Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • 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, setting implements or the like
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/72—Intramedullary pins, nails or other devices
  • A61B17/7216—Intramedullary pins, nails or other devices for bone lengthening or compression

Definitions

• This invention relates generally to surgical devices used to mend bones, and specifically to intramedullar devices used to lengthen or mend long bones.
• a bone or limb may need to be lengthened or mended, such as congenital bone disorders, disruptions in the bone's normal development, traumas, and many other medical problems.
• the resulting difference in the length of the limbs or other angular or rotational bone deformities needs to be resolved in order to provide an acceptable level of quality of life for the patient.
• Callotasis or bone distraction
• the bone is progressively healed and lengthened by the slow distraction of the two bone portions.
• the new tissue consolidates into a perfect new bone.
• distractors utilize said bone distraction phenomenon to lengthen various bones.
• Older, more common devices are external to the body and comprise, for example, sets of external rings, strings, and pins installed around the limb being treated and connected to the bone portions through the soft tissues.
• Such devices cause a large amount of pain and inconvenience to the patient. Additionally, such devices penetrate through the soft tissues, causing many septic problems and repetitive infections. Furthermore, these external devices are ungainly and greatly restrict the patient's ability to move about freely.
• Intramedullar devices tend to have a high cost and limited elongation capabilities.
• Physicians face difficulties in managing the treatment programs that require patients to arrive at the medical facility.
• the external actuation means itself may restrict the patient's mobility.
• the invention presented herein addresses the above-mentioned drawbacks of related art intramedullar distraction devices by providing a device with a number of novel improvements.
• the present invention describes a novel, implantable, intramedullar distraction device for bone elongation, as well as for angular or rotational deformity mending, that is introduced in a single surgical procedure.
• the elongation of the bone occurs by stretching the bone according to the previously described Callotasis phenomenon.
• the angular or rotational correction of the bone deformity occurs by correctly positioning the bone portions and then stretching them according to the Callotasis phenomenon.
• the user is able to operate the device without assistance.
• the frequency of actuation is determined and monitored by the treating physician. After the bone has been lengthened or mended and has completely consolidated itself, the device is easily removed in another single surgical procedure.
• the device presented herein is operated mechanically by means of a subcutaneous button that is actuated by the patient several times a day, without assistance from the doctor.
• a unique feature of the device is that it is mechanical in nature and completely self-contained, that is, this device operates without the assistance of external mechanisms or tools.
• Another unique feature of this device is the ratchet assembly that allows for this completely mechanical operation.
• the device relies on no connection to any external power sources for its operation, unlike related art apparatuses.
• a further unique feature of the present invention is the alignment holes that provide the doctor with a simple but precise tool for ensuring that the device is properly aligned within the bone.
• Yet another novel feature of the present invention is the ability not only to lengthen the distraction section of the device, but also to shorten the same section. This feature is particularly useful during insertion and removal the present invention.
• the present invention offers an highly reliable, inexpensive, comfortable, and relatively painless solution to bone elongation that allows the patient greater freedom of movement, decreased risk of infection, shorter hospital stays, and faster recovery time.
• Figure 1 is an elevated view of an embodiment of the present invention
• Figure 2 is an exploded top view of a ratchet assembly of the embodiment of Figure 1;
• Figure 3 is a sectional side view of the ratchet assembly of the embodiment of Figure 1, in the locked position;
• Figure 4 is a sectional side view of the device of the embodiment of Figure 1;
• Figure 5 A is a sectional top view of the ratchet assembly of the embodiment of Figure 1, configured for shortening;
• Figure 5B is a sectional top view of the ratchet assembly of the embodiment of Figure 1, configured for elongating.
• An embodiment is an example or implementation of the inventions.
• the various appearances of "one embodiment,” “an embodiment” or “some embodiments” do not necessarily all refer to the same embodiments.
• Methods of the present invention may be implemented by performing or completing manually, automatically, or a combination thereof, selected steps or tasks.
• method refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures either known to, or readily developed from known manners, means, techniques, and procedures by practitioners of the art to which the invention belongs.
• bottom, “below”, “top” and “above” as used herein do not necessarily indicate that a “bottom” component is below a “top” component or that a component that is “below” is indeed “below” another component or that a component that is “above” is indeed “above” another component.
• directions, components or both may be flipped, rotated, moved in space, placed in a diagonal orientation or position, placed horizontally, or vertically, or similarly modified. Accordingly, it will be appreciated that the terms “bottom”, “below”, “top” and
• the present invention describes an implantable, intramedullar distraction device for bone elongation.
• a feature of this intramedullar device is the ratchet assembly that allows for complete mechanical operation by the patient, wherein the patient may operate the intramedullar device by depressing a button.
• Another feature of the intramedullar device is that because it is mechanical in nature and completely self-contained, said intramedullar device may operate without the assistance of external mechanisms, motors, or tools. Once inserted, the user is able to operate the intramedullar device without assistance.
• this new intramedullar device is available in a large variety of diameters and lengths, and is useful in all of the long bones.
• Another feature of the present invention is an alignment hole that provides the doctor with a simple but precise tool for ensuring that the intramedullar device is properly aligned within the bone.
• a further feature of the intramedullar device is the ratchet mechanism that enables both the lengthening and shortening of the intramedullar device, thus providing greater flexibility to the physician during the crucial insertion and lengthening phase of the process.
• Another feature of the intramedullar device is that the actuation of said ratchet mechanism may be locked once elongation is complete, thus avoiding accidental lengthening of the bone by unwanted actuation of the button.
• an intramedullar device configured to provide an intramedullar device
• Ratchet assembly 100 houses the various components that operate intramedullar device 50, seen clearly in Figures 2, 5A, and 5B.
• the unique features of intramedullar device 50 enable the user to operate ratchet assembly 100 unassisted and without additional external mechanisms or devices.
• Nail assembly 200 houses the components necessary to carry out the bone distraction; these components are described in Figure 4.
• a subcutaneous button 115 is located at the outer most end of ratchet assembly 100. Once intramedullar device 50 is inserted, subcutaneous button 115 is positioned below and close to the surface of the skin, in a location that is comfortably accessible to the user. The user depresses subcutaneous button 115, according to a prescribed schedule defined by the medical doctor, in order to initiate the ratcheting action, thereby rotating a long screw 112.
• subcutaneous button 115 In the event that the length of ratchet assembly 100 is insufficient to correctly position subcutaneous button 115, there may be the option of extending subcutaneous button 115 to accommodate the thickness of the fat and skin by attaching a spacer 101, seen in Figure 3, between a center chamber 110 and subcutaneous button 115.
• a funnel shaped opening 113 may be included at the terminal end of subcutaneous button 115.
• a needle or pin may be inserted into funnel shaped opening 113 in order to permanently lock the entire ratchet assembly 100.
• Subcutaneous button 115 connects to center chamber 110, which is situated between subcutaneous button 115 and the area housing a leverage mechanism 107, as seen in Figures 2 and 3.
• Center chamber 110 may be further equipped with at least two diametrically opposed holes 106.
• cylinder- plate 104 is an extruded, substantially U-shaped member. The end of cylinder-plate 104 closest to subcutaneous button 115 may be dimpled.
• Cylinder-plate 104 may be further equipped with at least two diametrically opposed holes 103. Cylinder-plate 104 may slide freely within center chamber 110.
• Locking spring 105 may be located within cylinder-plate 104. The ends 116 of locking spring 105 may be formed so as to protrude in an outwardly direction.
• ends 116 of locking spring 105 may sit inside holes 103 of cylinder-plate 104, compressed against the internal wall of center chamber 110, thus holding cylinder-plate 104 in place.
• ends 116 of locking spring 105 may sit inside holes 103 of cylinder-plate 104, compressed against the internal wall of center chamber 110, thus holding cylinder-plate 104 in place.
• said cylinder-plate 104 while in said actuating position, when cylinder-plate 104 is pushed by a needle inserted through funnel shaped opening 113, said cylinder-plate 104 moves forward inside center chamber 110, towards leverage mechanism 107 until holes 103 of cylinder-plate 104 align with holes 106 of center chamber 110. This movement frees ends 116 of locking spring 105, which enables ends 116 to move out into holes 106 of center chamber 110.
• leverage mechanism 107 may be a rocker-type mechanism that spans the gap between center chamber 110 and a gear 111, as seen in
• the terminal end of leverage mechanism 107 is flexibly connected to center chamber 110.
• the second end of leverage mechanism 107 may include a pin
• leverage mechanism 115 with or without spacer 101, may be depressed, which causes center chamber 110 to move forward and actuate leverage mechanism 107.
• pin 109 of leverage mechanism 107 may connect with gear
• center chamber 110 together with leverage mechanism 107 and a main spring 117, may rotate, for example, 180 degrees around a longitudinal axis, allowing pin 109 to be positioned on the opposite side, relative to its original position, of ratchet assembly 100.
• gear 111 and consequently long screw 112 may turn in a direction opposite to the previous movement.
• intramedullar device 50 positioned for lengthening, as shown in Figure 5B, rotating the above-referenced components would enable shortening the length of intramedullar device 50, as shown in Figure 5 A.
• a floating stopper 108 may be mounted within ratchet assembly 100, between leverage mechanism 107 and gear 111, ensuring that gear 111 may always rotate in either of the desired directions.
• stopper 108 may ensure that the rotation of gear 111 and of long screw 112 is in a direction that causes the lengthening of intramedullar device 50, while at the same time preventing any motion of either gear 111 or long screw 112 in a reverse direction.
• intramedullar device 50 may be shortened prior to the final anchoring by rotating center chamber 110 as described above, and then pressing subcutaneous button 115 to turn gear 111 and long screw 112 in a direction that will reduce the length of intramedullar device 50.
• This bi-directional feature may also be used for other purposes, such as, but not limited to, assisting in the removal of intramedullar device 50 from the bone, where locking spring 105 mechanism has not been moved to a locked position.
• a ratchet cover 114 seen in Figure 4, ensures that ratchet mechanism is sealed.
• a screw 118 holds ratchet cover 114 in place and ensures that leverage mechanism 107 remains in the desired position.
• Ratchet assembly 100 is geared such that each depression of subcutaneous button 115 rotates long screw 112 an amount equivalent to one tooth on gear 111, providing very precise control of the extension activity.
• the diameter of the gear 111 and the size and quantity of teeth on gear 111 may vary according to different embodiments of the present invention.
• the top of nail assembly 200 is rigidly connected to ratchet assembly 100, and at substantially a right angle. According to some other embodiments, nail assembly 200 may be connected to ratchet assembly 100 at greater or less than a right angle.
• Nail assembly 200 shown in figure 4, like many known in the art devices, is a long, substantially tubular shaped metal piece that is designed to be inserted into the prepared medullar cavity of a long bone. Unlike the related art, nail assembly 200 of intramedullar device 50 may be manufactured in a wide range of diameters and lengths and is therefore suitable for a large variety of sizes of long bones, making intramedullar device 50 applicable to a wide range of patients.
• nail assembly 200 is comprised of an outer tube 201 within which is seated an inner tube 202, as seen in Figure 4.
• Long screw 112 runs down through the center length of both outer tube 201 and inner tube 202, connecting outer tube 201 to inner tube 202.
• Outer tube 201 of the present invention may be anchored to the upper portion of the patient's bone by inserting, for example, pins or screws through at least two upper anchoring holes 203, as seen in figure 4.
• Inner tube 202 moves longitudinally within outer tube 201 in a precise, stable manner.
• the upper section of inner tube 202 may be guided within the lower section of outer tube 201 by means of a key system 207, wherein outer tube 201 has a channel and inner tube 202 has a protrusion that slides within said channel.
• Key system 207 ensures the smooth, stable, and precise longitudinal relative movement of inner tube 202, with no tolerance for any rotational movements that may cause instability of intramedullar device 50.
• other suitable guiding systems may be employed.
• long screw 112 enters the top of inner tube 202 and may be connected to inner tube 202 by, for example, matching threads on inner tube 202 and long screw 112.
• ratchet assembly 100 rotates long screw 112, which in turn pushes inner tube 202 down along key system
• An important feature of the present invention is an alignment hole 205, located at the lower end of inner tube 202.
• Alignment hole 205 comprises a bored out section of inner tube 202 that provides the doctor with a simple tool to ensure that intramedullar device 50 is correctly positioned within the bone, after insertion.
• Alignment hole 205 allows the doctor to adjust the alignment of nail assembly 200 by rotating intramedullar device 50 if required, into its correct position.
• alignment hole 205 will appear as a single circumference in the X-ray. This feature is important because intramedullar device 50 must be properly aligned to ensure that anchoring screws are inserted into the proper part of the bone, while preventing undue damage to the surrounding tissue.
• Inner tube 202 of the present invention may also house at least one lower anchoring hole 204.
• Inner tube 202 may be anchored to the lower portion of the patient's bone by inserting, for example, pins or screws through at least one lower anchoring hole 204.
• alignment hole 205 may, according to some embodiments, further function as a hole for inserting additional anchoring screws.
• inner tube 202 may be constructed as a single component.
• intramedullar device 50 may be constructed from, for example, titanium alloys, stainless steel, or other acceptable materials for medical implanted devices.
• the bone is prepared, including performing the osteotomy, according to standard processes known to those who practice in the art.
• the present invention may then be inserted, as a single unit.
• intramedullar device 50 After nail assembly 200 is introduced into the bone, intramedullar device 50 must be aligned. Nail assembly 200 is slightly rotated around its longitudinal axis, until alignment hole 205 appears properly aligned on X-ray, that is, showing as a single circumference. This indicates that lower anchoring hole 204 and alignment hole 205 are properly positioned. It is important that when intramedullar device 50 is attached to the bone, each screw enter the bone in the proper location in order not to harm the surrounding blood vessels, tissues, and muscles in the area.
• pins or screws may be inserted through upper anchoring hole 203, lower anchoring hole 204 and, optionally, alignment hole 205 in order to affix intramedullar device 50 in place.
• Center chamber 110 is then rotated in order to allow gear 111, and long screw 112 to rotate in the desired direction.
• intramedullar device 50 is adjusted and intramedullar device 50 is affixed to the bone, intramedullar device 50 is ready for use.
• the user may activate intramedullar device 50, thereby elongating nail assembly 200, by depressing subcutaneous button 115 according to the instructions of the prescribing physician.
• Depressing subcutaneous button 115 presses center chamber 110 against leverage mechanism 107, causing leverage mechanism 107, in conjunction with pin 109, to rotate gear 111 the angle of one tooth.
• Gear 111 in turn rotates long screw 112 the same angle.
• long screw 112 rotates, it causes inner tube 202 to slide longitudinally away from outer tube 201 and the remainder of nail assembly 200, effectively lengthening intramedullar device 50 and the bone.
• Ratchet assembly 100 is geared so that a single depression of subcutaneous button 115 will cause long screw 112 to rotate a specific amount, which allows for very precise control of the extension activity.
• a medical doctor may insert a needle through funnel shaped opening 113. Pressing the needle forces 102 cylindrical plate 104 to move forward, and allows the holes 103 on cylindrical plate 104 and. holes 106 on center chamber 110 to align. Once holes 106 and 103 are aligned, ends 116 of locking spring 105 pop out through holes 106, as seen in Figure 3.
• locking spring 105 is positioned thusly, subcutaneous button 115 is prevented from further actuating leverage mechanism 107 and pin 109 or rotating long screw 112, thereby permanently locking entire ratchet assembly 100.
• intramedullar device 50 can be removed according to Standard processes known to those who practice in the art.

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

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• 2007
  • 2007-07-12 EP EP07789938A patent/EP2040615A4/de not_active Withdrawn
  • 2007-07-12 WO PCT/IL2007/000880 patent/WO2008007378A2/en active Application Filing
  • 2007-07-12 BR BRPI0713232-8A patent/BRPI0713232A2/pt not_active IP Right Cessation

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