Abstract:
A surgical support system provides a set of paddles receivable by a pegboard to provide larger area skin-supporting surfaces as stabilized by a pair of pegs received in the pegboard. The paddles may be primarily constructed of an autoclavable radiolucent polymer with short aluminum pegs in their lower ends for being;received in the pegboard.

Description:
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0001]    — 
       CROSS REFERENCE TO RELATED APPLICATION 
       [0002]    This application claims the benefit of U.S. provisional 62/256,351 filed Nov. 17, 2015, and hereby incorporated by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0003]    The present invention relates to a patient positioning apparatus and in particular to a set of improved paddles for use with a surgical, pegboard positioner. For many medical procedures, for example, an orthopedic procedure such as hip arthroplasty, it is important to stabilize the patient against on the table against movement resulting from forces applied to the patient during the procedure. 
         [0004]    One versatile stabilizing approach places a pegboard on the surgical table, held to the table, for example, by rail clamps. U.S. Pat. No. 9,254,179, naming the present inventors and hereby incorporated by reference, describes a pegboard of this type such as is also available through a number of commercial suppliers including, for example, the David Scott company of Framingham, Mass., USA. 
         [0005]    The pegboard provides a polymer plate having regularly spaced holes bored vertically in its surface to receive corresponding pegs that may extend upward from the holes adjacent to the patient where support is required. These pegs include aluminum shafts sized to, be received with sliding fit in the regularly spaced holes of the pegboard. The shaft may be covered with a coating of rubber having a generally circular horizontal cross-section. 
       SUMMARY OF THE INVENTION 
       [0006]    The present invention provides an improved peg (paddle) that provides a broader surface supported by two pegs received in the pegboard greatly reducing concentrated pressure on the patient such as can produce a pressure ulcer. The wider paddles permit the aluminum pegs to be truncated in height providing improved transparency to x-rays that may be required during certain orthopedic procedures. The wider paddles also eliminate the need for the cushioning provided by rubber such as can prevent the paddles from being readily sterilized in an autoclave. 
         [0007]    Specifically, the invention in one embodiment provides a surgical positioning system for use with the pegboard of a type having an upper surface for support of a patient and including regularly spaced vertical bore holes. This positioning system provides a set, of paddle elements attachable to the pegboard to extend upward therefrom, a lower end of each paddle element including at least two pegs slidably receivable within corresponding vertical bore holes of the pegboard and an upper end of each paddle element being constructed of a radiolucent polymer. Each paddle element provides a noncircular horizontal cross-section as attached to the pegboard presenting a broad lateral surface for contact with the skin of the patient. 
         [0008]    It is thus a feature of at least one embodiment of the invention to provide an improved patient support paddle providing reduced contact pressure with the patient and radiolucency using multi-peg support. 
         [0009]    The pegs are aluminum cylinders. 
         [0010]    It is thus a feature of at least one embodiment of the invention to provide a radiolucent paddle that nevertheless provides for the robust attachment provided by an aluminum polymer pegboard sliding tit. 
         [0011]    The pegs may extend into the radiolucent polymer by less than 2.5 inches from an upper surface of the pegboard when the paddle is installed in the pegboard. 
         [0012]    It is thus a feature of at least one embodiment of the invention to make use of the stronger upper paddle providing low-pressure patient contact to reduce the peg length improving radiolucency of the critical upper portions of the paddle. 
         [0013]    The radiolucent polymer maybe autoclavable at 273 degrees Fahrenheit without damage. 
         [0014]    It is thus a feature of at least one embodiment of the invention to provide a peg system that can be sterilized. 
         [0015]    An upper end of at least one paddle may include at least two upwardly extending bore holes for receiving pegs of a second paddle to attach the second paddle to the at least one paddle. 
         [0016]    It is thus a feature of at least one embodiment of the invention to permit a stacking of paddles to provide greater versatility in supporting the patient and greater contact area with the patient&#39;s skin. 
         [0017]    The sidewalls of the paddle installed in the pegboard may include concave opposed cutouts for fitting in between legs of a patient. 
         [0018]    It is thus a feature of at least one embodiment of the invention to provide a paddle that may fit between the patient&#39;s legs while maximizing support area. 
         [0019]    These particular objects and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]      FIGS. 1 a -1 e    are a front elevational view in partial cross-section, a side elevational view, a bottom plan view, a top plan view and a perspective view of a first paddle design intended for general use according to the present invention; 
           [0021]      FIG. 2  is a perspective view of a second paddle design having substantially identical top and bottom plan views as the paddle design of  FIG. 1 , the second paddle design intended for use between a patient&#39;s legs and having leg receiving cutouts; 
           [0022]      FIGS. 3 a -3 d    are a front elevational view, a side elevational view, a top view and a perspective view of a third paddle design having a substantially identical bottom plan view as the paddle design of  FIG. 1  providing an extender for use with another paddle to increase its length; 
           [0023]      FIGS. 4 a -4 c    are a top plan, a side elevational view in partial cross-section and a perspective view of a fourth paddle design having a bottom plan view substantially identical to that of the paddle of  FIG. 1 ; 
           [0024]      FIG. 5  is a figure similar to that of  FIG. 1 a    showing a single piece paddle providing improved, radiolucency and sterilizing, 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0025]    Referring now to  FIGS. 1 a   - 1   e,  a surgical positioning pegboard system  10  is designed to eliminate pressure points and offer radiolucency by providing a noncircular cross-section paddle  12 . The pegboard system  10  provides one or more paddles  12  having downwardly extending cylindrical pegs  14  that may be received within corresponding holes  16  in a pegboard  18 . The holes  16  may have one-inch diameters and may be arranged generally in rectilinear rows and columns separated by two inches on center. As so arranged, the holes  16  may accept in sliding tit two or more downwardly extending cylindrical pegs  14  of a given paddle  12  with the two or more mounting pegs  14  aligned parallel or perpendicular to the longitudinal edge  22  of the pegboard  18  extending generally along the longest dimension of the pegboard  18 . 
         [0026]    The holes  16  extend along axes that are generally perpendicular to a generally planar top face  20  of the pegboard  18 , the latter of which may be constructed of a polymer material such as extruded polyethylene. The pegboard  18  may be attached to the upper surface of a surgical table or the like through clamps to present a generally horizontal upper surface. The ends  24  of the pegboard  18  are tapered to, reduce pressure points on the patient that may extend off the end of the board. 
         [0027]    An upper body  15  of each paddle  12  may be constructed from, a solid, homogenous, acetal copolymer (Polyoxymethylene) to provide a generally radiolucent structure. Acetal gives a smooth, low friction surface and rigid support. It can be sterilized at 273 degrees Fahrenheit using a standard medical autoclave. The cylindrical pegs  14  extending from the lower end of the body  15  may be press fit cylindrical aluminum mounting pegs  14  for strength and ease of insertion. 
         [0028]    In one embodiment, the paddle  12  may have a width of four inches, a height of at least live inches and desirably being provided in regular sizes of six, nine, and 12 inches and a thickness of two inches. The body of the paddle  12  has a noncircular cross-section for most of its height, as visible from the bottom view of  FIG. 1 c    providing a substantially flat face  17  extending horizontally along an axis  21  and vertically from the pegboard  18  when the paddle  12  is installed in the pegboard  18 . Generally, this flat face  17  continues by at least two inches in width horizontally along axis  21  without deviation perpendicular to axis  21  by more than a quarter inch and preferably without deviation by more than ⅛ inch along its horizontal extent. Deviation from absolute flatness recognizes some compliance in the skin and tissue of the patient yet still provides a greatly reduced pressure such as could create pressure ulcers. 
         [0029]    The width of the paddle  12  is sufficient along axis  21  to support two cylindrical pegs  14  each having a one-inch diameter separated on center by two inches, a center point between the two cylindrical pegs  14  centered in the cross-section. In this regard, the body of the paddle  12  conforms generally to a rectangular parallelepiped rounded on its left and right edges and, top surface with a one-inch diameter radius having four vertical sidewalls when the paddle  12  is installed in the pegboard  18  oriented as described above. 
         [0030]    Two aluminum pegs  14  protruding from the bottom of the paddle  12  give a high-strength mounting system that is easy to assemble. The aluminum pegs  14  extend approximately 2.5 inches into the bottom of the paddle  12  (and thus 2.5 inches above the surface of the pegboard  18  when the paddle  12  is installed on the pegboard  18 ) giving the paddle  12  sufficient mechanical support without interfering with typical x-ray requirements for total hip arthroplasty in the upper body  15 . Specifically, the entirety of the paddle  12  above 2.5 inches over the surface of the pegboard  18  may be substantially transparent to x-rays. The use of multiple mounting pegs  14  eliminates rotation of the paddle  12  resulting in more controlled support of the patient. 
         [0031]    Paddles  12  are designed in several configurations (angled, tapered, curves and projections, straight, extensions, differing, heights) as shown for specific uses and correct anatomical interface with the patient. For example, as shown in  FIG. 2 , the left and right sides of the paddle  12  may include concave cutouts  26 , for example, so that the paddle  12  may fit between the patient&#39;s legs with the legs lying within the approximately equal diameter cutouts  26 . The cutouts are in the narrow vertical walls of the paddle  12  preserving a broader face for high-pressure contact with the patient. 
         [0032]    Referring to  FIGS. 3 and 4 , the invention also can provide extender paddles  12  having upwardly open secondary holes  30  (flat bottomed blind bores) that may receive the pegs  14  of another paddle  12  to extend the other paddle  12  upward in height either in a straight line or at an angle. So for example, the holes  30  of the extender of  FIG. 3  are axially aligned with the pegs  14  while the holes  30  of the extender of  FIG. 4  are canted at approximately 45 degrees with respect to axes of the pegs  14  within a plane of separation of the pegs  14 . Although the look of the upper portion of the paddles  12  will have angles and edges suited to a specific application, the wide flat surface on the face of the paddle  12  and the unique shape of the base of the paddle  12  preserve the benefits described above. 
         [0033]    Referring now to  FIG. 5 , in one embodiment, the paddles  12  may have downwardly extending cylindrical pegs  14  that are formed integrally with the upper body  15  of the paddle  12 , for example, as machined out of a single block of polymer material. In all other respects the dimensions of the paddle  12  may be the same as that described above with respect to  FIG. 1 . Although not shown, certain paddles  12 , particularly those which will not have substantial torques about a vertical axis, may have a single downwardly extending cylindrical pegs  14  centered on a central axis of the upper body  14   
         [0034]    Certain terminology is used herein for purposes of reference only, and thus is not intended to be limiting. For example, terms such as “upper”, “lower”, “above”, and “below” refer to directions in the drawings to which reference is made. Terms such as “front”, “back”, “rear”, “bottom” and “side”, describe the orientation of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology may include the words specifically mentioned above, derivatives thereof, and words of similar import. Similarly, the terms “first”, “second” and other such numerical terms referring to structures do not imply a sequence or order unless clearly indicated by the context. 
         [0035]    When introducing elements or features of the present disclosure and the exemplary embodiments, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of such elements or features. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements or features other than those specifically noted. It is further to be understood that the method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed. 
         [0036]    It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein and the claims should be understood to include modified, forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims. All of the publications described herein, including patents and non-patent publications are hereby incorporated herein by reference in their entireties.