Surgery – Instruments – Orthopedic instrumentation
Reexamination Certificate
1999-05-07
2001-03-13
Buiz, Michael (Department: 3731)
Surgery
Instruments
Orthopedic instrumentation
C606S060000, C606S130000
Reexamination Certificate
active
06200316
ABSTRACT:
BACKGROUND OF THE INVENTION
This invention relates to a targeting device for inserting a fastener into the distal end of a femoral nail.
Intramedullary nailing has become one of the most effective methods for stabilizing orthopedic shaft fractures. Designs that interlock bone and nail have expanded the indications for Intramedullary Nailing (IM) considerably.
These interlocking nail designs, while generally successful, are associated with some difficulties, such as an inability to localize the distal locking holes and missed locking, that result in prolonged operating and fluoroscopy time. In addition, since no reliable distal targeting device has been developed, most surgeons are exposed to considerable radiation during distal screw insertion.
The problem of properly inserting the distal locking screws from outside the limb of the patient into corresponding screw holes in the nail is a challenging one. The proper positioning of such locking screws or pins is typically the most time-consuming and difficult portion of the overall nail implantation procedure.
A number of different approaches have been taken in attempting to find an effective, safe, simple, and rapid method. These include U.S. Pat. No. 5,772,594 issued Jun. 30, 1998, to Earl F. Barrick for “Fluoroscopic Image Guided Orthopaedic Surgery System with Intraoperative Registration”; U.S. Pat. No. 5,540,691 issued Jul. 30, 1996 to John A. Elstrom and Peter Elstrom for “Optical Distal Targeting method for an Intramedullary Nail”; U.S. Pat. No. 5,013,317 issued May 7, 1991 to J. Dean Cole and A. Glenn Durham for “Medical Drill Assembly Transparent to X-rays and Targeting Drill Bit”; U.S. Pat. No. 4,976,713 issued Dec. 11, 1990 to Joël Landanger and Jean P. Michel for “Aiming Device to Position at Least One Fixing Component of the Centromedullar Nail Type, Through an Implant”; U.S. Pat. No. 4,803,976 issued Feb. 14, 1989 to Robert Frigg et al. for “Sighting Instrument”; U.S. Pat. No. 4,667,664 issued May 26, 1987 to Harold S. Taylor and John C. Taylor for “Blind Hole Targeting Device for Orthopedic Surgery”; and U.S. Pat. No. 4,418,422 issued Nov. 29, 1983 to Karl M. Richter et al. for “Aiming Device for Setting Nails in Bones”.
Typically, a C-arm x-ray provides an image for the surgeon to view the locking holes in the nail. It is necessary to precisely align the axis of the targeting device with the axis of the locking holes after the radiation axis of the x-ray has been aligned with the locking holes. Usually prior art viewing devices employ a carriage mounted on a mounting plate to move the targeting device in at least 2 degrees of freedom, in planes generally parallel to the nail to locate the axis of the targeting device with the locking holes. The viewing axis of the targeting device must be precisely located to coincide with the axis of the locking holes.
SUMMARY OF THE INVENTION
The broad purpose of the present invention is to provide an improved method and device for aligning the axis of a fastener insertion (locking) hole with the axis of the holes in the orthopedic hardware, such as the distal end of a femoral nail.
In the preferred embodiment, a mounting plate is strapped on the user's limb adjacent the distal end of the nail. The targeting device is slidably supported on rods disposed in a plane generally parallel to the implanted nail. A ball and socket joint supports the targeting device so that it can be rotated with the aid of a radiation source that is aligned with the locking holes until the viewing axis coincides with the axis of the locking holes. The bone is drilled and then the fastener is inserted both through the targeting device and the nail.
The intent/purpose of the invention is as follows: to improve the reliability/accuracy of alignment; to eliminate surgeon exposure to the associated radiation; to be inherently easy to use; and to improve the associated procedural time of surgery.
The principle features of the invention include: a one step adjustment for each the x and y directions; a ball and socket joint supporting the targeting device for spherical adjustment such that the viewing axis coincides with the axis of the distal holes of the nail; hands-free operation during x-ray; and a tourniquet design for secure attachment to the patient.
The procedure and apparatus may be used in other long bone fractures, such as a humeral bone, and for use either with a solid or hollow nail.
Still further objects and advantages of the invention will become readily apparent to those skilled in the art to which the invention pertains upon reference to the following detailed description.
REFERENCES:
patent: 4418422 (1983-11-01), Richter et al.
patent: 4667664 (1987-05-01), Taylor et al.
patent: 4803976 (1989-02-01), Frigg et al.
patent: 4976713 (1990-12-01), Landanger et al.
patent: 5013317 (1991-05-01), Cole et al.
patent: 5540691 (1996-07-01), Elstrom et al.
patent: 5746741 (1998-05-01), Kraus et al.
patent: 5772594 (1998-06-01), Barrick
patent: 5776143 (1998-07-01), Adams
patent: 2213066 (1989-08-01), None
Donohoe Owen F. M.
Zwirkoski Paul A.
Buiz Michael
Chandler Charles W.
Ngo Lien
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