shown;

Figure 31 is the schematic section according to the nail-plate embodiment of proximal humerus fixed system of the present invention.

The specific embodiment

Referring to Fig. 1, there is shown embodiment according to proximal humeral fracture fixed system 510 of the present invention.System 510 comprises humerus plate 512, and humerus plate 512 has one or more posts hole 536 and along its shaft portion 530 a plurality of screw holes 532 arranged in its head part 534.Each post hole 536 is provided with tubulose post 514.Referring to Fig. 1 and Fig. 2, post 514 comprises a pair of arm 560, and this rotatably connects around axle 561 arm 560, these 561 far-ends 562 that are adjacent to post 514.Also can provide embodiment with three or more arms.Each arm 560 comprises the cam that is adjacent to its rotating shaft 561 substantially driven surperficial 564.As shown in Figure 1 with following described like that, when cam driven surperficial 564 was subjected to power along far-end and horizontal direction, arm 560 just moved into radially in the open configuration.Post 514 comprises window 566, and with when arm 560 is in the close position (Fig. 2), arm 560 can flush on the remaining part that is positioned at post.Referring to Fig. 2, this post also comprises female thread 568.

Referring to Fig. 3, dog screw 570 is provided, this dog screw 570 is with female thread 568 engagements and comprise far-end, and this far-end is provided with cam 572, and this cam 572 is used for contacting cam driven surperficial 564 and arm 560 is radially outward moved into this open configuration.In this open configuration, each arm 560 can be 90 ° of extensions substantially with respect to post 514, promptly is parallel to this pass pitch plane generally also preferably in this front-back.But, more preferably the angle between each arm 560 and the post 514 is an acute angle, preferred about 60 ° to 89 °, so that these arms approach the articular surface profile of humerus head better.When these arms were surrounded by bone, this bone normally allowed these arms to pass resilient or fragility osteoporotic (osteoporotic) bone that moves therebetween.These arm 560 relative broads shown in the figure and in case great stability is provided and provides support to fracture when moving in this open configuration to articular bone surface.But, for the ease of passing the mobile of bone, the comparable relative narrower that illustrates in the drawings of these arms.And dog screw also can comprise and window 566 aligned boring 574 and distal openings 576, preferred biodegradable bone cement or other preferred fast fixedly filler can by these windows 566 be injected into by the opening of arm 560 (as among the figure with shown in the arrow) among the space that produced, so that other stability to be provided to reseting fracture.

Referring to Fig. 4,, so just dog screw 570 is got loose and, then post is pulled out from bone from post 514 dismountings if after implanting, be necessary or wish post 514 and arm thereof 560 are removed from bone.After dog screw 570 was removed, these arms 560 just can make progress and rotate towards the upper end of window 566, and rest in when post is withdrawn on the far-end 562 of post 514.

Referring to Fig. 5 to Figure 11, there is shown the another kind of post 714 that launches at these.Outer section of post 714 comprises nearly pipe rear end 802 (Fig. 6 A and 6B), central canal 804 (Fig. 7) and most advanced and sophisticated 806 (Fig. 8) far away.Referring to Fig. 6 A and 6B, rear end 802 comprises the head 807 with reference configuration, as fan-shaped notch 808, with respect to the humerus plate with post 802 rotatory orientations (as described in detail below) and progressively be reduced to mid diameter part and smaller diameter portion 809 and 810.Smaller diameter portion 810 limits two complete relative grooves 812.The far-end of rear end 802 also comprises female thread 817.Pipe 804 is positioned at the top of smaller diameter portion 810 and comprises two wings 814 that point to far-ends, and these two wings 814 mesh and will manage 804 and are locked on the rear end 802 and with the mid diameter part 809 of rear end 802 and flush engagement in groove 812.Pipe 804 comprises pair of windows 852.The tip 806 that to describe in detail in the back puts in pipe 804 far-end and is fixed on appropriate location on this pipe by pin 818, and pin 818 extends through the holes 819 and 821 and most advanced and sophisticated 806 in the pipe 804 respectively.

Referring to Fig. 5 and Fig. 9, in the rear end 802 of post 714, be provided with guide rod 820.Guide rod 820 comprise nearly mesh sleeve 822, with the thread center's part 823 and the far-end classification head part 824 of female thread 817 engagement of rear end 802, nearly mesh sleeve 822 as square or Hexagonal jacket, is convenient to instrument guide rod 820 with respect to rear end 802 rotations.Head part 824 is kept by nested 826 of coupling 828 and can be with respect to nested 826 rotation.Coupling 828 is limited by two hermaphroditic element 829, each hermaphroditic element 829 comprise with like on the corresponding component post 834 and the sleeve 836 that are complementary.Each hermaphroditic element 829 also limit track 837 and or groove 838, the part of anchor 840 be connected to track 837 and or groove 838 in and removable, as described below.

Referring to Figure 11, bone anchors 840 comprises nearly wheel shaft 842, and these nearly wheel shafts 842 are with big minispread, advancing in the groove 838 of coupling 828, and has rear end 843, and rear end 843 is designed for along the track 837 of this coupling and moves.These anchors 840 are along the arc bending, and each anchor has the relatively bone cutting tip 844 of point.Preferred these anchors are made with metal, but but also can make with the stiff materials of pottery or bio-absorbable.Referring to Fig. 8 and Figure 11, most advanced and sophisticated 806 limit two anchor guide rods 850, and each anchor guide rod 850 has the corresponding sweep of sweep with the convex side of anchor 840.Pipe 804 limits two windows 852, and window 852 is corresponding with the cross-sectional shape of anchor 840, and these anchors 840 can pass these two windows 852 and move forward from post 714.

Referring to Figure 12 and Figure 13, move forward and pass to guide rod 820 rotatory rear end 802, therefore cause coupling 828 to move forward and pass pipe 804.When coupling 804 moves forward, just anchor 840 is promoted, contacts guide rod 850 forward and depart from window 852 (Fig. 7) with outward direction, promptly cross the axle of post 714 substantially.According to an aspect of the present invention, move forward and during around wheel shaft 842 rotation, their rotating shafts in pipe 804 change at anchor 840, especially with respect to the initial direction shown in Fig. 5 (as on coupling by shown in the imaginary circle labelling).This obtains wheel shaft 842 laterally cooperation of locomotivity in the groove 838 of coupling 828.Referring to Figure 13, when all launching, preferred anchor 840 is outwards outstanding to manage between 2 to 3.5 times of 804 diameter.In a preferred embodiment, the diameter of pipe 804 is 4mm, and each anchor 840 outstanding about 10mm.

Referring to Figure 14, shown proximal plate 702 has a plurality of posts that are connected thereto 714 and unfolded anchor 840.Can in any suitable manner these posts 714 be locked onto plate 702.But, preferably with these posts 714 with respect to plate 702 locking, can pre-determining the direction of launching anchor 840, like shownly be parallel to each other like that on the whole.And, preferably these posts 714 are locked with respect to plate 712, and between them, be not threaded, because being difficult to machining screw connects, in this being threaded: (i) parts firmly are rigidly connected to together; (ii) the direction of rotation of post can pre-determine when locking for certain.However, to be connected be possible to machining screw certainly between post and plate, and within the scope of the present invention, in this being threaded, be furnished with inlet point and destination node, and has desired tolerance, to obtain identical result, i.e. predetermined direction of rotation when being completely fixed post onboard.

According to the preferred aspect of present embodiment, more preferably generation within 0 ° to 90 ° takes place with respect to of post hole 736 in being locked in less than post 714 between preferred post 714 and the post hole 736 separately fully within the rotation.

A kind of method that locks these posts is to utilize cam that each post is locked in the plate.Referring to Figure 15, preferred cam 856 is cylindrical usually, but has outer wall 858, and the radius of this outer wall 858 is formula increase in the shape of a spiral near about 270 ° of this cam circumference.Cam 856 also comprises the lower pin (not shown) and is used for the last hexagonal groove 860 of driver that this cam is around this lower pin rotation.

Referring to Figure 14, Figure 16 and Figure 17, for each post 714, plate 702 comprises post hole 736 and has the adjacent concavo-convex recessed cam slot 862 of centre bore 863 that this adjacent concavo-convex recessed cam slot 862 is held centrepin.Because the profile of cam 856 and cam slot 862 is so in case cam is contained among the cam slot, cam just is substantially limited in the cam slot.Before post 714 is inserted post hole 736, with cam 856 rotations, so that the orientation column hole, position of its least radius.Pass post hole 736 and hold post 714, determine that its direction is installed in cam 856 outer periphery with the fan-shaped notch 808 that will be positioned at this post rear end 802, and post 714 is pushed the post hole fully.Come rotating cam 856 with driver then, contact, thereby enough contacts are provided between them and effectively post 714 are locked onto plate 702 to be cut into cam bigger to provide between fillet part and this post.

Referring to Figure 18 to Figure 20, these illustrate post another embodiment with respect to the system of plate rotatory and axial locking.According to this system, the post 714 that post 914 is as described above substantially.(Fig. 5) compares with post 714, and the rear end 1002 of post 914 comprises the circular arrangement of the hook (catch) 1009 of ear 1008 and resilient outside sensing.In addition, referring to Figure 21, the rear end 1002 of post 914 also comprises along the footpath holes 1011, so that where necessary the post of implanting is taken off, as described in detail below.Still referring to Figure 21, this system comprises dog screw 1056, and this dog screw 1056 locks post 914 with respect to plate 902, as described below.This dog screw 1056 comprises kerve 1058, and hook 1009 is engagement in kerve 1058, but kerve 1058 also allows dog screw 1056 with respect to these hook rotations.

Referring to Figure 22, the diameter in each post hole 936 of plate 902 be the step shape and comprise screw thread 1060 and two along footpath ear portions 1062, screw thread 1060 last than major diameter partly in.Post 914 is inserted through post hole 936, so that ear 1008 is aimed at ear portions 1062.This just guarantees these anchors are aimed at (Figure 18) when afterwards these anchors being extended.Then dog screw 1056 rotations are made itself and screw thread 1060 engagements and continuation with its rotation, up to post 914 is locked in the appropriate position closely.

If be necessary post 914 is taken off, dog screw 1056 is rotated to disengaging configuration.When carrying out this operation, dog screw can unclamp from post.If this occurs, the instrument (not shown) can be inserted along the 1011 also pullings of directly holing, so that post is withdrawn from bone and hole 936.

Referring to Figure 23 to 28, these illustrate another embodiment of fixed system 1200, and fixed system 1200 is attached on the humerus 1300.Referring to Figure 23 and 24, system 1200 comprises the plate 1202 with head part 1234, head part 1234 has six post holes, comprise and be designed for newel hole 1236a, 1236b, 1236c and 1236d (being generically and collectively referred to as 1236) and near-end and distal post 1237a and the 1237b (being generically and collectively referred to as 1237) that admits post with screw head, preferred near-end and distal post 1237a and 1237b roughly are similar to post hole 936 (Figure 22), and be used to hold post, these posts optionally have the expansion anchor.In other words, preferred post hole 1237 comprises the system with the angle locking of post.This system also is applicable to and holds conventional threaded-head posts (having or do not have the deployable bracing or strutting arrangement of the subchondral bone on support joint surface), as Figure 25 and shown in Figure 26.And if use post without any bracing or strutting arrangement, these post holes just and do not require that any system comes to indicate or accurately fix these posts from angle so.Still referring to Figure 25 and Figure 26, newel hole 1236a, 1236b, 1236c and 1236d limit the illustrated axle by post 1214a, 1214b, 1214c and 1214d, and these newel holes are passed these posts and tilted mutually, thereby cause the horizontal and vertical separation of these posts.Near-end and distal post holes 1237a and 1237b limit axle, and preferred these lateral alignment and converging on angle are shown in post 1215a and 1215b.

Referring to Figure 24, head part 1234 also is provided with five mating holes 1218a, 1218b, 1218c, 1218d and 1218e (being generically and collectively referred to as 1218), and each Kong Yida minispread is closely to hold the K line post separately of post hole (roughly less than) along fixed axis.Particularly, the axle of 1218e points to the articular surface center of humerus head.Mating holes 1218 is directed on angle in the head part 1234 of plate, providing the path to the K line, these K lines can demonstrate these posts multiple boundary profile or identify advantage point with respect to the post of these implantation.More specifically, extremely shown in Figure 26 as Figure 24, the K line 1220 and 1222 that is arranged in hole 1218b and 1218c limits the boundary up and down of post 1214a, 1214b, 1214c and 1214d, and the K line 1224 that is arranged in hole 1218e points to the center of articular surface and limits the center, and the axle of near-end and distal post holes 1215a and 1215b converges towards this center.

Shown in Figure 24 and 27, narrow slit closes rail 1240 and extends near the proximal part of head part 1234.To sew up bottom surface 1250 liftings of rail 1240 with respect to the head part so that sewing needle enter and pass this rail and with respect to top 1252 recessed, to present relatively low outstanding profile.

Referring to Figure 27 to Figure 29, in use, utilize breast triangle (delto-pectoral) method to fracture and expose and removing.Utilize traction and direct manipulative skill with the reduction of the fracture, and the articular surface and the anatomical relationship between the humeral shaft 1352 of subchondral bone 1350 are being recovered aspect angular alignment and the hypsokinesis.Then with the location positioning of plate 1202 on humerus 1300, preferably and then after the intertubercular sulcus and be lower than supraspinatus (supraspinatus) and adhere to place about 1.5 to 2.0cm.Fixedly K line or the os integumentale screw that temporarily is inserted through non-locking oval screw hole 1232a temporarily are fastened to distal fragment with this plate to utilize as be inserted through the 2.0mm of axle of this plate then.Then by utilizing K line 1220,1222 and 1224 with reset locking, these K lines 1220,1222 and 1224 are inserted through the fixed angles K line hole on the head part 1234 of this plate and enter in one or more proximal fragment.Can use many lines to consider the position of final post in advance.

The axle of mating holes is corresponding to the axle of adjacent post holes.Whether preferred front and back and the oxter photo of utilizing comes fluoroscopic examination K line 1220,1222 and 1224, can be with the correct directed demonstration of these posts to provide.If this layout is correct, these K lines just remain on the position of plate the top of fracture.Can when the correctness of the position in coupled columns hole and direction is confident, bore these post holes then.If arrange unsatisfactoryly, so, the K line can be removed, and the surgeon can reorientate the K line and or redirect and can hole once more.Because the diameter of every K line is less relatively, so bone can be owing to boring procedure be subjected to very big damage, and the surgeon is not subjected to initial location and or directed constraint yet.Mating holes and the K line that passes them are used for the U.S. Patent application No.10/689 that trim panel was submitted on October 21st, 2003,797, the U.S. Patent application No.10/664 of JIUYUE in 2003 submission on the 17th, the U.S. Patent application No.10/985 that on November 10th, 371 and 2004 submitted to, done detailed description in 598, aforementioned application is integrally incorporated herein by reference.

By os integumentale screw being inserted through fully slotted eye 1232a the axle of plate 1,212 1230 is fixed to humerus backbone 1352 then.Any K line that may be used for fastener shaft is removed.

Utilize the drill guide (not shown) to get out the hole that is used for post.Utilize the degree of depth in the definite hole that is got out of depth gauge (not shown).Utilize driver that post 1214a, 1214b, 1214c, 1214d, 1215a and the 1215b of suitable length are inserted.The far-end of preferred these posts is lower than the articular surface 4 of subchondral bone 1350 to 6mm.Then the layout of the correct reduction of the fracture and post being carried out radiography confirms.

Referring to Figure 28 and 29, in these figure, post 1215a and 1215b comprise deployable anchors, and the surgeon launches anchor 1340, provides support with the articular surface to subchondral bone 1350.In practice, preferably before with anchor deployment, the K line in the head part 1,234 1220,1222 and 1224 is removed.

Also bore more hole to keep os integumentale screw, these os integumentale screws are used for the distal portions of plate is fixed to the backbone 1352 of humerus.

Secondly, if necessary, tuberosity resetted and utilizes and sew up or line is fixed to stitching rail 1240.

Carry out last radiography then and utilize suitable surgical technic the surgical wound closure.

Referring to Figure 30, there is shown another embodiment of shoulder plate 1402.The characteristic of plate 1402 roughly is similar to plate 1202, but comprises the structural distinctions that some are great.At first, the near-end of head part 1434 comprises three stitching guide rods 1440 with discrete arranged radially basically of transverse opening.Guide rod 1440 separately allowing pin to enter and pass there, and is not subjected to the obstruction of adjacent guide.Secondly, be provided with K line opening 1418f and 1418g in addition, to allow before post is inserted, using other K line, with the arrangement of perspective bone inner prop in the front and back of center K line opening 1418e.When surgical method produces at need when using one or more other opening, other K line opening 1418f and 1418g may be particularly useful.The 3rd, bone screw holes 1460 can be used with os integumentale screw and dog screw (not shown), thereby allows the pressure of os integumentale screw and the independent application of locking.Perhaps, can use other traditional os integumentale screw.

Having noticed that now not having the shoulder plate is universal models, because above-mentioned plate is suitable for being placed on left arm or the right arm, but is not to place.According to this point, each plate comprises it roughly being straight edge.When the head of this plate partly be positioned at be lower than supraspinatus adhere to the position at place 1.5 to 2.0cm and this straight edge after intertubercular sulcus and then on time, just guaranteed the suitable placement of this plate on humerus.For example, in Figure 30, this straight edge is edge 1470, and relative be slight curving edge 1472.Other shoulder plate described herein comprises corresponding straight and edge bending, and provides desirable layout when placing according to above-mentioned instruction.In addition, by with like this big distance the head of this plate is partly located with respect to intertubercular sulcus (this be with prior art in the difference at very approaching interval), the interference that may occur between the head of this plate part and the acromion with this arm lifting the time will drop to minimum.

Referring to Figure 31, there is shown another embodiment of humeral fracture fixed system 1510, this system 1510 is connected to shoulder 1500, and post 1514 extends through fracture 1502.This system 1510 comprises device 1512, neck 1515 and the axle 1530 with head part 1534 similar to plate.The neck 1515 of this device is attached on the head part 1534, to be located at the position that intralesional (intrafocally) is lower than fracture 1502 just.Because the forward location of neck 1515, one or more posts hole 1537 extensions in the head part 1534 similar to plate are also passed neck 1515.Preferred post hole 1537 is each other in the axial direction with angle offset.Compare with the embodiment of front, the shaft portion 1530 of device 1512 limits intramedullary pin, determines the size of this intramedullary pin, to be inserted into intralesional (passing fracture) and to be contained in then in the spinal canal of proximal humerus.Therefore, device 1512 is " nail-plates ".The preferred axes part 1530 low center of part 1534 is from the head stretched out, rather than stretch out the lower end of part 1534 from the head.One end of preferred axes part 1530 is tapered, so that enter spinal canal and stop at level and smooth bending section 1532, this level and smooth bending section 1532 helps the tip of the axis and enters focus and further insert spinal canal 1504.In addition, decision design shaft portion 1530 is positioned at bone and designs head part 1534 and is positioned on the surface of bone.Be provided with hole 1560 and 1562 in the shaft portion to hold securing member.There is screw thread in preferred hole 1560 and 1562, and therefore is applicable to and holds mechanical screw, and these mechanical screws can spur on shaft portion 1530 and the cortex against bone.Perhaps can use the hole that does not have screw thread and be provided with os integumentale screw, axle is connected to the humerus cortex.The U.S. Patent application No.10/315 that owns together that " nail-plate (nail-plate) " submitted at December in 2002 on the 10th has done detailed description in 787, and aforementioned application is integrally incorporated herein by reference.

This paper now to bone fracture fixation system and stable fracture particularly the method for humerus be described and illustrate.When indivedual embodiment of the present invention are described, and are not intended to and limit the present invention among these embodiment, because be intended to such broadness that scope of the present invention is understood too as this area allows and to description.Therefore, though, being appreciated that native system at the humeral fracture fixed system, embodiment also is applicable to the fracture of any articular surface fully with convex shape.So the system among the present invention equally also can be used for Treatment of Femoral Head Fracture.In this variation, this head part can be different with angle between the shaft portion, so that the head part correctly is positioned on the dissection.In addition, though related to indivedual embodiment some posts and os integumentale screw are disclosed, be appreciated that only require a post and can provide still less or more os integumentale screw hole and, maybe can use still less or more screw.And, though disclosed os integumentale screw is used for shaft portion is connected to bone, also can use other securing member equally.Further,, be appreciated that using these terms is for convenience's sake though term " post " and " nail " have been used for describing the present invention's individual elements, and and be not intended to and give special structure when using in the claims.Therefore, the device that is called " post " is intended to be interpreted as widely any securing member that is similar to axle that is connected to plate.Similarly, the device that is called " nail " is intended to be interpreted as widely the element that is similar to axle, and this element is to extend with the horizontal relationship of one of these posts and (i) to be connected to this post and or (ii) extend and be passed in formed transverse holes in this post.Therefore, this nail can be screw, no threaded rod, K line or the like.

And, though shown in the figure what go out is left hand humerus plate, have recognized that now right hand humerus plate generally is the mirror image of shown left hand humerus plate.Further, though the system that has been described is used for fracture, be appreciated that this system also can be used for the treatment of deep and bone does not connect (non-union) of proximal humerus and the treatment with other bone of convex articular surface.Therefore, those of skill in the art are appreciated that and also can carry out other variation and the scope of the present invention that do not break away from the claim to be advocated to proposed invention.

Claims (24)

1. the bone fracture fixation system of the fracture of a head part that is used for long bone, this long bone has the subchondral bone that limits the convex surface articular surface, and described system comprises:

A) plate;

B) post element, this post element stretches out and has a distal portions from described plate portion; With

C) support component, described support component can stretch out from the described distal portions of described post element, and orientable and enough hard, to provide support to described subchondral bone.

2. bone fracture fixation system as claimed in claim 1 is characterized in that, described support component can be contained in the described post element.

3. bone fracture fixation system as claimed in claim 1 is characterized in that, described support component is configured to be roughly parallel to described articular surface extends.

4. bone fracture fixation system as claimed in claim 1 is characterized in that, described support component can stretch out from the complete relative side of described post element.

5. bone fracture fixation system as claimed in claim 1 is characterized in that, to limit protruding side and recessed side, the concave side of described support component is facing to described plate with described support component bending.

6. the bone fracture fixation system of the fracture of a head part that is used for long bone, this long bone has the subchondral bone that limits the convex surface articular surface, and described system comprises:

A) plate; With

B) at least two post elements, described post element stretches out and has a distal portions from described plate portion, each described post has support component, described support component is connected to described post and can moves between non-expansion and deployment configuration, it is characterized in that, in described deployment configuration, described post and described support component limit the surf zone that supports described subchondral bone than bigger being used in described non-deployment configuration.

7. bone fracture fixation system comprises:

A) comprise the plate in post hole;

B) can insert the post in described post hole;

C) with predetermined direction described post rotatory ground being fixed on first in the described post hole installs; With

D) be connected to described plate provides pressure with the part of the described post in described post hole second device.

8. the plate of the bone fracture fixation system of the fracture of a head part that is used for long bone, this long bone has the subchondral bone that limits the convex surface articular surface, and described plate comprises:

A) has the head part of upper surface and lower surface;

B) shaft portion that partly stretches out from described head; With

C) a plurality of stitchings of partly arranging around described head are supported, and the described lower surface lifting with respect to described head part is supported in described stitching.

9. plate as claimed in claim 8 is characterized in that, described stitching is supported discrete each other.

10. plate as claimed in claim 9 is characterized in that, the roughly arranged radially of point on the described head part is supported in described stitching.

11. plate as claimed in claim 9 is characterized in that, described stitching is supported and is comprised the transverse opening that is used to sew up.

12. a plate that is used for bone fracture fixation system comprises:

Be provided with the head part in six post holes, two in the described post hole in front, two in the described post hole in the back, and two in the described post hole in the centre of described front and back, and one in the described intermediolateral column hole is nearest post hole, in the described intermediolateral column hole another is post hole farthest, it is characterized in that the axle in post hole, described front and back is fixed, and is separated from each other, the axle in described intermediolateral column hole is mutually facing to converging

The shaft portion that comprises a plurality of bone screw.

13. a plate that is used for bone fracture fixation system comprises:

Head part, with respect to the angled shaft portion of described head part, front face side and back side, it is characterized in that the described back side of described head part is bent, and the described front face side and the described shaft portion of described head part define straight line.

14. a fixture comprises:

Head part and shaft portion, described head part by the neck part from the horizontal and vertical biasing of described shaft portion,

Described head partly comprises at least one post hole, and described post hole also extends fully through described neck part, and

The cross section of described shaft portion diminishes gradually with the direction of leaving described neck part.

15. fixed system as claimed in claim 14 is characterized in that, described head part and described shaft portion are substantially parallel each other.

16. one kind is used for the fixed method of proximal humeral fracture, comprises:

A) provide the plate that comprises head part and shaft portion, the edge that a lateral confinement of described plate is roughly straight surely;

B) this plate is located on humerus, and be lower than supraspinatus and adhere to place 1.5 to 2.0cm, and and then the straight edge of this plate is aimed at after the intertubercular sulcus; And

C) this plate is connected to described humerus.

17. one kind is used for the fixed method of proximal humeral fracture, comprises:

A) provide fixture;

B) at least a portion of fixture is inserted in the spinal canal of humerus focus;

C) with the reduction of the fracture; And

D) described fixture is fastened to described humerus.

18. method as claimed in claim 17 is characterized in that,

Describedly provide fixture to comprise to provide device, and described insertion comprises described nail is partly inserted described spinal canal, and described plate portion is positioned at the outside of described humerus with plate portion and nail part.

19. a fixing head that is used to have the proximal humerus of humerus head comprises:

Be provided with the head part and at least one the K line mating holes that is located in the described head core partly in a plurality of posts hole, the size of determining described K line mating holes is closely to hold the K line and to guide the center of described K line towards described humerus head articular surface; And

The shaft portion that comprises at least one os integumentale screw hole.

20. a method that is used for the treatment of proximal humeral fracture, described proximal humerus comprises the humerus head, and described method comprises:

Fixture is provided, it has a plurality of posts hole that is used for holding at described humerus head fixed leg, and K line mating holes is provided, the size of determining described K line mating holes is closely to hold the K line and to guide the center of described K line towards described humerus head articular surface; And

The K line is inserted through described K line aims at, and towards the center of described articular surface.

21. a proximal humeral fracture fixed system comprises:

A) proximal humerus plate, described proximal humerus plate comprise head part with post hole and the shaft portion with at least one bone screw;

B) can insert the post in described post hole;

C) with predetermined direction described post rotatory ground being fixed on first in the described post hole installs; With

D) be connected to described post and to described post horizontal expansion second the device.

22. proximal humeral fracture fixed system as claimed in claim 21 is characterized in that, described first device comprises cam.

23. proximal humeral fracture fixed system as claimed in claim 21 is characterized in that, described first device comprises dog screw.

24. proximal humeral fracture fixed system as claimed in claim 21 is characterized in that, described first device comprises the screw thread of processing on described post hole and described post.

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