Surgery – Instruments – Orthopedic instrumentation
Reexamination Certificate
2000-05-15
2003-05-20
O'Connor, Cary E. (Department: 3732)
Surgery
Instruments
Orthopedic instrumentation
C602S021000
Reexamination Certificate
active
06565563
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Technical Field
The present invention relates to a medical and surgical method and apparatus for the correction of injuries and disorders of the musculoskeletal system in general and contractures of joints in particular. More particularly this invention relates to a dynamic orthopedic device designed to increase the range of motion of joints suffering from contractures particularly the small joints of the hand.
2. Related Art
Skeletal joint contractures often result from trauma, including fractures and dislocations of joints. In addition, bums and their scar contracture reduce the range of motion of joints. Contractures also result from muscle imbalance across joints secondary to diseases such as leprosy. Dupuytren's disease commonly causes flexion contractures of the small joints of the hand. However, contractures can be flexion or extension contractures and can occur in any skeletal joint.
Traditionally, these injuries have been treated with various different modalities including splinting, serial plaster casts, and surgical release. Recently, significant innovations have resulted in more effective dynamic methods of treating such injuries in certain joints. For example, U.S. Pat. No. 5,376,091 to Hotchkiss et al., incorporated herein by reference, describes a dynamic finger joint support that has a proven clinical record of successful treatment of contractures. The Hotchkiss device is designed to allow, for example, the proximal interphalangeal (PIP) joint to be flexed and extended by a continuous passive motion machine that applies torque to the joint. Such flexion and extension is known to help overcome joint contractures so that the patient is often able to regain the full range of motion in the affected joint.
A deficiency of some prior art devices, generally referred to as hand splints, is that the torque required to increase the range of motion of the joint, can only be applied to the joint through the skin overlying the skeletal segments extending from either side of the joint. In addition, the force required to increase the range of motion of a joint needs to be applied for a significant amount of time. If the force is transmitted to the skeleton indirectly through the skin, the force compromises the circulation of the skin causing it to become tender, red and inflamed. In severe cases, particularly those with compromised sensation, ulcers may develop. As shown in
FIGS. 1 and 2
, the Hotchkiss device
5
avoids this problem for the distal interphalangeal (DIP) joint
10
by applying force directly to both the middle phalanx
12
and the distal phalanx
14
. From the top view provided by
FIG. 2
, it is clear that pins
16
,
18
,
20
,
22
are embedded in the skeletal elements through the lateral surface of the middle
12
and distal
14
phalanges.
Despite the successful clinical record of devices like Hotchkiss', there is room for improvement in the field. Many of the prior art devices and methods have potential problems and significant limitations that restrict their use in many applications. In particular, as shown in
FIG. 2
, Hotchkiss type devices
5
are required to be mounted on the lateral surface of the bones that extend from the contracted joint
10
.
The Hotchkiss type device does not appear to be useable on metacarpal phalangeal (MP) joints. In the case of the proximal interphalangeal (PIP) joint
24
, for example, a Hotchkiss type device
5
appears to be most useful for the second and fifth PIP joints. However, because other fingers of the hand, including the webbing, would interfere with installation and use of the device on the middle finger and ring finger PIP joints, an alternate solution is required. Further, with regard to all of the PIP joints, there are soft tissues and tendons that glide along the lateral and medial surfaces of the phalanges, particularly the proximal phalanges of the fingers, that can be impaled by pins inserted into the sides of these phalanges, as required in Hotchkiss type devices used on the PIP joints. Additionally, installation of a Hotchkiss type device on the second and third DIP joints
10
would require the fingers to remain partially spread throughout the treatment period. The Hotchkiss device is depicted as applied to the DIP distal joint of the finger, however, this device and others including variations of the subject invention often are applied to the PIP joints of the fingers. With application of such devices to either the DIP or PIP joints, device portions mounted on the lateral and medial aspects of the finger or extending therefrom are troublesome as they impinge the adjacent fingers.
In light of such prior devices, what is needed is a means for biasing contracted joints that can be used on many different joints. What is further needed is a device that is not restricted to use only where it can be mounted on the lateral surface of the bones extending from a contracted joint. It would further be beneficial to identify a way to apply force directly to the skeleton without detrimentally disrupting soft tissue and tendons on the lateral surface of the bones extending from the joint. Such a device would preferably permit simultaneous treatment of joints of adjacent fingers.
In splinting techniques used in hand surgery and hand therapy, if a splint uses a single elastic element that crosses more than one joint to treat contracture of one or both joints, it is impossible to balance the torques applied to each of the joints. Thus, what is needed is a device or means which simultaneously applies independent, controlled torque to multiple contracted joints that are adjacent along an appendage such as a finger.
SUMMARY OF THE INVENTION
The above and other deficiencies and problems with the prior art are addressed by the present invention of a multiple contracted joint biasing apparatus and method. The inventive, apparatus crosses and selectively controls torque forces applied to each skeletal joint in axial series, specifically when a first joint is proximal or distal to another. When applied to the hand, a first adjustable joint biasing torque apparatus may be surgically attached to the dorsal surface of the middle phalanx of a finger. This first adjustable joint biasing torque apparatus may be linked to a second proximal adjustable biasing torque apparatus by a rigid linkage. The second proximal adjustable biasing torque apparatus is positioned relative to the flexion-extension axis of the proximal joint by a removable brace that extends from the forearm across the wrist to cradle or embrace the hand.
More generally, a first adjustably biased mechanical joint is positioned on the extension side of a first contracted skeletal joint. A distal member extends from the first mechanical joint and is surgically attached to the bone extending from the contracted skeletal joint. A rigid linkage extends from the first mechanical joint and is attached to a second adjustably biased mechanical joint. A proximal member extends from the second mechanical joint and is removably attached to the appendage that extends proximally from the second contracted skeletal joint.
The first adjustably biased mechanical joint is operable to rotate with the same degrees of freedom as a normal, non-contracted skeletal joint of the same type as the first contracted skeletal joint. The adjustable biasing torque is applied to the skeletal joint via the distal member in the rotational direction of the desired range of skeletal joint motion. The second mechanical joint is positioned on the exterior side of a second contracted skeletal joint which is adjacent along the appendage that extends from the first skeletal joint. The second mechanical joint is operable to rotate with the same degrees of freedom as a normal, non-contracted joint of the same type as the second contracted joint. As with the adjustable biasing torque applied to the first skeletal joint by the first mechanical joint, the adjustable biasing torque for the second mechanical joint is applied to the second skeletal joint via the proximal me
Agee John M.
King Francis C.
Woodhouse Jeffrey
Agee John M.
O'Connor Cary E.
Townsend and Townsend / and Crew LLP
LandOfFree
Method and apparatus for increasing the range of motion of... does not yet have a rating. At this time, there are no reviews or comments for this patent.
If you have personal experience with Method and apparatus for increasing the range of motion of..., we encourage you to share that experience with our LandOfFree.com community. Your opinion is very important and Method and apparatus for increasing the range of motion of... will most certainly appreciate the feedback.
Profile ID: LFUS-PAI-O-3042429