Abstract:
A flail chest stabilizing device to permit transportation of injured patients that finds effective use in battlefield and emergency medical settings.

Description:
CROSS-REFERENCE TO RELATED CASES 
       [0001]    The present case is the utility conversion of U.S. Provisional Application 61/725,116, filed Nov. 12, 2012, which is incorporated by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    Flail chest is a medical condition that occurs when several ribs are broken in several places. The injury destroys the integrity of the chest cavity and consequently it can no longer support respiration. Acute treatment options include mechanical ventilation (intubation) which does not require an intact chest. In former times and in a hospital setting a system of weights would be set up bedside. Each rib would have been attached to weight that was draped over a pulley system to allow the ribs to re-approximate their positions under the pull of gravity on the weights. This technique supplies sufficient rigidity to support respiration but has been abandoned in clinical practice. 
         [0003]    Today flail chest is a common battlefield injury where protective body armor distributes mechanical stresses over the entire chest. If enough force is applied many ribs will break in many locations at once. The injury is also common in high-speed automobile crashes where the steering wheel can cause a blunt trauma to the chest. 
         [0004]    The device and system of the present invention maybe used in a field setting or hospital setting and may be very useful for transporting the injured in a vehicle where weight systems and respirators are unworkable. 
       SUMMARY OF THE INVENTION 
       [0005]    The device of the invention is a system with several integral and several optional components. At a minimum the system includes one rib clamps for attachment to a flail (broken) rib, and a close by rib clamp connected to a more intact rib, in essentially every instance three or more rib clamps will likely be deployed. Each rib clamp has a terminal pin or proximal cap that carries a groove to accept an O-ring. All the rib clamps protrude though and resiliently and flexibly connect to an elongate connector bar. The connector bar has several (usually three) multiple pin or cap reception holes. In use the rib clamps support the ribs and the connector bar supports the rib clamps. Together they cooperate to re-approximate correct rib position and support the chest cavity sufficiently to support respiration. 
         [0006]    In general each rib clamp has distal tips shaped to grasp a curved rib surface. These distal tips are passed through the chest wall and can be fixed onto intact sections of broken ribs and onto adjacent intact ribs. Each clamp is screw adjustable onto the rib, and has a shank that terminates in a proximal pin or cap. Each pin or cap extends beyond the surface of the patient&#39;s chest. A connector bar forms a support strap that interconnects the several pins or caps and distributes the forces over much of the chest area. In use each rib clamp is affixed to rib segment and pulled into approximate position reestablishing the morphology of the chest cavity, this process is facilitated by the presence of complementary clamps on adjacent ribs. 
         [0007]    Next the connector bar support straps are arranged to pick up the pins and affix them to the support strap. Typically the interconnection of injured ribs to each other and to one or more intact ribs is sufficient to support the chest wall during respiration. By re-approximating the original rib locations the fractured ends of ribs are brought into proximity that facilitates and improves healing. It is also important to note that the coupling of the ribs to the connector bar is sufficiently compliant that the ribs naturally fall into a close approximation of their former position that accommodates rib cage motion and promotes healing while reducing pain. In essence the nearby intact ribs flexibly realigned flail sections of the chest and improve healing. 
         [0008]    In most of these cases there is a traumatic chest injury so the additional risks posed by the additional wounds from the clamp system is very small and well tolerated. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]    Throughout the several figures of the drawing identical reference numerals indicate identical structure, wherein: 
           [0010]      FIG. 1  is partial schematic view of a flailed chest; 
           [0011]      FIG. 2  is a cross section of a flail chest with the apparatus in place; 
           [0012]      FIG. 3  is a cross section of the connector bar; 
           [0013]      FIG. 4  is plan view of a rib clamp in isolation; 
           [0014]      FIG. 5  is side view of a rib clamp in isolation; 
           [0015]      FIG. 6  is a perspective view of a companion tool to puncture the chest; 
           [0016]      FIG. 7  is a composite view of the connector bar in cross-section and in plan view oriented to show structure; 
           [0017]      FIG. 8  is a partial view of a mechanism in isolation to adjust the rib clamps; 
           [0018]      FIG. 9  is a cross section of the proximal segment of the rib clamp; 
           [0019]      FIG. 10  is a perspective view of a companion tool to affix the o-rings to the rib clamps; and, 
           [0020]      FIG. 11  is a view of a rib clamp extension. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0021]    Turning to figures  FIG. 1  through  FIG. 3 ,  FIG. 1  shows a partial frontal view of the chest area of a patient  10 . The sternum  12  is seen along with several flail segments of the ribs. In the figure reference numeral  14  indicates a rib flail segment broken in at least two places. An intact rib is shown at  20 . 
         [0022]      FIG. 2  is a cross section of the chest showing flailed segments typified by segment  14  and also showing intact ribs typified in the figure by rib  20 . In this sagittal view a set of three rib clamps are seen at reference numeral  23 ,  22  and  16 . Rib clamp  16  is attached to rib flail segment  14  that has been pulled into alignment with is neighboring intact rib  20 . Rib clamp  22  is connected to that rib and each clamp is in turn coupled to the connector bar  18 . Note that in  FIG. 2  that the clamps all orient approximately the same direction as they connect the rib segments. This facilitates the use of the connector bar  18 . 
         [0023]      FIG. 3  shows that each of the proximal pin segments of each rib clamp may be exteriorized and may protrude through apertures typified by aperture  24  in the connector bar. Each rib clamp is affixed to the connector bar  18  by an O-ring that sits in a groove  26  on each pin (see  FIG. 4  and  FIG. 5 ). The level of the various clamps is well controlled by the connector bar but the angular alignment is flexible to allow the individual ribs to seek their own optimal position. This resilient coupling improves patient outcomes. The O-ring is partially trapped by a lip  21  that engages the O-ring  27 . The O-ring engagement gently forces the axis of the pin or cap to align with companion pins or caps dynamically to preserve chest geometry. 
         [0024]    Turning to figures  FIG. 4  through  FIG. 11 ,  FIG. 4  shows a typical rib clamp  16  in isolation. The rib clamp is an assembly including a first tine  36  and a second tine  32  with rib grasping distal tips. In this embodiment the first tine is integral with the proximal pin  30  structure. And the second tine  32  is free to pivot about joint pivot axis  34 . The second tine carries a sector gear  70  seen best in  FIG. 8  that engages a coarse thread screw  38  that will allow the tines to move together by rotation about joint  34  axis to grasp a rib  20 . It is preferred to incorporate a socket into the screw  38  to accept an Allen wrench  80  or the like to adjust the screw  38  and advance or retract it to couple motion to the sector gear. Thumb screws on an extended screw are contemplated but Allen wrench or screwdriver adjustment is slightly preferred to reduce the overall profile of the device in use. Also seen in this view are the curved shaped segments  86  and  82  of the tines engaging a rib  20  seen in phantom view these curved shaped distal tips function to provide a rib grasping surface. The side view of  FIG. 5  of the rib clamp in isolation shows the proximal rib clamp shank structure  30  clearly along the O-ring retainer groove  26 . 
         [0025]    Placement of the rib clamps is facilitated by companion tool  50  show in  FIG. 6 . As is clear from the figure spaced tines  51  and  53  have reduced section zones and trocar like tips that pierce the skin and intercostal tissues when plunged into the chest. The two offset punctures will straddle the flail rib segment in use and permit the introduction of the rib clamp. This companion tool  50  can make the required wounds and engage the broken rib permitting retraction and positioning. Once the rib is successfully placed then the rib clamp may be inserted through the punctures and secure the rib. The use of the tool is optional as the physician make desire to make placement wounds using other surgical techniques. 
         [0026]      FIG. 7  shows a view of the connector bar  18  in isolation in a cross section view placed above a plan view and aligned to show the relative position of connector bar features. Several holes or apertures typified by hole  24  are provided along the length of the bar  18 . Recessed lips typified by lip  21  allow the pin and groove  26  to protrude through the hole where the pin can be affixed by the application of an O-ring  27  forced on the pin and slide into groove  26  (see other figures). 
         [0027]    The tool of  FIG. 10  may be used to position the  0 -rings onto or off of the proximal rib clamp shank typified by shank  33  (see  FIG. 4 ). In general the o-ring is placed on the tool see  FIG. 10  that expands the O-ring  27 . Next the O-ring  27  and rolled off onto the pin cap  42  as better seen in  FIG. 9  and  FIG. 11 . Optional grooves seen for example at reference numeral  41  in  FIG. 9  may accept the O-ring pliers  43  tines  45  and  47  to assist in fixation of the O-ring  27  on the rib clamp cap  42 . 
         [0028]    In most patients fixed pin length are usable especially for closely spaced ribs. However provision may be made for adjusting the length of a rib clamp by incorporating a screw cap pin  42  onto the clip as seen in  FIG. 11 . Here the cap is essentially a nut engaging a screw formed in the proximal rib clamp shank. 
         [0029]    Many variations in structure can implement the present invention and the figures should be considered illustrative and not limiting.