Surgery – Instruments – Orthopedic instrumentation
Patent
1996-06-26
1998-03-03
Buiz, Michael
Surgery
Instruments
Orthopedic instrumentation
606 70, 606 71, 606 60, 606 72, 606 73, A61B 1758
Patent
active
057229767
DESCRIPTION:
BRIEF SUMMARY
This invention relates to a method and apparatus for surgically securing bone parts, and in particular but not limited to surgery in humans where the sternum is desired to be re-joined after being sawn into two parts transversely.
In cardiothoracic surgery, a trans-sternal bilateral thoracotomy is often performed in order to gain access to the heart and/or lungs. In this procedure, the sternum is sawn into two pieces laterally. A particular problem arises with this procedure in providing a secure closure of the sternum at the end of the operation. The conventional technique is to secure the sternum with two or three sutures of wire passed through the bone above and below. The two parts of the sternum are held together by the sutures, and the closure must be completely secure with no motion at the sternal incision if the bone is to heal properly. Currently, the failure rate of such sternal closures is on averages 30% and in some hospitals 60%. It is thought that factors which influence the high failure rate include the fragility of the sternum and the small cross-sectional area of the transverse sternum closure. The problem does not arise in alternative means of opening the sternum where the sternum is cut longitudinally, presumably because the longitudinal incision has a much larger cross-sectional area.
The object of the invention is to provide an alternative apparatus and method for securing bone parts, and in particular to provide an apparatus and method for closing transverse sternum incisions which provides a higher reliability than conventional methods.
Therefore in accordance with a first broad aspect of the invention there is provided an apparatus for surgically securing a first bone part to a second bone part, comprising a base and first and second securing means for attaching to the base and for securing each respective bone part to the base firmly such that relative movement of the bone parts is prevented and re-growth of the bone parts into an integral whole is promoted, each securing means preventing movement or relative pivoting of the corresponding bone part outwards from the base by holding the corresponding bone part onto the base, wherein
(i) the holding is performed by the application of external pressure applied to the bone parts by the securing means on a side of the bone parts opposite to the base; and
(ii) one or both of said securing means comprises a screw means and a receiving means, said screw means in use being inserted from one side through a drilled hole in the corresponding bone part and screwed into the receiving means disposed on the other said side of the bone; and
(iii) one or both of said securing means includes a post protruding from the base over which in use the corresponding bone part is positioned with the post inside the drilled hole.
For each said securing means, a plurality of screw means and receiving means and corresponding drilled holes may be provided.
Preferably, the or each receiving means comprises said post and in use the screw means is screwed into a thread in the post from a side of the corresponding bone part opposite the base.
The post may be welded, moulded or otherwise integrally formed with the base, or alternatively may be detachably joined to the base by attachment screws.
Still preferably, the apparatus and securing means further comprise a plate with a first hole and a second hole adapted to be positioned under heads on the screw means associated with the first and second securing means respectively, the plate being held in position on the bone part by the screw means and thereby providing said holding.
Alternatively, an enlarged head or washer on the or each screw means may act to provide said holding.
The apparatus can be made from any physiologically acceptable material capable of withstanding the stresses placed on it during use.
Preferably the apparatus is made from stainless steel or titanium to allow the provision of a thin base and a securing means which protrude as little as possible from the bone surface. The apparatus can also be con
REFERENCES:
patent: 4802477 (1989-02-01), Gabbay
Buiz Michael
Kerins John C.
Shai Daphja
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