WO2001082809A1 - Plaque d'osteosynthese profilee - Google Patents

Plaque d'osteosynthese profilee Download PDF

Info

Publication number
WO2001082809A1
WO2001082809A1 PCT/CH2001/000264 CH0100264W WO0182809A1 WO 2001082809 A1 WO2001082809 A1 WO 2001082809A1 CH 0100264 W CH0100264 W CH 0100264W WO 0182809 A1 WO0182809 A1 WO 0182809A1
Authority
WO
WIPO (PCT)
Prior art keywords
plate
screw
bone
contour
thread
Prior art date
Application number
PCT/CH2001/000264
Other languages
German (de)
English (en)
Inventor
Joachim Pfefferle
Peter Scheuble
Hermann Zeuner
Original Assignee
Medartis Ag
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 Medartis Ag filed Critical Medartis Ag
Priority to AU48216/01A priority Critical patent/AU4821601A/en
Publication of WO2001082809A1 publication Critical patent/WO2001082809A1/fr

Links

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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A61B17/8071—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for the jaw
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A61F2/2803—Bones for mandibular reconstruction

Definitions

  • the present invention relates to a bone plate, which means
  • Bone screws are to be fastened and in particular as a reconstruction system for the maxillofacial area of the human skull, e.g. for the lower jaw.
  • the bone plate and screws are blocked together.
  • the terms "plate”, “screw” and “plate-screw connection” will be used in abbreviated form.
  • Such plates are used, for example, to reinforce weakened, regressed bone structures. In the case of large continuity defects, the plates have to provide stability over long periods of time and absorb the loads that the missing bone would have to bear.
  • plates of this type consist of a straight, elongated branch with a multiplicity of plate members, in each of which there is a screw hole for receiving a screw.
  • An angled side branch is used as bridging plates on the left or right.
  • side branches angled on both sides extend from the elongated branch. The plates can be cut to the required length, which is done by removing excess plate members, and bent to adapt to the patient's anatomy.
  • Plates of the type relevant here as straight, elongated branches, as bridging plates with side branches angled to the right or left of the main branch or as total bridging plates with side branches angled to the main branch (double angled) have long been described in the literature , from many suppliers on the market and in widespread clinical use. Examples of this include the company
  • a reinforced angle segment is provided at the transition between the main branch and the angled side branches, see
  • these plates When applied, these plates must be bent to a relatively large extent to the patient's anatomy.
  • the plates used in the patient are constantly changing bending stress due to their activities, e.g. by swallowing and chewing.
  • the long-term bending fatigue strength of the plates which are mostly made of titanium, is reduced by the operative bending during insertion, thus reducing their fracture resistance and service life in the patient. This is an essential aspect of the imperfection of the bone plates of the type known to date.
  • US 5,810,823 proposes Arrange insertable or fixed spacer elements with an internal thread on the underside of the plate, which sit on the bone and are penetrated by the threaded shanks of the screws. Spacers that can be positioned variably also allow the screws to be aligned differently from the vertical. With this construction, the large-area pressing of the plate onto the periosteum is avoided, but increased pressure arises at the attachment points of the spacer elements. The relatively small insertable spacing elements complicate the surgical procedure. Regardless of whether the spacer elements are fixed or can be used, they do not provide improved protection against unintentional loosening of the screws.
  • WO 96/39975 describes a blocked plate-screw connection, where recessed securing elements are provided on the underside of the plate in the area of the screw holes.
  • the threadless neck portion of the screw shaft which has a smaller diameter than the threaded part, projects through the individual securing element.
  • the threaded part can be inserted through the securing element and screwed into the bone, the screw head coming to rest on the top of the plate.
  • the securing element shrinks so that the plate is held at a distance from the periosteum and the screw is secured against unscrewing.
  • This system requires the special security elements and devices and is therefore complex to handle and manufacture.
  • the bone plate has a plurality of holes provided in the direction of the longitudinal axis of the plate for the passage of screws.
  • the screw hole is oval, with its main axis lying in the longitudinal axis of the plate.
  • the screw hole is surrounded by a spherical countersink on the top of the plate.
  • the internal thread serves to accommodate a thread section located on the screw under its head, which is expanded in diameter compared to the threaded shaft of the screw.
  • the screw hole opens towards the underside of the plate in the area of the two ends of the main axis, i.e. outside the internal thread on the longitudinal axis of the plate.
  • the threaded shaft of the screw protrudes into the bone, while the threaded part engages with the internal thread in the screw hole. This supports the plate and does not force the screw onto the periosteum.
  • the screw is secured against unintentional removal by the threaded connection between the internal thread in the screw hole and the threaded part of the screw.
  • the plate and screw are interlocked.
  • the countersink around the screw hole allows a screw without a threaded part to be eccentrically created to produce compression between bone compartments. Screws without a thread section for blocking can also be screwed in differently from the vertical. There is more space for this in the direction of the longitudinal axis of the plate due to the oval hole shape and the only partial internal thread in the screw hole.
  • the object of the invention is to propose a bone plate of the type relevant here, where the number and intensity of the required bends are significantly reduced during the surgical adaptation to the patient's anatomy. This is primarily to increase the long-term fatigue strength of the plates and, as a synergy effect, to reduce the surgical effort for the surgeon.
  • the object of the invention is to propose an improved blockable plate-screw connection for the plates to be improved with regard to the adaptation. It is particularly important here to get by without third parts, such as inserts or expansion screws for locking and bending inserts.
  • the connections should be less sensitive to overtightening and angular misalignment of the screws in relation to the vertical and the longitudinal axis of the plate. It is desirable to achieve a high loosening torque within the plate-screw connection for the screws, in order to thus strictly avoid automatic loosening of the screws.
  • the clinical application for the surgeon should be as simple as possible. The possibilities of an osteosynthetic must be preserved Bring bone compression and use the connection with conventional screws unblocked. Finally, the parts of the connection must be able to be mass-produced efficiently.
  • a contoured bone plate which extends in a plane of the plate and whose longitudinal axis of the plate extends at least essentially in the form of a circular arc.
  • the circular longitudinal axis of the plate between the central axes of the webs and the central axis of the adjacent screw hole results in an offset with e.g. 1 ° to 10 °, preferably 2.5 °.
  • the plate has several plate members, which are connected to one another by webs. At least in some plate members, preferably in each plate member, there is a screw hole.
  • the bone plate consists at least of an arcuate main segment.
  • the main segment is provided with a lateral segment attached to it on one or both sides and lying in the plate level, which extends straight or curved.
  • Some screw holes on the bone plate may not be designed for blocking, but as standard cylindrical screw holes or as direction-oriented compression holes.
  • the arcuate bone plate is given its shape without reshaping, i.e. the plate is made from the material during manufacture, so that the plates produced in this way reach the surgeon without first being weakened by bending stresses.
  • the further development of the interlocking according to the invention is based on a bone plate and screws with an interlocking thread according to the genus from US Pat. No. 5,709,686.
  • the screw holes in the plate links are surrounded by a spherical countersink on the top of the plate.
  • an engagement contour is present in the screw hole, which consists partly of horizontal and radial circumferential valley troughs on the wall of the screw hole and adjacent remaining contour tips.
  • the diameter the countersink for receiving the screw head is greater than the clear width of the engagement contour. It runs out towards the edges of the engagement contour, so that smooth, non-contoured wall areas remain in the screw hole.
  • the screw hole is an elongated hole.
  • the engagement contour is preferably produced by milling and has, for example, a pointed, round, trapezoidal or sawtooth-shaped shape.
  • a blocking thread below the screw head which has a diameter of the same size or larger than the thread on the threaded shaft intended for engagement in the bone.
  • the screw with its threaded shaft protrudes through the screw hole and the thread of the threaded shaft rotates into the bone.
  • the locking thread below the screw head enters the engagement contour in the screw hole. Since the interlocking thread, with its helical shape and its pitch, is not complementary to the engagement contour, deformation occurs on both and thus a more resistant connection to loosening. Blocking of reduced thickness can still be achieved if there is a continuous thread on the screw, the uppermost threads of which undermine the engagement contour.
  • the bone plate according to the invention with an arcuate plate longitudinal axis - at least in the main segment, if the bone plate is provided with a lateral segment attached to it on one or both sides - provides the following advantages:
  • the bone plate takes up the inclination of a circular section of the lateral surface of a cone.
  • the plate-screw connection is efficient in clinical use since no third parts are required for blocking. No bending inserts are required even when bending the plate. Even with a deformation within the screw hole, the functionality of the blocking is not impaired.
  • the plate When blocking, no forces act on the periosteum, so that it is protected. Similar to a fixator, the plate can be positioned at a distance from the bone. - The internal engagement contour in the screw hole also allows a slight angular misalignment of the screw in relation to the vertical and longitudinal axis of the plate. This without loss of functionality of the blocking.
  • the plate can be equipped with different screws, namely those with which locking occurs and those without locking.
  • the screw holes act as neutral Compression holes to accommodate the screw head. This is the case, for example, when applying small screws to staple a bone compartment.
  • the screw can also be set at an angle. - Since the complete geometry of the screw holes in the plate can be machined from one side, there is no need for reclamping during machining, so that overall there is a cost-effective production that can also be carried out precisely with reasonable effort.
  • Figure 1A - a bone plate with an arcuate plate longitudinal axis Z and 16 screw holes;
  • Figure 1 B an enlarged view of three plate members according to Figure 1A
  • 1C a schematic diagram of a human lower jaw with the adapting circular-arch-shaped bone plate according to FIG. 1A and a straight bone plate drifting from the lower jaw according to FIG. 5A;
  • Figure 2 a bone plate with an arcuate plate longitudinal axis Z and 8 screw holes of different types;
  • FIG. 3A - a bone plate for the left jaw branch with an arc-shaped main segment according to FIG. 1A, a straight, rising lateral segment and a reinforced angular area with an additional screw hole;
  • Figure 3B the bone plate according to Figure 3A with a curved lateral segment and reinforced angular range without an additional screw hole;
  • FIG. 3C the bone plate according to FIG. 3B with an additional screw hole in the reinforced angular range
  • FIG. 3E the bone plate according to Figure 3A with reduced spacing of the screw holes in the lateral segment;
  • FIG. 4A a bone plate screwed onto a fractured lower jaw;
  • FIG. 4B - a bone plate screwed onto the lower jaw to bridge a continuity defect
  • Figure 5A - a straight bone plate with uniformly aligned screw holes in plan view
  • Figure 5B the representation according to Figure 5A with differently oriented screw holes
  • Figure 5C the bone plate according to Figure 5A in section on the line A-A with the engaging contour of the first embodiment, schematic diagram
  • FIG. 5D the representation according to FIG. 5C with the engagement contour, real contour
  • Figure 6A - a two-start bone screw with locking thread in the
  • Figure 6B the two-start bone screw according to Figure 6A with locking thread in the neck area and thick screw shaft
  • Figure 6C a bone screw with blocking thread in the neck area and self-drilling and self-tapping thread on
  • FIG. 7A the bone screw according to FIG. 6A screwed vertically into a screw hole from FIG. 5E;
  • FIG. 7B the view according to FIG. 7A with the bone screw screwed in at an angle
  • FIG. 7D bone screws screwed into a bent and twisted bone plate according to FIG. 5A;
  • FIG. 8A the bone screw according to Figure 6A with locking thread, deformed after locking
  • FIG. 8B a screw hole with an engagement contour of the first embodiment from FIG. 5E, deformed after the blocking;
  • Figure 9A shows a screw hole with an engagement contour of the second embodiment in plan view
  • FIG. 9B shows the representation according to FIG. 9A as a section on the line C-C;
  • FIG. 9C shows the representation according to FIG. 9A as a section on the line D-D;
  • FIG. 9D the bone screw according to FIG. 6E screwed into the screw hole from FIG. 9B, blocked;
  • Figure 10A a screw hole with an engagement contour of the third embodiment in plan view
  • Figure 10B the representation of Figure 10A as a section on the line E-E;
  • FIG. 10B screwed in in a blocked manner
  • Figure 11A - a screw hole with an engagement contour fourth embodiment in plan view
  • Figure 11 B the representation according to Figure 11 A as a section on the line F-F;
  • Figure 11 C the bone screw according to Figure 6G screwed into the screw hole of Figure 11 B blocked;
  • Figure 12A a screw hole with an engagement contour fifth embodiment in plan view
  • Figure 12B the representation of Figure 12A as a section on the line GG
  • Figure 12C the bone screw according to Figure 6H screwed into the screw hole of Figure 12B blocked;
  • FIG. 13A the situation before a fracture is closed by means of compression osteosynthesis
  • Figure 13B the situation during closure of the fracture
  • Figure 13C the situation after the fracture has closed
  • Figure 14A - a bone screw without locking thread
  • FIG. 14A with thicker screw shaft
  • FIG. 14C the bone screw according to FIG. 14A is screwed into a screw hole from FIG. 5E unblocked and vertically
  • FIG. 14D the representation according to FIG. 14C with the bone screw unblocked and screwed in at an angle
  • 14E the situation in a lag screw osteosynthesis with a bone screw without locking thread according to FIG. 14A screwed into a screw hole with engagement contours of the first embodiment according to FIG. 5E without being locked
  • FIG. 15B the representation according to FIG. 15A with the bone screw screwed in unblocked and at an angle.
  • the bone plate 1 "has an arcuate plate longitudinal axis Z with a multiplicity of plate members 2, which are connected to one another by webs 3.
  • the plate V extends in the unbent initial state in the plate plane Y.
  • a screw hole 4 is provided in each of the plate members 2.
  • all or individual screw holes 4 can be designed as cylindrical standard screw holes 40 or as known direction-oriented compression holes 41.
  • all or individual screw holes 4 can be provided with a special engagement contour 8 to be described later for the blocking.
  • the combination pattern of screw holes 4 shown in FIG. 2 is only intended to illustrate the variety of designs without being relevant in practice.
  • the outer screw holes 4 have the shape of standard cylindrical screw holes 40, while the three screw holes 4 in front are compression holes 41 acting in different directions or have engagement contours 8 intended for blocking.
  • the plate 1 ' is produced in the required length or is brought to the desired length by separating plate members 2 and webs 3.
  • the number, the positioning, the distance and the type of screw holes 4 can also be selected depending on the intended use.
  • FIG. 1C This figure illustrates a basic illustration of the direction of extension and the geometrical adaptation of a plate 1 'contoured according to the invention with a plate longitudinal axis Z which runs in a circular arc or a plate 1 with a conventionally straight plate longitudinal axis Z, both plates 1', 1 being attached to a human lower jaw and facing each other In the fully bent state, stretching the lower jaw, extend between the ascending jaw branches.
  • the straight plate 1 attached to the left branch of the jaw drifts out of the plate plane Y - virtually over the surface - from the lower jaw.
  • an additional bending in the plate plane Y must be carried out in each bar 3 - virtually over the edge. Only then does plate 1 follow the course of the lower jaw. Since this in principle has no vertical surfaces, but rather extends apically, in order to ensure that the plate 1 fits snugly against the jawbone, a subsequent setting or twisting of the plate members 2 is necessary. Due to the greater bending of the plate 1 required to adapt to the patient's anatomy, the flexural fatigue strength is reduced and thus the service life of the plate 1 used for the patient, which is subjected to constantly changing bending with the movements of the patient.
  • the conforming of the plate 1 'contoured according to the invention to the jawbone with the longitudinal axis Z of the plate running in a circular arc is achieved much more favorably. It is only necessary to bend the plate 1 'in the webs 3 out of the plate plane Y, quasi over the surface, in order to bring the plate into the U-shape encompassing the lower jaw. The bending generally takes place essentially in the area of the webs 3. The additional bending in the plate plane Y, quasi over the edge, and the setting or twisting omitted here. This plate 1 'is thus considerably less stressed by the adaptation, that is to say it is significantly less weakened by a substantially reduced preload.
  • the plate 1 ' Due to the arc-shaped initial geometry, the plate 1 ', after bending out of the plate plane Y, assumes the inclination of a circular section of the lateral surface of a cone. In this way, both the basically horizontal, U-shaped encirclement of the lower jaw in the longitudinal course of the plate V and the close fitting of the plate 1 "over its width to the apically pre-stretched bone are realized.
  • the circular arc-shaped initial geometry reduces the surgical effort for the surgeon considerably when fitting the plate 1 ', the plate 1' fits snugly against the lower jaw and the loss of strength is reduced as a result of less deformation - only from the plate plane Y.
  • the positive effects occur essentially when the arcuate plate 1 ' is produced without reshaping, so that the plates 1 'reach the surgeon in the arcuate geometry, but without prior bending.
  • FIGS. 3A to 3E variously modified plates 1 'with an arcuate plate longitudinal axis Z are shown. All of the plates 1 'have a main segment 10' in the form of a circular arc, to which a lateral segment 11 'extends on the right or left or on both sides.
  • the main segment 10 ' is provided here, for example, uniformly with 16 screw holes 4 suitable for blocking.
  • an angle segment 12' In the transition between the main segment 10 'and the lateral segment 11 "there is an angle segment 12', which is preferably reinforced in width in relation to the webs 3.
  • the angle segment 12 ' can be hole-free (see FIGS. 3B and 3D) or at least have a screw hole 4 (see FIGS. 3A, 3C and 3E).
  • the lateral segment 11 ' can extend straight (see FIGS. 3A, 13D and 3E) or curved (see FIGS. 3B and 3C) in the plane of the plate Y.
  • the modification 3E shows a plate 1 'with an arc-shaped main segment 10' and a straight lateral segment 11 'with a reduced spacing of the 5 screw holes 4 shown, the intermediate angle segment 12 'has a screw hole 4. If a curved lateral segment 11 'is provided on one or both sides of the circular-arc-shaped main segment 10', the latter can have a bending radius which differs from the main segment 10 '.
  • the pair of figures shows two typical applications of the bone plate 1 which can be blocked according to the invention, which together with bone screws 9 results in a plate-screw connection.
  • Plate 1 is particularly suitable for osteosynthesis of a lower jaw fractured in bone compartments (see FIG. 4A).
  • Another main application is in bridging a continuity defect, i.e. in the case of a missing piece of bone, the load must be permanently absorbed by plate 1 and stability must be established on the lower jaw (see FIG. 4B). Both pressing the plate 1 onto the periosteum and unintentional loosening of the screwed-in screws are to be avoided, so that solid blocking is particularly relevant here.
  • the simplest form of the plate 1 is initially assumed schematically as an elongated, unbranched branch through which the plate longitudinal axis Z extends in a straight line.
  • the plate 1 is composed of a plurality of plate members 2, which are each connected by webs 3.
  • the webs 3 form waisted transitions between adjacent plate members.
  • the screw holes 4 emerging on the underside of the plate 6 are surrounded by a spherical countersink 7 on the top side 5 of the plate. Inside screw hole 4 is the one that is now to be shown in detail Engagement contour 8.
  • the engagement contour 8 resembles a partial thread only at first glance; in fact the engagement contour 8 consists of contour valleys 80 extending on the wall of the screw hole 4 parallel to the plate plane Y and adjacent contour tips 81 alternating therewith.
  • the contour valleys 80 and tips 81 ′′ run partially in the screw hole 4, that is to say to the edges of the engagement contour 8 so that there are uncontoured wall areas 82 in the screw hole 4.
  • the countersink 7 has a depth in order to receive the screw heads countersunk. The diameter of the countersink 7 is larger than the clear width of the engagement contour 8.
  • the distance between opposite contour troughs 80 and contour tips 81 is less than the distance between the opposite, non-contoured wall areas 82, so that the outlet 83 of the screw hole 4 on the underside of the plate 6 shows an elongated hole shape to this it be arranged so that the longitudinal extent of the outlet 83 lies on the longitudinal axis Z of the plate (see FIG. 5A) or assumes different angles to the longitudinal axis Z of the plate (see FIG. 5B).
  • the non-contoured wall regions 82 are distributed along the longitudinal axis Z of the plate or offset to it.
  • the contour valleys 80 and contour tips 81 form trapezoidal passages.
  • the bone screw 9 has the screw head 90, which at the bottom is shaped like a box, complementary to the countersink 7 in the plate 1.
  • a recess 91 that can be grasped from above with a screwing tool, for example a cross recess.
  • an interlocking thread 92 here designed as a trapezoidal thread - corresponding to the engagement contour 8.
  • the two-start bone thread 94 is arranged along the screw shaft 93.
  • the bone thread 94 has, for example, an outer diameter of 2.5 mm, while the outer diameter of the blocking thread 92 is significantly larger and is, for example, 3.2 mm.
  • Figure 6B
  • a modified screw 9 with a larger diameter can be used on the bone thread 94, which e.g. Is 3.2 mm. With this diameter, too, the bone thread 94 can be moved effortlessly through the engagement contour 8 in the plate 1.
  • the self-drilling screw 9 shown can be used for a lockable plate-screw connection, which also has a trapezoidal locking thread 92 below the screw head 90, from which the bone thread 94 extends.
  • the bone thread 94 has a maximum outside diameter of 2.5 mm and the blocking thread 92 has an outside diameter of 3.2 mm.
  • the screw 9 according to FIG. 6D is additionally provided with a cutting groove 96 on the shaft tip 95.
  • These screws 9 have a thread with pointed thread flanks which is uniform across the screw shaft 93 and which is used with the appropriately contoured engagement contours 8 in the plates 1 in the upper part as a blocking thread 92 and in the lower part as a bone thread 94.
  • the screws 9 according to FIGS. 6E and 6H are single-start, the screw 9 to FIG. 6F is double-start.
  • the engagement contour 8 in the plate 1 allows the screw 9 with the locking thread 92 to be screwed into the screw hole 4 both vertically (see FIG. 7A) and with an angular offset ⁇ in relation to the longitudinal axis Z (see FIG. 7B).
  • a fully effective blocking occurs even when the screw 9 is positioned at an angle; the interlocking thread 92 also moves into the engagement contour 8.
  • the non-contoured wall areas 82 at the ends of the engagement contour 8 with the longitudinal extent of the outlet 83 offer space for the inclined blocking thread 92 to approach.
  • the screw head 90 comes to lie obliquely in the countersink 7 due to the inclined position of the screw 9.
  • the practically full and seamless support of the screw head 90 in the countersink 7 results from the complementary spherical surfaces lying one on top of the other.
  • engagement contour 8 and interlocking thread 92 are not complementary to one another.
  • the interlocking thread 92 has a helically extending thread tooth; with a two-start thread, two teeth.
  • the engagement contour 8, on the other hand, consists of the contour valleys 80 and contour tips 81, which do not run at a pitch angle, as in the case of a thread as a helix.
  • the interlocking thread 92 requires an additional helical internal thread and the horizontally running contour tips 81 brace against the retracting interlocking thread 92.
  • the interlocking thread 92 and the engagement contour 8 are deformed, that is to say, bending edges 920, 810, which are directed towards each other, occur on both of them, which when turning out Butt screw 9 against each other and thus form a significant resistance to unwanted loosening.
  • a strong torque must be exerted in order to partially deform the bending edges 920, 810 and to overcome the increased frictional resistance.
  • the preferred range of the vertical distance between repeating structures - the contour valleys 80 or the contour tips 81 - is between 0.5 mm and 1.0 mm.
  • the contour valleys 80 can expediently be produced by milling so that the contour tips 81 remain between the milled contour valleys 80.
  • the second embodiment of the engagement contour 8 is likewise formed from contour valleys 80 and contour tips 81, which are worked into the wall of the screw hole 4 parallel to the longitudinal axis Z of the plate and terminate at their ends in non-contoured wall areas 82.
  • the special feature here is that on both sides of the longitudinal axis Z of the contour troughs 80 and contour peaks 81 lie opposite each other offset.
  • the thread which is uniform on the screw shaft 93, acts in the upper part as a blocking thread 92, the thread teeth of which engage behind the contour tips 81, while the lower part serves as a bone thread 94 for screwing into the bone.
  • the dome-shaped screw head 90 sits in the spherical countersink 7.
  • the third embodiment of the engagement contour 8 is composed of contour valleys 80 and contour tips 81 which extend within the screw hole 4 parallel to the longitudinal axis Z of the plate and are saw-shaped.
  • the two-start screw 9 used in the local plate-screw connection also has a uniform thread through its screw shaft 93, the upper part of which engages under the contour tips 81 as a blocking thread 92 and whose lower part is provided as a bone thread 94 for screwing into the bone ,
  • the screw head 90 is in turn embedded in the spherical countersink 7.
  • the contour valleys 80 and the contour tips 81 have a rounded shape.
  • a screw 9 with a two-start locking thread 92 which is designed as a round thread, is used.
  • the pointed, double-start bone thread 94 extends below the blocking thread 92.
  • the rounded contour valleys 80 and contour tips 81 lie on both sides of the longitudinal axis Z of the plate at the same height with wall regions 82 which are uncontoured at the ends of the engagement contour 8.
  • the blocking thread 92 comes with the contour valleys 80 and -peaks 80.81 in blocked engagement.
  • the screw head 90 is 7 in the counterbore.
  • the special feature of the fifth embodiment of the engagement contour 8 is that the contour tips 81 in the screw hole 4 are offset from one another by 120 ° each in the plate plane Y and are located in a step-like manner in relation to one another in relation to the plate plane Y. Contour valleys and peaks 80.81 have an angular shape.
  • the screw 9 used has a uniform thread running over its screw shaft 93, the upper part of which engages under the contour tips 81 as a blocking thread 92 and the lower part of which represents the bone thread 94.
  • the spherical countersink offers 7 space for the screw head 90.
  • eccentric bores 100 are made in the two bone compartments K1, K2 to be connected - in relation to the screw holes 4 in the plate 1.
  • the distance between the bores 100 is greater than the distance between the screw holes 4 in the plate 1, which is brought into position with the bone gap X above the breaking point.
  • the screw holes 4 have the engagement contours 8 and the counterbores 7.
  • screws 9 are introduced into the holes 100 through the screw holes 4 in the plate 1.
  • the screws 9 are eccentrically fresh in the screw holes 4.
  • the bone thread 94 penetrates deeper into the bores 100 and the spherical surfaces at the bottom of the screw head 90, in cooperation with the spherical shaped countersinks 7 in the screw holes 4, bring about the successive centering of the screws 9.
  • the locking thread 92 of the screws 9 begins to move into the engagement contour 8.
  • the screws 9 are centered, they are moved towards one another and take the bone compartments K1.K2 with them; the bone gap X begins to close.
  • the two screws 19 shown have no locking blocking thread 92.
  • the screw 19 from FIG. 14A for example with an external thread diameter of 2.5 mm, is too weak to block with the engagement contour 8.
  • an undercut 97 is provided below the screw head 90, so that there is no locking thread 92 here either.
  • These screws 19 without interlocking thread 92, ie only with the bone thread 94, can also be used together with the plate 1, which has engagement contours 8 in its screw holes. Blocking does not occur here, as may be desired in the specific application (see FIG. 14C). Without problems, the screw 19 can also be inserted at an angle without the blocking thread 92, together with the plate 1 (see FIG. 14D).
  • FIG. 14E This illustration shows a lag screw osteosynthesis with the plate 1 which can be locked according to the invention and a conventional screw 19 without locking thread 92.
  • the screw head 90 is supported obliquely in the screw hole 4 and the screw shaft 93 projects through the two bone compartments K1, K2, which are pressed against one another should.
  • In the upper bone compartment K1 there is a through hole 101 with the width that the bone thread 94 cannot grip.
  • a bore 100 with a reduced diameter has been provided in the lower bone compartment K2, where the bone thread 94 engages.
  • FIGS. 15A and 15B For the sake of completeness, the two figures are intended to illustrate that small fragment screws 29, for example with an external thread diameter of 2.0 mm, can also be inserted vertically or obliquely into the plate 1.
  • the small screw head 90 is deeply supported in the screw hole 4 and the engagement contour 8 remains without function.
  • Such small fragment screws 29 with a screw shaft 93 protruding from the outlet 83 and the bone thread 94 serve for attaching smaller bone fragments.

Landscapes

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

Abstract

L'invention concerne une plaque d'ostéosynthèse (1') profilée, comprenant plusieurs éléments (2) de plaque, reliés entre eux par des liens (3) plus minces et disposés sur un plan (Y) de la plaque lorsqu'ils ne sont pas cintrés. Certains éléments (2) de plaque au moins sont dotés d'un orifice pour vis (4), dans ou à travers lequel une vis (9) pour os est introduite pour fixer la plaque d'ostéosynthèse (1'). L'axe longitudinal (Z) de la plaque d'ostéosynthèse (1'), qui s'étend dans le plan (Y) de la plaque, est au moins sensiblement arqué.
PCT/CH2001/000264 2000-05-03 2001-04-26 Plaque d'osteosynthese profilee WO2001082809A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU48216/01A AU4821601A (en) 2000-05-03 2001-04-26 Contoured bone plate

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE20007908U DE20007908U1 (de) 2000-05-03 2000-05-03 Konturierte Knochenplatte
DE20007908.5 2000-05-03

Publications (1)

Publication Number Publication Date
WO2001082809A1 true WO2001082809A1 (fr) 2001-11-08

Family

ID=7940955

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/CH2001/000264 WO2001082809A1 (fr) 2000-05-03 2001-04-26 Plaque d'osteosynthese profilee

Country Status (3)

Country Link
AU (1) AU4821601A (fr)
DE (1) DE20007908U1 (fr)
WO (1) WO2001082809A1 (fr)

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006072379A1 (fr) * 2004-12-30 2006-07-13 Königsee Implantate und Instrumente zur Osteosynthese GmbH Plaque d'osteosynthese, par exemple plaque de tete radiale ou humerale, comprenant une pluralite d'orifices destines a recevoir des vis a os
WO2008056015A1 (fr) * 2006-11-08 2008-05-15 DURÁN VAN ARX, José Système d'ancrage squelettique destiné à être utilisé dans des traitements orthodontiques
ES2299387A1 (es) * 2006-11-08 2008-05-16 Jose Duran Von Arx Placa aplicable a sistemas de anclaje esqueletico, adaptable a dos o mas microimplantes.
US20100030277A1 (en) * 2008-07-31 2010-02-04 Haidukewych George J Periarticular bone plate with biplanar offset head member
KR100999789B1 (ko) 2008-05-14 2010-12-08 (주)트라디메딕스 접골용 보철
US8262707B2 (en) 2008-07-31 2012-09-11 Biomet C.V. Periarticular bone plate with biplanar offset head member
KR101200822B1 (ko) * 2004-05-21 2012-11-13 신세스 게엠바하 본 플레이트
WO2016095978A1 (fr) 2014-12-17 2016-06-23 Medartis Holding Ag Plaque d'ostéosynthèse, ensembles chirurgicaux et ensembles de reconstruction
US10751100B2 (en) 2014-12-17 2020-08-25 Medartis Holding Ag Bone screws and surgical sets comprising bone screws

Families Citing this family (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050059970A1 (en) * 2003-09-17 2005-03-17 Eric Kolb Bone fixation systems
DE10361044B4 (de) * 2003-12-23 2005-12-29 Stryker Leibinger Gmbh & Co. Kg Selbstbohrende Knochenschraube und Implantatsystem
DE102005032026B3 (de) 2005-07-08 2006-12-14 Stryker Leibinger Gmbh & Co. Kg Osteosyntheseplatte mit schräg zur Plattenebene verlaufenden Durchgangsöffnungen
US20070162019A1 (en) * 2005-12-21 2007-07-12 Paul Burns Resorbable anterior cervical plating system with screw retention mechanism
EP2231055B1 (fr) 2007-12-10 2017-11-29 Jeffrey R. Marcus Dispositif de fixation prémaxillaire
US10010347B2 (en) 2007-12-31 2018-07-03 Jeffrey R. Marcus Intermaxillary fixation device and method of using same
US9066767B2 (en) 2009-12-11 2015-06-30 DePuy Synthes Products, Inc. Mandibular fixation plate

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2806207A1 (de) * 1978-02-14 1979-08-16 Luhr Hans Georg Prof Dr Dr Bausatz fuer unterkieferrekonstruktion
EP0290138A2 (fr) * 1987-04-07 1988-11-09 POLLOCK, Richard Allison Méthode de fabrication des plaques à conformation anatomique
DE4343117A1 (de) * 1993-12-17 1995-06-22 Wolter Dietmar Fixationssystem für Knochen
WO1996039975A1 (fr) 1995-06-07 1996-12-19 Sdgi Holdings, Inc. Dispositif destine a empecher la sortie d'une vis dans un systeme de fixation d'une plaque sur un os
WO1997009000A1 (fr) * 1995-09-06 1997-03-13 Synthes Ag Chur Plaque pour liaison osseuse
US5709686A (en) 1995-03-27 1998-01-20 Synthes (U.S.A.) Bone plate
DE19629011A1 (de) * 1996-07-18 1998-01-22 Wolter Dietmar Prof Dr Med Hilfsmittel für die Osteosynthese
US5810823A (en) 1994-09-12 1998-09-22 Synthes (U.S.A.) Osteosynthetic bone plate and lock washer
WO2000066012A1 (fr) * 1999-05-03 2000-11-09 Medartis Ag Plaque pour osteosynthese pouvant etre bloquee

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2806207A1 (de) * 1978-02-14 1979-08-16 Luhr Hans Georg Prof Dr Dr Bausatz fuer unterkieferrekonstruktion
EP0290138A2 (fr) * 1987-04-07 1988-11-09 POLLOCK, Richard Allison Méthode de fabrication des plaques à conformation anatomique
DE4343117A1 (de) * 1993-12-17 1995-06-22 Wolter Dietmar Fixationssystem für Knochen
US5810823A (en) 1994-09-12 1998-09-22 Synthes (U.S.A.) Osteosynthetic bone plate and lock washer
US5709686A (en) 1995-03-27 1998-01-20 Synthes (U.S.A.) Bone plate
WO1996039975A1 (fr) 1995-06-07 1996-12-19 Sdgi Holdings, Inc. Dispositif destine a empecher la sortie d'une vis dans un systeme de fixation d'une plaque sur un os
WO1997009000A1 (fr) * 1995-09-06 1997-03-13 Synthes Ag Chur Plaque pour liaison osseuse
DE19629011A1 (de) * 1996-07-18 1998-01-22 Wolter Dietmar Prof Dr Med Hilfsmittel für die Osteosynthese
WO2000066012A1 (fr) * 1999-05-03 2000-11-09 Medartis Ag Plaque pour osteosynthese pouvant etre bloquee

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
"Leibinger Titanium Micro System", November 1990, OSWALD LEIBINGER GMBH, MÜHLHEIM-STETTEN,DEUTSCHLAND, XP002170614 *
"OSTEOSYNTHESIS Traumatology Orthopaedics", November 1996, OSTEO AG, SELZACH, SCHWEIZ, XP002170615 *

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
KR101200822B1 (ko) * 2004-05-21 2012-11-13 신세스 게엠바하 본 플레이트
WO2006072379A1 (fr) * 2004-12-30 2006-07-13 Königsee Implantate und Instrumente zur Osteosynthese GmbH Plaque d'osteosynthese, par exemple plaque de tete radiale ou humerale, comprenant une pluralite d'orifices destines a recevoir des vis a os
WO2008056015A1 (fr) * 2006-11-08 2008-05-15 DURÁN VAN ARX, José Système d'ancrage squelettique destiné à être utilisé dans des traitements orthodontiques
ES2299387A1 (es) * 2006-11-08 2008-05-16 Jose Duran Von Arx Placa aplicable a sistemas de anclaje esqueletico, adaptable a dos o mas microimplantes.
KR100999789B1 (ko) 2008-05-14 2010-12-08 (주)트라디메딕스 접골용 보철
US8262707B2 (en) 2008-07-31 2012-09-11 Biomet C.V. Periarticular bone plate with biplanar offset head member
US8257405B2 (en) * 2008-07-31 2012-09-04 Biomet C.V. Periarticular bone plate with biplanar offset head member
US20100030277A1 (en) * 2008-07-31 2010-02-04 Haidukewych George J Periarticular bone plate with biplanar offset head member
WO2016095978A1 (fr) 2014-12-17 2016-06-23 Medartis Holding Ag Plaque d'ostéosynthèse, ensembles chirurgicaux et ensembles de reconstruction
EP3616636A1 (fr) 2014-12-17 2020-03-04 Medartis Holding AG Plaque d'ostéosynthèse, ensembles chirurgicaux et ensembles de reconstruction
US10751100B2 (en) 2014-12-17 2020-08-25 Medartis Holding Ag Bone screws and surgical sets comprising bone screws
US10828068B2 (en) 2014-12-17 2020-11-10 Medartis Holding Ag Bone plate, surgical sets and reconstruction sets
EP4197466A1 (fr) 2014-12-17 2023-06-21 Medartis Holding AG Plaque osseuse, ensembles chirurgicaux et ensembles de reconstruction
US11839409B2 (en) 2014-12-17 2023-12-12 Medartis Holding Ag Bone plate, surgical sets and reconstruction sets

Also Published As

Publication number Publication date
AU4821601A (en) 2001-11-12
DE20007908U1 (de) 2000-12-21

Similar Documents

Publication Publication Date Title
EP1175181B1 (fr) Plaque pour osteosynthese pouvant etre bloquee
DE69519732T2 (de) Knochenschraube mit reversibler Verschluss
DE102005004841B4 (de) Osteosyntheseplatte mit einer Vielzahl von Bohrungen zur Aufnahme von Knochenschrauben
DE19951760B4 (de) Implantat für Osteosynthesen
EP1861031B1 (fr) Plaque d'osteosynthese
EP1030616B1 (fr) Implant pour la stabilisation d'une fracture et vis a utiliser en chirurgie
EP1608278B1 (fr) Logement pour un element de blocage et element de blocage
EP0260222B1 (fr) Ensemble d'implant pour ostéosynthèse
DE10260222B4 (de) Rohrförmiges Element für ein in der Wirbelsäulen- oder der Knochenchirurgie zu verwendendes Implantat und Implantat mit einem solchen Element
EP0328883B1 (fr) Dispositif d'étaiement de la colonne vertébrale humaine
DE4343117A1 (de) Fixationssystem für Knochen
EP1622527B1 (fr) Implant pourvu d'un element de blocage pour une vis a os
WO2001082809A1 (fr) Plaque d'osteosynthese profilee
CH686339A5 (de) Schraubenmutter fuer die Plattenosteosynthese.
WO2000003649A1 (fr) Vis d'osteosynthese, s'utilisant notamment lors d'une fixation par vis vertebrale translaminaire
DE29909025U1 (de) Osteosynthetische Knochenplatte
EP1211993A1 (fr) Systeme de fixation pour os
DE9321544U1 (de) Osteosynthetische Platte
WO1995032674A1 (fr) Plaque vissee bifurquee
CH651192A5 (de) Osteosynthetische vorrichtung und dazu passende bohrlehre.
DE102004009429A1 (de) Knochenverankerungselement
EP0903113A2 (fr) Raccord à vis à angle fixe pour plaques d'ostéosynthèse
EP1096891B1 (fr) Vis d'osteosynthese
WO2008075160A1 (fr) Plaque d'implant, à utiliser notamment sur la colonne vertébrale, avec une fermeture à vis
DE102009060396B4 (de) Knochenplatte mit Vorrichtung zur winkelstabilen Schraubenfixation und Schrauben hierfür

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT TZ UA UG US UZ VN YU ZA ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GH GM KE LS MW MZ SD SL SZ TZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE TR BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: JP