US2500370A - Repair of femur fracture - Google Patents

Description

March 14, 1950 MoKlBBlN 2,500,370

REPAIR OF FEMUR FRACTURE Filed- June 30, 1947 INVIEJNTOR: Gen euleue M ffau? Patented Mar. 14, 1950 UNITED STATES PATENT OFFICE REPAIR OF FEMUR FRACTURE Genevieve McKibbin, Seattle, Wash.

Application lune 30', 1947, Serial No. 752993 4 Claims (01.128 92) This invention relatesv to medical apparatus, has particular reference to the field of fracture surgery; and pertains especially to the repair of breaks occurring in the upper extremity of the femur; or thigh bone, of the human skeleton.

-For its general object the invention aims to Drovidemeans expressly designed for use in those fairly common fracture. cases in which the break lies between: the head of the thigh bone and the shaft of the latter, andccmprehends the provision ofa perfected permanent splint, and associated equipment for applying thevv splint, to ef fectuate a. firm grip securely holding the facing surface of the bone section. which lies at one side of the break against transverse slippage in relation to. the. facing surface of the bone section which lies atthe. other side of the. break.v Other and. more particular objects. of the invention will, with the foregoing, appear and be understood. in the course of the following description and. claims. the invention consisting in the novel construction and in the adaptation and combination of parts hereinafter described and claimed.

In the accompanying drawing: Figure 1 is a view partly in longitudinal vertical section and partly in elevation illustrating a splint, constructedin accordance. with the preferred embodiment of the present invention and portrayed. in, operative position upon. a broken thighbone, the bone being shown fragmentarily. Fig.2 is a plan view of the splint. Fig. 3 is a. fragmentary transverse. sectional view on broken line 33 of Fig. 1. Fig. 4 is a view partly in longitudinal vertical section and partly in elevation to illustrate, the jig whichI. provide for guiding. a drill inpreparing the bone section. for application. of the splint. and showing said jig in the performance of its intended end .of guiding the drill into a thigh bone, the latter being represented fragmentarily. Fig, 5 is, a fragmentary side elevational view with parts in section to illustrate one means of pressing the splint into operating position upon a prepared thigh bone and Fig. 6 is a somewhat similar view incorporating a fragmentary showing of the thigh bone and showing a somewhat modified, tool for use in forcing the splint home. Before. proceeding with. a detailed description of the present invention, clarity in an understanding thereof will. perhaps be advanced by first reierring to the structural. nature of the bone, and namely the. femur or. thigh. bone, on which my splint isexpresslv intended to be used. The present invention is concerned only with the upper extremity and which consists of a rounded head, denoted a, which articulates with the cavity in the hip bone and which is joined to the shaft 1) by a constricted neck 0, with an eminence known as the trochanter d surmounting the shaft and jutting outwardly therefrom. 1

The splint of the present invention is preferably produced from stainless steel although any other material of suitable strength, and having the necessary characteristic of being free of any toxic effect when placed under the flesh, would suffice for the purpose. This splint provides a comparatively narrow plate designated by the numeral Hi and, considered in transverse section, such plate is made slightly concave upon the underside to conform more or less tothe circumferential curvature of the shaft 1) and, considered, in side elevation, is substantially straight for the. major part of its length with the upper terminus curved outwardly, giving to the plate a shape conforming, more or less closely to the profile configuration of that part of a thigh bones outer face. which includes the lower portion of the greater trochanter d and. extends for a. substantial distance along the shaft proper. Piercing the curved upper end and spaced one from the. other on thelongitudinal median line of the plate there are provided a. pair of spikes II and. 12 which are directed angularly upwardly along parallel axes. The spikes are made an integral part of the plate and when the latter is placed. to lie snugly against the outer face of a thigh bone, the angularity of these spikes is desirably such as to approximately parallel the axis of the neck 0, and the length is such as to have the spikes substantially traverse the cancellated structure.

of the neck and. bring the tips into the head proper Without, however, piercing the coating of compact tissue which lies at. the surface. Between and. parallel with the axial lines of these spikes the curved end. of the plate is pierced by a counter-sunk hole 13. In its other or lower end the.

plate is drilled to provide two quite widely spacedv and tapered holes [4 and I5 of fairly large diameter andv which likewise are placed on the longitudinal median line, and between these tapered holes. there. is. provided a third and threaded hole the The. purpose of. the several. holes will become apparent inthe course of describing the application of the plate. 4 v

Associated with the plate and arranged and adapted to be used for drilling into the bone to prepare the latter for reception of the spikes II and 1.2 there is provided a. jig, and this jig presents a head I! pierced with a center hole l8 and having, both fore and aft thereof, a guide hole 28 paralleling the center hole. These guide holes are arranged to receive a bit 22 therethrough of a diameter substantially the same as the spikes, and with the center hole l8 are spaced apart in substantial correspondence with the spacing which obtains between the spikes and the center hole 13 of the plate. Extending angularly outwardly from the base of the head there is provided a stabilizing arm 23, and working through a threaded opening in the end of this arm is an adjusting screw 24;

In applying my splint, and assuming that the fracture line of the femur under repair is the more or less usual transverse break pictin'ed in the drawing and running between the greater and lesser trochanters, the procedure is to first expose the bone by laying back the flesh and the jig is then placed in the desired position (see Fig, 4) while adjusting the screw 2-! to compensate for individual peculiarities in the bone structure. The surgeon then inserts a fine bit in the center hole l8 and drills into the bone and through the cancellated structure until the leading end has worked well into the head a, whereupon the bit is removed and replaced by a straight length 25 of a fairly heavy-gauge wire, With this wire holding the jig against shifting, the surgeon then repeats the drilling operation, using the larger bit 22, and again working through the cancellated structure well into the head a this time on the paralleling axial lines prescribed by each of the two guide holes 20. The jig is now removed, and the two spike tips of the splint inserted in the drilled holes, and in performing this step the wire may be first removed or it may be temporarily left in the bone and the splint guided into position by feeding the exposed end of the wire through the center opening [3. As the entering spikes encounter resistance, and this will usually occur as the tips near the inner ends of the drilled channels, the surgeon may then either forcefully complete the insertion by heavy thumb pressure or he may employ a tool similar to one or the other of the two tools 26 and 21 which I have illustrated in Figs. and 6, each of which are characterized by their provision of a taper nose, as 28 and 29, which seats in the countersunk recess of the center opening 13. In the instance of the preferred tool 21 the surgeon simply presses the nose of the tool against the tapering socket and holds the tool such that the exerted endwise thrust is directed along an axis closely paralleling the axes of the spikes, whereas with the tool 26 provision is made for fixedly locating the center line of the tools thrust-transmitting stem. In such latter case, the tool presents a threaded shank 30 disposed in following relation to the nose 28, the shank working in the threaded bore of an arm 3t and which is in turn anchored upon the plate H! by a cap screw 32 workin in the threads of the drilled opening l6.

Having now accomplished a seating of the plate against the exposed surface of the bone, the surgeon then anchors the bottom end of the plate by applying screws 33 and 34 through each of the two tapered holes l4 and I5, drawing the plate firmly against the bone. These anchoring screws, which are of a length sufficient to pierce the compact outer tissue and pass through the medullary canal and into the compact tissue at the opposite side of the bone, are by preference applied such that their axial lines lie in diver ing relation, the upper screw slanting upwardly and the lower screw slanting downwardly. To complete the surgery, the opening through which the bone was exposed is closed and the incision stitched, leaving the splint permanently in place upon the repaired bone.

It should, perhaps, be pointed out that the spikes H and I2 and which, like the plate Ill and the screws 33 and 34, are desirably composed of stainless steel, admit of being quite readily bent to vary their upward angle of inclination. While normally there is no call for changing the predetermined angle at which the same are set, there are rare instances in which, due to a bone deformity, there is an objectionably large discrepancy between the axis of the bones neck portion 0 and the median of the axial lines which the spikes would normally occupy upon a seating of the splint against this deformed femur. In such a case it is desirable to bend the spikes in such degree as may be necessary, the bend then taking place at the root end of the spikes and without any appreciable curvature occurring within the lengths of the spike shanks.

It is thought that my perfected splint and the jig employed to apply the same will have been clearly understood from the foregoing detailed description of the invention. Also, and while no particular novelty is professed therefor, it is believed that the nature and manner of application of a suitable tool for exert ng a straight-line pressure upon the splint to force the spikes into the receiving channels therefor will likewise have been clearly understood. Changes in structural details will largely be self-evident having knowledge of my now-preferred and illustrated embodiment, and it is therefore my intention that no limitations be implied and that the hereto annexed claims be given a scope in their interpretation fully commensurate with the broadest interpretation of which the employed language fairly admits.

What I claim is:

1. A splint for repairing fractures in the upper extremity of the femur comprising an elongated plate arranged to overlie and closely fit that part of the outer face of the bone which includes the upper section of the shaft proper and a portion of the greater trochanter and providing a pair of spikes fixedly associated with the upper section of the plate and proiecting parallel to one another from the underside of the plate in such angular relation to the general plane of the latter as. upon application of the spikes to located holes drilled into the bone, to cause the spikes to project along the approximate axis of the femurs constricted neck through the neck and into the head prominence of the femur. sa d upper section of the plate being also provided with an aperture placed to locate its axis parallel with and intermediate the axes of the spikes and functioning as a slide journal for the protruding end of a guide wire embedded in the bone, thus to hold the sp kes co-axial to their located drillholes when initiating the operation of forcing the spikes home, the lower section of the plate providing a pair of apertures spaced at intervals of the length, and each arranged to accommodate the insertion into the femur shaft of a headed screw whereby to draw the plate firmly against the shaft.

2. A s lint for repairing fractures in the upper extremity of the femur comprising an elongated plate having a curved extremity and arranged to overlie and closely fit that part of the outer face of the bone which includes the upper section of the shaft proper and a portion of the greater trochanter and formed at the plates lower end with a pair of apertures spaced at intervals of the length, a pair of spikes integrally joined by their root ends to the curved extremity to lie in separated rela tion on the longitudinal median line of the latter and projecting inwardly from the underside thereof in such angular relation to the general plane of the plate as, upon application of the splint to the bone, to cause the spikes to project through the constricted neck and into the head prominence of the femur along axes parallel one with the other and with the approximate axis of said neck, the outer face of said curved end being also provided with a recess disposed intermediate the axial lines of the spikes and serv ing as a socket to receive the mating nose of a thrust-applying tool for forcing the spikes into the bone, and headed screws for said apertures of the plate arranged to be inserted therethrough and into the shaft of the femur for drawing the plate firmly against the shaft.

3. A jig for use in preparing a femur bone for application of a splint characterized in its provision of parallel bone-penetrating spikes adapted when the splint is applied to the bone to occupy positions along the approximate axial center of the femurs constricted neck, said jig providing a head drilled along parallel axes to present a median bore and two end bores of somewhat larger diameter than the median bore placed one at one side and the other at the other side of the center bore and spaced apart a distance corresponding to the spacing between the spikes, the end bores serving as bit-receiving guides to hold the drill-bits on parallel axes during the operation of drilling the bone to produce channels for the reception of the spikes and the median bore acting to receive a straight length of boneembedded wire to localize the jig while said channels are being drilled, said jig also having an arm extension projecting laterally from the head, and an adjusting screw working in said arm and arranged to bear upon the shaft of the femur for stabilizing the head.

a. The splint of claim 2 in which the plate is provided in its lower end with a threaded and an arm member providing means for stabilizing the thrust-applying tool removably anchored to the splint and arranged to he used with the latter when the splint is being set in position, the anchoring instrumentalit comprising a cap screw working in said threaded aperture.

GENEVIEVE MCKIBBIN.

REFERENCES CETED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 2,414,882 Longfellow Jan. 28, 1947 OTHER REFERENCES Journal of Bone and Joint Surgery for January 19%, page 54. (Copy in Library.)

The Lan et "for February 13, 1937, pages 375-6. (Copy in Div.)

Surgery, Gynecology & Obstetrics for 1914; volume '18, pages 260-261.

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