Abstract:
An intrafocal plate and method of use for securing bone fractures comprising an elongated plate element having a flat plate surface at one end thereof defining a top surface and a bottom surface and a leading end and a trailing end. A longitudinally extending resilient body element depends from the trailing end of the flat plate surface so as to define a shoulder at the juncture of the body element and the flat plate surface and a pin at the other end of the body element. The intrafocal plate is formed so that a force applied at the pin end causes a force to be applied in the opposite direction at the flat plate surface. The intrafocal plate is particularly intended for use to secure metaphyseal bone fractures by having the body element of the intrafocal plate inserted into the tubular hollow of the bone through the fracture site so as to cause the shoulder of the intrafocal plate to seat in the fracture site and urge the flat plate surface of the plate element against the outside surface of the bone.

Description:
TECHNICAL FIELD 
     The present invention relates generally to surgical apparatuses and methods, and more particularly, to a percutaneous intrafocal plate surgical apparatus and method. 
     RELATED ART 
     There are a variety of apparatuses and methods presently being used to address metaphyseal fractures. As is well known to those skilled in the art, metaphyseal fractures consist of fractures near the end of a bone in the area of the junction between the tubular shaft of the bone and the spongy, blocky, end portions of the bone known as the metaphysis and epiphysis. Bone fractures in this metaphyseal area, especially fractures that are oblique, tend to cause the fragment to be pulled off to one side of the shaft by the forces applied by the muscles which are, in effect, continually attempting to shorten the bone. A variety of apparatuses and methods for surgically addressing metaphyseal fractures have been developed and are well known in the medical arts. Examples of such apparatuses and methods include, for example, casts, external fixators, pins and plates. Each of these will be discussed hereinafter for a better understanding of the state of the art in apparatuses and methods for addressing metaphyseal bone fractures. 
     Casts 
     Casts are used to align metaphyseal fractures that are transverse and to prevent the bone sections from falling off to the side. However, when a fracture is not transverse but oblique, the fracture tends to shorten within the cast and thereby allow displacement and an unsatisfactory outcome. Although casts are often attempted with fractures which might otherwise be treated with the apparatus and method of the invention described and claimed hereinafter, they are frequently unsuccessful and subsequently require that the patient be treated surgically to effect a satisfactory outcome. 
     External Fixators 
     External fixators are devices which consist of pins implanted in the bone on opposing sides of the fracture and connected with a metal frame which is external to the patient&#39;s limb. The pin insertion site where the pin penetrates the skin and underlying fat, muscle and the like on its way to insertion into the bone becomes a source of pain for a patient as well as a site of infection due to the chronically open wound about the pin during the time that the fracture is healing. Furthermore, in one of the most common locations for this kind of fracture, the distal radius, the pins often irritate the tendons which pass over and about the bone and thus induce stiffness of the fingers because of the patient&#39;s reluctance to move his fingers and thereby induce pain from the tendons. 
     Pins 
     Percutaneous pins are often used to treat metaphyseal fractures and, in fact, some of the percutaneous pins are inserted intrafocally. These are called “Kapandji” pins. These pins are usually left sticking out through the skin and thus, similarly to the external fixators discussed above, serve as a source of infection and as a source of pain and irritation to neighboring tendons. Pins can, however, be inserted through a small incision and provide an excellent reduction for some metaphyseal fractures. 
     Plates 
     Metaphyseal fractures can be addressed quite well with conventional plates. However, a large incision is required to implant a plate and this is known to result in a large scar. Moreover, the plate is known to be a large, broad and lumpy device which can be prominent underneath the underlying tendons and skin and soft tissue, and thus it can many times be painful. In addition, tendons which traverse over plates are often irritated by the plates and this can lead to stiffness. 
     Thus, despite the existence of a wide variety of conventional apparatuses and methods for surgically addressing a metaphyseal fracture, there remains much room for improvement in the art, particularly for a percutaneous intrafocal plate apparatus and method which is simple, safe and effective for addressing a metaphyseal fracture and which is inserted percutaneously or through a very small incision, that does not protrude through the skin, and which presents a low profile so as not to irritate overlying tissue. 
     DISCLOSURE OF THE INVENTION 
     In accordance with the present invention, an intrafocal plate apparatus and method are provided for addressing metaphyseal and similar bone fractures. The apparatus comprises an elongated plate element having a flat plate surface at one end thereof defining a top surface and a bottom surface and a leading end and a trailing end. A longitudinally extending resilient body element depends from the trailing end of the flat surface and defines a shoulder at one end which joins the flat plate surface and an arcuate pin at the other end. The intrafocal plate is formed so that a force applied at the arcuate pin end causes a force to be applied in the opposite direction at the flat plate surface. 
     Also, in accordance with the present invention, a method for addressing a metaphyseal or similar type of bone fracture is provided utilizing the intrafocal plate described herein above. In a preferred embodiment, the method according to this invention comprises the initial step of providing an intrafocal plate as described herein before. The pin end of the elongated plate element is inserted through a skin incision formed proximate to the metaphyseal bone fracture site and the pin end is intrafocally inserted into the fracture site. Next, the elongated plate element is manipulated as necessary in order to lever the metaphyseal fracture into a reduced position. Finally, the body element of the elongated plate element is pushed into the tubular hollow of the fractured bone such that the pin will resiliently contact the inside wall surface of the tubular hollow at a site opposing the fracture site and thereby cause the shoulder of the elongated plate element to seat in the fracture site and urge the flat plate surface of the elongated plate element against the outside surface of the bone. 
     It is therefore an object of the present invention to provide a novel intrafocal plate for addressing metaphyseal and similar type fractures and a method for using the same. 
     It is another object of the present invention to provide an intrafocal plate apparatus and method for using same which can safely and effectively be utilized to address metaphyseal and similar type fractures. 
     It is another object of the present invention to provide an intrafocal plate apparatus and method for using same which is inserted percutaneously or through a small incision so as not to protrude through the skin and which is stable in use and low profile in construction so as not to irritate overlying tissue. 
     Some of the objects of the invention having been stated herein above, other objects will become evident as the description proceeds, when taken in connection with the accompanying drawings as best described herein below. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIGS. 1A,  1 B of the drawings are a front elevation view and side elevation view, respectively, of the intrafocal plate according to the present invention; 
     FIGS. 2A,  2 B of the drawings are a front elevation view and a side elevation view, respectively, of a second embodiment of the intrafocal plate according to the present invention; 
     FIG. 3 of the drawings is a side elevation view of a break-away screw which can optionally be used with the intrafocal plates shown in FIGS. 1A,  1 B and FIGS. 2A,  2 B; 
     FIGS. 4A,  4 B of the drawings show the intrafocal plate of FIG. 1A,  1 B used with screw(s) to secure a Colles fracture and a radial styloid fracture, respectively; 
     FIGS. 5A-5D of the drawings are schematic views of the method of the present invention utilizing the intrafocal plate of FIGS. 1A,  1 B to secure a radial styloid fracture; 
     FIG. 6A of the drawings shows a schematic drawing of the intrafocal plate of FIGS. 1A,  1 B inserted without a screw for a Colles fracture wherein the arrow shows the direction which the bone fragment would attempt to displace and which the intrafocal plate has been positioned to prevent; and 
     FIG. 6B of the drawings is a schematic view showing the use of two intrafocal plates of FIGS. 1A,  1 B to address a transverse fracture of the proximal tibia which could tend to displace in either direction but which has been stabilized by the two intrafocal plates positioned on opposing sides of the bone. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     A novel intrafocal plate apparatus and method for using the same to address a metaphyseal bone fracture or the like are provided in accordance with the present invention. Referring now to FIGS. 1A,  1 B through FIGS. 6A,  6 B of the drawings, the percutaneous intrafocal plate apparatus  10  and the method of use of apparatus  10  will now be described in detail. 
     Intrafocal plate  10  is intended to solve many of the problems of prior art devices for addressing metaphyseal bone fractures (and other similar fractures) by being inserted percutaneously, or through a very small incision, so as not to be left protruding through the skin. Apparatus  10  is particularly advantageous since it is a low profile device that will not tend to irritate overlying tissue. 
     Apparatus  10  comprises a plate element  10 A top portion, a downwardly and inwardly extending body element  10 B. Body element  10 B of apparatus  10  forms a shoulder  10 C at one end at its juncture with plate element  10 A and an arcuate pin  10 D at the other end thereof. Referring particularly to FIGS. 1A,  1 B, it will be appreciated that plate element  10 A defines one or more apertures  10 A′ therein (applicant contemplates from 1 to 4 apertures) to facilitate affixation of intrafocal plate  10  to a bone in a manner to be described hereinafter. Although one or more apertures  10 A′ may be provided in plate element  10 A of intrafocal plate  10 , applicant contemplates that the intrafocal plate could be affixed to a metaphyseal fracture using the methodology described hereinafter without the necessity for one or more screws, or in other words that the use of screws in combination with intrafocal plate  10  is optional. Further, applicant contemplates that apparatus  10  can be formed without shoulder  10 C at the juncture of body element  10 B and plate element  10 A as a matter of design choice; however, applicant believes it preferable to incorporate shoulder  10 C into apparatus  10 . 
     Referring now to FIGS. 2A,  2 B, wherein like numbers represent like parts, intrafocal plate  10  will be understood to be formed from plate element  10 A and body element  10 B wherein the top portion of body element  10 B forms shoulder  10 C at its juncture with plate element  10 A and an arcuate pin  10 D at its other end. Additionally, in this alternative embodiment of the invention, applicant contemplates that plate element  10 A may be provided with one or more spikes  10 E depending outwardly from the bottom surface of plate element  10 A to facilitate affixation of intrafocal plate  10  to a metaphyseal fracture. Although applicant does not believe the invention requires providing one or more apertures in plate element  10 A, it is preferable that this embodiment of the invention incorporate both one or more apertures  10 A′ in plate element  10 A in addition to one or more spikes  10 E. Shoulder  10 C is also optional in this embodiment of apparatus  10 , but applicant believes it preferable to incorporate shoulder  10 C into the apparatus to enhance seating of apparatus  10  in the fracture site as described hereinafter. 
     FIG. 3 depicts a screw, generally designated  20 , which can be used in combination with intrafocal plate  10  if so desired by a surgeon. As noted herein before, the insertion of one or more screws  20  through apertures  10 A′ of intrafocal plate  10  is optional and is not required by the apparatus of the invention. Referring again to FIG. 3, it will be appreciated that screws  20  are provided with a threaded portion  20 A and a stem portion  20 B which define a neck N at the juncture thereof. Thus, the neck at the juncture of the threaded portion  20 A and the stem portion  20 B will allow the stem or pin to be broken off the screw after insertion by the physician. This facilitates easy insertion of screw  20  through intrafocal plate  10  and the bone thereunder, and then removal of the stem or pin  20 B so that no portion of screw  20  will be left protruding through the skin. 
     Referring now to FIG. 4A, intrafocal plate  10  can be seen implanted in a typical Colles fracture of the distal radius, and FIG. 4B shows intrafocal plate  10  planted in a radial styloid fracture. In both FIGS. 4A and 4B, it can be seen that the fracture is somewhat oblique and thus, muscle will attempt to shorten the bone and tend to force the bone fragments to slide laterally to the right. Intrafocal plate  10  when affixed to the fracture site will prevent this sliding from taking place. Screws  20  may optionally be used with intrafocal plate  10  as necessary, and their use may keep intrafocal plate  10  from sliding in or out of the bone and may hold the bone fragment in a more secure position in certain situations. It will be appreciated that in the second embodiment of the invention, intrafocal plate  10  shown in FIGS. 2A,  2 B may be used to address the fracture shown in FIGS. 4A,  4 B and the spikes  10 E thereof would also serve to keep the plate in a secure position affixed to the bone of the fracture site. 
     Also in accordance with present invention, the method for securing a metaphyseal bone fracture or the like is provided utilizing intrafocal plate  10  as described herein above. In a preferred embodiment, the method according to this invention can be appreciated with reference to FIGS. 5A-5D which demonstrate the insertion of pin end  10 D into a radial styloid fracture similar to that shown in FIG.  4 B. The method of insertion of intrafocal plate  10  is similar regardless of the type of fracture that is being addressed, although applicant contemplates that intrafocal plate  10  will normally be used to address metaphyseal bone fractures. 
     Referring to FIG. 5A, a skin incision I is made more proximate to the end of the bone than the actual fracture site F. In FIG. 5B, pin end  10 D of intrafocal plate  10  is inserted through incision I, tugging the incision somewhat proximal on the radius so that pin end  10 D can be inserted into the fracture site F. This can be done by palpation and with fluoroscopic guidance without actually seeing fracture site F and therefore using a very small incision. As shown in FIG. 5B, arcuate pin end  10 D is inserted 180 degrees rotated relative to the position in which it will eventually lie so that it is easier to slip into fracture site F. In FIG. 5C, once pin  10 D is inserted into fracture site F, intrafocal plate  10  is rotated 180 degrees to put the curve of pin end  10 D back proximally along the shaft of the radius. As plate element  10 A of intrafocal plate  10  is pushed distally, fracture site F is itself reduced by the leverage force applied by pin end  10 D. This also takes tension off of skin incision I so that it is not pulled as far proximately as was done initially. Pin end  10 D is then pushed down into the tubular hollow of the more proximal portion of the bone as shown in FIG.  5 D. 
     FIG. 5D shows pin end  10 D of intrafocal plate  10  completely inserted and held with an insertion tool (similar to a small angled pliers). Pin end  10 D of intrafocal plate  10  is resiliently urged against the remote back wall of the tubular hollow from the fracture site as also shown in FIG.  5 D. Shoulder  10 C of intrafocal plate  10  between plate element  10 A and pin end  10 D is now seated in fracture site F so as to keep intrafocal plate  10  from sliding further into the bone or from sliding out of the bone, and also the shoulder helps to avoid a tendency to over-reduce the fracture site. Once intrafocal plate  10  is fully inserted into the fracture site and bone, the insertion tool can be removed so as to allow plate element  10 A of intrafocal plate  10  to snap back against the bone and skin incision I to fall back into place. At this point, intrafocal plate  10  may be stable without a screw  20  being used to affix intrafocal plate  10  to the bone. However, one or more screws  20  may be inserted to ensure that intrafocal plate  10  does not slide in or out of the fracture site and to further stabilize the fracture fragment against shortening or lateral displacement. The alternative embodiment of intrafocal plate  10  shown in FIGS. 2A,  2 B is used in the same manner as the first embodiment of the invention, but one or more spikes  10 E depending from the bottom surface of plate element  10 A will serve to secure the intrafocal plate to the bone when intrafocal plate  10  is fully inserted and the insertion tool removed so as to allow plate element  10 A of intrafocal plate  10  to snap against the bone. The use of screws  20  for either of the two intrafocal plates is optional and the decision of the physician performing the procedure. 
     FIG. 6A of the drawings shows intrafocal plate  10  inserted without a screw for a Colles fracture. The arrow depicted therein shows the direction which the upper bone fragment will try to displace and which intrafocal plate  10  is used in order to prevent. Intrafocal plate  10  can also be used in fractures where the direction of displacement is not preordained by the obliquity of the fracture as best shown in FIG.  6 B. This transverse fracture of the proximal tibia may tend to displace in either direction, but can be stabilized with two intrafocal plates  10  as shown on opposing sides of the fractured bone. Further, if the dotted line shown in FIG. 6B represents yet another fracture splitting the end of the bone into two fragments, two intrafocal plates  10  from either side can be used to squeeze the two fragments together. Normally, another screw would be used to hold the two bone fragments together in addition to two intrafocal plates  10  and two screws  20 , but intrafocal plates  10  may be used in order to get the reduction so that another screw can be inserted later. 
     Applicant believes that intrafocal plate  10  lends itself to use most commonly in the distal radius, like intrafocal pins are currently being used, but that intrafocal plates  10  can also be used in many other long bone locations in the body, such as the tibia and fibula, femur, ulna, humerus, metacarpal, metatarsal, and phalanges. Applicant further believes that most uses of intrafocal plate  10  would be for metaphyseal bone fractures (e.g., fractures near the end of the bone in the area of the junction between the tubular shaft and the spongy, blocky, ending of the bone known as the metaphysis or epiphysis). However, applicant does not intend to limit the use of the novel intrafocal plate to metaphyseal bone fractures since other uses may be found for the novel apparatus and method described herein before, and all such apparatuses and uses are intended to fall within the scope of the invention as set forth in the appended claims. 
     As previously observed, although screws  20  shown in FIG. 3 of the drawings may optionally be used with intrafocal plates  10  of the invention shown in FIGS. 1A,  1 B and  2 A,  2 B, applicant does not believe that screws  20  are necessary to be used with intrafocal plates  10 . 
     It will be understood that various details of the invention may be changed without departing from the scope of the invention. Furthermore, the foregoing description is for the purpose of illustration only, and not for the purpose of limitation—the invention being defined by the claims.