CA2104029A1 - Anatomic wrist - Google Patents
Anatomic wristInfo
- Publication number
- CA2104029A1 CA2104029A1 CA 2104029 CA2104029A CA2104029A1 CA 2104029 A1 CA2104029 A1 CA 2104029A1 CA 2104029 CA2104029 CA 2104029 CA 2104029 A CA2104029 A CA 2104029A CA 2104029 A1 CA2104029 A1 CA 2104029A1
- Authority
- CA
- Canada
- Prior art keywords
- wrist
- ball
- anatomic
- component
- stem
- Prior art date
- Legal status (The legal status 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 status listed.)
- Abandoned
Links
Classifications
-
- 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
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
-
- 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
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
- A61F2002/4264—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists for radio-carpal joints
-
- 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
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
- A61F2002/4269—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists for distal radio-ulnar joints, i.e. DRU joints
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
ABSTRACT
This implantable wrist prothesis incorporates an improved assembly of components which assembly is particularly well adapted and intended for use as a replacement for a disfunctional wrist joint. The novel total wrist joint prothesis which is particularly suitable as an implanted wrist prothesis incorporates a carpal component comprising a capitate replacement spur which is implanted into the two adjacent second and third medacarpal bones and a radial component which is inserted into the radius. These spurs each provide those components with fixation into two metacarpals and the radius respectively.
In addition, a joint of a ball and socket hinged configuration incorporates a laterally attached ball and socket connection with a stem for affixation into the ulnar.
This implantable wrist prothesis incorporates an improved assembly of components which assembly is particularly well adapted and intended for use as a replacement for a disfunctional wrist joint. The novel total wrist joint prothesis which is particularly suitable as an implanted wrist prothesis incorporates a carpal component comprising a capitate replacement spur which is implanted into the two adjacent second and third medacarpal bones and a radial component which is inserted into the radius. These spurs each provide those components with fixation into two metacarpals and the radius respectively.
In addition, a joint of a ball and socket hinged configuration incorporates a laterally attached ball and socket connection with a stem for affixation into the ulnar.
Description
210~0~ ~
L~: OF THE INVEN~ION
l~na tomic Wris t B~cKGr~uND I~ND SU~ Y OF TIIE INV~NTIO~l :
.
'rh,is invention relates to prosthesis r~edical devices, and more particulaxly it relat2s to an implantable wrist prosthee,is which ,incorporates an improved assembly of components for use as a repl~cement for a dysfunctional wrlst joint.
' , OME PRIOR ~T
Several prosthesis have been con~trained as hinges and have resulted in loosening.
~ ' European model by Mueli and an ~merican model by Hamas produced by Zimmer are simple ball and socket joints.
The problem witll these wrist joints was reproducing the center of rotation of the wrist which is, in fact, at the capitate. The~e wrists would frequently go into imbalance.
There was an additional problem with a loosening ~n the bones since the ~lamas was fixed in only a single metacarpal~
The present Beckenbaugh Mayo Clinic wrist and the present Biomet wrist fix only a third metacarpal and are therefore subject to loo~enlng. They also do not allow for adjustment in the length of the prosthesis which is a definite limitation to the surgeon and the patient.
Finally, they do not capture the instant center of the wrist - : ........................................ . . . .
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i 21~2~
at the capitate but rather give the patlent an elliptical artlculation whlcll the s~rgeon hoped would approach the center of the wrist.
~DDITION~L P~T~NT ~RT
1~he fo]lowlng cited paten~ provide some indication of prosthetic wrist joints which have been conce~ved. Howevert nelther these joints nor the joint~ known in the prior art as }lamas ~oints or the Mueli joint presently ln use, provide the various desirable features which have been ~ncorporated in ~pplicant's wrist prosthesis.
You~ et al 4,229,841 Weber 4,307,473 Green et al 4,352,212 Beckenbaugh et a~ 4,784,661 U. S. Patent to Weber, No. 4,307,473 and U. 5. Patent to Green et al, No. ~,352,212 each show a cylindrical head of the metacarpal component received within a semi-cylindrical recess of the radial component.
The ~oum et al patent, No. 4,229,841 relate~ to a wrist prosthesis with a proximal component af ixed to the radiu~
of the forearm. ~ distal component is affixed to the hand.
Both are connected by a joint which prevents axial rotation between the components rel~tive to the forearm axi~ hey provide relative movement of the axi~ for radial-ulnar hand . , ~, :
.
.. . . . ..
L~: OF THE INVEN~ION
l~na tomic Wris t B~cKGr~uND I~ND SU~ Y OF TIIE INV~NTIO~l :
.
'rh,is invention relates to prosthesis r~edical devices, and more particulaxly it relat2s to an implantable wrist prosthee,is which ,incorporates an improved assembly of components for use as a repl~cement for a dysfunctional wrlst joint.
' , OME PRIOR ~T
Several prosthesis have been con~trained as hinges and have resulted in loosening.
~ ' European model by Mueli and an ~merican model by Hamas produced by Zimmer are simple ball and socket joints.
The problem witll these wrist joints was reproducing the center of rotation of the wrist which is, in fact, at the capitate. The~e wrists would frequently go into imbalance.
There was an additional problem with a loosening ~n the bones since the ~lamas was fixed in only a single metacarpal~
The present Beckenbaugh Mayo Clinic wrist and the present Biomet wrist fix only a third metacarpal and are therefore subject to loo~enlng. They also do not allow for adjustment in the length of the prosthesis which is a definite limitation to the surgeon and the patient.
Finally, they do not capture the instant center of the wrist - : ........................................ . . . .
.
i 21~2~
at the capitate but rather give the patlent an elliptical artlculation whlcll the s~rgeon hoped would approach the center of the wrist.
~DDITION~L P~T~NT ~RT
1~he fo]lowlng cited paten~ provide some indication of prosthetic wrist joints which have been conce~ved. Howevert nelther these joints nor the joint~ known in the prior art as }lamas ~oints or the Mueli joint presently ln use, provide the various desirable features which have been ~ncorporated in ~pplicant's wrist prosthesis.
You~ et al 4,229,841 Weber 4,307,473 Green et al 4,352,212 Beckenbaugh et a~ 4,784,661 U. S. Patent to Weber, No. 4,307,473 and U. 5. Patent to Green et al, No. ~,352,212 each show a cylindrical head of the metacarpal component received within a semi-cylindrical recess of the radial component.
The ~oum et al patent, No. 4,229,841 relate~ to a wrist prosthesis with a proximal component af ixed to the radiu~
of the forearm. ~ distal component is affixed to the hand.
Both are connected by a joint which prevents axial rotation between the components rel~tive to the forearm axi~ hey provide relative movement of the axi~ for radial-ulnar hand . , ~, :
.
.. . . . ..
2 ~ 2 ~
movement and flexion-extension hand movement. This prosthesis structure dlffers substantia11y from the structure of the instant ln~ention which will be descrlbed subsequently.
'rhe Beckenbaugh et al U. S. Patent No. 4,784,661 is the only pertinent patent of the prior art known to the inventor. It relates to an endo-prosthetic wrist replacement device comprising two components which have means for Lntramedullary implantation in the radius and a metacarpal bone, respectively.
The radial component is provided with a distal head in which there is a distally facing transversely extending groove trough of generally semi-cylindrical configuration.
The metacarpal component has a proximally located ovoid ball head of ~enerally oval shape ln cross section which is recelved within the head of the radlus component.
It is shaped in the proxlmal-distal direction to conform to the semi-cylindrical groove trough in a transverse direction allowing flexion and extension and radial and ulnar deviation as the oval metacarpal component moves within the radial trough. The ovoid ball does not duplicate the instant center of the wrist at the capitate and the single stem of the metacarpal component is prone to loosen.
In the speciEication of Beckenbaugh, there is an adequate aescription of prior art joint prosthesis patents and this description by Beckenbaugh is hereby incorporated .. . .
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^~ 21~v2~
by reference into this patent application. It also includes some indlcatlon oE a prosthetic wrlst ~oint which ha~ been conceived, and is considered to be the most pertinent prior art. Ilowever, none of the prior art joints provlde the various desirable features which have been incorporated in the wrist prosthesis.
These artiEicial wr~st jo~nts use methylmethacrylate, an acrylic bone cement used to secure the pros~hetic stems or spurs to tlle bone~. The metal components are fabricated from a biologically inactlve metal, Vitallium and high density polyethylene. ~hese materials are utilized to minimize friction between metal and plas~ic parts and thereby ~aximize wear life.
B~C~GROUND, CONST~UCTION ~ND SUMM~R~ OF Tll~ INVENTION
In a preferr~d embodiment of this invention, 1exion or extension simulating the normal motion of the human wrist i~
provided by the like biconvex joint portion which is received in a biconcave longitudinal spur portioh pro~ided in the radius.
The unique p~eferred conf~gurations for the components of the bearing portions of the -joint movement component provide an accurate reproductlon of the movement required in the activities Oe daily living. The normal human ~rist comprises attachments and actuations of three sets of bone~.
The forearm, comprlsing the radlus and ulnar is one set, the carpal~ as a second set, and the metacarpal bones comprise . . . . ... . ~ .
the thlrd set. The carpals are the bones most closely associated with the motion of the wrist.
~ s aforestated, ln the forearm, there are two bones, the radius and the ulnar. In the wrist there are eight carpals, which are divided into rows, the proximal and the distal. The proximal row includes a navicular, a lunate, a triguetrum and a pisiform. The distal row includes a trapezium and a trapezoid, a capitate and a hamate. There are five metacarpals consecutlvely arranged from the thumb through the last or little finger.
Wrist movement is divided between the radlocarpal and mid-carpal joints of the wrist, in a relatively complex ma~ner. The configuratlon o~ each row of bones changes according to the position o~ the hand. ~lthough both joints contribute to all hand motions, palmar flexion is predominately a mid carpal motion. In dorsiflexion, it i5 radiocarpal.
Ulnar deviatlon also occurs at the radlocarpal joint, while radial deviation takes place at the mid-carpal radial level. In the anatomic wrist, the motion is simplified allowing prosthetic 3S degrees dorsiflexion and 35 degrees palmar flexion at the radiocarpal component junctiorl and 15 degrees radial and 15 degrees ulnar deviation at the metacarpal capitate - carpal component.
Deterioration or destruction of the carpal bones, or loss of integrity of thelr ligaments with secondary :` ' ,. ~. ~ ;
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21 0402~
stlffness and pain affects the joint and results in wrist disability.
The carpal bones are held together ~y ligaments.
Collateral ligaments provide lateral support of the wrist, while palmar radiocarpal and dorsal radlo~arpal ligaments maintain support of the carpal area. These ligaments define a symmetrical pattern due to insextlons into the scaphoid lunate, triquetrum and capitate bones. It is important that the integrity of the radiocarpal and ulnar carpal bands of ligaments as well as the dorsal and volar capsule be maintained in carpal bone surgery and that these tissues not be interfered with or impinged on by the implant.
Currently, there are a number of devices available for either total or partial prosthesis of the wrist joint.
These devices use one or more of the possible types of mechanical articulations available, which are the hin~e, ball and socket, or anatomic spacers.
Most devices use intramedullary stems and methyl methacrylate bone cement to secure the prosthesis t the bone. Presently available prosthesis have components constructed from several types o~ biologically inactive metals and they are de~igned to articulate with other components constructed from a pla~tic such a~ high density polyethylene.
Several methods or techniques are used to insure that the components remain articulated, and these methods include the use of soft tissue existent at the time of implantation, : ~
``' 2104~29 , the use of pins or scre~s to hold the articulate surface together and the use of band type locks. certain types of available prosthesi~ are quite simple while other types comprise complex mechanical systems, wlth both types having attendant or inhe~ent disadvantages.
The principal disadvantage oE the simple pro~thesis is that they may not reproduce an adequate, stable range of motion of the joint and frequently distort lt, while the prlncipal disadvalltage of the complex prosthesis is the potential dlfficulty of surgery and increased failure.
Fin~lly, existing prosthesis do not center the anatomic axis properly as no other includes the dlstal ulnar as part of the comp~nent.
Severely arthritLc wrists are presently still preferentially treated by wrist fusion. ~his procedure leaves the patient unable to place the hand where he needs to place it for the activities of dally living wherein 70 degrees of flexion and extension are routinely used.
SoM~ PRINCIPAL OBJECTS ~ND ~DV~NTAGES O~ INVENTION
~ his anatomic wrist lnvention relates to a mechanlcal device for surgical replacement of certain bones and joints, in a diseased or otherwise damaged human wrist. More particularly, it relates to a total wrist prosthesis providing maximum correspondence of the proviaed motion with that of the human wrist.
~ -. - :- - - .: : , i 21~02~
Total wr.i~t arthroplasty lnvolves prosthetlc replacement of the wrist by an artlficlal joint designed to simulate normal wrlst motlon. Prosthetic replacement of the wrist requires careful consideration of both anatomlc and mechanical facto~s, together wlth appllcatlo~ of the skilled surgical techn1ques of implant flxation an~ recogn~tion of soft tisiue balancé acxoss the wrist.
The surgically imp]antable wrist prosthesis of the present invention incOrpGrateS an lmpxoved assembly of components wi1lch is particularly well adapted and intended for use in replacetnent of the dysfunctional wrist joint.
There are three components to this implantable prosthesis.
The me~acarpal component comprises a capitate replacement from which two spurs insert into the medullary canal of the adjacent, stable, second and third metacarpal bones. ~ radial component lnserts into the adjacent radius.
The carpal component comes in three adjustable thicknesses to attach to the capitate as a ball and socket "pop ball" joint where it is allowed to move in a radial ulnar deviation plane and articulate with the radial component as a biconvex articulation with the biconcave xadial component where lt is allowed to Plex and extend.
There is an addltional and optlonal ulnar component which allows articulation rom the radlal component to the distal ulna. Thls is comprised of an ulnar cap whlch captures an ulnax head ball. It then receives an ulnar stem - : ................. , , ~......... ~ ........ .. ~ , - ., . ~ ...................... . ,.~
.
21~402~
which is in turn, inserted lnto the patient's distal ulna by a flex lock peg. ~ree movement of the ulnar ball wlthin the ulnar cap, and free motion of the ulnar stem within the ball allows full and stable pronation and supination.
~ he kinematics of the wrist are very complex in the motions thereof. In the pàst the wrist motlohs could not be simply reproduced and incorporated in the design of a joint prosthesis. sa~ed on experience of previous wrist arthroplastesis and anatomic and ~lnetic principles found in the llterature, a successful comp~omise i5 achieved in the present invention.
'rhe studies which have been directed to normal wri.sts of healthy individuals have led to the flnding that the center of rotation of the wrist is located within the head of the capitate. In tlle case o radial-ulnar deviation, the center of rotation has been found to lie toward the ulnar side of the axis of the third metacarpal and the axis of the distal radius.
The center oE flexion-extension motion of the wrist was known to be offset toward the palm or volar from the axis of the third metacarpal of the additional radius also located in the head of the capitate. Pronation and supination are rotational movements of the arm about the longitudinal axls of the distal ulna. The wrist does not rotate significantly in relation to the radlus, hence the wrist has been describea as a biaxial joint with two degrees of freedom.
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-' , , ' ' ' ~ ~ ' ' - ' ' ` ' ' .
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:: , i -' 210~02~
The index fing~r or second metacarpal is s-table in its attachment with the capitate and lesser multi~angular (trapeæoid), function with very little motion occurring between these bones during all natural positions of flexion-extension motion or radial-ulnar deviation. : :
Also, the head of the capitate contains the rotation of ~oth of the aforementioned motions. The capitate-third metacarpal fixed unit is likewise stable, therefore the logical position choice for the metacarpal component of the ;~
wrist prosthesis is fixation between these stable index and long fingers ~second and third) metacarpals, a single metacarpal fixation having proven unstable and quick to loosen.
The anatomic wrist captures the instant center exactly with the capitate metacarpal component. It allows radial ulnar deviation at that point and allows flexion and extension at the radiocarpal joint within the 70 degrees of motion that patients historically have found necessary for the activities of daily living.
Previous ball and socket joints which have allowed 100 to 110 degrees of motion have been known to reduce to the 70 degrees of motion over time as that seems to be the motion that the patient uses in the activities of daily living.
Finally, the incorporation of an ulnar component to this wrist is a first and allows stability on the ulnar side of the joint in patients whose distal radial ulnar joint is - . : ,.... .. .. . .. . . .
` i 21~0~
destroyed by the same disease that ha~ dest~oyed the radiocarpal joint.
~T~IER FE~U~ES ~N~ OTIIER OBJEC~S OF T~E INVENTION
It is a feature of the invention to provlde a new and novel lmplantable wrlst joint prosthe~is design wherein the design concerns in use, the ablllty of the surgeon to adjust carpal height. The fixation of the prosthesis device to two metacarp~ls parts, thereby further obviating loosening of the fix, and by allowlng lnclusion o~ and fixatios~ to the dlstal ulna thereby directed to the lnteraction of a plurality of components in the prosthesis, which afford a movement and degree of freedom similar to those of the natural wrists.
Ohe object lles in a carpal component of varying heigllt which allows adjustab].e tension and length at the time of surgery.
Still another object resides in the provi~ion of an improved wrist prosthesis design which overcomes and/or obviates substantially all of the shortcomings or disadvantages o~ prior implantable wrist prosthesis devices and which wrist prosthesis represents the most anatomlc replacement of the wrist joint to date and is a signiflcant advance over exi~tlng implantable compottents..
~ nd still inal optimal object of the lnvention resides in the provision o a laterally extending plurality of components compr.tsing a ball and socket joint, which is .. . . . . .
.-. : : . . . .
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-, : :: . : . :
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` 2~:~402~
confi~ured to provide for a certain degree of and arranyed for connection with the ulnar to provide deslred wrist rotation.
One object of the invention resides in the provlsion of an implantable wrist prosthesis having a unique metacarpal attachment, anatomic in design allowing stability while being easily insertable.
Other objects and many of the attendant advantages of the invention will be clear to those skllled in the art and/or made apparent when consldered in connection wi~h the accompanying detailed description and drawings wherein-~ he inventlon is descxlbed in detail with reference totwo somewhat different embodiments, the choice of whlch in practlce, is determilled by the surgeon to fit the needs of patients. ~ccordingly, the preferred embodiment thereo which as a wrist joint prosthesis is the more complex of the two embodiments ln that it incorporates the first ulnar component device.
It is intended that reference to this second embodiment as an additional smbodiment shall not limit the scope of the invention relative to a first prosthesis embodlment, i.e.
not providing an ulnar implant device for rotational movement of the wrist, as some patients require only the radius bone implant. ~ence the invention is intended to be limited only by the scope o~ the appended claims.
210~(~29 DESCP~IPTIO~ OF T1113 DR~WINGS
These and other objects and advantages of this invention will become more obvious and apparent from the following de-tailed specification and accompanying drawings in which:
Fig. 1 is an illustration of a posterior-anterior view of a skeleton of a right wrist and hand;
Fig. 2 is an illustration of a lateral view of the skeleton of the wrist with a number of bones being omitted for purposes of clarity;
Fig. 3 is a diagrammatic posterior-anterior view of the skeleton of the right hand with a prosthesis according to a first embodiment of the present invention inserted therein;
Fig. 4 is a diagrammatic view of the skeleton of a wrist, with the illustration being as observed with the prosthesis of the major assemblies of the present invention inserted therein which embodiment is similar to Fig. 3 incorporating the prosthesis of Fig. 3, yet additionally including a stem implant for the ulna, which as illustrated has an additional ball and socket joint coupler for the provision of a certain amount of control of wrist movement and is further characterized in that the spurs disposed respectively in the radius and the ulnar reside in a common plane;
Fig. 5 is a left side elevation view of the metacarpal-capitate component with elements of the prosthesis shown in their assembled relationship;
:: . . . , - , - .
. ~ ~ . :: . :
- . . .. , : ~ : -: ' .
, . . ~:" ' ' ' '`; ' ' ~ ~
` 210~029 Fig. 6 is a bottom plan vlew o.~ the metacarpal-cap~tate subassembly of F.ig. S of the prosthesis in carpal component;
Fig. 7 is a r.ight side elevation vlew of a trough socket and stem port.i.on of the radial prosthesi~ which receives and mate~ w.tth the subassembly illustrated in Figs.
and 6 with the stem portion thereoE configured for insertion into the radius bone Fig. 8 iS ~ frontal obllque perspective view of the subAssembly of components of Fig. 7;
Fig. 9 is an assembled side elevation view o~ the preferred embodiment of the prostilesis of Fig. 4:
Fig. 10 is partially sectional elevation view of ~he subassembly of Fig. 6:
Fig. 11 is a front end elevation view of the portion of the implant which includes the implantable stem for the radius bone of the embodiment of Fig. 3;
Fig. 12 is a top plan view of the element o f Fig . 11;
Fig. 13 is a front end elevation view similar to ~ig.
11 but further illustrating the ball and soc~et joint for the ulnar implant portion of Fig. 4~ -Fig. 14 is a top plan view of the element of Fig. 13 Fig. 15 is a left side elevatlon view similar to Fig.
7 but additionally illustrating details of a flex lock peg disposed at the terminal end oP the stem for implantation and fixation in the ulnar bone and Fig. 16 is a detail illustration of the ulnar stem which is received in the bore of the captive ulnar ball.
~ . , , ,~
2 ~ 2 9 DESC~IPTI~N OF TIIE PRE~EIURE~ ~MBOVIM~N~S ~F Tl~ V~N~ION
In order to better promote an understanding of the principals oE the invention, reference is now made to the two preferred embodiments illu~trated in the drawings.
Specific and cons.istent language is used throughout the description to describe the variations t the two embodiments (as illustrated in the drawings), wherein the same or like reference characters are used for the same purpose throughout the var,lous Figs. of the drawings.
Speciic language relating to wrist anatomy is used to describe the drawings.
. It is to be understood that no limitation of the scope of th~ inventlon is intended, although alterations and further modificati.ons of the two illustrated embodiments of the wrist prosthesis devices may come to mind or be made.
Such further and/or structurally simpll1ed applications of the principals o~ radius bone embodiment are herewith not suggested. The more complex preferred radius and ulna embodiment of the invention are contemplated to the extent that would normally occur to one skilled in the ar-t to which the invention relates without resorting to th~ exercise of invention.
Referring now to Fig. 1, a showing is made ln profile of a healthy right wrist skeleton. The hand ls supported b~
two bones, the radius lO and the ulnar 11. These bones bear upon each othex ~t their distal extremities and th0 distal face of the radius comprises an important artlcular su~face ' , .. , . ' ' ~ ., '` . `' ~ ' `. ' ' ~
'.' ' ~ 210~029 indic~ted at 12.
~ dditionally, Flg. 1 illllstrates the bo~es in the hand including the second metacarpal 13 and the third metacarpal 14 which are just behind the index 15 and middle fih~er 16, respectively. Eigllt carpal bones (carpus) are shown between the articular surface 12 of the radius and the metacarpals.
The capitate 17 is fixed, relatively, to the third metacarpal 14. These two bones move as a unit ko define the plane of the hand in both flexion-extension and rad.ial-ulnar~deviat.ion.
Disposed at the hase of the ~econd metacarp~l 13 is a ca~pal known as the trapezoid.
~ he two axls o~ wrist motion are known to pass through an area known as a head 17~ of the capitate 17. In Fig. 1, the radial side of the wrist is the side on which the radius 10 is located, while the ulnar side is the side in which the ulnar 11 is located.
Fig. 2 of the drawings illustrates the dorsal side of the wrist which is the side corresponding to the back of the hand. while the volar or palmar side of the wrist ~s at the side corxesponding to the side of the palm of the hand.
Referring to Figs. 3 and 4 of the drawings, the~e is illustrated the ba~sic structural assembly of component elements of the two embodiments of a wrist pro~thesis as implanted in a reconstructed wrist. One wrist prosthesis embodiment, Fig. 3, is for the radius bone 10 and an alternative more elaborate construction, Fig. 4, which .
- , `` 21~29 further includes a ball and socket joint and ~tem for the ulnar bone 11.
The illustration is made with portions thereof not shown for purposes of clarity, which may be constru~d either as a second embodiment of the invention or as an intermediate component comprising a po~tion of Flg. 3 prosthetic wrist joint with the ulnar assembly not belng shown and thereby illustrating a somewhat pictorial side view of the hand with the prosthesis of either of two embodiments incorporated therein.
Referring now, more partlcularly to Flgs. 3 and 4, there is illustrated a pair of wrist prosthesis embodiments positioned within the human wrist. Baslc procedures employed in the implantation o either of the wrist prosthesis configurations or embodiments oE the pre~ent invention is well known in the art and does not differ substantially from other procedures applicable with prior art devices known to those skilled in the art to which this prosthesis pertains.
Since these procedures are known to practitioners skilled in the art, and do not form a part of the present invention, details o the procedure are not considered necessary to a full understanding of the descrlption o~ the present invention and are not provided herein. As can be noted rom Figs. 3 and 4, in locating the prosthesis in position certain of the carpals are removed from the wrist and the distal radius 10 and ulnar 11 are resected. This . , . ,. .. --. . .
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removal of the carpi and reseetioning of the distal xadius and ulnar ls simllar to that carried out in other wrist prosthesis operations.
By reference to Fig. 3 of the drawings, it will be observed that the wrist prosthesis 20 includes a metacarpal-capitate component 21 and a radial component 22.
The metacarpal-capltate component 21 has a fixation spur and s~em combination 23 which is of a dual nature and is located through the capitate 17 and into the medullary cavity ak 24 of the second and third metacarpals as indicated at 14. The radlal component 22 also has a fixation spur 26 which is located in the medullary cavity at 27 o~ the radius 10.
~ 9 shown with respect to the preferred embodiment of Flg. 4, the metacarpal component 21 has a convex ball shaped articulating surface 19 which extends from the base portion of the metacarpal component. It is pivotally received within a hemispherlcally concave ball shaped socket in the carpal component wllicll then provides an articulating surface for the radial component 22 when the device is inserted in the wrist.
The detail~ of the preferred embodiment of the metacarpal component 21 of the prosthesis 20 will be more particularly described with respect to ~igs. 5 and 6. I'he metacarpal component 21 lncludes dual fixation stems indicated at 23 attached to a head portion 25 wherein the head portion 25 deflnes a seml-spherical articulatlng .
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s~rface at ~B. The c~pitate stem provides a third point of fixation for the metac~rpal-capitate component thereby further decreasing the ch~nce of loosening of this component.
FUNCT N~L SUMMA~Y OF T~l~ VESCRIPTION
The metacarpal-capitate component is seen with a central stem which inser~s in the stable third metacarpal and a shorter second stem which inserts in the second metacarpal. This position, an~ulation arc and length allows for easy surgic~l insertion into the two metacarpals simultaneously with maximum stabilization in the second metac~rpal while allowing minimal difficulty with its insertion.
T}~e ball portlon of this metacarpal component matches the size and position of the patient's capltate. In the event of collapse of the capitate, lt can still ~ubstitute for the prior position by removal of less bone.
The carpal component duplicates the joint sur~aces of the scaphoid and~lunate which have been removed. It comes in three sizes, increasing at 2mm. increments which allows adjustment of the carpal height or muscle tension across the artificial wrist jolnt.
The radial component 22 duplicates the scaphold and lunate fossa in the normal radlus. It allows 70 degrees of motion in flexion-extension while being totally unconstrailled. The radial ulnar deviation occurs at the ~ `~
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metacarpal-capitate component 21 allowing 15 degrees of radial and 15 decJ~ees of ulnar de~iation which is re~uired for activities of daily living.
The flexion and extension occurs in an unconstrained manner at the radio-carpal junction. Ilowever, because it is unconstrained, it relieves any constraint on radial ulnar deviation in the metacarpal carpal component.
The radial component 22 is fixed to the distal end of radius 10 by the rac~ial stem 26 which is held with methylmethacrylate glue. The metacarpal component stems are likewise, held in the metacarpals with methylmethacrylate glue.
In the event that an ulnar component is desired, the ulnar head is replaced with a cap not shown, but located at 29 and ball 3Q which receives the ulnar stem 31. The ~lnar stem 31 is glued into the ulna 11 and held at proper length by the flex lock peg. The shank end of stem 31, as illustrated in Fig. 16, which is a loose or slip fit in ball to provide for a desirable longitudinal movement in fitting the ulnar stem relative to the ball, wh~ch receives the cylindrical shank end thereof. ~s the radial component 22 is inserted, it is rece~ved ln the radial head ball 19 and this allows ~table support of the radial component 22.
It allows full pronation and supination and is yet, unconstrained ln distraction to protect from loosening.
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- 21~29 The st~m 26 po~tion as shown in Figs. 7, n, 9 and 12 illustrates the portlon implanted in the distal end of radius 10 as aforementioned. Fig. 13 shows the addition of a laterally disposed socket 33 which receives a ball 30 as shown in Fig. 1~ and which is a view looklng toward the longitudinal groove o ~ig. 11 and the rear portion of the hal~-socket of Fig. 13.
Fig. 14 is a plain view ~hich shows an assembly of the socket 33 and ball element 30 o~ the stem 31 for the ulnar implantation. It shows a Elex-lock peg 32 locking arranqement al~o shown in Figs. 9, 14 ancl 16 which retains th~ stem ln the bone struct~re. ~he loclcing end is co~prised of a plurality of circular disc-like elements which will deorm as the implant is inserted in the ulna bone 11, and WhiCIl thereafter resists longitudinal movement in the opposite direction thereby preventing loosening of the connection with the bone.
The details of the spur stems and ball and socket joint are indicated in further detail in Figs. 5, 6 and 7 whereln the stPm 23 also includes a depending spur 23 whlch is implanted in the carpal. The plan view in Fiq. 6 shows the configuration of the surface of the intermediate membex which as shown incorporates the ~ocket portlon o the ball and socket connection.
The capitate ball is captured by the carpal component in Pig. 5 by the flexibility of the hiqh density polyethylene.
21~029 The ulnar head 23 captures the ulnar ball 30 by reducing the balls size by freezing. The ball 30 once expanded to room or body temperature, will turn freely but is not easily dislocated from the ulnar head.
The configuration can possibly be described in a manner more readily understood by indicating that a portion of this would be in the shape of the knuckles of two fingers, that is, they have a round configuration in plan but are somewhat cylindrical in elevation as shown by Fig. 10.
Fig. 7 shows the curved view in which the vitallium portions of Fig~ 6 may articulate in the general configuration of the intermediate portion contained in the socket as shown in the cross section in Fig. 10. The major portion of the sub-assembly of Fig. 6 would ride without mechanical restraint at the right inside portion thereof in grooves of longitudinal trough like semi-cylindrical cross sectional configuration with generally spherical ended portions of the grooves as shown in the view of Fig. 8.
The two units are assembled as shown in Fig. 9 and a distally extending spur 23 shown in Fig. 7 is implanted in the metacarpal while the proximally extending spur 26 i5 implanted in the radius. Fig. 11 is a view looking directly into the dual grooves of the left hand portion of Fig. 7 while Fig. 12 is a plan view incorporating the grooves of Fig. 11 therein.
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tt is considerecl to be apparent from the foregoing description that the lnvention provides a metacarpal~capitate component constructed anatomic divergence o~ the second, third metacarpal ~tems to give maximum stability, while allowing ready insertion in the human hand.
~ ttention is directed to the fact that adjustable components allow adiustment of carpal length at surgery~ It is invisioned t:llnt carpal components varying in ~ize by lncrements of approximately 2mm will accommodate this adj~stment capability at surgery. Also prosthesis sizes may vary by about 20 percent between the sizes respectively between ~ale and female patients.
In the case o female patients wtth large hands, the larger male size may suEflce.
It is also considered to be apparent that the availability of the ulnar component and its adjustability resulting from the slip fit of the ulnar stem in its ball further enhances the utility of the invention's prosthesis to provide advantages not heretofore known ln the prior art.
Obviously, many modifications and variations of the present invention are poss~ble in light o the above teachings. It is, therefore, to be understood that within the scope o~ the appended claim~, the invention may be practiced otherwise than as specifically described.
movement and flexion-extension hand movement. This prosthesis structure dlffers substantia11y from the structure of the instant ln~ention which will be descrlbed subsequently.
'rhe Beckenbaugh et al U. S. Patent No. 4,784,661 is the only pertinent patent of the prior art known to the inventor. It relates to an endo-prosthetic wrist replacement device comprising two components which have means for Lntramedullary implantation in the radius and a metacarpal bone, respectively.
The radial component is provided with a distal head in which there is a distally facing transversely extending groove trough of generally semi-cylindrical configuration.
The metacarpal component has a proximally located ovoid ball head of ~enerally oval shape ln cross section which is recelved within the head of the radlus component.
It is shaped in the proxlmal-distal direction to conform to the semi-cylindrical groove trough in a transverse direction allowing flexion and extension and radial and ulnar deviation as the oval metacarpal component moves within the radial trough. The ovoid ball does not duplicate the instant center of the wrist at the capitate and the single stem of the metacarpal component is prone to loosen.
In the speciEication of Beckenbaugh, there is an adequate aescription of prior art joint prosthesis patents and this description by Beckenbaugh is hereby incorporated .. . .
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by reference into this patent application. It also includes some indlcatlon oE a prosthetic wrlst ~oint which ha~ been conceived, and is considered to be the most pertinent prior art. Ilowever, none of the prior art joints provlde the various desirable features which have been incorporated in the wrist prosthesis.
These artiEicial wr~st jo~nts use methylmethacrylate, an acrylic bone cement used to secure the pros~hetic stems or spurs to tlle bone~. The metal components are fabricated from a biologically inactlve metal, Vitallium and high density polyethylene. ~hese materials are utilized to minimize friction between metal and plas~ic parts and thereby ~aximize wear life.
B~C~GROUND, CONST~UCTION ~ND SUMM~R~ OF Tll~ INVENTION
In a preferr~d embodiment of this invention, 1exion or extension simulating the normal motion of the human wrist i~
provided by the like biconvex joint portion which is received in a biconcave longitudinal spur portioh pro~ided in the radius.
The unique p~eferred conf~gurations for the components of the bearing portions of the -joint movement component provide an accurate reproductlon of the movement required in the activities Oe daily living. The normal human ~rist comprises attachments and actuations of three sets of bone~.
The forearm, comprlsing the radlus and ulnar is one set, the carpal~ as a second set, and the metacarpal bones comprise . . . . ... . ~ .
the thlrd set. The carpals are the bones most closely associated with the motion of the wrist.
~ s aforestated, ln the forearm, there are two bones, the radius and the ulnar. In the wrist there are eight carpals, which are divided into rows, the proximal and the distal. The proximal row includes a navicular, a lunate, a triguetrum and a pisiform. The distal row includes a trapezium and a trapezoid, a capitate and a hamate. There are five metacarpals consecutlvely arranged from the thumb through the last or little finger.
Wrist movement is divided between the radlocarpal and mid-carpal joints of the wrist, in a relatively complex ma~ner. The configuratlon o~ each row of bones changes according to the position o~ the hand. ~lthough both joints contribute to all hand motions, palmar flexion is predominately a mid carpal motion. In dorsiflexion, it i5 radiocarpal.
Ulnar deviatlon also occurs at the radlocarpal joint, while radial deviation takes place at the mid-carpal radial level. In the anatomic wrist, the motion is simplified allowing prosthetic 3S degrees dorsiflexion and 35 degrees palmar flexion at the radiocarpal component junctiorl and 15 degrees radial and 15 degrees ulnar deviation at the metacarpal capitate - carpal component.
Deterioration or destruction of the carpal bones, or loss of integrity of thelr ligaments with secondary :` ' ,. ~. ~ ;
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stlffness and pain affects the joint and results in wrist disability.
The carpal bones are held together ~y ligaments.
Collateral ligaments provide lateral support of the wrist, while palmar radiocarpal and dorsal radlo~arpal ligaments maintain support of the carpal area. These ligaments define a symmetrical pattern due to insextlons into the scaphoid lunate, triquetrum and capitate bones. It is important that the integrity of the radiocarpal and ulnar carpal bands of ligaments as well as the dorsal and volar capsule be maintained in carpal bone surgery and that these tissues not be interfered with or impinged on by the implant.
Currently, there are a number of devices available for either total or partial prosthesis of the wrist joint.
These devices use one or more of the possible types of mechanical articulations available, which are the hin~e, ball and socket, or anatomic spacers.
Most devices use intramedullary stems and methyl methacrylate bone cement to secure the prosthesis t the bone. Presently available prosthesis have components constructed from several types o~ biologically inactive metals and they are de~igned to articulate with other components constructed from a pla~tic such a~ high density polyethylene.
Several methods or techniques are used to insure that the components remain articulated, and these methods include the use of soft tissue existent at the time of implantation, : ~
``' 2104~29 , the use of pins or scre~s to hold the articulate surface together and the use of band type locks. certain types of available prosthesi~ are quite simple while other types comprise complex mechanical systems, wlth both types having attendant or inhe~ent disadvantages.
The principal disadvantage oE the simple pro~thesis is that they may not reproduce an adequate, stable range of motion of the joint and frequently distort lt, while the prlncipal disadvalltage of the complex prosthesis is the potential dlfficulty of surgery and increased failure.
Fin~lly, existing prosthesis do not center the anatomic axis properly as no other includes the dlstal ulnar as part of the comp~nent.
Severely arthritLc wrists are presently still preferentially treated by wrist fusion. ~his procedure leaves the patient unable to place the hand where he needs to place it for the activities of dally living wherein 70 degrees of flexion and extension are routinely used.
SoM~ PRINCIPAL OBJECTS ~ND ~DV~NTAGES O~ INVENTION
~ his anatomic wrist lnvention relates to a mechanlcal device for surgical replacement of certain bones and joints, in a diseased or otherwise damaged human wrist. More particularly, it relates to a total wrist prosthesis providing maximum correspondence of the proviaed motion with that of the human wrist.
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Total wr.i~t arthroplasty lnvolves prosthetlc replacement of the wrist by an artlficlal joint designed to simulate normal wrlst motlon. Prosthetic replacement of the wrist requires careful consideration of both anatomlc and mechanical facto~s, together wlth appllcatlo~ of the skilled surgical techn1ques of implant flxation an~ recogn~tion of soft tisiue balancé acxoss the wrist.
The surgically imp]antable wrist prosthesis of the present invention incOrpGrateS an lmpxoved assembly of components wi1lch is particularly well adapted and intended for use in replacetnent of the dysfunctional wrist joint.
There are three components to this implantable prosthesis.
The me~acarpal component comprises a capitate replacement from which two spurs insert into the medullary canal of the adjacent, stable, second and third metacarpal bones. ~ radial component lnserts into the adjacent radius.
The carpal component comes in three adjustable thicknesses to attach to the capitate as a ball and socket "pop ball" joint where it is allowed to move in a radial ulnar deviation plane and articulate with the radial component as a biconvex articulation with the biconcave xadial component where lt is allowed to Plex and extend.
There is an addltional and optlonal ulnar component which allows articulation rom the radlal component to the distal ulna. Thls is comprised of an ulnar cap whlch captures an ulnax head ball. It then receives an ulnar stem - : ................. , , ~......... ~ ........ .. ~ , - ., . ~ ...................... . ,.~
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21~402~
which is in turn, inserted lnto the patient's distal ulna by a flex lock peg. ~ree movement of the ulnar ball wlthin the ulnar cap, and free motion of the ulnar stem within the ball allows full and stable pronation and supination.
~ he kinematics of the wrist are very complex in the motions thereof. In the pàst the wrist motlohs could not be simply reproduced and incorporated in the design of a joint prosthesis. sa~ed on experience of previous wrist arthroplastesis and anatomic and ~lnetic principles found in the llterature, a successful comp~omise i5 achieved in the present invention.
'rhe studies which have been directed to normal wri.sts of healthy individuals have led to the flnding that the center of rotation of the wrist is located within the head of the capitate. In tlle case o radial-ulnar deviation, the center of rotation has been found to lie toward the ulnar side of the axis of the third metacarpal and the axis of the distal radius.
The center oE flexion-extension motion of the wrist was known to be offset toward the palm or volar from the axis of the third metacarpal of the additional radius also located in the head of the capitate. Pronation and supination are rotational movements of the arm about the longitudinal axls of the distal ulna. The wrist does not rotate significantly in relation to the radlus, hence the wrist has been describea as a biaxial joint with two degrees of freedom.
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The index fing~r or second metacarpal is s-table in its attachment with the capitate and lesser multi~angular (trapeæoid), function with very little motion occurring between these bones during all natural positions of flexion-extension motion or radial-ulnar deviation. : :
Also, the head of the capitate contains the rotation of ~oth of the aforementioned motions. The capitate-third metacarpal fixed unit is likewise stable, therefore the logical position choice for the metacarpal component of the ;~
wrist prosthesis is fixation between these stable index and long fingers ~second and third) metacarpals, a single metacarpal fixation having proven unstable and quick to loosen.
The anatomic wrist captures the instant center exactly with the capitate metacarpal component. It allows radial ulnar deviation at that point and allows flexion and extension at the radiocarpal joint within the 70 degrees of motion that patients historically have found necessary for the activities of daily living.
Previous ball and socket joints which have allowed 100 to 110 degrees of motion have been known to reduce to the 70 degrees of motion over time as that seems to be the motion that the patient uses in the activities of daily living.
Finally, the incorporation of an ulnar component to this wrist is a first and allows stability on the ulnar side of the joint in patients whose distal radial ulnar joint is - . : ,.... .. .. . .. . . .
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destroyed by the same disease that ha~ dest~oyed the radiocarpal joint.
~T~IER FE~U~ES ~N~ OTIIER OBJEC~S OF T~E INVENTION
It is a feature of the invention to provlde a new and novel lmplantable wrlst joint prosthe~is design wherein the design concerns in use, the ablllty of the surgeon to adjust carpal height. The fixation of the prosthesis device to two metacarp~ls parts, thereby further obviating loosening of the fix, and by allowlng lnclusion o~ and fixatios~ to the dlstal ulna thereby directed to the lnteraction of a plurality of components in the prosthesis, which afford a movement and degree of freedom similar to those of the natural wrists.
Ohe object lles in a carpal component of varying heigllt which allows adjustab].e tension and length at the time of surgery.
Still another object resides in the provi~ion of an improved wrist prosthesis design which overcomes and/or obviates substantially all of the shortcomings or disadvantages o~ prior implantable wrist prosthesis devices and which wrist prosthesis represents the most anatomlc replacement of the wrist joint to date and is a signiflcant advance over exi~tlng implantable compottents..
~ nd still inal optimal object of the lnvention resides in the provision o a laterally extending plurality of components compr.tsing a ball and socket joint, which is .. . . . . .
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confi~ured to provide for a certain degree of and arranyed for connection with the ulnar to provide deslred wrist rotation.
One object of the invention resides in the provlsion of an implantable wrist prosthesis having a unique metacarpal attachment, anatomic in design allowing stability while being easily insertable.
Other objects and many of the attendant advantages of the invention will be clear to those skllled in the art and/or made apparent when consldered in connection wi~h the accompanying detailed description and drawings wherein-~ he inventlon is descxlbed in detail with reference totwo somewhat different embodiments, the choice of whlch in practlce, is determilled by the surgeon to fit the needs of patients. ~ccordingly, the preferred embodiment thereo which as a wrist joint prosthesis is the more complex of the two embodiments ln that it incorporates the first ulnar component device.
It is intended that reference to this second embodiment as an additional smbodiment shall not limit the scope of the invention relative to a first prosthesis embodlment, i.e.
not providing an ulnar implant device for rotational movement of the wrist, as some patients require only the radius bone implant. ~ence the invention is intended to be limited only by the scope o~ the appended claims.
210~(~29 DESCP~IPTIO~ OF T1113 DR~WINGS
These and other objects and advantages of this invention will become more obvious and apparent from the following de-tailed specification and accompanying drawings in which:
Fig. 1 is an illustration of a posterior-anterior view of a skeleton of a right wrist and hand;
Fig. 2 is an illustration of a lateral view of the skeleton of the wrist with a number of bones being omitted for purposes of clarity;
Fig. 3 is a diagrammatic posterior-anterior view of the skeleton of the right hand with a prosthesis according to a first embodiment of the present invention inserted therein;
Fig. 4 is a diagrammatic view of the skeleton of a wrist, with the illustration being as observed with the prosthesis of the major assemblies of the present invention inserted therein which embodiment is similar to Fig. 3 incorporating the prosthesis of Fig. 3, yet additionally including a stem implant for the ulna, which as illustrated has an additional ball and socket joint coupler for the provision of a certain amount of control of wrist movement and is further characterized in that the spurs disposed respectively in the radius and the ulnar reside in a common plane;
Fig. 5 is a left side elevation view of the metacarpal-capitate component with elements of the prosthesis shown in their assembled relationship;
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` 210~029 Fig. 6 is a bottom plan vlew o.~ the metacarpal-cap~tate subassembly of F.ig. S of the prosthesis in carpal component;
Fig. 7 is a r.ight side elevation vlew of a trough socket and stem port.i.on of the radial prosthesi~ which receives and mate~ w.tth the subassembly illustrated in Figs.
and 6 with the stem portion thereoE configured for insertion into the radius bone Fig. 8 iS ~ frontal obllque perspective view of the subAssembly of components of Fig. 7;
Fig. 9 is an assembled side elevation view o~ the preferred embodiment of the prostilesis of Fig. 4:
Fig. 10 is partially sectional elevation view of ~he subassembly of Fig. 6:
Fig. 11 is a front end elevation view of the portion of the implant which includes the implantable stem for the radius bone of the embodiment of Fig. 3;
Fig. 12 is a top plan view of the element o f Fig . 11;
Fig. 13 is a front end elevation view similar to ~ig.
11 but further illustrating the ball and soc~et joint for the ulnar implant portion of Fig. 4~ -Fig. 14 is a top plan view of the element of Fig. 13 Fig. 15 is a left side elevatlon view similar to Fig.
7 but additionally illustrating details of a flex lock peg disposed at the terminal end oP the stem for implantation and fixation in the ulnar bone and Fig. 16 is a detail illustration of the ulnar stem which is received in the bore of the captive ulnar ball.
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2 ~ 2 9 DESC~IPTI~N OF TIIE PRE~EIURE~ ~MBOVIM~N~S ~F Tl~ V~N~ION
In order to better promote an understanding of the principals oE the invention, reference is now made to the two preferred embodiments illu~trated in the drawings.
Specific and cons.istent language is used throughout the description to describe the variations t the two embodiments (as illustrated in the drawings), wherein the same or like reference characters are used for the same purpose throughout the var,lous Figs. of the drawings.
Speciic language relating to wrist anatomy is used to describe the drawings.
. It is to be understood that no limitation of the scope of th~ inventlon is intended, although alterations and further modificati.ons of the two illustrated embodiments of the wrist prosthesis devices may come to mind or be made.
Such further and/or structurally simpll1ed applications of the principals o~ radius bone embodiment are herewith not suggested. The more complex preferred radius and ulna embodiment of the invention are contemplated to the extent that would normally occur to one skilled in the ar-t to which the invention relates without resorting to th~ exercise of invention.
Referring now to Fig. 1, a showing is made ln profile of a healthy right wrist skeleton. The hand ls supported b~
two bones, the radius lO and the ulnar 11. These bones bear upon each othex ~t their distal extremities and th0 distal face of the radius comprises an important artlcular su~face ' , .. , . ' ' ~ ., '` . `' ~ ' `. ' ' ~
'.' ' ~ 210~029 indic~ted at 12.
~ dditionally, Flg. 1 illllstrates the bo~es in the hand including the second metacarpal 13 and the third metacarpal 14 which are just behind the index 15 and middle fih~er 16, respectively. Eigllt carpal bones (carpus) are shown between the articular surface 12 of the radius and the metacarpals.
The capitate 17 is fixed, relatively, to the third metacarpal 14. These two bones move as a unit ko define the plane of the hand in both flexion-extension and rad.ial-ulnar~deviat.ion.
Disposed at the hase of the ~econd metacarp~l 13 is a ca~pal known as the trapezoid.
~ he two axls o~ wrist motion are known to pass through an area known as a head 17~ of the capitate 17. In Fig. 1, the radial side of the wrist is the side on which the radius 10 is located, while the ulnar side is the side in which the ulnar 11 is located.
Fig. 2 of the drawings illustrates the dorsal side of the wrist which is the side corresponding to the back of the hand. while the volar or palmar side of the wrist ~s at the side corxesponding to the side of the palm of the hand.
Referring to Figs. 3 and 4 of the drawings, the~e is illustrated the ba~sic structural assembly of component elements of the two embodiments of a wrist pro~thesis as implanted in a reconstructed wrist. One wrist prosthesis embodiment, Fig. 3, is for the radius bone 10 and an alternative more elaborate construction, Fig. 4, which .
- , `` 21~29 further includes a ball and socket joint and ~tem for the ulnar bone 11.
The illustration is made with portions thereof not shown for purposes of clarity, which may be constru~d either as a second embodiment of the invention or as an intermediate component comprising a po~tion of Flg. 3 prosthetic wrist joint with the ulnar assembly not belng shown and thereby illustrating a somewhat pictorial side view of the hand with the prosthesis of either of two embodiments incorporated therein.
Referring now, more partlcularly to Flgs. 3 and 4, there is illustrated a pair of wrist prosthesis embodiments positioned within the human wrist. Baslc procedures employed in the implantation o either of the wrist prosthesis configurations or embodiments oE the pre~ent invention is well known in the art and does not differ substantially from other procedures applicable with prior art devices known to those skilled in the art to which this prosthesis pertains.
Since these procedures are known to practitioners skilled in the art, and do not form a part of the present invention, details o the procedure are not considered necessary to a full understanding of the descrlption o~ the present invention and are not provided herein. As can be noted rom Figs. 3 and 4, in locating the prosthesis in position certain of the carpals are removed from the wrist and the distal radius 10 and ulnar 11 are resected. This . , . ,. .. --. . .
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removal of the carpi and reseetioning of the distal xadius and ulnar ls simllar to that carried out in other wrist prosthesis operations.
By reference to Fig. 3 of the drawings, it will be observed that the wrist prosthesis 20 includes a metacarpal-capitate component 21 and a radial component 22.
The metacarpal-capltate component 21 has a fixation spur and s~em combination 23 which is of a dual nature and is located through the capitate 17 and into the medullary cavity ak 24 of the second and third metacarpals as indicated at 14. The radlal component 22 also has a fixation spur 26 which is located in the medullary cavity at 27 o~ the radius 10.
~ 9 shown with respect to the preferred embodiment of Flg. 4, the metacarpal component 21 has a convex ball shaped articulating surface 19 which extends from the base portion of the metacarpal component. It is pivotally received within a hemispherlcally concave ball shaped socket in the carpal component wllicll then provides an articulating surface for the radial component 22 when the device is inserted in the wrist.
The detail~ of the preferred embodiment of the metacarpal component 21 of the prosthesis 20 will be more particularly described with respect to ~igs. 5 and 6. I'he metacarpal component 21 lncludes dual fixation stems indicated at 23 attached to a head portion 25 wherein the head portion 25 deflnes a seml-spherical articulatlng .
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s~rface at ~B. The c~pitate stem provides a third point of fixation for the metac~rpal-capitate component thereby further decreasing the ch~nce of loosening of this component.
FUNCT N~L SUMMA~Y OF T~l~ VESCRIPTION
The metacarpal-capitate component is seen with a central stem which inser~s in the stable third metacarpal and a shorter second stem which inserts in the second metacarpal. This position, an~ulation arc and length allows for easy surgic~l insertion into the two metacarpals simultaneously with maximum stabilization in the second metac~rpal while allowing minimal difficulty with its insertion.
T}~e ball portlon of this metacarpal component matches the size and position of the patient's capltate. In the event of collapse of the capitate, lt can still ~ubstitute for the prior position by removal of less bone.
The carpal component duplicates the joint sur~aces of the scaphoid and~lunate which have been removed. It comes in three sizes, increasing at 2mm. increments which allows adjustment of the carpal height or muscle tension across the artificial wrist jolnt.
The radial component 22 duplicates the scaphold and lunate fossa in the normal radlus. It allows 70 degrees of motion in flexion-extension while being totally unconstrailled. The radial ulnar deviation occurs at the ~ `~
` 2~0~2~
metacarpal-capitate component 21 allowing 15 degrees of radial and 15 decJ~ees of ulnar de~iation which is re~uired for activities of daily living.
The flexion and extension occurs in an unconstrained manner at the radio-carpal junction. Ilowever, because it is unconstrained, it relieves any constraint on radial ulnar deviation in the metacarpal carpal component.
The radial component 22 is fixed to the distal end of radius 10 by the rac~ial stem 26 which is held with methylmethacrylate glue. The metacarpal component stems are likewise, held in the metacarpals with methylmethacrylate glue.
In the event that an ulnar component is desired, the ulnar head is replaced with a cap not shown, but located at 29 and ball 3Q which receives the ulnar stem 31. The ~lnar stem 31 is glued into the ulna 11 and held at proper length by the flex lock peg. The shank end of stem 31, as illustrated in Fig. 16, which is a loose or slip fit in ball to provide for a desirable longitudinal movement in fitting the ulnar stem relative to the ball, wh~ch receives the cylindrical shank end thereof. ~s the radial component 22 is inserted, it is rece~ved ln the radial head ball 19 and this allows ~table support of the radial component 22.
It allows full pronation and supination and is yet, unconstrained ln distraction to protect from loosening.
;,. .,. i .,.- ., : , .-. .
., - :
, ' ' ' " ~ , , " ~ ' , ~
- 21~29 The st~m 26 po~tion as shown in Figs. 7, n, 9 and 12 illustrates the portlon implanted in the distal end of radius 10 as aforementioned. Fig. 13 shows the addition of a laterally disposed socket 33 which receives a ball 30 as shown in Fig. 1~ and which is a view looklng toward the longitudinal groove o ~ig. 11 and the rear portion of the hal~-socket of Fig. 13.
Fig. 14 is a plain view ~hich shows an assembly of the socket 33 and ball element 30 o~ the stem 31 for the ulnar implantation. It shows a Elex-lock peg 32 locking arranqement al~o shown in Figs. 9, 14 ancl 16 which retains th~ stem ln the bone struct~re. ~he loclcing end is co~prised of a plurality of circular disc-like elements which will deorm as the implant is inserted in the ulna bone 11, and WhiCIl thereafter resists longitudinal movement in the opposite direction thereby preventing loosening of the connection with the bone.
The details of the spur stems and ball and socket joint are indicated in further detail in Figs. 5, 6 and 7 whereln the stPm 23 also includes a depending spur 23 whlch is implanted in the carpal. The plan view in Fiq. 6 shows the configuration of the surface of the intermediate membex which as shown incorporates the ~ocket portlon o the ball and socket connection.
The capitate ball is captured by the carpal component in Pig. 5 by the flexibility of the hiqh density polyethylene.
21~029 The ulnar head 23 captures the ulnar ball 30 by reducing the balls size by freezing. The ball 30 once expanded to room or body temperature, will turn freely but is not easily dislocated from the ulnar head.
The configuration can possibly be described in a manner more readily understood by indicating that a portion of this would be in the shape of the knuckles of two fingers, that is, they have a round configuration in plan but are somewhat cylindrical in elevation as shown by Fig. 10.
Fig. 7 shows the curved view in which the vitallium portions of Fig~ 6 may articulate in the general configuration of the intermediate portion contained in the socket as shown in the cross section in Fig. 10. The major portion of the sub-assembly of Fig. 6 would ride without mechanical restraint at the right inside portion thereof in grooves of longitudinal trough like semi-cylindrical cross sectional configuration with generally spherical ended portions of the grooves as shown in the view of Fig. 8.
The two units are assembled as shown in Fig. 9 and a distally extending spur 23 shown in Fig. 7 is implanted in the metacarpal while the proximally extending spur 26 i5 implanted in the radius. Fig. 11 is a view looking directly into the dual grooves of the left hand portion of Fig. 7 while Fig. 12 is a plan view incorporating the grooves of Fig. 11 therein.
-. . . ~ ~ .. . . ' `' . :. - , ': . ' :~ ~ : : . , ~ 2 ~
tt is considerecl to be apparent from the foregoing description that the lnvention provides a metacarpal~capitate component constructed anatomic divergence o~ the second, third metacarpal ~tems to give maximum stability, while allowing ready insertion in the human hand.
~ ttention is directed to the fact that adjustable components allow adiustment of carpal length at surgery~ It is invisioned t:llnt carpal components varying in ~ize by lncrements of approximately 2mm will accommodate this adj~stment capability at surgery. Also prosthesis sizes may vary by about 20 percent between the sizes respectively between ~ale and female patients.
In the case o female patients wtth large hands, the larger male size may suEflce.
It is also considered to be apparent that the availability of the ulnar component and its adjustability resulting from the slip fit of the ulnar stem in its ball further enhances the utility of the invention's prosthesis to provide advantages not heretofore known ln the prior art.
Obviously, many modifications and variations of the present invention are poss~ble in light o the above teachings. It is, therefore, to be understood that within the scope o~ the appended claim~, the invention may be practiced otherwise than as specifically described.
Claims (22)
1. An anatomic wrist implantable component for implantation with the adjacent metacarpal bones and radius bone of a human hand and wrist to provide an artificial wrist joint, comprising, an assembly of a pair of interconnected adjacently disposed means configured for implantation in the adjacent metacarpal bones of a human hand and terminated by a frictional surface means for engagement and relative movement with respect to another component of a wrist prosthesis, means providing a ball and socket connection, said implantable component being interconnected to said functional surface means by said means providing said ball and socket connection.
2. The anatomic wrist implantable component of claim 1, a pair of spur means, with the ball of said ball and socket connection assembly being integrally attached to the rearward portion of said pair of spur means, and the socket portion of said ball and socket assembly being secured to the forward portion of said frictional surface means.
3. The anatomic wrist implantable component assembly for an anatomic wrist prosthesis of claim 1, wherein the socket of said ball and socket assembly is fixedly attached to the rearward end of said stem assembly and the ball is secured to the forward end of said frictional surface means.
4. An anatomic wrist implantable component for an anatomic wrist prosthesis of claim 1, comprising a forward portion having a frictional engagement surface means and a radius bone stem means disposed at the opposite end thereof.
5. The anatomic wrist implantable prosthesis component for an anatomic wrist prosthesis of claim 4, further having a laterally disposed ball and socket assembly, the ball of said socket assembly having a diametrical bore therethrough for reception of a pin means of a ulnar bone spur means.
6. The anatomic wrist structure for an anatomic wrist prosthesis of claim 5, further including a stem for implantation in the ulnar bone, said means having a rod element for slidable reception in the diametric bore of the ball of the laterally disposed ball and socket assembly of the radius bone stem means, thereby providing for length adjustability of said ulnar bone stem means in the bore of said ball.
7. The anatomic structure for an anatomic wrist prosthesis of claim 6, further comprising the incorporation of a flex-lock means at the implantable terminal end of the stem for the ulnar bone.
8. An anatomic wrist implantable component for an anatomic wrist prosthesis comprising an assembly of a pair of interconnected adjacently disposed stems configured for implantation in the adjacent metacarpal bones of a human hand and terminated by a frictional surface element for engagement and relative movement with respect to another component of a wrist prosthesis, said implantable component being interconnected to said functional surface element by means providing a ball and socket connection.
9. The anatomic wrist implantable component of claim 8 being further characterized by the ball of said ball and socket connection assembly being integrally attached to the rearward portion of said pair of spurs, and the socket portion of said ball and socket assembly being secured to the forward portion of said frictional surface element.
10. The anatomic wrist implantable component assembly of claim 8, wherein the socket of said ball and socket assembly is fixedly attached to the rearward end of said stem assembly and the ball is secured to the forward end of said frictional surface element.
11. An anatomic wrist implantable component for an anatomic wrist prosthesis of claim 8, comprising a forward portion having a frictional engagement surface and a radius bone stem portion disposed at the opposite end thereof.
12. The anatomic wrist implantable prosthesis component of claim 11, further having a laterally disposed ball and socket assembly, the ball of said assembly having a diametrical bore therethrough for reception of a pin of a ulnar bone spur.
13. The anatomic wrist structure of claim 12, further including a stem for implantation in the ulnar bone, said stem having a rod element for slidable reception in the diametric bore of the ball of the laterally disposed ball and socket assembly of the radius stem, thereby providing for length adjustability of said ulnar stem in the bore of said ball.
14. The anatomic structure of claim 13, further comprising the incorporation of a flex lock peg at the implantable terminal end of the stem for the ulnar bone.
15. An anatomic wrist prosthesis for implantation respectively with adjacent metacarpal bones and radius bone of a human hand and wrist to provide an artificial wrist joint, comprising, in combination, a dual stem portion component for implantation into two adjacent metacarpal bones, terminated at a portion thereof remote from the implantable portions of said dual stem portion component with a substantially spherical ball, an intermediate component of said prosthesis having a hemispherical socket concavity for reception and moveable retention of said ball of said dual stem portion component, said intermediate component having the aforementioned receptacle portion, further defining ellipsoidal male dual-convex portions at the rear portion of said component remote from said first mentioned hemispherical socket concavity, said portion being configured and adapted to be received for movement in a third component of said prosthesis, said third component incorporating as a head portion thereof, a stem for implantation in the radius bone of a human arm, said third portion having a pair of ellipsoidal grooves at the head end thereof configured as semi-circular in cross section to receive and allow for linear movement of the intermediate component in said longitudinal ellipsoidal grooves, providing a concave articulating surface shaped complimentary to the ellipsoidal convex articulating surface of said intermediate component, first affixation means for affixing a first fixation stem portion and a second fixation stem portion thereof respectively to one of the adjacent metacarpal bones of said human hand, and further having a spur of smaller dimensions disposed below said dual stems to be implanted into a carpal bone, an additional fixation stem means providing for fixation in the radius bone.
16. The anatomic wrist prosthesis of claim 15, being further characterized in that the ellipsoidal convex articulating surface of said first intermediate component is substantially convex with the ellipsoidal concave mating articulating surface portion of the adjacently disposed receiving portion thereof, there being only a non-mechanical, frictional connection between these two articulating surface portions when mutually engaging one another.
17. The anatomic wrist prosthesis of claim 16, in which said first component is provided with a laterally disposed semi-socket for captive engagement reception of a ball disposed therein to provide a limited ball and socket type movement configuration, an additional component comprising a ball disposed thereon, having an axial bore therethrough and having a rod like shaft portion dimensioned to provide a sliding fit of one end thereof in the bore of said ball disposed thereon and further terminating in an opposite end portion including a stem for implantation and fixation in the ulhar bone.
18. The anatomic wrist prosthesis of claim 17, further including fixation means for retention of the last mentioned stem in the ulnar bone.
19. The anatomic wrist prosthesis of claim 18, wherein said fixation means for the ulnar bone includes a deformable locking component at the terminal end thereof remote from said ball, which is readily inserted, but after implantation, provides A locking means disposed and arranged to prevent loosening or ready removal of said fixation means thereof.
20. The anatomic wrist prosthesis of claim 19, further characterized in that the deformable locking member is a flex-lock peg.
21. The anatomic wrist prosthesis of claim 20, wherein the flex-lock peg comprises a plurality of uniformly spaced disc like elements disposed in a longitudinal arrangement along the terminal end of said ulnar stem.
22. The anatomic wrist prosthesis of claim 21, further characterized by having only a non-mechanical frictional connection existent between the rear engagement surfaces of the intermediate component and the mating surfaces of the forward portion of the radius stem.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US93027692A | 1992-08-17 | 1992-08-17 | |
| US07/930,276 | 1992-08-17 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2104029A1 true CA2104029A1 (en) | 1994-02-18 |
Family
ID=25459133
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2104029 Abandoned CA2104029A1 (en) | 1992-08-17 | 1993-08-13 | Anatomic wrist |
Country Status (2)
| Country | Link |
|---|---|
| CA (1) | CA2104029A1 (en) |
| GB (1) | GB2269752B (en) |
Families Citing this family (28)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| ATE204449T1 (en) * | 1995-06-21 | 2001-09-15 | Sulzer Orthopaedie Ag | ARTIFICIAL WRIST |
| CN1216456A (en) | 1996-02-29 | 1999-05-12 | 阿米特·埃吉 | Prosthetic systems for anatomical replacement in the hand and wrist |
| US5938699A (en) * | 1997-04-18 | 1999-08-17 | Campbell; G. Stewart | Distal radial ulnar joint reconstruction system |
| US5951604A (en) * | 1997-12-31 | 1999-09-14 | Avanta Orthopedics, Inc. | Distal radioulnar joint prosthesis |
| DE19820015C2 (en) * | 1998-05-06 | 2000-09-07 | Schaefer Micomed Gmbh | Prosthetic wrist |
| SE516039C3 (en) * | 2000-03-23 | 2002-01-09 | Philippe Kopylov Ab | Sound substitute for the distal radioulnar joint |
| DE10237016A1 (en) * | 2002-08-13 | 2004-02-26 | Moje-Keramik-Implantate | Modular wrist implant, comprising convex elliptical part joined with cylindrical shaft to concave elliptical socket |
| US8821581B2 (en) * | 2002-10-24 | 2014-09-02 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
| US8940055B2 (en) | 2002-10-24 | 2015-01-27 | Biomet Manufacturing, Llc | Method and apparatus for wrist arthroplasty |
| US8105389B2 (en) | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US8105390B2 (en) | 2002-10-24 | 2012-01-31 | Biomet Manufacturing Corp. | Method and apparatus for wrist arthroplasty |
| US6746486B1 (en) | 2002-10-24 | 2004-06-08 | Biomet, Inc. | Method and apparatus for total wrist angled back carpal plate |
| US7625408B2 (en) | 2003-07-22 | 2009-12-01 | Avanta Orthopaedics, Llc | Prosthetic wrist implant |
| FR2877209B1 (en) * | 2004-10-28 | 2007-02-02 | Dedienne Sante Soc Par Actions | LOWER RADIAL HEAD PROSTHESIS |
| US7160331B2 (en) * | 2004-12-01 | 2007-01-09 | Mayo Foundation For Medical Research And Education | Sigmoid notch implant |
| US8052757B1 (en) | 2005-10-13 | 2011-11-08 | Aptis Medical, Llc | Combined total wrist and total distal radioulnar joint prosthesis |
| US7819924B2 (en) * | 2005-11-14 | 2010-10-26 | Ascension Orthopedics, Inc. | Distal radioulnar joint prosthesis |
| US7708781B2 (en) | 2005-12-22 | 2010-05-04 | Aptis Medical, Llc | Lateral elbow prosthesis—proximal radioulnar joint |
| US8048162B2 (en) | 2005-12-22 | 2011-11-01 | Aptis Medical, Llc | Lateral elbow prosthesis—proximal radioulnar joint |
| US7608111B2 (en) | 2006-01-24 | 2009-10-27 | Biomet Manufacturing Corp. | Methods and devices for resurfacing the wrist joint |
| US20080051909A1 (en) | 2006-08-22 | 2008-02-28 | The Hospital For Special Surgery | Wrist implants |
| WO2010054400A1 (en) | 2008-11-10 | 2010-05-14 | Acumed Llc | Partial or complete prosthetic replacement arthroplasty of the distal radioulnar joint |
| CN101708139B (en) * | 2009-05-31 | 2012-08-08 | 天津市威曼生物材料有限公司 | Ball-and-socket type wrist joint prosthesis device |
| EP2706960B1 (en) | 2011-05-12 | 2016-01-06 | Howmedica Osteonics Corp. | Wrist implant for carpal hemiarthroplasty |
| GB201110679D0 (en) * | 2011-06-23 | 2011-08-10 | Orthofitz Implants Ltd | Prosthesis |
| CN103445888B (en) * | 2013-09-11 | 2015-04-01 | 徐永清 | Externally clamping fixed high-functionality artificial wrist joint prosthesis device |
| US11166822B2 (en) * | 2017-09-08 | 2021-11-09 | Orthopedix, Inc. | Implant for total wrist replacement |
| CN110623776B (en) * | 2019-10-15 | 2025-02-11 | 北京爱康宜诚医疗器材有限公司 | Wrist Prosthesis |
Family Cites Families (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4040130A (en) * | 1976-10-12 | 1977-08-09 | Laure Prosthetics, Inc. | Wrist joint prosthesis |
| US4229840A (en) * | 1978-08-01 | 1980-10-28 | Pfizer Inc. | Total trispherical wrist prosthesis |
| US4307473A (en) * | 1980-02-11 | 1981-12-29 | Weber Edward R | Prosthetic wrist joint |
| FR2681240A1 (en) * | 1991-09-12 | 1993-03-19 | Tornier Sa | TOTAL WRIST PROSTHESIS. |
-
1993
- 1993-08-13 CA CA 2104029 patent/CA2104029A1/en not_active Abandoned
- 1993-08-17 GB GB9317088A patent/GB2269752B/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| GB2269752A (en) | 1994-02-23 |
| GB9317088D0 (en) | 1993-09-29 |
| GB2269752B (en) | 1996-06-12 |
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| EEER | Examination request | ||
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