Patent Publication Number: US-2021169537-A1

Title: Accessory for bone surgery, advantageously for operative arthroscopy

Description:
TECHNICAL FIELD TO WHICH THE INVENTION RELATES 
     The present invention generally relates to the field of bone surgery. 
     It relates in particular to the ancillaries for bone surgery, advantageously for operative arthroscopy (for example, for a Latarjet procedure), operable for positioning and fixing a bone fragment on a target bone surface. 
     TECHNOLOGICAL BACK-GROUND 
     Certain bone surgery techniques recommend cutting a bone fragment, before positioning and fixing it on a target bone surface. 
     This is for example the case in the Latarjet procedure (or “coracoid bone block abutment”) that consists in placing, in front of the shoulder, a bone block (coracoid) and a tendon (coraco-biceps) normally fixed thereto. 
     This operation is generally made on patients having dislocating shoulders, whose damaged anatomic structures are not repairable or are not sufficient to stabilize the shoulder. 
     The Latarjet “open-air” procedure is at present the standard technique. 
     An arthroscopic procedure has also been developed in order, in particular, to position the abutment more accurately and to perform, if need be, in the same operative time, an associated operation on the soft tissues. 
     However, despite the simplicity of its principle, the current ancillaries are sources of technical difficulties that may cause severe complications and that require long operation times. 
     Given the above, there exists a need for new ancillaries for bone surgery, advantageously for operative arthroscopy, which could combine a procedure that is fast and the less traumatic possible, while ensuring an accurate positioning of the bone fragment then a solid fixing on the target bone surface. 
     OBJECT OF THE INVENTION 
     In order to remedy the above-mentioned drawback of the state of the art, the present invention proposes an ancillary for bone surgery, advantageously for operative arthroscopy (for example, for a Latarjet procedure), operable for positioning and fixing a bone fragment on a target bone surface. 
     This ancillary comprises: 
     (i) at least one operating handle, 
     (ii) a sighting (or aiming or targeting) body comprising—two opposite end faces, a front one and a rear one, and—at least one sighting (or aiming or targeting) hole (for example, one or two) that opens to said two end faces, for guiding at least one screw and/or pin intended to be implanted into said bone fragment and into said target bone surface, 
     (iii) a feeler element, protruding from the front end face of said sighting body and having a lower face intended to bear against a part of said target bone surface. 
     The front end face of said sighting body and the lower face of said feeler element form together a dihedral receiving surface against which said bone fragment is intended to bear. 
     According to the invention, said ancillary comprises pressing means operable for temporarily holding said bone fragment bearing against said dihedral receiving surface. 
     The ancillary for bone surgery according to the invention thus facilitates the operative process, in particular within the framework of a Latarjet procedure. 
     This ancillary has in particular for advantage to allow a correct, fast and reproducible positioning of the bone fragment on its target bone surface. 
     According to a preferred embodiment, the pressing means comprise: 
     a bearing panel arranged opposite the front end face of said sighting body, and 
     translational guiding means, operable for guiding said bearing panel in translation along a translation axis directed parallel to said at least one sighting hole of the sighting body so as to ensure its spacing adjustment with respect to said front end face of the sighting body. 
     Other non-limitative and advantageous characteristics of this preferred embodiment, taken individually or according to all the technically possible combinations, are the following: 
     the bearing panel of the pressing means comprises at least one recess formed opposite said at least one sighting hole equipping the sighting body; 
     the pressing means cooperate with said sighting body through said translational guiding means; the pressing means and said sighting body cooperate through at least one rib/groove couple; the sighting body preferably comprises two lateral faces each comprising a first element of said rib/groove couple, and the pressing means comprise a base that carries the bearing panel and that is provided with a second element of said rib/groove couple; still preferably, the base of the pressing means comprise a lower panel, opposite a lower face of said sighting body, wherein said lower panel comprises two ends: a first end provided with the bearing panel, and a second end provided with translational guiding means; 
     the pressing means comprise gripping means, advantageously carried by said base, for the translational operation of said bearing panel by an operator; the gripping means of said pressing means advantageously comprise two lateral hooks that extend on either side of the sighting body and that open opposite said bearing panel; 
     the translational guiding means comprise indexing means (for example, a set of teeth), for providing said bearing panel with a translational pitch, for example a pitch comprised between 1 and 3 mm; the pressing means advantageously comprise mean for deactivating said indexing means, in particular for operating said bearing panel so as to space it from to the front end face of said sighting body. 
     Other non-limitative and advantageous characteristics of the ancillary according to the invention, taken individually or according to all the technically possible combinations, are the following: 
     the pressing means are removable with respect to said ancillary; 
     the feeler element cooperates with said sighting body through height adjustment means, along a second translation axis directed perpendicular to the axis of said at least one sighting hole; the feeler element advantageously carries a metric scaling directed along said second translation axis; 
     the sighting body comprises two through-holes juxtaposed and coplanar to each other in a sighting plane; said at least one handle advantageously extends in a plane perpendicular, or at least approximately perpendicular, to said sighting plane. 
     The invention also proposes a system of ancillaries, capable of being coupled to an arthroscopy, comprising: 
     (i) at least one first ancillary according to the invention, 
     (ii) at least one second ancillary of the screw type; 
     wherein said at least one second ancillary comprises: 
     an upstream portion, intended to enter said sighting hole of the sighting body and to protrude from said front end face, which comprises an upstream end forming a drilling/screwing head and a progressive thread profile, and 
     a downstream portion, intended to cooperate with a rotational operation member, 
     an abutment structure arranged between said upstream and downstream portions, adapted to come into abutment against the rear end face of the sighting body, and 
     a central channel, arranged coaxially to said second ancillary, adapted to the passage of a pin. 
     Preferably, the system of ancillaries comprises two second ancillaries having downstream portions of different lengths with respect to each other. 
     The system of ancillaries also advantageously comprises a ruler having: 
     a first measurement portion provided with a scaling, for measuring the depth of penetration of a pin into the bone fragment and the target bone surface, 
     a second measurement portion provided with a scaling, for measuring the width of the bone fragment, and 
     a portion for the assembly to the sighting body, at its rear end face. 
     The invention also proposes a bone surgery method, advantageously hybrid “open-air/arthroscopy”, comprising: 
     measuring the width of the bone fragment, advantageously by means of said ruler, 
     adjusting the height of the feeler element of the first ancillary taking into account the measurement obtained with the ruler, 
     holding the bone fragment against the dihedral bearing surface of the first ancillary, thanks to the pressing means, 
     inserting at least one second ancillary through said at least one sighting hole equipping the sighting body and into said bone fragment, 
     removing the pressing means, 
     positioning the bone fragment against the target bone surface, 
     inserting at least one pin through said at least second ancillary, 
     measuring the depth of insertion of said at least one pin, by means of the ruler, to determine the length of said at least one compression screw to be installed, 
     removing successively each second ancillary and replacing it by said compression screw. 
    
    
     
       DETAILED DESCRIPTION OF AN EXEMPLARY EMBODIMENT 
       The following description in relation with the appended drawings, given by way of non-limitative example, will allow a good understanding of what the invention consists of and of how it can be implemented. 
       In the appended drawings: 
         FIG. 1  in an overall and perspective view of an ancillary for bone surgery, advantageously for operative arthroscopy (for example, for a Latarjet procedure), 
         FIG. 2  is a partial and enlarged side view of the ancillary according to  FIG. 1 ; 
         FIG. 3  in an overall and perspective exploded view of the ancillary according to  FIGS. 1 and 2 ; 
         FIG. 4  shows a system of ancillaries according to the invention, comprising in particular the ancillary according to  FIGS. 1 to 3 ; 
         FIGS. 5 and 6  show ancillaries of the gripper/screwdriver type, part of the system of ancillaries according to  FIG. 4 ; 
         FIG. 7  is a top view of a ruler belonging to the system of ancillaries according to  FIG. 4 ; 
         FIG. 8  shows the implementation of the system of ancillaries according to the invention, during a Latarjet bone surgery procedure. 
     
    
    
     ANCILLARY FOR BONE SURGERY 
       FIGS. 1 to 3  show an ancillary  1  according to the invention that is operable for bone surgery, advantageously for operative arthroscopy. 
     Operative arthroscopy allows mini-invasive, intra-articular surgical procedures. 
     In particular, the ancillary  1  according to the invention is operable for positioning and fixing a bone fragment F on a target bone surface S ( FIG. 8 ). 
     Such an ancillary  1  is particularly suitable for performing a Latarjet procedure. 
     This Latarjet procedure is a surgical operation during which the bone fragment F is used as a bone abutment intended to be positioned at the anterior part of the glenoid cavity; this bone abutment is made from the coracoid apophysis. 
     The ancillary  1  according to the invention, also called “sighting (or aiming or targeting) ancillary” or “sighting (or aiming or targeting) guide”, comprises for that purpose different parts: 
     an operating handle  2 , 
     a sighting (or aiming or targeting) body  3 , operable for guiding at least one screw and/or pin intended to be implanted into the bone fragment F (for example, the coracoid apophysis) and/or into the target bone surface S (for example, the anterior part of the glenoid cavity), 
     a feeler element  4 , intended to bear against a part of the target bone surface S, and 
     pressing means  5  comprising in particular a bearing panel  51 , operable for temporarily holding the bone fragment F within the ancillary  1 . 
     The sighting body  3  is here in the form of a generally parallelepipedal block. 
     This sighting body  3  is delimited by a set of faces ( FIGS. 2 and 3 ): 
     two opposite end faces, a front one  31  and a rear one  32 , 
     two opposite lateral faces  33 , 
     a so-called “lower” face  34 , and 
     a so-called “upper” face  35 . 
     This sighting body  3  comprises at least one sighting (or aiming or targeting) hole  37 , here two in number ( FIG. 3 ). Each sighting hole  37  is operable for guiding at least one screw and/or one pin intended to be implanted into the bone fragment F and/or into the target bone surface S. 
     Each sighting hole  37  is here a through-hole: it opens to the two above-mentioned end faces  31 ,  32 . 
     The sighting holes  37  each define a longitudinal axis  37 ′. The longitudinal axes  37 ′ here extend parallel to each other, juxtaposed and coplanar to each other in a general plane P that is also called “sighting (or aiming or targeting) plane” ( FIG. 3 ). 
     The two lateral faces  33  here comprise translational guiding means  331  that are intended to cooperate with the pressing means  5  for guiding these latter in translation. 
     These translational guiding means  331  here comprise a first element  331  of a rib/groove couple, here a groove extending parallel to the longitudinal axis  37 ′ of the sighting holes  37  ( FIG. 3 ). 
     This groove  331  here comprises indexing means, for example a set of teeth  3311  (several teeth distributed over the length of the groove  331 ), for providing the bearing panel  51  with a translational pitch. This translational pitch is for example comprised between 1 and 3 mm. 
     As described hereinafter, such a translational pitch is interesting to ensure a removable holding of the spacing adjustment applied to the bearing panel  51  during the pinching of the bone fragment F. 
     The feeler element  4  comprises two portions: 
     a front portion  41 , protruding from the front end face  31  of the sighting body  3 , and 
     a rear portion  42 , arranged at the upper face  35  of the sighting body  3  for its detachable fixing to the latter. 
     The rear portion  42  of the feeler element  4  is herein placed within a housing  351  (or imprint) that is formed in the upper face  35  of the sighting body  3  ( FIG. 3 ). 
     This rear portion  42  of the feeler element  4  cooperates with the sighting body  3  through height adjustment means  45 , along a translation axis A directed perpendicular to the longitudinal axis  37 ′ of the sighting holes  37 . 
     The rear part  42  of the feeler element  4  is guided in translation by the complementary housing  351 . 
     For that purpose, the rear portion  42  of the feeler element  4  carries a screw  451  (with a rotational degree of freedom and no translational degree of freedom) that cooperates with a threaded hole  452  (schematically shown in  FIG. 3 ), directed coaxially with respect to said translation axis A. 
     The height stroke of this feeler element  4  goes for example from 0 mm to 6 mm, corresponding to an offset from 3.5 to 9.5 mm. 
     The rear portion  42  of the feeler element  4  also carries a metric scaling  421  that is directed along the above-mentioned translation axis A. 
     This metric scaling  421  is intended to serve as a landmark for the height adjustment of the feeler element  4 , taking into account the dimensions of the bone fragment F. 
     This metric scaling  421  is formed on the rear portion  42 , laterally and over the height thereof, so as to use the upper face  35  of the sighting body  3  as a height adjustment landmark. 
     For its part, the front portion  41  of this feeler element  4  has a lower face  411  that is intended, as described hereinafter, to bear simultaneously against the bone fragment F and a part of the target bone surface S. 
     This lower face  411  of the feeler element  4  forms, in combination with the front end face  31  of the sighting body  3 , a dihedral receiving surface D against which the bone fragment F is intended to bear and to be held by the pressing means  5  ( FIG. 2 ). 
     The pressing means  5  are operable for temporarily holding the bone fragment F bearing against this dihedral receiving surface D ( FIG. 2 ). These pressing means  5  are moreover advantageously removable with respect to the ancillary  1 , useful during the positioning and fixing of the bone fragment F. 
     The pressing means  5  here comprise: 
     the bearing panel  51  arranged opposite the front end face  31  of the sighting body  3 , 
     the translational guiding means  52 , operable for guiding this bearing panel  51  in translation along a translation axis T ( FIG. 2 ), directed parallel to the longitudinal axis  37 ′ of the sighting holes  37  of the sighting body  3 , and 
     a base  53  carrying this bearing panel  51  and these translational guiding means  52 . 
     The base  53  here comprises a lower panel  531 , intended to come opposite the lower face  34  of the sighting body  3 . 
     This lower panel  531  comprises two ends: 
     a first, front end  532 , provided with the bearing panel  51 , and 
     a second, rear end  533 , provided with the translational guiding means  52 . 
     This lower panel  531  has here a generally Y or fork shape ( FIG. 3 ), comprising: 
     a front arm  5311  carrying the bearing panel  51 , and 
     two rear legs  5312  carrying the translational guiding means  52 . 
     This embodiment of the base  53  aims to allow an elastic deformation spacing the rear legs  5312  with respect to the associated translational guiding means  52 . 
     The bearing panel  51  comprises different portions ( FIGS. 2 and 3 ): 
     a rear face  511 , directed towards the front end face  31  of the sighting body  3 , 
     a front face  512 , opposed to said rear face  511 , 
     a lower edge  513 , integral with the base  53 , and 
     an upper, free edge  514 , intended to come opposite and to travel along the lower face  411  of the feeler element  4 . 
     The bearing panel  51 , and in particular the rear face  511  thereof, comprises at least one recess  517  (blind or through) arranged opposite each sighting hole  37  equipping the sighting body  3 . 
     Each recess  517  is useful to receive the free end of an ancillary brought through the coaxial sighting hole  37  (in particular, a second ancillary  6  described hereinafter in relation with  FIG. 4 ). 
     The translational guiding means  52  allow the spacing adjustment of the bearing panel  51  with respect to the front end face  31  of the sighting body  3 ; in other words, the translational guiding means  52  allow guiding the bearing panel  51  in translation, parallel to each other, along the translation axis T. 
     These translational guiding means  52  here further allow a separation of the pressing means  5  with respect to the sighting body  3 , by an extraction move on the side of the front end face  31  of the sighting body  3 . 
     For that purpose, the translational guiding means  52  of the pressing means  5  here cooperate with the translational guiding means  311  of the sighting body  3 . 
     These translational guiding means  52  here comprise a second element  521  of the rib/groove couple adapted to cooperate, to within a clearance, with the first element  311  of the rib/groove couple of the sighting body  3  ( FIG. 3 ). 
     The second element  521  of the rib/groove couple, here a rib, comprises indexing means, for example at least one tooth  5211 , intended to cooperate by elastic deformation with the indexing means  3311  of the groove  311  equipping the sighting body  3 . 
     The pressing means  5  also comprise gripping means  55 , here carried by the rear end  533  of the base  53  and by the translational guiding means  52 . 
     The gripping means  55  are operable for the translational operation by an operator of the pressing means  5  and the bearing panel  51  thereof, in particular in a direction moving the bearing panel  51  closer to the front end face  31  of the sighting body  3 . 
     The gripping means  55  comprise for that purpose two lateral hooks  551 , having here a generally U shape, which extend on either side of the sighting body  3  (here symmetrically) and which open opposite the bearing panel  51 . 
     Here, each lateral hook  551  comprises: 
     an inner section  5511 , intended to bear on one of the lateral faces  33  of the sighting body  3  and provided with the second element  521  of the rib/groove couple, 
     a transverse section  5512 , serving as a traction bearing surface for the operator, and 
     an outer section  5513 , opposite and remote from the inner section  5511 . 
     The two inner sections  5511  of the lateral hooks  551  hence extend opposite and remote from each other. They are intended to take in sandwich the lateral faces  33  of the sighting body  3 . 
     The pressing means  5  here also comprise, optionally, means for deactivating the indexing means  3311 ,  5211 , in particular for a free operation spacing the bearing panel  51  from the front end face  31  of the sighting body  3  during the disassembly of the pressing means  5 . 
     These means for deactivating the indexing means  3311 ,  5211  are here formed by the outer section  5513  of the lateral hooks  551 . 
     Indeed, a pinching force aiming to move the two outer sections  5513  closer to each other tends to space apart and make diverge the inner sections  5511  of the lateral hooks  551  by a phenomenon of elastic deformation, then leading to the spacing of the indexing means  5211  of the ribs  521  with respect to the indexing means  3311  of the grooves  331 . The pressing means  5  are then free to slide over the length of the sighting body  3 , which is in particular useful to separate these pressing means  5  from the ancillary  1 . 
     To be complete, the handle  2  is here made integral with the upper face  35  of the sighting body  3 , on the side of the rear front face  32 . 
     This handle  2  advantageously extends in a plane L perpendicular, or at least approximately perpendicular, to the sighting plane P. 
     In practice, this arrangement of the handle  2  is particularly ergonomic for the practitioner, during the operative process. 
     System of Ancillaries 
     The ancillary  1  according to the invention, described hereinabove in relation with  FIGS. 1 to 3 , advantageously belongs to a system of ancillaries, capable of being coupled to an arthroscopy, which is schematically shown in  FIG. 4 . 
     This system of ancillaries comprises: 
     at least one first ancillary  1  described hereinabove in relation with  FIGS. 1 to 3 , 
     a second ancillary  6  of the screw type, here having a gripper/screwdriver function, 
     at least one pin  7 , 
     compression screws (not shown), preferably cannulated compression screws, and advantageously 
     a ruler  8 . 
     The second ancillaries  6  of the screw type, shown in detail in  FIGS. 5 and 6 , are in particular useful for temporarily holding the bone fragment F on the ancillary  1  after disassembly of the pressing means  5 . 
     These second ancillaries  6  comprise: 
     an upstream portion  61 , intended to enter the sighting hole  37  of the sighting body  3  and to protrude from the front end face  31 , 
     a downstream portion  62 , intended to cooperate with a rotational operation member (not shown) that has advantageously the shape of a screwdriver handle, 
     an abutment structure  63  formed between the upstream  61  and downstream  62  portions, adapted to come into abutment against the rear end face  32  of the sighting body  3 , and 
     a central channel  64 , arranged coaxially to the body of this second ancillary  6 , adapted to the passage of the above-mentioned pin  7  (as schematically illustrated in  FIG. 7 ). 
     The upstream portion  61  has a diameter corresponding, to within a clearance, to the diameter of the sighting hole  37  of the sighting body  3 . 
     This upstream portion  61  has an upstream end  611  that is composed of two portions, in series: 
     a terminal drilling/screwing head  6111 , and 
     progressive thread profile  6112 . 
     The drilling/screwing head  6111  has a structure having two functions: 
     a drilling head function for drilling into the bone fragment F placed against the dihedral receiving surface D, and 
     a screwing head function for a head of a compression screw intended to be implanted between the bone fragment F and the target bone surface S. 
     The progressive thread profile  6112  is adapted to be screwed into the bone fragment F. 
     The second ancillaries  6  are advantageously two in number and have advantageously downstream portions  62  that have different lengths with respect to each other. This length difference aims to avoid a conflicting encumbering during the operative process. 
     The ruler  8 , generally plate-shaped, advantageously comprises the following portions: 
     a rear portion  81  adapted for the implementation of different measurements, and 
     a front portion  82  adapted for the assembly to the sighting body  3 , at its rear end face  32 . 
     The rear portion  81  has two faces provided with measurement portions: 
     an upper face  811  forming a first measurement portion provided with a metric scaling  8111 , for measuring the depth of penetration of a pin  7  into the bone fragment F and the target bone surface S, and 
     a lower face  812  forming a second measurement portion provided with a metric scaling (not shown), for measuring the width of the bone fragment F. 
     The front portion  82  forms a part of a tenon/mortise assembly. 
     This front portion  82  here have a tenon shape intended to be received into a complementary housing (not shown) opening on the side of the rear end face  32  of the sighting body  3 . 
     The ruler  8  is hence adapted to be mounted on the sighting body  3 , in protrusion from its rear end face  32 , so as to extend opposite a section of pins  7  coming from the side of this rear end face  32 . 
     The pins  7  are intended to allow the guided packing and the validation of the centring and of the centre distance of the future compression screws. 
     These pins  7  advantageously comprise a visual landmark  71  to determine their depth of penetration by means of the metric scaling  8111  of the first measurement portion  811  ( FIG. 7 ). 
     The metric scaling  8111  of the first measurement portion  811  is adjusted as a function of the length of the pins  7  and of the position of its visual landmark  71 . 
     In practice, the depth of penetration of each pin  7  is obtained by reading the value of the metric scaling  8111  that is located opposite the visual landmark  71  of this pin  7 . 
     Method 
     The system of ancillaries according to the invention allows combining a procedure that is the less traumatic possible, while ensuring a fast and accurate positioning of the bone fragment then a solid fixing on the target bone surface. 
     In practice, the bone surgery method first comprises extracting and preparing, according to a conventional procedure, the bone fragment F, for example the coracoid bone block (with the coraco-biceps tendon) during a Latarjet procedure. 
     The bone surgery method then comprises the following steps in succession, for preparing the first ancillary  1  and for attaching the first ancillary  1  with the bone fragment F, i.e.: 
     measuring the width of the bone fragment F, preferably in its three planes, advantageously by means of the ruler  8  (more precisely by means of the second measurement portion  812 ), 
     adjusting the height of the feeler element  4  of the first ancillary  1  taking into account the measurement obtained with the ruler  8  in the axial plane, 
     inserting a bone fragment F into the first ancillary  1  and operating the pressing means  5  so that its bearing panel  51  hold this bone fragment F by pinching with the dihedral bearing surface D of the first ancillary  1 , 
     inserting second ancillaries  6  through sighting orifices  37  equipping the sighting body  3 , from the rear end face  32  thereof, so that the upstream end  611  of each second ancillary  6  opens on the side of the front end face  31  and is screwed into the bone fragment F, generating a temporary attachment first ancillary  1 /bone fragment F (advantageously the shortest second ancillary  6  is firstly inserted to avoid the encumbering problems), 
     removing the pressing means  5  with respect to the first ancillary  1 , so that the bone fragment F is held against the dihedral bearing surface D of the first ancillary  1  through the second ancillaries  6  and so that the bone fragment F is released to be installed. 
     These different previous steps (extraction/preparation/fixing) are advantageously performed during an open-air time. 
     The bone surgery method then comprises the succession of the following steps for positioning and fixing the bone fragment F against the target bone surface S, advantageously during an arthroscopic time, i.e.: 
     positioning the bone fragment F against the target bone surface S, guided in particular by the feeler element  4  that bears against a part of the target bone surface S, for example the articular surface of the glenoid cavity in a Latarjet procedure ( FIG. 8 ), 
     inserting the pins  7  within the second ancillaries  6  so that they each pass through the bone fragment F and the target bone surface S ( FIG. 8 ), 
     measuring the depth of insertion of the pins  7  by means of the ruler  8  (more precisely by means of the first measurement portion  811 ), to determine the length of the compression screws to be implanted ( FIG. 7 ), 
     removing successively each second ancillary  6  and replacing it by a compression screw that is guided through each sighting hole  37 , over the length of a pin  7 , and that is screwed by means of this second ancillary  6 . 
     The bone fragment F is hence fixed to the target bone surface S through compression screws that pass through this bone fragment F and that are anchored to the target bone surface S. 
     Once the bone fragment F suitably fixed, the pins  7  and the first ancillary  1  can be removed. 
     The surgical method is hence advantageously hybrid “open-air/arthroscopy”, comprising extracting and preparing the abutment in an open-air time then positioning and fixing the bone fragment F against the target bone surface S in an arthroscopic time.