Surgical appliance for the fixation of fractured bones

A surgical appliance for the fixation of fractured bones includes two anchoring members each adapted to be imbedded into a respective segment of a fractured bone. Each anchoring member has a head portion which extends from the bone, the head portion including a channel therethrough to receive a bolt. In one embodiment, one of the channels is threaded. The bolt, which is formed of a shaft and a head, has at least a portion of the shaft provided with screw threads which mate with the threads of the one channel. The shaft of the bolt is adapted to pass through the channel of the first anchoring member and to be threadedly received in the channel of the second anchoring member so as to exert a compressional force on the segment of the fractured bone when the bolt is tightened. In another embodiment, the channels of both heads of the anchoring members are provided with screw threads.

BACKGROUND OF THE INVENTION 
This invention relates to a surgical appliance for the fixation of 
fractured bones and, more particularly, to an extramedullary surgical 
appliance which, when in use, exerts a desirable compressional force on 
the segments of the fractured bone. 
Various devices are known for use in setting fractured bones. One type of 
device is described in U.S. Pat. Nos. 3,374,786 and 3,996,931, both issued 
to G. R. Callender. This device is particularly adapted for the fixation 
of fractured bone segments in a femur. A trochanteric plate is secured to 
the upper segment of the femur by means of surgical screws, this plate 
being provided with a sleeve member attached thereto at an appropriate 
angle. The upper segment of the femur is bored to receive the sleeve 
member and also to receive an elongated shaft having a screw portion, 
which shaft is embedded within the femoral head by means of the surgical 
screw portion. An adjustable limit screw assembly serves to retain the 
shaft member within the sleeve member. The sleeve member carries a key 
which is insertable into grooves of different lengths on the shaft member, 
depending upon the type of fixation which is desired. Axial compression is 
provided by adjusting the limit screw assembly. 
Unfortunately, the device of the type described in the aforementioned 
Callender patents is limited solely for use in the fixation of a femur. 
Because of the particular angular displacement of the sleeve member 
relative to the plate member on which it is formed, this device cannot be 
used in other bones, particularly the humerus bone. Also, the device 
described in the Callender patents is relatively complex and, accordingly, 
is accompanied by relatively high manufacturing costs. Still further, it 
is somewhat difficult to use. Moreover, since the throchanteric plate and 
the shaft member must be embedded into the femur, it is difficult to use 
this device in combination with other, conventional fixation devices, such 
as surgical pins or screws, in the event of a three-part fracture, or 
other multiple fracture, of the femur. 
Another type of surgical appliance which has been proposed for the fixation 
of fractures is described in U.S. Pat. No. 1,997,466, issued to E. E. 
Longfellow. This device consists of a pair of skeletal pins which are 
inserted through the bone on either side of the fracture, which pins 
extend from the injured limb. Turnbuckles are secured to opposite ends of 
the pair of pins and are suitably tightened so as to exert a compressional 
force on the fracture. However, since the pins extend externally of the 
injured limb, and since the turnbuckles must be secured at the extreme 
outward ends of such pins, there is the danger of infection. Also, in the 
event of an inadvertent blow or force imparted to the turnbuckle assembly, 
the injured limb can be further damaged. Still further, the overall 
appliance is relatively bulky and unwieldy for the patient, thus adding to 
his discomfort. In addition, the device is not easily usable by the 
surgeon. 
A device which has been proposed for correcting certain forms of physical 
deformity by exerting compressional forces onto selected vertebrae is 
described in U.S. Pat. No. 3,997,138, issued to H. V. Crock et al. In this 
device, a pair of surgical screws are embedded into the vertebrae. Each 
screw includes a head containing channels through which rods are passed. A 
caliper, formed of a pair of levers, is used to urge the surgical screws, 
which are embedded into the vertebrae, either closer together or farther 
apart. When the proper relative position of these screws is attained, the 
rods which link the screws are clamped thereto, and then the caliper is 
removed. Thus, the position of the screws, and thus the vertebrae, is 
fixed. 
While this device might be suitable for correcting certain physical 
deformities, the fact that a caliper is required to position the surgical 
screws results in a complicated procedure whereby the device is not suited 
for the fixation of fractures. Furthermore, the caliper which must be used 
with the surgical screws is quite expensive, in and of itself. 
Accordingly, there is a need for a surgical device for the fixation of 
fractured bones which is relatively simple to manufacture and to use, yet 
which is adapted to exert desirable compressional forces on the fracture. 
Also, there is a need for such a surgical device which can be used in 
conjunction with other fixation devices, such as other intramedullary 
devices, or can be used with extramedullary devices. 
OBJECTS OF THE INVENTION 
Therefore, it is an object of the present invention to provide an improved 
surgical appliance for the fixation of fractured bones which overcomes the 
aforenoted disadvantages of the prior art and, moreover, which satisfies 
the aforenoted need. 
Another object of this invention is to provide an extramedullary appliance 
for the fixation of fractured bones and, particularly, for the fixation of 
the humerus bone. 
A further object of this invention is to provide an improved surgical 
applicance which can be used in the fixation of a multi-part fracture 
wherein intramedullary pins or screws can be used to fix some of the parts 
and wherein the improved appliance can be used to fix the remaining part 
or parts, and particularly small bone fragments. 
An additional object of this invention is to provide an improved surgical 
appliance which is readily adapted for the fixation of fractures in the 
supracondylar and intracondylar regions of the humerus bone. 
Yet another object of this invention is to provide an improved surgical 
device for the fixation of fractured bones, which device is of relatively 
simple construction and which can be used easily and quickly by a surgeon. 
Various other objects, advantages and features of the present invention 
will become readily apparent from the ensuing detailed description, and 
the novel features will be particularly pointed out in the appended 
claims. 
SUMMARY OF THE INVENTION 
In accordance with this invention, a surgical appliance is provided for the 
fixation of fractured bones. The appliance includes a pair of anchoring 
members, each adapted to be embedded into a respective segment of a 
fractured bone, and each member having a head portion which extends from 
its segment and which includes a channel therethrough for receiving a 
bolt. At least one of the channels through the head portions of the 
anchoring members is threaded. The bolt, which is adapted to pass through 
the channels of the anchoring members, is provided with screw threads on 
at least a portion of its shaft, which screw threads mate with the threads 
of the one channel. Thus, the bolt is threadedly received in the channel 
of the appropriate anchoring member so that, when the bolt is tightened, a 
compressional force is exerted on the two anchoring members, thereby 
exerting a compressional force on the segments of the fractured bone. In 
one embodiment, one of the channels is smooth so as to slidably receive 
the bolt. In another embodiment, both channels of the anchoring members 
are threaded so that the bolt is screwed into both anchoring members.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT 
Referring now to the drawings, wherein like reference numerals are used 
throughout, there is illustrated one embodiment of a surgical appliance 10 
in accordance with the present invention. FIG. 1 illustrates the use of 
appliance 10 for the fixation of a fracture in the condyle at the distal 
end of the humerus bone. As is known, fractures in the supracondylar and 
intracondylar regions of the humerus bone present a particular problem in 
the fixation thereof. This is because of the anatomical configuration of 
the condyle. That is, because of the very narrow medullary canal of the 
bone, it is difficult to use intramedullary appliances. Furthermore, 
because a fracture of this region of the humerus bone generally results in 
one or more small fragments, an extramedullary fixation device, such as a 
plate, cannot be used easily with such small fragments. 
These problems are solved by appliance 10 which is illustrated as being 
used for the fixation of the fracture between segments A and B of the 
illustrated bone. As shown in FIGS. 1-3, device 10 is comprised of a pair 
of anchoring members 12 and 22, these members being formed of head 
portions 14 and 24 from which extend shafts 18 and 28, respectively. These 
shafts are provided with screw threads 18a and 28a. Preferably, each 
anchoring member is of unitary construction and is formed of surgical 
steel, titanium or other conventional material normally used in surgically 
implanted devices. Head portion 14 of anchoring member 12 is provided with 
a channel 16 therethrough. In the illustrated embodiment, channel 16 is 
smooth. Head portion 24 of anchoring member 22 is provided with a channel 
26 therethrough. As shown more clearly in FIGS. 2 and 3, channel 26 is 
threaded, as represented by screw thread 26a. 
A bolt 30, having a head portion 34 and a shaft 32, is provided. At least a 
portion of shaft 32 is provided with screw threads 32a, these threads 
mating with screw threads 26a provided in channel 26 in head portion 24 of 
anchoring member 22. In FIGS. 1 and 2, a portion 32b of shaft 32 is free 
of screw threads. However, in an alternative embodiment, screw threads are 
provided along the entire length of shaft 32. 
Preferably, the axis of each of channels 16 and 26 is perpendicular to the 
longitudinal axis of shafts 18 and 28, respectively. Thus, when used, 
shaft 32 passes through channels 16 and 26 and is disposed substantially 
perpendicular to the threaded shafts of each of the anchoring members. Of 
course, if desired, any other geometric or angular relationship between 
shaft 32 and shafts 18 and 28 may be selected. 
The top surface of each of head portions 14 and 24 of anchoring members 12 
and 22 is adapted to receive an insertion tool (not shown) whereby the 
anchoring member can be suitably rotated and thus screwed into a 
respective segment of the fractured bone. In FIG. 1, the top surface of 
each of head portions 14 and 24 is provided with a square-shaped 
receptacle 19 and 29, adapted to receive a socket-type insertion device. 
Alternatively, the head portion of each anchoring member may be provided 
with a suitable slot into which a screw driver can be inserted. Still 
further, head portion 14, as well as head portion 24, may be suitably 
shaped, such as square-shaped, so that a socket-type screw driver may be 
placed thereover and rotated so as to drive the respective anchoring 
members into the respective segments of the fractured bone. 
In operation, anchoring member 12 is screwed into segment A such that its 
threaded shaft 18 is embedded into the bone segment. Then, anchoring 
member 22 is inserted into segment B. As mentioned above, any conventional 
insertion tool can be used to insert the respective anchoring members into 
segments A and B. Of course, head portion 14 extends upward from segment 
A, and head portion 24 likewise extends upward from segment B. Channels 16 
and 26 of anchoring members 12 and 22 are aligned with each other. Then, 
shaft 32 is inserted into and passes through smooth channel 16. When 
threaded portion 32a of shaft 32 extends to channel 26, bolt 30 is rotated 
such that the bolt is screwed into this channel. That is, screw threads 
26a of channel 26 threadedly engage screw threads 32a of bolt 30. In this 
regard, head 34 of bolt 30 may be provided with a slot or other suitable 
device for receiving a suitable tool which facilitates the rotation of the 
bolt. 
As bolt 30 is tightened further, it is appreciated that head 34 soon will 
abut against head portion 14 of anchoring member 12, as shown in FIG. 1. 
Then, any further tightening of the bolt exerts a compressional force on 
the anchoring members, thus exerting a corresponding compressional force 
on segments A and B. It is appreciated that this compressional force is 
urged along the length of shaft 32 of bolt 30. The amount of compressional 
force is, of course, dependent upon the amount by which the bolt is 
tightened into channel 26 of anchoring member 22. Since mating screw 
threads are provided between this channel and shaft 32 of the bolt, this 
compressional force can be made to vary substantially continuously as a 
function of the degree of tightening. 
In the illustrated embodiment, channel 16 in head portion 14 of anchoring 
member 12 is free of screw threads. In an alternative embodiment, this 
channel may be provided with screw threads (not shown), similar to 
threaded channel 26. When using this alternative embodiment, bolt 30 first 
is screwed into and through channel 16 until threaded portion 32a is 
received by channel 26 of the other anchoring member. Then, continued 
rotation of bolt 30 urges head 34 thereof toward head portion 14. When 
head 34 abuts against head portion 14, further tightening of bolt 30 
exerts a compressional force on the two anchoring members, and thus on 
segments A and B, as in the above-described embodiment. Thus, a desired, 
precise compressional force can be exerted on these fractured bone 
segments. 
As yet another alternative embodiment, shaft 32 of bolt 30 may be provided 
with screw threads 32a along its entire length. That is, head 34 may be 
secured directly to one end of the threaded shaft of bolt 30, and need not 
necessarily be separated therefrom by smooth portion 32b, as illustrated 
in FIGS. 1 and 2. Regardless of whether shaft 32 is threaded along its 
entire length or over only a portion of that length, bolt 30 cooperates 
with anchoring members 12 and 22 in substantially the same manner. 
The entire surgical appliance, comprised of anchoring members 12 and 22 and 
bolt 30, is intended for internal use. That is, the entire device is 
disposed beneath the skin and muscle of the limb (e.g. the arm) to which 
it is secured. Depending upon the thicknesses of the particular bone of 
the patient with which this device is used, shafts 18 and 28 may be of any 
desirable lengths. Preferably, various different length shafts will be 
provided so as to accommodate bones of different thicknesses. Similarly, 
head portions 14 and 24 may be of different diameters. Likewise, the 
length and diameter of bolt 30 may be manufactured in a variety of sizes 
so as to be readily adapted for different situations. As may be 
appreciated, depending upon the fracture site, anchoring members 12 and 22 
may be separated from each other by a relatively large distance, thus 
requiring a bolt having a relatively long shaft length. In other 
fractures, when the anchoring members are suitably embedded into segments 
A and B, such anchoring members may be separated by a relatively short 
distance. Hence, the bolt which is to be used therewith preferably should 
be of a relatively short length. 
It also is contemplated that, in order to facilitate the alignment of 
channels 16 and 26 for the passage of shaft 32 of bolt 30 therethrough, 
head portions 14 and 24 each may be rotatable with respect to shafts 18 
and 28, respectively, by, for example, an amount limited to 180.degree.. 
Such partial rotation of the respective head portions will permit the 
respective channels to be aligned, yet will also enable a suitable tool to 
be used for the insertion and subsequent withdrawal of the anchoring 
members. That is, by limiting the rotational movement of the head portion 
of each anchoring member, a screw driver, insertion drill or the like 
still can be used to rotate the entire anchoring member, and thus screw 
that member into the bone segment. Nevertheless, this will not present an 
undesirable impediment against the exertion of compressional forces on the 
anchoring members once they are inserted into the fractured bone segments. 
It may be appreciated that the device shown and described herein can be 
used for the fixation of almost any fracture and need not be limited 
solely for use in the fixation of the condyle of the humerus bone. This 
extramedullary device is particularly advantageous for use in fixing small 
fragments which cannot be fixed easily by the use of conventional 
appliances, such as plates. Thus, the present invention can be used in 
cooperation with other conventional fixation appliances, such as pins or 
screws. For example, in a three-part fracture, it is possible that two of 
the fragments could be fixed by use of intradmedullary pins which, of 
course, are inserted into the medullary canal. However, as is common, by 
using such intramedullary pins, there may be insufficient space for yet a 
third pin. Nevertheless, by providing the device of the present invention, 
the third fragment can be suitably fixed with proper compression exerted 
thereon. That is, anchoring member 12, as shown and described herein, can 
be embedded into the third fragment, and anchoring member 22 can be 
embedded into the main portion of the fractured bone. 
While the present invention has been particularly shown and described with 
reference to certain preferred embodiments, it should be appreciated that 
various changes and modifications in form and details can be made without 
departing from the spirit and scope of the invention. It is, therefore, 
intended that the appended claims be interpreted as including all such 
changes and modifications.