INTRAMEDULLARY NAIL FOR FIXATION OF LONG BONE FRACTURES
Field of the invention
The present invention is generally applicable to the field of bone surgery devices and particularly relates to an intramedullary nail for fixation of long bones, particularly the humerus, in accordance with the preamble of claim 1.
Background of the invention
The use of intramedullary nails for fixation of bone fractures, particularly of long bones such as the humerus, the tibia and the femur, is known to promote the reduction of healing times and to simplify the overall surgical procedure.
Common nails are formed of an elongate tubular member, which is susceptible of being introduced and secured in the medullary cavity by means of one or more threaded pins or through screws inserted in corresponding holes formed in the side wall of the nail, generally in proximal and distal positions.
Thus, by tightening the screws into the bone cortex, any translation and/or rotation of the nail in the medullary cavity is prevented.
Nevertheless, these conventional solutions are rather invasive and generally require complex and delicate procedures for introduction and removal of the fastening screws, which may directly or indirectly cause infections.
In an attempt to overcome the above drawbacks, certain solutions have been proposed, in which the nail is locked in the medullary cavity using metal stabilization wires to wholly or partly replace the fastening screws, thereby reducing the invasiveness of the whole device.
Metal wires are conveniently pointed at least at one end so that, once they are
introduced in the tubular cavity and arranged to come out of a corresponding hole, they can engage in the bone cortex or be locked thereagainst.
A similar solution is known, for instance, from the European patent application EP 0922437, which discloses an intramedullary nail for long bone fractures whose stabilization in the medullary cavity is obtained by means of a pair of metal wires.
These wires are caused to penetrate the inner side wall of the nail thanks to a compression exerted by a threaded plug which is tightened into the nail.
Nevertheless, such compression force may be insufficient to ensure attachment of the wires to the side wall of the medullary channel and nail stabilization may be inadequate.
Summary of the invention
The main object of the present invention is to overcome the above drawbacks, by providing an intramedullary nail for fixation of long bone fractures that is highly efficient and relatively cost-effective.
A particular object is to provide an intramedullary nail that has a greatly reduced invasiveness to the bone cavity in which it is introduced, while maintaining its stability.
A further object is to provide an intramedullary nail that can be used for either right or left limbs.
These and other objects, that will appear more clearly hereinafter are fulfilled by an intramedullary nail for fixation of bone fractures as defined in claim 1 , which comprises a hollow tubular body having a proximal end and a distal end, said tubular body having an axial opening said distal end and at least one side opening near said proximal end, a wire-like anchor rod to be introduced in the inner cavity of said tubular body and having end portions designed to at least partly come out of said distal and proximal end openings respectively, at least one of said end
portions being bent outwards, and means for locking said rod at said distal end, which means comprise a threaded plug to be introduced in said axial opening to lock said rod against the wall of said tubular member.
The nail is characterized in that the locking means have a substantially axial slot at the distal end of the tubular body, said slot being designed to receive a corresponding end of said anchor rod.
Thanks to this feature, the nail may be stabilized in a medullary cavity without the help of fastening screws, while ensuring reduced invasiveness and high stability.
Advantageously, the distal end portion of the nail may be inclined relative to the rest of the tubular body at a predetermined angle to facilitate introduction thereof in the medullary cavity and bilateral orientation of the portion of such wire-like rod coming out of such proximal side opening.
Also, the proximal side opening may be diametrically opposite to the distal slot and two distal slots may be advantageously provided which are substantially symmetrical with respect to the axis of said proximal side opening.
Thanks to this particular configuration, the nail may be used either for right and left limbs without having to provide special nails for each part of the body.
Brief Description of the Drawings
Further features and advantages of the invention will be more readily apparent upon reading of the detailed description of a preferred but non exclusive embodiment of an intramedullary nail for bone fracture fixation according to the invention, which is shown as a non limiting example with the help of the annexed figures, in which:
FIG. 1 is a front view of an intramedullary nail according to the invention in a first preferred configuration, inserted in the medullary channel of a fractured
homerus;
FIG. 2 is a top view of the nail of FIG. 1 ;
FIG. 3 is an exploded front view of the nail of FIG. 1 ;
FIG. 4 is a sectional view of the nail of FIG. 1 , as taken along the plane td\ FIG. 5 is an enlarged view of a detail of FIG. 4;
FIG. 6 is an enlarged view of a detail of the nail according to the invention in a second preferred configuration;
FIG. 7 is a top view of the detail of FIG. 6.
Detailed description of one preferred embodiment
With reference to the above figures, the intramedullary nail according to the invention, generally designated by numeral 1 , may be used for fixation of long bone fractures, particularly for fractures of the humerus, the tibia and the femur. With reference to FIG. 1 , the intramedullary nail 1 is introduced in the medullary channel M of a long bone B, such as a homerus, having fractures F.
According to the invention, the intramedullary nail 1 comprises a hollow tubular body 2 with a proximal end 3 and a distal end 4. The hollow tubular body 2 has an axial opening 5 at the distal end 4 and a side opening 6 near the proximal end 3.
A wire-like anchor rod or a wire 7 is further provided, which is designed to be introduced in the inner cavity 8 of the tubular body 2 and has end portions 9, 10, one of which is at least slightly bent outwards. Both end portions 9, 10 are designed to at least partly come out of the distal 5 and proximal 6 end openings.
Locking means 11 are further provided for locking the rod or wire 7 at the distal end 4, which locking means comprise a threaded plug 12 to be inserted in the axial opening 5 to force the rod 7 against the wall 13 of the tubular body 2.
A peculiar feature of the intramedullary nail according to the invention is that the locking means 1 1 have a substantially axial slot 14 which is formed at the distal
end 4 of the tubular body 2, and is designed to receive a corresponding end 9 of the anchor rod 7.
The terms "distal" and "proximal" as used herein are to be intended with particular reference to a retrograde humeral nail, in which case the anchor rod 7 is inserted in the portion remote from the limb root, i.e. at the elbow.
As particularly shown in FIG. 3, the locking means 1 1 have a threaded annular rim 15 which is designed to cooperate with the plug 12 for stabilizing the rod 7 with respect to the inner axial cavity 8.
Furthermore, the wall 13 of the tubular body 2 has a substantially constant thickness s-i, except at the proximal 16 and distal 17 end portions, where it has respective increased thicknesses S2 and S3.
Advantageously, the distal end portion 17 is inclined relative to the rest of the tubular body 2 at a predetermined angle α to facilitate bilateral orientation of the end 10 of the anchor rod 7 that comes out of the proximal side opening 6 and insertion thereof in the medullary cavity.
The sectional view of FIG. 4 shows that the axis X of the inclined end portion 17 defines a longitudinal symmetry plane π with the axis Y of the remaining portion 18 of the tubular body 2, along which the wire-like rod 7 extends upon installation of the intramedullary nail 1 in the bone cavity.
Furthermore, the axis W of the proximal side opening 6 may be contained in the symmetry plane π, and be oriented substantially opposite the extension plane π' of the distal slot 14.
Thus, in humeral fracture reduction procedures, as the nail 1 is inserted in the bone cavity, the proximal end 10 of the anchor rod 7 will substantially fit into the humerus head, unlike prior art nails, which are secured in the bone at the
diaphysis.
In an alternative embodiment, not shown, the tubular body 2 may have two proximal side openings 6 having respective axes W contained in the symmetry plane π and oriented oppositely and symmetrically with respect to the axis Y.
This will afford a very wide anchorage area for the rod 7, wherefore the same nail may be used both for the right arm homerus and the left arm homerus, without providing different nails for the particular limbs to be treated.
Further, as shown in FIG. 3, the slot 14 preferably extends along most of the distal end portion 17. The slot 14 may further have a transverse dimension d1 greater than the maximum diameter d2 of the cross section of the rod 7 at its distal end portion 9, for easier passage thereof.
The threaded plug 12 has a first substantially cylindrical portion 19, with an appropriately threaded surface, and terminates in a substantially conical end portion 20 which is designed to compress the wire-like rod 7 against the bottom 21 of the slot 14, as shown in the enlarged detail of FIG. 5.
According to the preferred but non limiting embodiment of the annexed figures, the anchor rod 7 has a substantially circular cross section of constant diameter d2, with a pointed proximal end 10 for facilitating engagement thereof against or into the bone cortex.
Before insertion of the nail 1 in the inner cavity 8, the rod 7 may be substantially straight or be advantageously pre-shaped with its end portion 10 slightly inclined to facilitate insertion of the proximal end portion 10 in the side opening 6.
For increased stability of the nail 1 in the medullary cavity, a transverse through hole 22 may be formed at the distal end portion 17 of the tubular body 2 for passage of an anchor screw 23 which will be fixed in the side wall of the medullary
cavity of the bone in which the nail 1 is to be inserted.
For this purpose, in a second preferred configuration of the nail 1 , the distal end portion 17 of the tubular body 2 may have a substantially elliptical cross section 24 having at least one axis a greater than the maximum diameter d3 of the remaining section 18 of the body 2, as particularly shown in FIG. 6 and FIG. 7.
In this second configuration, such increased maximum dimension a of the tubular body 2 allows to form a through hole 22 of greater diameter d4 as compared with the first configuration.
This will allow insertion of an anchor screw 23 of increased diameter d5 and improved mechanical strength.
In this way, the same anchor screw 23 can interfere with the anchor rod 7 to lock it against the wall 13 of the tubular body 2, thereby eliminating the need of the threaded plug 12.
In both illustrated configurations, an axial opening 25 may be formed at the proximal end portion 3 of the tubular body 2, for the passage of a guidewire, not shown, which is designed to allow guided insertion of the nail 1 in the medullary cavity.
In view of the foregoing it clearly appears that the invention fulfils the intended objects, and particularly provides an intramedullary nail for fixation of long bone fractures, having reduced invasiveness to the limb in which it is inserted, without affecting its stability in the medullary cavity.
The intramedullary nail according to the invention is susceptible of many changes and variants within the inventive principle disclosed in the annexed claims. All the details thereof may be replaced by other technically equivalent parts, and the materials may vary depending on different needs, without departure from the
scope of the invention.
While the intramedullary nail has been described with particular reference to the annexed figures, the numerals referred to in the disclosure and claims are only used for the sake of a better intelligibility of the invention and shall not be intended to limit the claimed scope in any manner.