Guiding instrument for piercing the cortical bone, suitable for the location of the holes for intra marrow pins

Abstract: This invention relates to an instrument (10) auxiliary in the fastening of intra-marrow pins during treatment of fractures and the like. Said instrument is shaped to correctly and precisely position radially to said pin, the holes thereof and furthermore to contribute in an efficient manner, in the guiding of the piercing tool during the drilling of the cortical of the bone under surgery. The instrument is constituted by a flat elongated body (26) carrying at the free end thereof a handle (28) with the other end of the body being narrower than the rest of the instrument. Transversal to the body of said instrument, and in the neighbourhood of the narrower end thereof, a body (16) is provided, along which a prisma plate slides carrying one or more through holes and arranged to move towards and from the instrument body by means of a screw (18) and said flat body.

Description: Presently fractures and diaphysary pseudo-arthroses of femur, tibia and humerus are surgically treated by means of hollow or solid pins provided with a number of orifices or holes located along the longitudinal axis thereof, which are introduced within the marrow channel of said bones, and are fastened thereto by means of screws or bolts passing freely through the pin orifices, and threaded on the bone cortical, thus forming said bone, pin and bolts a sole assembly assuring the stability of the fracture or pseudo-arthrosis for the necessary time for the consolidation thereof, it being fundamental to obtain adequate stability of the corresponding bone in order to have the corresponding bone joining. In addition to fractures and diaphysary pseudoarthroses which can be suitably treated with hollow or solid pins, it is also possible to treat osteothomy, tibia or femur shortenings or elongations by these same elements. The treatment of fractures and the like by means of pins gives the patient the opportunity to carry out his or her normal activities only few days following the treatment, which stimulates the bone joining and, therefore, the expeditous cure of the patient. The main problem faced by the surgeon when using pins in the treatment of the above mentioned sufferings is to find the pin orifices during the operation, since the implant or pin is already inserted within the bone marrow channel, i. e., out of the sight of the surgeon. In order to solve this problem and to find the pin orifices, nearly all the present day techniques make use of an X-ray apparatus with an image-intensifier, looking that on the screen of this apparatus the images of the pin orifices are superposed to that of a positioner instrument, either of manual type or constituted as an elongated slider to be affixed to the end of the pin or to the end of the impactor, the bit being introduced through the orifice of the instrument and drilling thus the bone cortical until the pin orifice is reached. However, there are failures in this technique since it is easy that the bit slides into the bone surface and, as a consequence thereof, the drilling may not register the pin orifice. US-A-4667664 discloses a guiding instrument comprising a drill guide adjustable transversely relative to an intra-marrow pin; the guide is also adjustable in the longitudinal direction of the pin. This invention provides a guiding instrument for drilling the bone cortical, and suitable for use as an auxiliary in the positioning of the orifices in intra-marrow pins, comprising a drill guide and means for adjusting the drill guide transversely with respect to the pin, characterised by an elongated flat main body with a handle or grip at one end with the other end being narrower than the main body of said instrument; a flat guide body, transverse to the main body of the instrument, and situated between the ends of the main body nearer the narrow end of the main body; and a prismatic alignment body which slides on the said flat body, said sliding being controlled by means of a screw mounted both to the main body of the instrument and to said alignment body; said alignment body having main faces transverse to the guide body, narrower edges between these main faces, and at least one hole near a respective one of the narrower edges of said prismatic body and running parallel to the main faces thereof and to the narrow portion, of the main body, the arrangement being such that in use the effective support of said instrument is on the cortical of the bone. The instrument is capable of contributing to the efficient positioning of the intra-marrow pin orifices and also serves as a guide in the drilling of the bone cortical. It can be used in the surgical operations in the treatment of fractures and/or diaphysary pseudo-arthroses of femur, tibia and humerus, making the treatment technique much easier and eliminating the need to use an image intensifier on the X-ray apparatus. It can be used in an open-core or closed-core surgical operation. A detailed description of instruments embodying the invention is given hereinbelow by way of example only and with reference to the accompanying drawings, wherein:- Figure 1 is a perspective view of an embodiment of the instrument of this invention. Figure 2 is an enlarged side view of the instrument shown in Fig. 1, substantially showing the most important parts thereof. Figure 3 is a perspective view showing the use of said instrument during the positioning of the orifices of an intra-marrow pin, and as a guide for the drilling bit. Figure 4 shows in a somewhat diagrammatical manner the fixing of an intra-marrow pin in the treatment of a bone fracture. Figure 5 shows a screw employed in the fixing of the intra-marrow pin. Figure 6 illustrates a pin auxiliary in the fixation of intra-marrow pins to the bone. Figure 7 is a partially broken perspective view of a intra-marrow pin. Figure 8 is a detailed perspective view of the assembling end of an intra-marrow pin; and Figure 9 is a schematic illustration of a second embodiment of the instrument of this invention. With reference to Figures 1 and 2, wherein a first embodiment of the invention is illustrated, it can be seen that the instrument 10 is substantially constituted by a elongated main body 26, of width and thickness suitable to resist the surgeon's pushing and ensuring the correct application of the instrument on the cortical of the bone being surgically treated. On the upper free end of said body 26, a grip 28 is provided by means of which said instrument 10 can be handled. The opposite end 14 narrows substantially in order to reduce, as much as possible, the incision made by this portion in the patient's tissues. Said portion 14 ends with a sharpened end 30 facilitating likewise the separation of tissue from the bone. Said instrument 10 is provided with a guide projection 12 as a part of said elongated body 26, arranged at 90° to the end 14 of the said instrument 10. Said projection 12 carries, either on its wider surface or on its longitudinal edge, a gage 24 marked in centimeters and millimeters or else in inches and fractions thereof, on which projection a prismatic alignment body 16 slides thanks to the screw 18 facilitating the movement toward and from said body 16, relating said body 26 of the instrument, and maintaining the same fastened to the previously selected distance. The prismatic alignment body 16 has, as can be seen in the drawings, two parallel main faces transverse to the longitudinal direction of the guide projection 12, and narrower edges between these main faces, comprising top and bottom edges, and two side edges. In the alignment body 16 are two holes 20 parallel to the main faces and to the narrow end of the main body, extending between the top and bottom narrow edges and adjacent to respective narrow side edges of the alignment body 16. The use of the holes 20 will be explained below. As can be clearly seen in Figure 3 of the annexed drawings, said instrument 10 of this invention is an instrument useful both for finding the orifices of an intra-marrow pin and for guiding a drilling bit. It can be seen in said Figure that the longitudinal position of said orifices 48 on said pin 36 (Figures 7 and 8) is assured by the use of an impactor 42, on which both the gaged slide 40 and the end 50 of the intra-marrow pin 36 are mounted. Said gaged slide 40 is provided, at the free end there of, with a sleeve 68 of suitable diameter, which can be moved to and from the body 70 of said impactor 42, thanks to a butterfly screw (not shown) which is suitably mounted on said body 70 of said impactor 42, and the position thereof according to the calibration thereof, registers exactly the various orifices in said pin 36. On the other side, said pin 36 is fixed at the end 50 thereof to the threaded end 46 of said impactor 42, with the handle 44 of said impactor 42 rotating suitably, thus establishing the longitudinal distances every orifice 48 has regarding the end 50 thereof. Said prismatic body 16 of said instrument 10 must be previously positioned to a suitable distance on said projection 12, according to the thickness of the body cortical being treated, at the corresponding portion thereof, which is determined by means of an X-ray plate previously taken of the patient's member. In order to effect the affixing of the intra-marrow pin 36 at the bone the surgical treatment of which is being carried out, it is determined, in the first place, into which one of the pin holes is to be inserted the first of said screws 52, whereby the slider 40 is positioned adequately on the body 70 of said impactor 42 and, by means of the piercer 76, a suitably integrated assembly is formed with said impactor 42, said slider 40, said instrument 10 and said pin 36. Likewise, upon knowing from the X-ray plate the thickness of the bone cortical and the radius of pin 36, it is easy to calculate the distance from the bone cortical to which the various holes or orifices 48 of said pin 36 are located and, accordingly, by means of the instrument 10, the drilling of said bone 34 can be carried out with utmost precision, with said bit 38 so as to insert therethrough said screw 52 and threading the same conveniently to the corresponding wall of said bone. In order to carry out said technique, a pin 36 is positioned at the impactor 42 and introduced into the marrow channel of the bone. The slider 40 is positioned on said impactor 42, so the sleeve 68 registers the more proximal orifice 48 of said pin 36 among those which it is desired to drill. Said instrument 10 is positioned, once previously calibrated, on the cortical of the bone 34, so one of the orifices 20 of said prismatic body 16 is in register with the hole of the sleeve 68 of said slider 40. The piercer 76 is passed through said sleeve 68 of said slider 40, thus connecting both instruments to each other. Through the free end 20 of said intrument 10 a bit 38 of a diameter substantially equal to the diameter of said orifice 20 of said prismatic body 16, is passed through just one cortical of bone 34. Next, a pin 56 is inserted into the hole thus formed. Said piercer 76 and said slider 40 are withdrawn thus clearing the other orifice 20 of said prismatic body 16 and another hole such as that of the prior orifice is made. A bit with a lesser diameter is inserted through the orifice having no pin 56, so as to enter the orifice 48 of pin 36, and the other cortical is drilled. A screw 52 is positioned into the same orifice, previous to the withdrawal of said instrument 10, and said pin 56 is withdrawn from the other hole, making a drill of a smaller diameter through the other cortical and inserting a second screw 52 (Figure 5) with a screwdriver with hexahead of suitable dimension, so as to accommodate at the respective cavity thereof the head 54 of said screw 52. Said screws are exclusively threaded onto the first cortical of the bone, by means of the thread 53 and pass freely through said holes 48 of pin 36 and the next cortical. Thereafter it is proceeded with the positioning, as mentioned above, of the screws on the other side of the fracture, thus completing the affixing of the marrow pin 36 in the bone under surgery. Finally, the impactor 42 is withdrawn by unscrewing its end 46 by rotating the handle 44, whereby the corresponding surgical operation is practically ended. In Figure 5 one of the screws 52 employed in the affixing of the pin 36 has been illustrated, which comprises an elongated body, of circular cross-section, the diameter of which is slightly smaller than the diameter of the holes 48 of said pin 36, in order that the same are able to slide through said holes from one side to the other of the cortical of said bone, said pin presenting exclusively a threaded zone 52 and a hexa head 54, in order to facilitate the threading thereof into the first cortical exposed of the bone being surgically treated. The length of this screw can vary depending on the thickness of the bone being treated. In Figure 6 the pin 56 is illustrated presenting a section 58 of smaller diameter and an upper section 60 of greater diameter and substantially greater length, thus establishing a step 57. This pin serves to temporarily maintain the register of the holes drilled into the bone and the holes in the pin 36 and said step 57 has as a purpose serving as a stop against the body of said pin 36, as the diameter of the portion 58 corresponds practically to the diameter of the holes 48 in said pin. It can be observed in Figures 7 and 8 the shape of the pin 36, which can be provided with more than two pairs of holes 48 along the length thereof, there being employed two pairs thereof or all of them, as required by the particular operation being perfomed. This pin exhibits one pointed end 35 and the opposite end is provided with cutdown portions 50 establishing an intermediate relief 66 from which a sleeve 62 depends with internal threads 64, which serve the purpose of temporarily fastening the impactor 42, as well as the withdrawal of said pin upon the complete healing of the bone. Figure 9 represents, in a somewhat schematical form, an embodiment of the instrument 10, wherein like parts are identified with like references, but primed and with a progressive and different numbers those parts having no equivalent in the previously described embodiment. It is to be observed in this embodiment that the part 14′ of said instrument 10′ is of a length substantially greater than the corresponding part of said instrument 10, and the prismatic body 16′ carries a hole 20′ of diameter substantially greater than that of holes 20 of prismatic body 16 in the first embodiment of the invention, in order to accommodate at the interior thereof said sleeve 72 through which the sleeve 74 and the piercer 76 are inserted. Said instrument carries also a butterfly screw 78 or the equivalent thereof to fix to a suitable height said sleeve 72 inside said hole 20′; depending said height on the depth of the bone under treatment, as said instrument 10′ is useful to make surgical operations under closed-core practice. The use of this instrument requires further to the actions provided for said instrument 10, fixing the height of the sleeve 72, as said part 24′ of this instrument must rest on the surface of the dermis of the limb under intervention, and the inner end of the bushing 72 must be supported firmly on the cortical of said bone 34, as shown in Figure 9. Obviously, the part 14′ of said instrument will be inserted through the tissue of the patient and the surface thereof will be supported also on the cortical of the bone, as depicted. In order to practice the operation with this instrument, it is required that the sleeve 68 of the slider 40 is joined to one of the orifices 20′ of said prismatic body 16′ by means of the piercer 76. Through the free orifice 20′ of said prismatic body 16′ a hole is made on just one cortical, with a bit having the same diameter as the orifice 20′, temporarily introducing thereinto a pin 56. Said piercer and slider 40 are withdrawn, and through said sleeve 74 another hole, like the previous one, is made. In this latter hole, with a slender bit passing through the orifice of said pin 36, the other cortical is drilled, positioning thereafter said screw 52 of suitable length with the help of a screw driver, through said sleeve 72, previous to the withdrawal of said sleeve 74. Then the pin 56 is withdrawn and into said orifice the previous steps are taken. Thereafter the same procedure is carried out on the other side of the fracture. Although in Figure 1 of the drawings a specific form has been illustrated for the mounting of the prismatic body 16 on the gaged element 12, it is apparent that some other manner can be employed, without departing from the spirit and scope of the present invention. It is obvious that the entire instrumental is to be manufactured in stainless steel or any other material suitable to be sterilized, and having a resistance adequate to make pressure therethrough against the walls of the cortical of said bones being subject to surgery. Regarding the techniques of surgery, although the same do not constitute the subject matter of this invention, it is to be noted that, depending on the fact that the surgery is being effected on a femur, a tibia or an humerus, or if it is of open-core or closed-core type, the same can be slightly varied but, in essence, they follow the above disclosed as regards the use of the instrument object of this invention.

Claims: A guiding instrument for drilling the bone cortical, and suitable for use as an auxiliary in the positioning of the orifices (48) in intra-marrow pins (36), comprising a drill guide (16, 20) and means (12, 18) for adjusting the drill guide transversely with respect to the pin, characterised by an elongated flat main body (26) with a handle or grip (28) at one end with the other end (14) being narrower than the main body of said instrument; a flat guide body (12), transverse to the main body (26) of the instrument, and situated between the ends of the main body nearer the narrow end (14) of the main body; and a prismatic alignment body (16) which slides on the said flat body (12), said sliding being controlled by means of a screw (18) mounted both to the main body of the instrument and to said alignment body; said alignment body having main faces transverse to the guide body (12), narrower edges between these main faces, and at least one hole (20) near a respective one of the narrower edges of said prismatic body and running parallel to the main faces thereof and to the narrow portion (14), of the main body (26), the arrangement being such that in use the effective support of said instrument is on the cortical of the bone. A guiding instrument according to Claim 1, wherein said alignment body slides on said flat guide body (12) away from and towards said main body (26) of the instrument, to register transversally the hole or holes of said prismatic alignment body (16) to the holes of said pin and carry out the drilling of the bone cortical to implant thereinto the screws thereof, through the holes of said pin. A guiding instrument according to Claim 1 or 2 further including means (40, 42, 68) for adjustably locating the instrument in the longitudinal direction of and relative to a said pin. A guiding instrument as claimed in any preceding claim in which the narrow end (14) has a sharpened edge (30) to facilitate and provide for the insertion of said narrow end (14) into soft tissue of a patient, and to separate the soft tissue from the bone cortical and free from enveloping the bone. A guiding instrument as claimed in any preceding claim in which the transverse guide body (12) is provided with a gauge in length units. A guiding instrument as claimed in any preceding claim, the said alignment body having two said holes (20) near narrower edges thereof and running parallel to the main faces thereof. The instrument of any of the preceding claims, comprising an impactor (42) having a body portion (70) and including a gauged slide (40) coupled with said body portion (70) and an end of said impactor body portion having a said intra-marrow pin (36) releasably mounted thereon; and a sleeve (68) connected with said gauged slide for movement towards and away from the body of said impactor for alignment with an orifice (48) of said intra-marrow pin. The instrument of Claim 7, including a piercer (76) passing through said sleeve and a said hole (20) of said alignment body for adequately positioning said gauged slide on said body of said impactor to form an integrated assembly of said impactor, said gauged slide, said main body (26) and said intra-marrow pin, thereby connecting the impactor with said main body and said alignment body, and the said alignment body has another said hole (20) for registry with another orifice (48) of said intra-marrow pin (36) to facilitate a drilling operation through the bone to provide an opening therein to connect said other orifice (48) in said intra-marrow pin with the other hole (20) in said alignment body for positioning therethrough said last-mentioned hole and orifice and said opening in said bone for placement therein of a pin prior to removal of said instrument. A guiding instrument according to any one of the preceding claims, wherein said hole or holes in the prismatic body (16) has or have a diameter such that through the same two concentric sleeves (72, 74) are inserted; the sleeve (72) with greater diameter being fixable at a convenient height relative to the prismatic body, and the second sleeve (74) serving as a guide for a marking piercer (76) and for the insertion of a bit with a substantially equivalent diameter. A guiding instrument according to Claim 9, wherein the fastening of the outer sleeve on said prismatic body is by means of a screw (78). A guiding instrument according to Claim 9 or 10, wherein the length of the narrower portion (14') of the instrument is greater than the length of said sleeves to be inserted through said prismatic body.

Inventors: ROZAS FERNANDO COLCHERO, ROZAS, FERNANDO COLCHERO
Applicants: ROZAS FERNANDO COLCHERO, ROZAS, FERNANDO COLCHERO
Application year: 1989
Main classification: A61B17
IPC codes: A61B17