WO2005027759A1 - Percutaneous scaphoid fixation method and guide wire alignment device - Google Patents
Percutaneous scaphoid fixation method and guide wire alignment device Download PDFInfo
- Publication number
- WO2005027759A1 WO2005027759A1 PCT/US2003/026380 US0326380W WO2005027759A1 WO 2005027759 A1 WO2005027759 A1 WO 2005027759A1 US 0326380 W US0326380 W US 0326380W WO 2005027759 A1 WO2005027759 A1 WO 2005027759A1
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- WO
- WIPO (PCT)
- Prior art keywords
- bone
- guide wire
- limb
- jaw
- scaphoid
- Prior art date
Links
- 238000000034 method Methods 0.000 title claims abstract description 24
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 49
- 208000010392 Bone Fractures Diseases 0.000 claims abstract description 39
- 238000005553 drilling Methods 0.000 claims abstract description 6
- 230000005855 radiation Effects 0.000 claims abstract description 3
- 210000003557 bones of lower extremity Anatomy 0.000 claims abstract 6
- 230000000087 stabilizing effect Effects 0.000 claims abstract 6
- 210000000707 wrist Anatomy 0.000 claims description 39
- 206010017076 Fracture Diseases 0.000 claims description 31
- 210000003189 scaphoid bone Anatomy 0.000 claims description 30
- 239000012634 fragment Substances 0.000 claims description 13
- 210000003414 extremity Anatomy 0.000 claims description 10
- 210000001519 tissue Anatomy 0.000 claims description 9
- 206010048049 Wrist fracture Diseases 0.000 claims description 6
- 238000003780 insertion Methods 0.000 claims description 5
- 230000037431 insertion Effects 0.000 claims description 5
- 230000004927 fusion Effects 0.000 claims 1
- 150000001875 compounds Chemical class 0.000 description 9
- 239000012530 fluid Substances 0.000 description 6
- 208000007536 Thrombosis Diseases 0.000 description 4
- 108010088842 Fibrinolysin Proteins 0.000 description 2
- 229940001501 fibrinolysin Drugs 0.000 description 2
- 230000035876 healing Effects 0.000 description 2
- 239000007943 implant Substances 0.000 description 2
- 238000002513 implantation Methods 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 210000002435 tendon Anatomy 0.000 description 2
- 241001465754 Metazoa Species 0.000 description 1
- 208000006670 Multiple fractures Diseases 0.000 description 1
- 241000826860 Trapezium Species 0.000 description 1
- 206010003246 arthritis Diseases 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 230000036770 blood supply Effects 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000034994 death Effects 0.000 description 1
- 239000003550 marker Substances 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 230000017074 necrotic cell death Effects 0.000 description 1
- 206010033675 panniculitis Diseases 0.000 description 1
- 229920003023 plastic Polymers 0.000 description 1
- 239000004033 plastic Substances 0.000 description 1
- 210000004304 subcutaneous tissue Anatomy 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 210000003813 thumb Anatomy 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
- 210000000466 volar plate Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1782—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hand or wrist
Definitions
- the present invention relates to surgical
- the boat shaped scaphoid bone in the human wrist is the largest bone
- the scaphoid is
- scaphoid inhibits healing of a fracture of that bone unless the fracture fragments
- intervention to fix the scaphoid bone typically includes the use of a screw that
- the present invention provides a simple percutaneous method that
- the scaphoid bone is disposed in the wrist at a compound angle that
- the apparatus of the present invention comprises a clamp or vise-like device
- a fixation device may be resolved, including visualization of the angle of the
- the wire is drilled through
- a cannulated drill bit is passed over the guide wire and a hole coaxial
- a cannulated lag screw of appropriate length is
- Figure 1 is a perspective view of the clamping and guide wire
- Figure 2 is an exploded view of apparatus shown in Figure 1.
- Figure 3 is a perspective view of the apparatus as it would be viewed
- Figure 4 is a side view of the clamping apparatus of Figure 3 with
- portions of the wrist cut away to reveal the scaphoid and associated bone
- Figure 5 is a top view of the lower jaw plate of the clamping
- Figure 5 A is a front view of the lower jaw plate of the clamping
- Figure 5B is a diagrammatic top view of the lower jaw plate with the
- Figure 5C is an exaggerated diagrammatic side view of the lower jaw
- Figure 5D is a cross sectional view taken along lines 5D-5D of
- Figure 6 is a perspective view of a human hand and wrist showing
- Figure 7 is a posterior (dorsal) view of the human hand and wrist
- Figure 8 is a lateral view of the human hand and wrist with skin
- Figure 9 is a view similar to that of Figure 7, and illustrating a
- Figure 10 is an enlarged detail of the tip end of the drill taken within
- Figure 11 is a view similar to that of figure 9, showing the insertion
- Figure 12 is an enlarged view of the tip end of the cannulated lag
- Figure 13 is a view similar to that of Figure 11, but illustrating the
- guide wire alignment apparatus of the present invention are primarily directed
- the invention can be used in the treatment of fractures in other human or animal
- a fixation device such as a lag screw.
- the vice and clamping apparatus of the present invention provides a
- the vise provides alignment
- Figures 1-4 illustrate a preferred form of the limb vise 2.
- the vise comprises a pair of substantially parallel spaced
- Such alternative structures might include a traditional vise screw, a ratchet
- the jaws are said to be substantially parallel because
- the jaws 4 and 6 are shown as being substantially similar in
- the jaw plates 4 and 6 are constructed
- palmar when it is in the clamping position will be referred to herein as the palmar
- the opposing jaw 6 will be referred to as the dorsal jaw.
- clamping jaw is important for taking of proper x-rays of the wrist and for firmly
- the scaphoid bone is to drill a guide wire into the bone across the fracture site.
- This guide wire acts as the pilot for future drilling and fixing operations.
- the axis of the scaphoid bone represents
- the horizontal component angle is generally in the range
- component angle is generally in the range of 40° to 50° from the palmar plane.
- conduits 28 are disposed in the palmar jaw 4 at a variety of compound angles
- each of the bores extends from the inferior
- the bores 28 diverge from a common opening 10L on the superior, or upper,
- common opening 10L provides a number of jigs in the form of bores, or
- a metal collar 17 which serves as a marker
- the wrist is properly positioned to receive the guide wire, as will be later
- Figures 1 to 5 and 5 A, 5B and 5C, the nine bores comprise three sets of three
- FIG. 5C sectional view of Figure 5C, comprises three bores 28a, 28b and 28c having
- the three bores of the middle set, 28a', 28b' and 28c' are all inclined at a
- bores 28 may be whatever is required to substantially align the guide wire with
- a second group of bores.29 may be placed in the palmar jaw 4 for use with the
- the bores 29 are configured similarly to the left wrist bores 28,
- the fixation method and the accessory device 2 is to ultimately implant a
- fixation device such as a lag screw 44
- a guide wire is drilled into the fracture site.
- a line may be drawn, or a line may just be visualized, along the desired course
- the lateral view X-ray is used to determine the vertical angle from
- scaphoid bone a particular one of the applicable group of bores is selected for
- the wire is then drilled into the wrist tissue, the volar distal
- dorsal proximal pole 21 of the scaphoid as shown in Figures 10 and 11.
- the guide wire 32 is implanted into the scaphoid 16, the guide wire is severed. between the wrist and the superior surface 5 of the palmar jaw, allowing the
- a small longitudinal incision 34 is made proximally and distally on
- drill bit 40 creates a pilot hole 36 in the scaphoid along the desired course of the
- fixation device of sufficient diameter and length to accommodate such a device
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Biomedical Technology (AREA)
- Molecular Biology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Engineering & Computer Science (AREA)
- Dentistry (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Pathology (AREA)
- Radiology & Medical Imaging (AREA)
- Surgical Instruments (AREA)
Abstract
A method and associated apparatus for percutaneous internal fixing of a fractured limb bone comprising, placing the limb in a stabilizing clamp (2) that is, transparent to x-ray radiation, demonstrating the fractured bone, resolving the course through the fractured bone of an intended fixation device, inserting a guide wire (32) along the resolved course and across the fracture faces of the bone through an alignment conduit (28) in the stabilizing clamp, drilling a pilot hole in the bone through the fracture faces by directing a cannulated drill (40) over the guide wire, and introducing a cannulated fastening screw (44) within the drilled pilot hole and across the bone fracture site.
Description
PERCUTANEOUS SCAPHOID FIXATION METHOD AND GUIDE WIRE ALIGNMENT DEVICE
[0001] This application is a continuation-in-part of U.S. Application No.
09/693,580, filed October 20, 2000. The present invention relates to surgical
methods and devices for fixation of broken bones and in particular to the
percutaneous fixation of a fractured scaphoid bone in the human wrist,
BACKGROUND
[0002] The boat shaped scaphoid bone in the human wrist is the largest bone
of the proximal row of the carpus on the lateral (radial) side, articulating with
the radius, lunate, capitate, trapezium, and trapezoid. The scaphoid is
surrounded on 80% of its surface by joint fluid containing fibrinolysin, a
substance that dissolves blood clots.
[0003] The scaphoid is frequently fractured in young adults through the mid-
portion, or "waist" of the bone. Because blood clots are necessary for the
healing of bone fractures, the substantial presence of fibrinolysin around the
scaphoid inhibits healing of a fracture of that bone unless the fracture fragments
are in sufficiently good apposition that joint fluid is prevented from entering the
fracture site. Failure to properly fix the bone fragments into apposition will
result in a non-union because of the presence in the fracture site of joint fluid.
[0004] In addition to an undesirable non-union, resulting from poor
apposition, a fracture of the scaphoid through its waist often leads to avascular
necrosis or death of the distal pole of the bone. This is because the blood
supply to the bone is chiefly through the proximal pole and an unhealed
fracture at the bone waist cuts off the blood supply to the distal pole, resulting
eventually in severe arthritis and deformity of the wrist.
[0005] The traditional conservative treatment of a fractured scaphoid
includes the application of a cast to the hand and thumb with the hand in radial
deviation in an effort to oppose the fracture ends of the bone. Surgical
intervention to fix the scaphoid bone typically includes the use of a screw that
requires the expertise of a hand surgeon specialist and is a tedious and difficult
exposure of the scaphoid bone.
[0006] The percutaneous method and the device of the present invention will
allow a less experienced hand surgeon or an orthopedist to fix a scaphoid
fracture with a lag screw. Such simplification of the procedure lead's to good
apposition of the bone fragments and an overall improved result, including the
minimization of surgical exposure of the wrist.
SUMMARY OF THE INVENTION
[0007] The present invention provides a simple percutaneous method that
incorporates a novel appliance to promote the procedure. The essence of the
method is to accurately resolve the required course of a fixation device, such as
a lag screw, and to be able to implant the device along the desired course.
[0008] The scaphoid bone is disposed in the wrist at a compound angle that
is demonstrated only with an anterior-posterior x-ray and a lateral x-ray of the
wrist. Even with the assistance of these x-ray, it is difficult to insert a fixation
device that will follow the desired course into the scaphoid bone without
substantial surgical intervention, accompanied by possible multiple attempts, or
without the aid of an alignment jig, such as the one of the present invention.
The apparatus of the present invention comprises a clamp or vise-like device
having a pair of opposed relatively movable jaws between which the wrist
containing the fractured scaphoid is inserted. Upon closing the jaws of the vise
over the dorsal and palmar sides of the wrist, it is held in position so that A-P
and lateral view x-rays may be taken. From these x-rays, the desired course of
a fixation device may be resolved, including visualization of the angle of the
scaphoid, as shown on the A-P view, and its vertical angulation, as shown on
the lateral view. Once the course is determined, the single one of a plurality of
bore holes in the lower jaw of the vice that is most closely aligned with the
desired course is chosen for aligning and positioning a guide wire. Using the
chosen bore to support and direct the guide wire, the wire is drilled through
skin and subcutaneous tissue into the scaphoid bone, along the direction and at
the angle imposed by the aligning bore.
[0009] Once the guide wire is drilled into the bone, the wrist is removed
from the clamping vise. A small longitudinal incision is made in the tissue on
either side of the guide wire and that tissue is then spread in order to
accommodate the bit of a drill and the lag screw that will be inserted into the
bone.
[0010] A cannulated drill bit is passed over the guide wire and a hole coaxial
with the wire is drilled to terminate near the proximal end of the scaphoid bone.
Following removal of the drill, a cannulated lag screw of appropriate length is
passed over the guide wire and screwed into the bone, bringing the fracture
fragments snugly together in good apposition. The spread tissue is allowed to
retract, the guide wire is removed and the incision is closed with a few sutures.
[0011] The bone apposition achieved by the accurately placed and well
fitted lag screw prevents joint fluid from entering the fracture site and
dissolving the blood clots that are necessary for bone union.
DESCRIPTION OF THE DRAWINGS
[0012] Figure 1 is a perspective view of the clamping and guide wire
alignment apparatus of the present invention.
[0013] Figure 2 is an exploded view of apparatus shown in Figure 1.
[0014] Figure 3 is a perspective view of the apparatus as it would be viewed
with a human wrist clamped into the device.
[0015] Figure 4 is a side view of the clamping apparatus of Figure 3 with
portions of the wrist cut away to reveal the scaphoid and associated bone
structure of the wrist similarly to what would be shown with a lateral view X-
ray.
[0016] Figure 5 is a top view of the lower jaw plate of the clamping
apparatus.
[0017] Figure 5 A is a front view of the lower jaw plate of the clamping
apparatus.
[0018] Figure 5B is a diagrammatic top view of the lower jaw plate with the
angles and sizes of the jig bores exaggerated to more clearly illustrate the
construction.
[0019] Figure 5C is an exaggerated diagrammatic side view of the lower jaw
plate of the clamping apparatus.
[0020] Figure 5D is a cross sectional view taken along lines 5D-5D of
Figure 5C
[0021] Figure 6 is a perspective view of a human hand and wrist showing
the approximate location on the palmar side of the hand where the guide wire
enters the tissue and the location of the incision that is made to permit the
drilling and placement of a fixation device.
[0022] Figure 7 is a posterior (dorsal) view of the human hand and wrist
with skin muscles and tendons broken away to reveal the bone structure as it
would appear in an anterior-posterior (AP) x-ray, illustrating a fractured
scaphoid and the necessary horizontal angular alignment of a pre-fixation guide
wire.
[0023] Figure 8 is a lateral view of the human hand and wrist with skin
muscles and tendons broken away to reveal the bone structure as it would
appear in a lateral x-ray, illustrating the fractured scaphoid and the necessary
vertical angular alignment of a pre-fixation guide wire.
[0024] Figure 9 is a view similar to that of Figure 7, and illustrating a
portion of a cannulated drill bit being inserted over the guide wire that has
previously been inserted into the scaphoid bone.
[0025] Figure 10 is an enlarged detail of the tip end of the drill taken within
the circle in figure 9.
[0026] Figure 11 is a view similar to that of figure 9, showing the insertion
of a cannulated lag screw into the drilled hole in the scaphoid that was created
by the drill bit of figure 10.
[0027] Figure 12 is an enlarged view of the tip end of the cannulated lag
screw as it is passed over the guide wire.
[0028] Figure 13 is a view similar to that of Figure 11, but illustrating the
end result of the process, where the scaphoid bone fragments have been secured
in apposition by a lag screw type of final fixation device.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0029] The bone fracture fixation method and associated clamping and
guide wire alignment apparatus of the present invention are primarily directed
toward treatment of a fractured scaphoid bone in the human wrist. However,
the invention can be used in the treatment of fractures in other human or animal
bones that present the same challenge in determining and following the proper
course or angle for the implantation of a fixation device, such as a lag screw.
[0030] The vice and clamping apparatus of the present invention provides a
device to stabilize the limb having a broken bone while x-rays or MRI pictures
are taken. Then, with the use of the x-rays or MRI, the vise provides alignment
means for the insertion of a guide wire that will thereafter pilot the course of
subsequent procedures, including drilling and the implantation of a fixation
device, such as a screw, across the fracture site of the bone.
[0031] Figures 1-4 illustrate a preferred form of the limb vise 2. Referring
to Figures 1 and 2, the vise comprises a pair of substantially parallel spaced
apart jaw forming plates 4 and 6. The jaws are moved and positioned with
respect to one another by three spacing posts 7, 8 and 9, one end of which are
each fixed to the sides of the bottom jaw 4. The other ends of the posts are
adjustably secured to the top jaw 6 by wing nuts 10 that thread onto bolt shafts
12 that protrude from the top jaw 6 into grooves 13, 14 and 15 in the spacing
posts.
[0032] Although threaded rods and nuts are shown in the preferred
embodiment of the invention, other forms of adjustable connectors can be used.
Such alternative structures might include a traditional vise screw, a ratchet
device, or electrical, pneumatic or hydraulically driven adjustable
interconnecting linkages. The jaws are said to be substantially parallel because
in use they appear to be parallel when casually viewed in their clamping
positions on the dorsal and palmar sides of a human wrist 13 (See Figures 3 and
4). However, the adjustment mechanism provided by the spacing posts 1, 8 and
9, or its equivalent, permit the plates to be placed in a slightly non-parallel
configuration if such a position is necessary to properly secure the particular
patient's limb. The jaws 4 and 6 are shown as being substantially similar in
their lateral and longitudinal extents, however such resemblance is not
necessary. If the particular limb being clamped makes it necessary or desirable
for the two jaw plates to have different shapes, those diverse shapes would still
be within the scope of the invention. The jaw plates 4 and 6 are constructed
from any rigid material that is transparent, or pervious, to x-ray radiation, such
as any number of plastics.
[0033] The jaw plate 4 that is contacted by the palmar side of the patient's
wrist when it is in the clamping position will be referred to herein as the palmar
jaw. The opposing jaw 6 will be referred to as the dorsal jaw. The dorsal jaw 6
is fitted on its lower side with a semi-cylindrical pressure pad 11 that makes
contact with the dorsal side of the patient's wrist to force the volar (palmer)
side of the wrist down against the upper surface 5 of the palmer jaw when the
dorsal and palmar jaw plates are brought together. Positioning the volar side of
the wrist against, or at least in close proximity, to the surface 5 of the lower
clamping jaw is important for taking of proper x-rays of the wrist and for firmly
holding the wrist in a properly fixed position for the insertion of a guide wire.
Following the taking of x-rays or MRI pictures, the first step in the fixation of
the scaphoid bone is to drill a guide wire into the bone across the fracture site.
This guide wire acts as the pilot for future drilling and fixing operations. To
effectively use the guide wire in subsequent operations, it must be inserted at a
point on the wrist and at a compound angle that substantially corresponds to
that of the axis of the scaphoid bone. The axis of the scaphoid bone represents
a compound angle comprising a horizontal component, as visualized in the A-P
x-ray view (Figure 7), and a vertical component, as visualized in the lateral x-
ray view (Figure 8). The horizontal component angle is generally in the range
of 25° to 35° from a vertical sagittal plane through the arm, while the vertical
component angle is generally in the range of 40° to 50° from the palmar plane.
[0034] Serving as a selection of alignment jigs, a plurality of bores or
conduits 28 are disposed in the palmar jaw 4 at a variety of compound angles,
one of which will substantially correspond to the compound angle of the axis of
the scaphoid bone of the patient. Each of the bores extends from the inferior
lower surface 3 of the palmar jaw 4 to the superior surface 5 of the palmar jaw.
The bores 28 diverge from a common opening 10L on the superior, or upper,
surface 5 of the palmar plate 4 to spaced apart openings, each of which intersect
the inferior surface 3 of the palmar jaw 4. Divergence of the bores from the
common opening 10L provides a number of jigs in the form of bores, or
conduits, each with a distinct compound angle. Surrounding the inside
circumference of the opening 10L is a metal collar 17 which serves as a marker
on the x-ray views to establish the position of the common opening for the
plurality of jigs. It is necessary that this position be ascertained to insure that
the wrist is properly positioned to receive the guide wire, as will be later
explained.
[0035] It has been found that nine guide wire jig bores 28 provide a
satisfactory number from which to chose a single one that substantially matches
the compound angle of the axis of the scaphoid bone in the patient, however
this number of bores is not critical, as there can be more Or less. As shown in
Figures 1 to 5 and 5 A, 5B and 5C, the nine bores comprise three sets of three
bores each. The front set, seen in the top view, Figure 5A and the cross
sectional view of Figure 5C, comprises three bores 28a, 28b and 28c having
horizontal angular components H, measured from a sagittal plane 30 passing
through the common opening 10L, of, for example, 25°, 30° and 35°. The
middle set, 28a', 28b' and 28c' and the rear set, 28a" and 28b" and 28c" have
the same horizontal component angles.
[0036] The bores of the first set 28a, 28b and 28c are all inclined at an angle
to the palmar plane of, for example, 25°, as shown diagrammatically in Figure
5B. The three bores of the middle set, 28a', 28b' and 28c' are all inclined at a
vertical component angle to the palmar plane of, for example 45° while the rear
set, 28a", 28b" and 28c" are inclined at an exemplary component angle of
50°. These angles and the number of bores are exemplary only, it being
apparent that other selections of compound angles, numbers of or grouping of
bores are within the teaching of this invention. The respective angles of the
bores 28 may be whatever is required to substantially align the guide wire with
the pertinent axis of the scaphoid bone, considering the bone's inclination with
respect to a palmar plane, as seen in a lateral X-ray view of the wrist, and the
horizontal angle of the bone with respect to the sagittal plane, as seen in the A-
P view of the wrist.
[0037] It is apparent that a single group of bores, such as the three sets of
three described above will function for only one wrist, that is, the left or the
right. The bores 28 for the left wrist have been discussed above. Accordingly,
a second group of bores.29 may be placed in the palmar jaw 4 for use with the
other wrist. The bores 29 are configured similarly to the left wrist bores 28,
except they are at reverse horizontal component angles, diverging from a
common opening 10R in the upper surface of the lower jaw 4 to a plurality of
spaced apart openings in the bottom surface of the lower jaw.
[0038] The novel percutaneous fixation method of the present invention
makes use of the clamping device 2 of the present invention. The purpose of
the fixation method and the accessory device 2 is to ultimately implant a
fixation device, such as a lag screw 44, accurately across the faces of the
fracture fragments so as to achieve maximum apposition of the bone fragments.
Snug fitting bone fragments tend to resist the entry of joint fluid into the
fracture site, thus eliminating the destruction of the blood clots that are
necessary to the union of the bone.
[0039] Because the scaphoid bone is relatively small and is disposed in the
wrist at a compound angle, it is normally very difficult to visualize the position
of the bone with sufficient accuracy that a fixation device may be properly
implanted across the fracture site. According to the present invention, and
assuming a fracture through the scaphoid bone, a guide wire is drilled into the
bone along the same course as that desired for the intended fixation device,
such as, for example, a lag screw or a bone graft. Once the guide wire is
properly in place, the remaining steps of the fixation procedure may proceed,
using the guide wire as the pathfinder for subsequent steps of the procedure.
[0040] With the patient's wrist 13 secured in the clamping device 2, as
shown in Figures 3 and 4, anterior-posterior (AP) and lateral X-ray are taken to
demonstrate the position of the scaphoid bone in two planes. On the AP X-ray,
a line may be drawn, or a line may just be visualized, along the desired course
of the fixation device from the scaphoid distal pole through the bone fracture
site at the point where the fixation device should pass.
[0041] The lateral view X-ray is used to determine the vertical angle from
the horizontal of the scaphoid bone, as shown in Figure 4. When the vertical
angle is known, the course of the guide wire in the vertical plane is established.
Next, using the measured angle of bone inclination and the AP alignment of the
scaphoid bone a particular one of the applicable group of bores is selected for
piloting the guide wire into the scaphoid bone 16.
[0042] When the bore selection is made, a guide wire 32 is inserted into the
chosen bore hole. The wire is then drilled into the wrist tissue, the volar distal
pole 20 of the scaphoid bone and across the fracture faces 25 and 26 to the
dorsal proximal pole 21 of the scaphoid, as shown in Figures 10 and 11. Once
the guide wire 32 is implanted into the scaphoid 16, the guide wire is severed.
between the wrist and the superior surface 5 of the palmar jaw, allowing the
vise 2 to be loosened and the wrist removed therefrom for completion of the
fixation procedure.
[0043] A small longitudinal incision 34 is made proximally and distally on
either side of the guide wire 32, as illustrated in Figure 7. Next, as shown in
Figures 10 and 11 a cannulated drill bit 40 is passed over the guide wire 32 and
through the incision 34 prepared in the tissue. Following the guide wire 32, the
drill bit 40 creates a pilot hole 36 in the scaphoid along the desired course of the
fixation device of sufficient diameter and length to accommodate such a device
44. The drill bit 40 is withdrawn and the cannulated lag screw 44 is passed
over the guide wire 32 and screwed into the scaphoid bone 16, as shown in
Figures 12, 13 and 14. When the screw has been fully seated and the bone
fragments are pulled together in apposition (Figure 14), the guide wire 32 is
removed and the small incision 34 is closed with a few sutures.
[0044] Employment of the apparatus 2 and the method of the present
invention result in good apposition of the bone fragments with reasonable
assurance that a union of the fragments will take place, since joint fluid has thus
been isolated from the fracture site.
Claims
1. A surgical tool for aligning fixation apparatus incident to the repair or
fusion of human limb bones, comprising, a vise, having relatively movable x-ray pervious first and second spaced
apart jaws for retaining a portion of a limb there between, means interconnecting the jaws and operable to fix the spacing there
between, at least one conduit extending through the second jaw and directed
toward the limb for receiving a guide wire.
2. The tool of claim 1 where the second jaw has upper and lower spaced
apart surfaces and where the at least one conduit is a plurality of conduits that
diverge from a common intersection with the said upper surface to spaced apart
intersections with the lower surface of the second jaw.
3. The appliance of claim 2 and further including an x-ray impervious ring
around the common opening on the upper surface of the second jaw.
4. A surgical appliance for repairing fractures of the scaphoid bone in a
human wrist, comprising, vise means, having upper and lower spaced apart jaws that are
transparent to x-ray radiation and are relatively movable toward and away from
one another for retaining there between at least a portion of a human wrist, the
lower jaw having spaced apart inferior and superior surfaces, means interconnecting the upper and lower jaws for fixing the spacing
between the jaws, « a plurality of bores through the lower jaw that diverge from a common
intersection with the said superior surface to spaced apart intersections with the
inferior surface of the second jaw.
5. The appliance of claim 4 and further including a second plurality of
bores through the lower jaw that diverge from a common intersection "With the
said superior surface to spaced apart intersections with the inferior surface of
the second jaw.
6. An appliance for aligning a wire guide preparatory to insertion of a
fixation device for repairing limb bone fractures, comprising, first and second substantially parallel jaws for clamping there between a
limb containing a fractured bone, at least one adjustable connector for interconnecting and selectively
spacing the plates apart, one from the other, at least one straight wire guide passageway having a longitudinal axis
and carried by the second jaw, where the longitudinal axis of the passageway is
aligned so that an extension thereof crosses the fracture site in the bone of the
limb being clamped between the jaws.
1. A method for percutaneously internally fixing a fractured limb bone
including, placing the limb in a stabilizing clamp, demonstrating the fractured bone to be fixed, resolving the course through the fractured bone of an intended fixation
device, placing a guide wire through exterior and interior tissue adjacent the
fractured bone along the resolved course and across the fracture faces of the
bone, incising the tissue around the guide wire; drilling a pilot hole in the bone through the fracture faces by directing a
cannulated drill over the guide wire; installing a cannulated fastening screw within the drilled hole and across
the bone fracture site to achieve apposition of the fracture fragments of the
bone.
8. The method of claim 7 where the step of demonstrating the fractured
bone to be fixed includes, demonstrating the anterior-posterior view of the fractured bone, and
demonstrating the lateral view of the fractured bone.
9. The method of claim 8 and further including the step of extracting the
guide wire and closing the tissue incision.
10. A method for percutaneous fixing of a fracture of a human scaphoid
bone having volar and dorsal extents, including, placing the wrist in a stabilizing clamp, demonstrating the fractured scaphoid bone with anterior-posterior and
lateral X-rays, resolving the course through the scaphoid bone of a guide wire and the
intended fixation device, inserting a guide wire through a selected guide wire alignment device in
the stabilizing clamp that is substantially coincident with the resolved course
and into the scaphoid bone for a distance sufficient to cross the fracture site. drilling the scaphoid coaxially with the guide wire and through the
fracture faces therein; installing a cannulated fastening screw over the guide wire within the
drilled bone and across the fracture site to acquire apposition of the fracture
fragments of the bone.
11. The method of claim 10 and further including the step of extracting the
guide wire.
12. A method of installing a pre-fixation guide wire in <a fractured limb
bone, including, stabilizing the limb in a clamping vice, visualizing the required course of a pre-fixation guide wire that' is to
span the fracture site in the limb bone, inserting a guide wire across the fracture site in the bone following
insertion of the guide wire into a conduit or bore in the clamping vice that
aligns the guide, wire with the visualized course.
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/US2003/026380 WO2005027759A1 (en) | 2003-08-22 | 2003-08-22 | Percutaneous scaphoid fixation method and guide wire alignment device |
AU2003260012A AU2003260012A1 (en) | 2003-08-22 | 2003-08-22 | Percutaneous scaphoid fixation method and guide wire alignment device |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/US2003/026380 WO2005027759A1 (en) | 2003-08-22 | 2003-08-22 | Percutaneous scaphoid fixation method and guide wire alignment device |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2005027759A1 true WO2005027759A1 (en) | 2005-03-31 |
Family
ID=34374764
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2003/026380 WO2005027759A1 (en) | 2003-08-22 | 2003-08-22 | Percutaneous scaphoid fixation method and guide wire alignment device |
Country Status (2)
Country | Link |
---|---|
AU (1) | AU2003260012A1 (en) |
WO (1) | WO2005027759A1 (en) |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE202007014672U1 (en) | 2007-10-19 | 2009-02-26 | Citak, Musa, Dr. med. | Rail for storing body parts during examinations or operations |
WO2009059800A2 (en) * | 2007-11-10 | 2009-05-14 | Waldemar Link Gmbh & Co. Kg | Instruments for carrying out an operating procedure on a joint |
CN103190949A (en) * | 2013-02-28 | 2013-07-10 | 陈山林 | Scaphoid guide apparatus |
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US4427005A (en) * | 1982-03-04 | 1984-01-24 | Tener William S | Apparatus and method for treating breast tumors |
US4465065A (en) * | 1983-01-07 | 1984-08-14 | Yechiel Gotfried | Surgical device for connection of fractured bones |
US5980526A (en) * | 1997-02-12 | 1999-11-09 | Orthopaedic Innovations, Inc. | Wedge osteotomy device including a guide for controlling osteotomy depth |
US6033407A (en) * | 1998-01-27 | 2000-03-07 | Behrens; Alfred F. | Apparatus and method for intramedullary nailing and intramedullary nail therefor |
US6036696A (en) * | 1997-12-19 | 2000-03-14 | Stryker Technologies Corporation | Guide-pin placement device and method of use |
-
2003
- 2003-08-22 WO PCT/US2003/026380 patent/WO2005027759A1/en active Application Filing
- 2003-08-22 AU AU2003260012A patent/AU2003260012A1/en not_active Abandoned
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4427005A (en) * | 1982-03-04 | 1984-01-24 | Tener William S | Apparatus and method for treating breast tumors |
US4465065A (en) * | 1983-01-07 | 1984-08-14 | Yechiel Gotfried | Surgical device for connection of fractured bones |
US5980526A (en) * | 1997-02-12 | 1999-11-09 | Orthopaedic Innovations, Inc. | Wedge osteotomy device including a guide for controlling osteotomy depth |
US6036696A (en) * | 1997-12-19 | 2000-03-14 | Stryker Technologies Corporation | Guide-pin placement device and method of use |
US6033407A (en) * | 1998-01-27 | 2000-03-07 | Behrens; Alfred F. | Apparatus and method for intramedullary nailing and intramedullary nail therefor |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE202007014672U1 (en) | 2007-10-19 | 2009-02-26 | Citak, Musa, Dr. med. | Rail for storing body parts during examinations or operations |
WO2009059800A2 (en) * | 2007-11-10 | 2009-05-14 | Waldemar Link Gmbh & Co. Kg | Instruments for carrying out an operating procedure on a joint |
WO2009059800A3 (en) * | 2007-11-10 | 2009-07-09 | Link Waldemar Gmbh Co | Instruments for carrying out an operating procedure on a joint |
KR101234387B1 (en) | 2007-11-10 | 2013-02-18 | 발데마르 링크 게엠베하 운트 코.카게 | Instruments for carrying out an operating procedure on a joint |
US8882778B2 (en) | 2007-11-10 | 2014-11-11 | Waldemar Link Gmbh & Co. Kg | Instruments for carrying out an operating procedure on a joint |
CN103190949A (en) * | 2013-02-28 | 2013-07-10 | 陈山林 | Scaphoid guide apparatus |
Also Published As
Publication number | Publication date |
---|---|
AU2003260012A1 (en) | 2005-04-11 |
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