Abstract:
A system and method for pressing fragments of a fracture against each other includes a compression device comprising a hollow shaft. The system has an inner engagement portion for engaging an outer feature of a screw head arranged at a distal end of the shaft. The system has a supporting element with a contact surface adapted to abut on one of the fragments, and a joint is provided between the supporting element and the hollow shaft. The joint is formed so as to allow a rotation of the shaft about a longitudinal axis thereof relative to the supporting element. Additionally, the joint is formed to allow a pivot movement of the supporting element relative to the shaft.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority from European Patent Application 12 191 599.5 filed on Nov. 7, 2012, the disclosure of which is hereby incorporated herein by reference. 
       BACKGROUND OF THE INVENTION 
       [0002]    The present application claims priority from European Patent Application 12 191 599.5 filed on Nov. 7, 2012, the disclosure of which is hereby incorporated herein by reference. 
         [0003]    The invention relates to a device for fracture reduction and/or intrafragmentary compression. Furthermore, the invention relates to a method for operating the device. Compression screws may be introduced into a fractured object (bone) by means of a compression device adapted to press fragments of the object against each other. Usually, the longitudinal axis of the elongated compression device extends along the longitudinal axis of the compression screw so that the screw may be rotated by rotating the compression device about that axis. 
         [0004]    However, the contact surface, i.e. the end face of the compression device, which has to come in contact with the fractured object for applying a force which presses fragments of the fractured object against each other, will cause undesired damage or injury to the contact area adjacent the entry point of the compression screw at the object. This may particularly be caused due to the rotation of the compression device creating friction, as well as due to an uneven or inclined abutment of the end face of the compression device onto the object surface. 
       BRIEF SUMMARY OF THE INVENTION 
       [0005]    One aspect of the invention may be to provide a device and a method for pressing two fragments of a fracture against each other, with a reduced interference between the device and the fragments. Another aspect may be to provide a device and a method by means of which fragments of a fracture can be stably and reliably pressed against each other. 
         [0006]    This is achieved by the subject-matter of the respective independent claims. Further embodiments are described in the dependent claims. 
         [0007]    In general, a system for pressing fragments of a fracture against each other according to an embodiment, includes a compression device comprising a hollow shaft, wherein an inner engagement portion for engaging an outer feature of a screw head is arranged at a distal end of the shaft, a supporting element with a contact surface adapted to abut on one of the fragments, and a joint between the supporting element and the hollow shaft. The joint is formed so as to allow a rotation of the shaft about a longitudinal axis thereof relative to the supporting element. Additionally, the joint is formed to allow a pivot movement of the supporting element relative to the shaft. 
         [0008]    It is noted that the rotation may be realized like a shaft bearing with or without rolling elements. On the other hand, the pivot movement may be realized about only one axis but also about two or more axes, such as a ball and socket joint. 
         [0009]    According to one embodiment, the joint may include a ball joint, wherein the joint may include an outer spherical portion formed at the distal end of the hollow shaft, and an inner spherical portion formed at the supporting element. It will be understood that the outer spherical portion, i.e. a part of a ball, may be formed at the supporting element, whereas the inner spherical portion may be formed at the distal end of the hollow shaft. 
         [0010]    According to another embodiment, the joint between the hollow shaft and the supporting element includes a snap fit connection which may provide for the possibility to separate the supporting element from the hollow shaft. Accordingly, it may be possible to utilize a single supporting element together with a plurality of different hollow shafts, as long as the respective hollow shaft is provided with a joint element which corresponds to the counterpart at the supporting element. 
         [0011]    The provision of a joint between the supporting element and the hollow shaft allows a flat and smooth abutment of the contact surface at the supporting element on an outer surface of a fragment, even if it is intended to introduce a compression screw into the fragment with a non-perpendicular angle, i.e. inclined, between the longitudinal axis of the screw (the hollow shaft) and the outer surface of the fragment, adjacent the entry point of the screw into the fragment. 
         [0012]    Regarding the inner engagement portion for engaging an outer feature of a screw head, it is noted that any contour may be suitable as long as it comprises at least one edge on the circumference which allows applying a rotational force on a screw head. For example, the inner engagement portion may be formed like a hexagonal wrench adapted to fit to a screw head formed like a hexagonal nut. 
         [0013]    According to a further embodiment, the inner engagement portion at the distal end of the hollow shaft comprises an inner thread for engaging an outer thread formed on a screw head. 
         [0014]    According to yet another embodiment, the system further comprises a compression screw having a first outer thread at a distal end and a proximal end referred to in the following as screw head, with an outer feature corresponding to the inner engagement portion of the hollow shaft. That is, the system may comprise a combination of a compression device and a compression screw, wherein the head of the compression screw fits into the inner engagement portion at the distal end of the shaft of the compression device. 
         [0015]    In a case, in which the inner engagement portion comprises a thread, the screw head should have also a corresponding thread. 
         [0016]    It is noted that a screw having a first thread on the distal portion of the screw shaft as well as a second thread on the screw head may be screwed completely into an object, with the diameter of the two threads being substantially the same. Even if the diameter of the shaft is smaller than the diameter of the head, it is possible to provide the threads with the same pitch so that both threads may engage simultaneously at an object to be screwed into the same. 
         [0017]    According to an embodiment, a pitch of the outer thread at a distal end of the compression screw may be greater than a pitch of an outer thread at the screw head. Such a configuration results primarily in different lengths per turn by which the respective threads enter an object. In a case in which the distal thread engages in a first fragment and the proximal thread engages in a second fragment, these fragments will be pulled together or pushed away from each other depending on the rotation direction of the screw. Accordingly, it is possible to achieve a further compression between two fragments by completely screwing in the compression screw into both fragments. 
         [0018]    To allow a controlled introduction of a compression screw into an object, the system may further comprise a drill to prepare a bore for receiving the compression screw. 
         [0019]    According to another embodiment, the compression screw further comprises a through bore in a longitudinal direction of the screw, so that the compression screw may be adapted to slide onto a Kirschner wire, with the Kirschner wire accommodated in the through bore of the compression screw. 
         [0020]    According to yet a further embodiment, the system may further comprise a screwdriver with an outer screw engagement portion at a distal end of the screwdriver. The screwdriver may be adapted to be at least partially accommodated in the hollow shaft of the compression device. On the other hand, the compression screw may further comprise a corresponding inner tool engagement portion formed in the screw head, for engaging the outer screw engagement portion of the screwdriver. 
         [0021]    In general, a method for pressing fragments of a fracture against each other comprises the steps of coupling a screw head of a compression screw with a hollow shaft of a compression devise, rotating and thus screwing in the compression screw by rotating the compression device through a first fragment and into a second fragment, until a contact surface of a supporting element of the compression device abuts on the first fragment, and pressing the first and second fragments against each other by further rotating the compression device and thus the compression screw. 
         [0022]    According to an embodiment, the compression screw may be screwed into a bore previously prepared into the first and second fragments for receiving the compression screw. 
         [0023]    According to another embodiment, the method may further comprise the steps of coupling an outer screw engagement portion of a screwdriver with an inner tool engagement portion in the screw head of the compression screw, and disconnecting the hollow shaft from the head of the compression screw. Furthermore, the compression screw may be completely screwed into an object by means of the screwdriver, while disconnecting the compression screw from the shaft of the compression device, i.e. while turning the outer thread at the screw head out of the inner thread in the hollow shaft. This is possible with the contact surface of the supporting element being in contact with an outer surface of a fragment. 
         [0024]    It has to be noted that embodiments of the invention are described with reference to different subject-matters. In particular, some embodiments are described with reference to method-type claims, whereas other embodiments are described with reference to apparatus-type claims. However, a person skilled in the art will gather from the above and the following description that, unless otherwise notified, in addition to any combination of features belonging to one type of subject-matter, also any combination of features relating to different subject-matters is considered to be disclosed with this application. 
         [0025]    These and other objects, features and advantages of the exemplary embodiments of the present invention will become apparent upon reading the following detailed description of exemplary embodiments, when taken in conjunction with the appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]      FIG. 1  is an isometric visualization of an embodiment of a system with a compression device, a compression screw and a screwdriver; 
           [0027]      FIG. 2  shows an example of use of the system according to another embodiment; 
           [0028]      FIG. 3  is a side view of a system according to an embodiment; 
           [0029]      FIG. 4  is a section view of the system of  FIG. 3 ; 
           [0030]      FIG. 5  is a detail view of a joint between a supporting element and a hollow shaft; 
           [0031]      FIG. 6  illustrates steps of a method according to one embodiment; and 
           [0032]      FIG. 7  is a flowchart representing method steps in accordance with embodiments. 
       
    
    
       [0033]    It is noted that the illustration in the drawings is only schematically and not to scale. Throughout the drawings, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components, or portions of the illustrated embodiments. Moreover, while the present invention will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments and is not limited by the particular embodiments illustrated in the figures, as defined by the appended claims. 
       DETAILED DESCRIPTION 
       [0034]      FIG. 1  provides an isometric illustration of an embodiment of a system for pressing fragments against each other, the system comprising a compression device, a compression screw  30  and a screwdriver  40 . The compression device comprises a hollow shaft  10  and a supporting element  20 . 
         [0035]    The hollow shaft  10  of the compression device includes a ball head, i.e. an outer spherical surface  12  formed at a distal end of the hollow shaft  10  and a grip portion  14  at a proximal end portion of the hollow shaft. The spherical portion may be formed integrally with or may be attached to the hollow shaft. The grip portion may be formed as a thickened portion onto the sleeve-like shaft with grooves on its circumference allowing a better grip. 
         [0036]    Fixed on the spherical portion  12  of the shaft  10  is a supporting element  20  including a portion  22  with an inner spherical recess  13  which corresponds to the outer spherical portion  12  of the hollow shaft  10 . The supporting element further comprises a flat plate portion which provides an enlarged contact area in order to distribute the load more evenly on the object surface acting as a temporary washer. Furthermore, with the ball joint the screw may be inserted at an angle other than 90 degrees to the object surface. Lastly, the plate does not rotate with the shaft during the compression process. Thus, friction on the object surface is avoided. 
         [0037]      FIG. 2  shows an example of use of a system according to another embodiment. Here, the system comprises a compression device with a hollow shaft  10  and a supporting element  20 , as well as a Kirschner wire, i.e. a means for preparing a bore  50  in the fragments and for leading a compression screw along a desired path into the object which is in this case a foot bone. As can be seen, the screw has been inserted with an angle of approximately 60 degrees with respect to the bone surface onto which the contact surface of the supporting element  20  abuts. The ball joint allows both the rotation of the shaft  10  relative to the supporting element  20  and an angled positioning of the supporting element relative to the shaft. 
         [0038]      FIG. 3  is a side view of a system comprising a compression device with a shaft  10  and a supporting element  20 , the system further comprising a compression screw  30  and a screwdriver  40 .  FIG. 4  is a section view of the system of  FIG. 3 .  FIG. 4  particularly shows the ball joint between the hollow shaft  10  and the supporting element  20 . The portion  22  includes an inner spherical portion  13  in which the outer spherical portion  12  is arranged. As shown in  FIG. 3 , axial slots  105  are provided in the portion  22 , wherein these slots provide an elasticity of the respective circumferential sections in a radial direction so that a snap fit is realized between the inner spherical portion of portion  22  and the outer spherical portion  12 . There may be five, six or even more slots  105 . The contact surface of the supporting element which is, in this example, arranged perpendicular to the longitudinal axis of the hollow shaft, is denoted with reference sign  24  in  FIG. 3 . 
         [0039]    Denoted with reference sign  18  in  FIG. 4  is a through bore  18  formed in the shaft  10  for accommodating for example a screwdriver  40 . At the proximal end of the screwdriver, a grip coupling portion  44  may be provided for a form-fit connection between the elongated shaft of the screwdriver and a grip which may have a greater diameter. The compression screw  30  is provided with a through bore  34  through which a Kirschner wire may extend leading the screw to the desired location in for example a bone. At the distal end portion of the compression screw a first outer thread  32  is formed. 
         [0040]    The section including the ball joint is further detailed in  FIG. 5 . In the shown embodiment, the spherical portion  12  is integrally formed with and at the distal end of the hollow shaft, and an inner engagement portion in form of a thread  16  is formed at the distal end of the through bore inside the shaft. The inner thread  16  engages with an outer thread  36  formed on the outer surface of the head of the compression screw. Furthermore, an inner tool engagement portion  38  is formed in the screw head so that a corresponding outer screw engagement portion  42  of a screwdriver as well as the inner thread  16  of the shaft may engage the screw head at the same time. Therefore, the compression screw may be easily disconnected from the shaft by rotating the shaft and the screwdriver in opposite directions relative to each other. 
         [0041]      FIG. 6  shows a series of sketches schematically illustrating a sequence of stages during a process of pressing two fragments against each other. It is noted that for reasons of clear view the supporting element is omitted in the sketches of  FIG. 6 . 
         [0042]    In stage A 1 , the outer thread  36  at the proximal end of the compression screw  30  is coupled to the inner thread  16  of the hollow shaft  10 . Furthermore, the first fragment  100  as well as the second fragment  200 , to be pressed together, have been provided with a bore for receiving the compression screw. 
         [0043]    In stage A 2 , the combination of the shaft  10  and the screw  30  is rotated, indicated by arrow R 1 , so as to be inserted firstly into bore section  110  of fragment  100 . 
         [0044]    In stage A 3 , the combination is further rotated so that the distal thread  32  of the screw  30  is inserted into bore section  210  of fragment  200 , after leaving the first bore section  110  of fragment  100 . 
         [0045]    In stage A 4 , the combination of shaft and screw is further rotated so that the second fragment is pulled towards the first fragment, until the fragments are in contact to each other. In this situation, further rotating of the shaft and screw result in a pressure P acting between the fragments. This can be achieved when no thread of the screw engages the first fragment. Instead, the first fragment should merely be supported by the end face of the shaft, i.e. the contact surface of the supporting element. 
         [0046]    In stage A 5 , a screwdriver having a grip  46 , is introduced through the through bore of the hollow shaft until the distal screw engagement portion  42  of the screwdriver engages the inner tool engagement portion in the screw head, with the outer thread  36  at the screw head furtheron engaging the inner thread in the distal end of the hollow shaft. The pressure P is maintained. 
         [0047]    In stage A 6 , the compression screw is further rotated by means of the screwdriver, indicated by arrow R 2 , while the hollow shaft may be not moved, i.e. may be hold stably. By the rotation of the screwdriver with the screw relative to the shaft, the proximal thread  36  of the compression screw is disconnected from the inner thread  16  of the shaft, and at the same time screwed into the first fragment  100 . As soon as the thread  36  is completely inserted into the fragment  100 , it is easy to remove the compression device including the shaft as well as the screwdriver. 
         [0048]    In stage A 7 , a fixation of the fragments  100 ,  200  is achieved. The compression screw  30  is completely inserted into both fragments, with the distal thread  32  engaging the second fragment  200  and the proximal thread  36  engaging the first fragment  100 . The pressure P may be increased while the proximal thread  36  has been screwed into the first fragment, in a case in which the pitches of the thread differ from each other, as described above. 
         [0049]    The flow-chart in  FIG. 7  illustrates the principles of using the system according to slightly different embodiments, i.e. the flow-chart illustrates the principles of operating the system. It will be understood that the described steps are major steps, wherein these major steps might be differentiated or divided into several sub-steps. Furthermore, there might be also sub-steps between these major steps. 
         [0050]    The schematically illustrated methods start at the circle denoted with ‘start’. 
         [0051]    In step S 1 , a bore is prepared in fragments of a fracture, for receiving a compression screw. Step S 1  is an optional step. 
         [0052]    In step S 2 , which may be an initial step or which may follow the step of preparing a bore, an outer engagement portion at a proximal end of a compression screw is coupled with a corresponding inner engagement portion of a rotatable shaft of a compression device. 
         [0053]    In step S 3 , the screw is screwed in and through a first fragment and into a second fragment, by rotating the shaft of the compression device. A result of this step is that the first and second fragments abut on each other and the contact surface of the supporting element abuts on the outer surface of the first fragment. 
         [0054]    In step S 4 , a pressure is build up between the fragments, by further rotating the shaft of the compression device and thus the compression screw, with the first fragment compressed between the contact surface of the supporting element and the second fragment. 
         [0055]    In step S 5 , which may be an optional step, a distal screw engagement portion of a screwdriver is coupled with an inner tool engagement portion at the screw head of the compression screw. 
         [0056]    In step S 6 , particularly the proximal thread of the compression screw is screwed in the first fragment until the compression screw is completely inserted into the fragments. Simultaneously, the proximal thread may be disengaged from the inner thread at the distal end of the shaft of the compression device. In other words, the proximal thread of the compression screw is screwed out of the thread of the shaft and into the first fragment, simultaneously. 
         [0057]    It is noted that either at the end of step S 4  or at the end of step S 6 , the intended pressure between the fragments may be achieved. 
         [0058]    In step S 7 , the compression device with the hollow shaft and the supporting element is removed from the compression screw. In the case in which the screw is completely inserted, also the screwdriver is removed from the compression screw. 
         [0059]    The methods end at the circle denoted with ‘end’. 
         [0060]    While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive. The invention is not limited to the disclosed embodiments. Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practising the claimed invention, from a study of the drawings, the disclosure, and the appended claims. 
         [0061]    In the claims, the word “comprising” does not exclude other elements, and the indefinite article “a” or “an” does not exclude a plurality. 
         [0062]    The mere fact that the certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage. Any reference signs in the claims should not be construed as limiting the scope. 
         [0063]    As used herein when referring to bones or other parts of the body, the term “proximal” means close to the heart and the term “distal” means more distant from the heart. The term “inferior” means toward the feet and the term “superior” means toward the head. The term “anterior” means toward the front part or the face and the term “posterior” means toward the back of the body. The term “medial” means toward the midline of the body and the term “lateral” means away from the midline of the body 
         [0064]    Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.