Abstract:
A modular table is described for supporting a patient during application of a spica cast. In various embodiments, the table is modular, having a support for the patient&#39;s upper body and a separate support for the patient&#39;s lower body. The supports have coupling members that interface with existing examination or operating tables, or with additional members attached thereto. The coupling members may be placed into features shaped to receive them in one or more spaced-apart positions, or in other embodiments may slide through T-shaped slots or tracks that guide relative alignment of the supports. The tracks for the two supports may be the same or different; straight or curved; and parallel, perpendicular, or skew. Additional fixtures attach to the table or additional members to assist in applying traction to the patient during the application.

Description:
REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation of, and claims priority to, PCT Patent Application No. PCT/US 10/25465, filed Feb. 25, 2010, with title “Table for Placement of a Spica Cast,” pending. The entire disclosure in that application is incorporated herein by reference as if fully set forth. 
     
    
     FIELD 
       [0002]    The present invention pertains to a table utilized during medical procedures, and in particular to a table to be used during preparation of a spica cast. 
       BACKGROUND 
       [0003]    Although the application of hip spica casts in the management of fractures of the femur in children has been a standard modality of treatment since the invention of plaster, the early application as a definitive method of fracture treatment has only recently been driven in popularity by the economics of health care. The traditional method of treating fractured femurs prior to the 1990&#39;s in most pediatric centers was the application of traction followed by a hip spica cast once the fracture had consolidated with callus. 
         [0004]    As health care costs escalated in the 1980&#39;s and 1990&#39;s, innovative methods were used to decrease the prolonged hospitalization required by traction techniques, even though this type of management of a fractured femur is still very effective in obtaining a good long-term result and should be considered for patients in whom other modalities of treatment are inappropriate due to the type of trauma or other complicating factors regarding the fracture. One such innovative method is the application of hip spica casting for fractured femurs in children. Some of the advantages of early hip spica casting in pediatric patients include: (1) decreased hospital stay and costs; (2) avoidance of complications of skin and skeletal traction; (3) decreased radiographic exams; and (4) rapid return of child to the family environment. 
         [0005]    A hip spica includes the trunk of the body and one or more legs. A hip spica which covers only one leg to the ankle or foot may be referred to as a single hip spica, while one which covers both legs is called a double hip spica. A one-and-a-half hip spica encases one leg to the ankle or foot and the other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on the injury and the surgeon. The spica may extend only to the navel, allowing mobility of the spine and the possibility of walking with the aid of crutches, or may extend to the rib cage or even to the armpits in some rare cases. Hip spicas are used for congenital hip dislocations, and then mostly while the child is still an infant. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]      FIG. 1  is a side schematic drawing of an apparatus according to one embodiment of the present invention. 
           [0007]      FIG. 2  is a frontal, right side, top perspective drawing of an apparatus according to another embodiment of the present invention. 
           [0008]      FIG. 3  is a frontal, right side, top perspective drawing of an apparatus according to still another embodiment of the present invention. 
           [0009]      FIG. 4  is a frontal, right side, top perspective drawing of an apparatus according to yet another embodiment of the present invention. 
           [0010]      FIG. 5  is a frontal, right side, top perspective drawing of an apparatus according to yet another embodiment of the present invention. 
           [0011]      FIG. 6  is a frontal, right side, top perspective drawing of an apparatus according to yet another embodiment of the present invention. 
           [0012]      FIG. 7  is a frontal, right side, top perspective drawing of an apparatus according to yet another embodiment of the present invention. 
           [0013]      FIG. 8  is a frontal, left side, top perspective drawing of an apparatus according to still another embodiment of the present invention. 
           [0014]      FIG. 9  is a frontal, left side, top perspective drawing of a support in the embodiment of  FIG. 8 . 
           [0015]      FIG. 10  is a frontal, left side, top perspective drawing of an upper body support in the embodiment of  FIG. 8 . 
           [0016]      FIG. 11  is a rear, right side, top perspective drawing of an upper body support in the embodiment of  FIG. 8 . 
           [0017]      FIG. 12  is a frontal, left side, top perspective drawing of the embodiment of  FIG. 8 . 
           [0018]      FIG. 13  is a frontal, right side, top perspective drawing of a foot pocket in the embodiment of  FIG. 8 . 
           [0019]      FIG. 14  is a frontal, right side, top perspective drawing of a foot pocket in the embodiment of  FIG. 8  in an alternative configuration. 
           [0020]      FIGS. 15-18  are perspective views of alternative, interchangeable platforms for use in another alternative embodiment. 
       
    
    
     DESCRIPTION 
       [0021]    For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates. At least one embodiment of the present invention will be described and shown, and this application may show and/or describe other embodiments of the present invention. It is understood that any reference to “the invention” is a reference to an embodiment of a family of inventions, with no single embodiment including an element, step, or composition that must be included in all embodiments, unless otherwise stated. 
         [0022]    The use of an N-series prefix for an element number (NXX.XX) refers to an element that is the same as the non-prefixed element (XX.XX), except as shown and described thereafter. As an example, an element  1020 . 1  would be the same as element  20 . 1 , except for those different features of element  1020 . 1  shown and described. Further, common elements and common features of related elements are drawn in the same manner in different figures, and/or use the same symbology in different figures. As such, it is not necessary to describe the features of  1020 . 1  or  20 . 1  that are the same, since these common features are apparent to a person of ordinary skill in the related field of technology. Although various specific quantities (spatial dimensions, temperatures, pressures, times, force, resistance, current, voltage, concentrations, wavelengths, frequencies, etc.) may be stated herein, such specific quantities are presented as examples only. Further, discussion pertaining to a specific composition of matter is by way of example only, and does not limit the applicability of other species of that composition, nor does it limit the applicability of other compositions unrelated to the cited composition. 
         [0023]      FIGS. 1 and 2  depict an apparatus  20  according to one embodiment of the present invention. Table assembly  20  includes a support table  30  that provides relative placement of an upper body support  40 , a lower body support  50 , a foot support  60 , and a traction device  70 . In some embodiments, support table  30  is positioned on a supporting surface (not shown) such as an operating table or a gurney by a plurality of attachment brackets  24  extending around the periphery of support table  30 . However, in yet other embodiments, support  30  is integral with a table or gurney, and does not need attachment brackets. Preferably, apparatus  20  is fabricated from material that is radiolucent so as to not impact the use of X-rays. Various embodiments are constructed in various ways, as discussed further herein. 
         [0024]    As best seen in  FIG. 1 , a patient P such as a pediatric patient is supported in large measure by upper body support  40  and lower body support  50 . Upper body support  40  includes a platform  42  that is supported by a column  44 . Column  44  includes a coupling  45  that is received within a complementary-shaped coupling feature  32  within main support  30  (as best seen in  FIG. 2 ). Preferably, the patient P rests her body on a cushion  46  supported by platform  42 . In some embodiments, platform  42  includes a warming device  48 , such as a resistive electronic heater. 
         [0025]    Further support for patient P is provided by a lower body support  50 . Support  50  includes a platform  52 , on which the lower back and upper back side of the legs of the patient P are placed. A support column  54  supports platform  50  at a height above the surface of table  30 . Support column  54  is located on table  30  by the fastening of a coupling  55  to a complementary-shaped feature  34 . A projection  58  extends upward from platform  52 . Projection  58  is placed between the legs of patient P, and limits the movement of patient P in the direction toward traction device  70 . As shown in  FIG. 1 , projection  58  can be longitudinally offset from column  54 . However, as shown in  FIG. 2 , projection  58 ′ can also be an extension of column  54 . 
         [0026]    The feet of the patient P are supported by a foot support  60  spaced apart from lower body support  50 . Support  60  includes a platform  62  for supporting one or both feet. Platform  62  is spaced above the surface of table  30  by a column  64 . Column  64  includes a coupling  65  on one end that mates with a complementary-shaped feature  36  of table  30 . In some embodiments, platform  62  is a single, unitary platform having a width great enough to support both feet of patient P. In yet other embodiments, apparatus  20  includes a pair of foot supports  60 , one each for the right and left feet. As best seen in  FIG. 2 , in one embodiment table  30  includes a plurality of coupling features  36  to permit relatively quick and easy placement of foot support  60 . In some embodiments, woven nylon straps (or slots for attachment thereof) are included on each foot support  60  to hold the feet of patient P in position during the spica application procedure. 
         [0027]    Apparatus  20  in some embodiments further includes one or more traction devices  70   a  and  70   b  for placing a load on patient P. In one embodiment, traction device  70  includes a tower  72  having a pulley  76  located at the top. Referring to  FIG. 1 , a tether  74  can be applied to the leg of patient P on one end, and on the other end of tether  74 , a weight or other tensioning device (not shown) is attached. Referring to  FIG. 2 , one or more traction device clamps  38  couple column  72  to end  71  of table  30 . 
         [0028]    Referring to  FIG. 1 , apparatus  20  includes three body supports (upper body support  40 , lower body support  50 , and foot support  60 ) that are spaced upwardly from the top surface table  30 , and which further are spaced apart from each other. These spacing and gaps facilitate access to patient P for purposes of applying a spica cast, while at the same time supporting patient P in a manner that facilitates various procedures in an operating room. Each of the three supports are spaced upwardly from the top surface of table  30 : upper support  40  being spaced upwardly by a distance  26   a ; lower body support  50  being upwardly spaced by a distance  26   b ; and foot support  60  being upwardly spaced by a distance  26   c . In some embodiments, one or more of these upward spacings are adjustable. In some embodiments, in addition to or instead of adjustability, apparatus  20  includes a plurality of upper, lower, and foot supports provided in a kit, such that, for example, there are multiple foot supports  60 , each having a different length for column  64 . 
         [0029]    In addition to this upward spacing, the three supports for patient P are spaced apart, and thereby provide gaps for application of the spica cast. Still referring to  FIG. 1 , there is a horizontal gap  26   e  between opposing edges of platforms  42  and  52 . Similarly, there is a horizontal gap  26   d  between opposing edges of platforms  52  and  62 . These gaps provide sufficient open space for the medical professional to apply the spica cast around the body of patient P. 
         [0030]      FIG. 3  shows an apparatus  120  according to another embodiment. Apparatus  120  is the same as apparatus  20 , except for the differences that are shown or described here. 
         [0031]    Apparatus  120  includes features for adjusting the distance  126   d  and  126   e  between adjacent platforms. Lower body support  150  is coupled to support table  130  in such a way that it can be moved horizontally along a longitudinal axis of support table  130 . Lower body support  150  includes a coupling  155  between support column  154  and table  130  that includes one or more projections  155   a  that are received within a slot  134   a . Projection  155   a  extends downwardly into slot  134   a . Coupling  155  also includes a locating and fixation feature  155   b  that mates with a corresponding fixation feature  134   b  on table  130 . In one embodiment, fixation features  155   b  include a through hole and a threaded fastener, the fastener being received within a threaded hole  134   b  extending laterally from either side of slot  134 . 
         [0032]    In addition, table assembly  120  includes a foot support  160  that likewise includes one or more projections  165   a  that extend downwardly from a coupler  165  into track  134   a . In similar fashion to coupling  155 , coupling  165  includes a pair of coupling features  165   b  that mate with a corresponding feature  134   b  within table  130 . 
         [0033]    By loosening of the threaded attachments  155   b  or  165   b  from the corresponding threaded hole  134   b , the medical professional is able to adjust the position of supports  150  and  160  relative to upper body support  140 . In addition, foot support  160  includes a pair of separate supports  162   a  and  162   b  that can move laterally within a track  165   c  contained within coupling  165 . Coupling  165  further includes complementary features for fixing the lateral location of supports  162   a  and  162   b . In one embodiment, coupling  165  includes a plurality of through holes  165   d  that permit engagement of a fastener into a corresponding threaded hole within support column  164   a  or  164   b . The medical professional can place individual foot supports  162   a  and  162   b  in a position best suited for application of the spica cast to the particular patient P. 
         [0034]    Traction device  170  includes towers  170   a  and  170   b  that can be moved laterally within a track  138   a  of support table  130 . Each separate traction device includes a clamp or coupling  171  that permits fixation of the traction devices at various different lateral locations. In one embodiment, coupling  171  includes a threaded fastener and a through hole which is accepted within a threaded through hole  138   b  of support table  130 . The medical practitioner can thereby move the separate traction devices  170   a  and  170   b  so as to best apply the traction load onto the legs of patient P as positioned by foot supports  162   a  and  162   b.    
         [0035]    In addition, it can be seen that in some embodiments upper body support  140  includes a plurality of columns  144   a ,  144   b , and  144   c  for secure positioning of the upper body of patient P above the surface of table  130 . The columns  144   a ,  144   b , and  144   c  fit into front support coupling features  132   a  and  132   b . In the illustrated embodiment, coupling feature  132   a  receives two columns, and coupling feature  132   b  receives one, though many equally acceptable configurations, attachment feature types, and support mechanisms will be used in various embodiments as will occur to those skilled in the art in view of this disclosure. 
         [0036]      FIG. 4  shows an apparatus  220  according to another embodiment of the present invention. In this embodiment, lower body support section  250  includes platform  252 , through which support column  254  extends as projection  258 . Support column  254  is mounted on coupling element  255 , which includes projections  256  that extend into track or slot  234   a  in such a way that lower body support  250  can be moved along the longitudinal axis of secondary table section  230   a . This flexibility allows medical practitioners to adjust table  220  so that upper body support  240  and lower body support  250  are a desired distance apart, varying continuously from a space of zero (where center tab  247  touches platform  252 ) up to some maximum distance (where base platform  245  and coupling element  255  are at extreme opposite ends of their respective table sections). This adjustability allows the table to accommodate patients of different sizes in various clinical environments, and to manipulate materials around the cast and the patient P as required. 
         [0037]    Table assembly  220  also has a main portion  230   b  of table  230 . Main portion  230   b , like secondary table section  230   a , has tracks or slots  234   b  through which projections  256  on the bottom of base platform  245  so that upper body support structure  240  can be moved closer to and further away from lower body support structure  250  as necessary or desired. Support columns  244  are affixed to the top of base platform  245  to support platform  242 , upon which patient P rests during the spica cast application procedure. Center tab  247  extends from platform  242  toward lower body support  250  to provide additional support for the upper body of patient P without extending laterally to such an extent as to impede access to the patient and the spica cast by healthcare professionals. A foot support system and/or traction system may be added to the elements shown in  FIG. 4 , as will occur to those skilled in the art in view of the disclosure herein. 
         [0038]      FIG. 5  illustrates yet another table assembly embodiment  320 . This assembly  320  includes a pedestal  331  with base  331   a , post  331   b , and platform  331   c . Lower body portion  330   a  and upper body portion  330   b  of main support  330  lie on and are supported by platform  331   c . In some forms of this embodiment, main support  330  is permanently attached to platform  331   c  of pedestal  331 , while in others main support  330  is removably attached to platform  331   c  by removable nylon straps, post-and-socket joints, or other means as will occur to those skilled in the art in view of this disclosure. 
         [0039]    Both portions of main support  330  include a track or slot feature  334  that guides movement of upper body support assembly  340  and lower body support assembly  350 . Lower body support  350  includes coupling number  355 , which has projection  355   a  that extends into and is slidable through track or slot  334 . Support column  354  extends up from coupling number  355  to support platform  352 , which has a somewhat different design from platforms  52  and  252  discussed elsewhere herein. Projection  358  extends up from platform  352  to limit movement of patient P and provide a fixed reference point for table assembly  320 . Upper body support  340  in this illustrated embodiment is like upper body support  240 , illustrated in  FIG. 4 , except that it omits center tab  247 . 
         [0040]      FIG. 6  illustrates table assembly  420 , which includes pedestal  431 , upper body support  440 , lower body support  450 , and foot support assembly  460 . Upper body support  440  in the illustrated embodiment is similar to upper body support  340  as illustrated in  FIG. 5 , though alternative embodiments will occur to those skilled in the art in view of the description herein. 
         [0041]    Lower body support  450  in  FIG. 6  resembles lower body support  350  illustrated in  FIG. 5 , except that platform  452  has a bell shape, whereas platform  352  had a horseshoe shape. Platform  442  also has a center tab  447  (not shown) projecting from it toward lower body support  450 , and in this embodiment it projects into a receiving slot  457  (not shown) in platform  452  to enhance the support for patient P at the upper end of platform  452 . 
         [0042]    Foot support assembly  460  includes coupling plates  445  that mount on lower portion  430   a  of main support  430  and/or to each other using a tongue-in-groove attachment mechanism (not shown). Support columns  464  extend up from coupling plates  465 , and brackets  467  are slidably attached thereto. Platforms  462   a  and  462   b  for the feet of patient P include posts  468  extending from the back thereof, each through a bracket  467  and slidably, removably, and adjustably fixed into position relative thereto. 
         [0043]    Yet another apparatus is shown in  FIG. 7  as table assembly  520 . Table assembly  520  includes pedestal  531 , first support section  530   a , second support section  530   b , and third support section  530   c . Each has a track or slot  534   a  into which projection  547  on the bottom of upper body support  540 , and projection  559 , extending from coupling plate  555 , extend. Projections (not shown) extend from third table section  530   c  into extension slots  439   a  and  439   b  in the side of secondary table section  430   b , which is illustrated in  FIG. 6 . This alternative configuration is more convenient in some circumstances. 
         [0044]    Still another apparatus is shown in  FIGS. 8-14  as table assembly  620 . Support section  630  has tracks or slots  634   a  and  634   b  into which projections (not shown) on the bottom of upper body support  640  and coupling plate  655  extend. Platform  642  is supported by columns  644  on top of base  645 , which is connected to support platform  630  and its tracks or slots  634   a  and  634   b.    
         [0045]    Apparatus  620  includes handholds  622  around the perimeter of both support  630  and platform  642 . These handholds  622  facilitate movement of both the apparatus  620  and its components as well as the patient P when she is positioned on platform  642 . 
         [0046]    Similarly, strap holes  624  are placed along the edges of support  630  and upper body platform  642 . In some embodiments, strap holes  624  are long and narrow, corresponding generally to the shape of woven nylon straps used for various purposes during use, transport, and/or storage of apparatus  620 . Some slots also include a retention indentation  626  (see, for example,  FIG. 10 ) along the edge of a handhold  622  or strap hole  624 . Indentations  626  help retain straps in their places once they are affixed to the component, such as platform  642 . 
         [0047]    Lower body support  650  includes platform  652 , which is held by support column  654  on plate  655 . Fins  657  reinforce support column  654  in its vertical position. 
         [0048]    Foot supports  660  include foot pockets  662 , which hold the feet of patient P during the spica application procedure. Pockets  662  include strap slots  663  for securing the foot to the pocket  662 . In this embodiment, pockets  662  are each supported by a straight support member  664   a , which is connected by right angle tube connector  667  to curved support member  664   b . Curved support member  664   b  in this embodiment passes through a hole  665   d  in coupling plate  665 , which in turn is connected to main support  630  by way of projections (not shown) that extend into slots  634   a  and  634   b . Right angle tube connector  667  is fitted with set screws that releasably attach support members  664   a  and  664   b  in a given position. This form of attachment mechanism provides several degrees of freedom in the positioning of pockets  662  for the comfort and convenience of patient P and medical personnel. Similarly, holes  665   d  use set screws, releasable friction fits, or other attachment techniques to secure curved support members  664   b  in a particular relative position to support plate  665 . In some embodiments, a groove  668  in curved support member  664   b  (see  FIG. 13 ) cooperates with the set screw in right angle tube connector  667  to resist rotation of pocket  662  and straight support member  664   a  about the longitudinal axis of curved support member  664   b.    
         [0049]      FIGS. 15-18  illustrate alternative, interchangeable support platforms  752 ,  852 ,  952 , and  1052  for placement on a suitably configured post, such as support column  654  shown in  FIGS. 8-14 .  FIG. 15  illustrates platform  752 , which is approximately teardrop-shaped and defines a hole that fits snugly over a suitable support column to hold it in place. Support platform  852  in  FIG. 16  provides an extended surface that reaches further away from the support column (toward the upper body support, for example) to support a heavier patient P. Similarly,  FIG. 17  illustrates support platform  952 , which also extends more toward the associated upper body platform, but includes a slightly wider structure, and  FIG. 18  illustrates support platform  1052  that provides a still wider, lobed support surface. These alternative support surfaces can be exchanged easily according to the preference of the medical professionals performing the spica application procedure, the patient, and other preferences and circumstances. 
         [0050]    In various embodiments, the modular platforms according to the various embodiments herein are attached to an existing examination or operating room table using means that will occur to those skilled in the art. Such attachment techniques include, but are not limited to, clamps, brackets, sliding joints, mortise and tendon joints, dovetail joints, hook-and-loop fabric strips or pads, rope, tubular nylon straps, and the like. Other attachments will occur to those skilled in the art in view of this description. 
         [0051]    The attachment and connection features of the various embodiments described herein enable construction and use of these and many other table configurations as will occur to those skilled in the art. In some embodiments, a upper body support is easily moved along a first track in a first part of a support table, while a lower body support is easily moved along a second track in a second part of the support table. The tracks can be straight or otherwise, and may be parallel, perpendicular, skew, or otherwise. 
         [0052]    Various embodiments are constructed of any of a variety of materials or composites using any of a variety of manufacturing methods. Some embodiments, for example, are molded using a “rotational molding” technique that will be familiar to those skilled in the art of plastic-based manufacturing. In various such embodiments, the spica tables as described herein are constructed of polyethylene (of either the high-density or low-density varieties), acrylonitrile butadiene styrene (ABS), polytetrafluoroethylene composite fabric (such as that sold under the trade name RAYDEL by Saint-Gobain Performance Plastics of Williamsville, N.Y.), polypropylene, polyvinyl chloride, nylon, polycarbonate, or polyoxymethylene (sold, for example, under the trade name DELRIN by Dupont). Other embodiments will be constructed of other materials and using different techniques as will occur to those skilled in the art. 
         [0053]    In embodiments manufactured using a rotational molding process, the initial step of formation of the table platforms leaves voids within the pieces. In some embodiments, these voids are filled with polyurethane foam or other materials as will occur to those skilled in the art. In some embodiments, these materials resist heat transfer, thereby providing a warmer-feeling experience for the patient. Using materials having low density to fill the cavity contributes to the overall light weight of the system while supplementing its strength. 
         [0054]    While embodiments of the invention have been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only a number of embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.