Surgery – Instruments – Orthopedic instrumentation
Patent
1991-04-17
1992-08-18
Brown, Michael A.
Surgery
Instruments
Orthopedic instrumentation
606216, A61B 1756, A61B 1708
Patent
active
051394987
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to a device for closing an opening performed in the sternum during heart surgery and for fixing the two breast bone halves separated by said opening, in relation to each other, said device consisting of (a) an elongate plate comprising two flat, thin, longitudinal, parallel, uniform anchoring members, which are spaced a predetermined distance from each other and provided with through-holes, and at least two spaced apart, transverse, flat, thin connection pieces which are connected to the anchoring members to form a rigid unit therewith, and (b) a plurality of attachment wires to be inserted into the breast bone halves from below and into said holes, the pairs of end portions of said attachment wires being twisted together to the plate.
Wires, applied in various ways, are used to close the long opening made in the sternum, i.e. the breast bone, during heart surgery and to fix the two breast bone halves together (see The Journal of Thoracic and Cardiovascular Surgery, 1977-78, pages 267-268). One technique is to drill a number of through-holes in the two breast bone halves and thread lengths of wire through the holes so that the lengths of wire extend across the opening, subsequently twisting the ends of each wire together. Another technique is to entirely surround the two breast bone halves with lengths of wire and twist the ends together in order, in the same way, to form a transversal wire joint which draws the breast bone halves towards each other, thus closing the opening and fixing the breast bone halves together. However, in certain cases the wire may cut through the breast bone halves, destroying the wire joint and causing the breast bone to crack along the previous opening. This risk is particularly great if the quality of the breast bone is poor or the patient suffers from a chronic obstructive pulmonary disease, or a combination of these conditions. Sternum insufficiency, i.e. when the breast bone cracks, resulting in open wounds, constitutes one of the most serious and difficult post-operative complications, particularly if an infection occurs as happens in most cases. For patients who have undergone heart surgery, this complication in many cases entails several extra months in hospital and usually a plurality of unsuccessful operations attempting to join the thorax. It is also known through U.S. Pat. No. 4,512,346 and U.S. Pat. No. 4,583,541 to combine the attachment wires with different types of means, however, also in these cases the attachment wires are passed through the two breast bone halves and are attached across the opening. Consequently, the above problem persists. Through GB 1 579 575 it is known to use a bone plate having two anchoring members which are connected by inclined cross pieces and having a few holes. This bone plate is intended to be attached in opposite bone sections of a bone fracture by means of screws inserted in said holes, i.e. the longitudinal direction of the bone plate is substantially perpendicular to the fracture opening or surfaces. However, such a bone plate is not useful for fixing the breast bone halves to each other. Neither the specification gives any suggestions or proposals for solving the problem associated with the closure of sternum in connection with heart surgery. In this context it would also be noted that the behaviour of sternum in the healing process subsequent to median sternotomi does not in any way follow the same rules as those for other bones in the body. This is because sternum is in direct connection with the function of breathing. The treatment of sternum and its complications constitutes therefore a specific problem.
The object of the present invention is to greatly reduce the problems mentioned above and to provide a device which, in an efficient and simple manner, can be used to close and fix the breast bone after opening for heart surgery.
The novelty of the invention resides in that the holes in each anchoring member are disposed in a continuous row from the one end to the other of the anchoring member
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Robicsek et al., "The Prevention and Treatment of Sternum Separation Following Open-Heart Surgery", The Journal of Thoacic and Cardiovascular Surgery, Mar. 26, 1976, pp. 267-268.
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