Abstract:
A brace for reducing a metacarpal fracture is presented. The brace comprises a palm plate and a finger trough for receiving a finger having a metacarpal fracture. The trough couples to the palm plate at a proper angle of flexion for reducing the fracture. An individual places the brace on the plamar side of their hand and places the finger having the fracture in the trough. A fastening system holds the brace in a stable position on the hand. The trough maintains the metacarpal-phalangeal joint at the proper angle of flexion while also maintaining necessary axial compression along the finger to reduce the fracture.

Description:
[0001]    This application claims the benefit of priority to U.S. provisional application having Ser. No. 60/998,311 filed on Oct. 7, 2007. This and all other extrinsic materials discussed herein are incorporated by reference in their entirety. Where a definition or use of a term in an incorporated reference is inconsistent or contrary to the definition of that term provided herein, the definition of that term provided herein applies and the definition of that term in the reference does not apply. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The field of the invention is fracture reduction technologies. 
       BACKGROUND 
       [0003]    Metacarpal fractures, a boxer&#39;s fracture for example, are difficult to correct because the metacarpal-phalangeal (MP) joint should be immobilized at a proper flexion angle (e.g., about 90 degrees) to promote proper healing. The standard reduction technique for a boxer&#39;s fracture includes flexing the little finger&#39;s MP joint to 90 degrees and pushing axially along the finger to place the fracture in a proper position for healing. Once in position, the MP joint and finger should remain immobilized until healing is complete after six to twelve weeks. 
         [0004]    Various braces for immobilizing the MP joint and finger in response to a metacarpal facture are commonly available. One example is U.S. Pat. No. 4,294,237 to Frazier titled “Splint for Reducing Fractures of the Metacarpals” filed on Dec. 26, 1979, which describes using a pressure plate to reduce the apex of a broken metacarpal. Another example includes U.S. Pat. No. 4,366,812 to Nuzzo titled “Adjustable Digital and Metacarpal Splint Apparatus” filed on May 26, 1981, which discloses the use of an elongated splint having an adjustable position. Yet another example is U.S. Pat. No. 4,662,364 to Viegas et al. titled “Method and Brace to Immobilize Fractures” filed on Apr. 2, 1985, which discusses using pads on an adjustable brace to apply pressure in a desired area of a facture. And yet another example includes U.S. Pat. No. 4,813,406 to Ogle titled “Orthopedic Splint Arrangement” filed on Aug. 6, 1986, which describes using a ring-like splint to immobilize a portion of the body, including a digital member. These and other braces fail to achieve proper fracture reduction due to the hypothenar pad and required pressure on the palmar side of the MP joint, thereby immobilizing the MP joint in extension. Keeping the MP joint in extension can cause permanent extension contracture. Although the above braces have found their respective niches in the market, they collectively fail to offer the standard reduction maneuver for a metacarpal fracture over an extended period of time and, among other issues, fail to allow for mobility of remaining fingers. 
         [0005]    Ideally a brace for reducing a metacarpal fracture would immobilize the MP joint and finger at a proper flexion angle for extended periods of time while also allowing the remaining fingers on the hand to have a high degree of mobility. It has yet to be appreciated that a brace can be constructed where the MP joint is held at proper flexion angle while also applying an axial pressure along the finger to reduce the fracture. 
         [0006]    Thus, there is still a need for braces that reduce metacarpal fractions. 
       SUMMARY OF THE INVENTION 
       [0007]    The present invention provides apparatus, systems and methods in which a metacarpal fracture (e.g., a boxer&#39;s fracture) can be secured using a brace to reduce the fracture. The brace includes a palm plate and a finger trough coupled to the palm plate at a proper angle of flexion. The brace can also include a support tube that can be placed around the finger having the fracture. The tube and finger can be inserted into the trough. An adjuster coupled to the trough can position the tube by moving the tube axially toward the head of the fractured metacarpal causing the finger to apply appropriate axial compression to the fractured metacarpal, restoring it to a proper position. The brace also preferably includes a fastener system that holds the palm plate and trough in a stable position on an individual&#39;s hand. In a preferred embodiment, the palm plate, trough, and support tube are substantially radiolucent. 
         [0008]    In one aspect of the inventive subject matter, the brace can include an additional trough for immobilizing a finger adjacent to the finger having the fractured metacarpal. In some embodiments the additional trough is removeably affixed to the palm plate, and possibly to the first finger trough, to support manufacturing a single brace design that can operate on either the left or right hand. 
         [0009]    Various objects, features, aspects and advantages of the inventive subject matter will become more apparent from the following detailed description of preferred embodiments, along with the accompanying drawings in which like numerals represent like components. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         [0010]      FIG. 1  is a schematic of a hand having a metacarpal fracture. 
           [0011]      FIG. 2A  is a schematic of a brace having a finger trough coupled to a palm plate at a proper flexion angle with respect to the palm plate. 
           [0012]      FIG. 2B  is a schematic of a brace having multiple finger troughs. 
           [0013]      FIG. 3  is schematic of a brace having support tube disposed within a finger trough. 
           [0014]      FIG. 4  is a schematic of fracture reduced by the contemplated brace. 
           [0015]      FIG. 5  is a schematic of a hand wearing a brace strapped to a hand via a fastening system. 
       
    
    
     DETAILED DESCRIPTION  
       [0016]    In  FIG. 1 , hand  105  has experienced a metacarpal fracture  100 , for example a boxer&#39;s fracture. Fracture  100  can be reduced by the use of a brace that induces a proper angle of flexion (e.g., about a 90 degree flexion angle) at MP joint  125  located between phalanges  120  and metacarpal  180 . The brace can also be constructed to apply an axial pressure along phalanges  120  to reduce the apex of fracture  100 . 
       Brace Overview 
       [0017]    In  FIG. 2A , brace  200  comprises palm plate  210  and finger trough  230  that provide for proper reduction of a metacarpal fracture. Palm plate  210  preferably is placed on the palmar side of a hand having a metacarpal fracture. The finger associated with the metacarpal fracture is inserted into trough  230 . Finger trough  230  and plate  210  cause the finger to reside at a proper angle of flexion. 
         [0018]    Palm plate  210  approximately defines a plane that is roughly parallel to the metacarpals of the hand having the fracture. The angle of flexion provided by finger trough  230 , as discussed below, is described with respect to the plane of plate  210  for ease of description. However, one skilled in the art will recognize that angle of flexion provided trough  230  also corresponds to a proper angle of flexion at the MP joint of the fracture. 
         [0019]    Although plate  210  is illustrated as flat, it should be noted that palm plate  210  can be also be contoured to fit a human hand. It is also contemplated that palm plate  210  can be manufactured out of a moldable material to allow for custom fitting plate  210  to the hand having a fracture. An example of an acceptable material includes KYDEX® Thermoplastic Sheets available from Kleerdex Company, LLC. 
         [0020]    Finger trough  230  is preferably coupled to palm plate  210  to form a proper flexion angle for a fracture. As used herein “a proper flexion angle” should be broadly interpreted to include angles that provide sufficient flexion for adequate healing of a metacarpal fracture. In a preferred embodiment, a proper flexion angle includes flexion angles between about 70 degrees to about 100 degrees, inclusively. In a more preferred embodiment to address a boxer&#39;s fracture, a proper flexion angle is between about  85  degrees to about 95 degrees, inclusively. In yet more preferred embodiments, the proper flexion angle is about 90 degrees. One skilled in the art will recognize that other angles are also possible depending on the nature or location of the fracture, all of which are contemplated. 
         [0021]    One should note the value of having a brace that maintains the proper angle of flexion at the MP joint. When the MP joint is in flexion during healing, the collateral ligaments on either side of the MP joint remain flexed thereby ensuring the finger and hand retains flexibility after the fracture has healed. Otherwise, if the MP joint is in extension during healing, the collateral ligaments could tighten causing loss of mobility of the finger or permanent contracture. 
         [0022]    In some embodiments, trough  230  and plate  210  are molded as a single work piece. For example, brace  200  could be formed through an injection mold process. It other more modular embodiments, trough  230  could be a separate component that couples to the plate  210  mechanically (e.g., slot and tabs, bolts, snaps, etc . . . ) or chemically (e.g., glue, thermal, etc . . . ) to form a rigid bracing structure. It some embodiments, trough  230  can have its flexion angle adjusted as desired for a patient. For example, in embodiments where brace  200  is a single work piece and is formed from a thermoplastic, brace  200  can be heated and trough  230  can be adjusted to a proper angle of flexion. In modular embodiments, trough  230  can be attached to plate  210  at a desirable angle. 
         [0023]    In a preferred embodiment, trough  230  is configured to restrict or otherwise immobilize a finger disposed within the trough. Finger movement can be restricted using any suitable method. In some embodiments, finger trough  230  can be tapered to hold the finger tightly. Additionally, trough  230  can be formed with an overly small diameter and having an open face as shown in  FIG. 2A . When a finger is inserted into such a trough, the sides of trough  230  expand to receive the finger while also splinting the finger. In yet another embodiment, the finger can be wrapped in padding, possibly initially disposed within trough  230 , to provide a snug fit within trough  230 . 
         [0024]    Trough  230  also preferably applies axial pressure (e.g., force along the finger toward the MP joint) to a finger. For example, in embodiments where trough  230  it tapered, a finger within the trough is forced back toward the MP joint in a reduction maneuver where the finger is pushed against the metacarpal head to reduce the fracture. The same axial pressure can also be achieved through the use of padding. 
         [0025]    In yet another embodiment, brace  200  can include an additional support tube that can be disposed within trough  230 . The support tube can also be used to restrict movement of a finger and apply axial pressure. For example, the position of the support tube can be adjusted by positioning the tube at different points along stops  220 . Support tubes are discussed in greater detail below. 
         [0026]    One skilled in the art will appreciate that trough  230  can take on many different forms while still falling within the scope of the inventive subject matter. For example, trough  230  can be a full, hollow cylinder that substantially covers a received finger, or trough  230  can have one or more open faces as shown. It is also contemplated that trough  230  can include one or more vents or other holes to allow free flow of air in and around a finger disposed in trough  230 . 
         [0027]    In a preferred embodiment, brace  200  having plate  210  and trough  230  are manufactured to fit either the left or right hand. Brace  200  can be customized at the time of use to provide a proper fit. For example, when brace  200  comprises a thermoplastic, brace  200  can be heated and then molded to fit comfortably on an individual&#39;s hand. Once cooled, brace  200  will again be rigid and provide the necessary support or reduction. 
         [0028]      FIG. 2B  presents an additional exemplary embodiment of brace  200  having multiple finger troughs  230  and  230 B. Finger trough  230 B also provides further movement restriction by restricting the movement of adjacent fingers to the finger having a fracture. For example, a little finger can be placed within trough  230  while a ring finger is placed in trough  230 B. 
         [0029]    Finger trough  230 B also preferably couples to palm plate  210  in a similar fashion as trough  230 ; molded as a single unit, mechanically coupled, or chemically coupled. In some embodiments, trough  230 B is a separate component that can be coupled on either side of trough  230 . For example, trough  230 B can be removeably affixed to palm plate allowing for replacement or for adjusting placement (e.g., location or flexion angle) of trough  230 B. Such an approach also provide for creating a brace that can be used on either hand. 
         [0030]    Trough  230 B can also couple to trough  230  to prevent relative movement of fingers disposed within the troughs. The troughs can be coupled mechanically (e.g., straps, snaps, screws, etc . . . ), chemically (e.g., glue, thermal setting, etc . . . ), or other coupling method. 
         [0031]    Toughs  230  and  230 B preferably can be formed having a “U” shape or “C” shape cross section where the open face allows for easy viewing of fingers disposed within the troughs. As a practitioner fits an individual with brace  200 , the practitioner can determine if the fingers and hand have good capillary refill by visually inspecting the finger nail beds through the open faces of the trough. 
       Support Tube 
       [0032]    In  FIG. 3 , brace  300  comprises palm plate  310 , trough  330 , and an additional, optional support tube  340  that can be inserted within finger trough  330 . Support tube  340  is configured to be disposed within trough  330  and to slide axially within the trough toward palm plate  310  to apply sufficient axial pressure to reduce a metacarpal fracture. Brace  300  can apply axial pressure to a finger by positioning tube  340  within trough  330  to a desired position. Adjuster  350  can be used to lock tube  340  in a substantially fixed position to maintain axial compression. 
         [0033]    Support tube  340  can comprise a rigid material that can be placed around a finger having a metacarpal fracture and can function as a finger splint. As describe previously with respect to finger troughs, tube  340  can also take on many different forms to restrict movement of the finger. For example, tube  340  can be tapered or made overly small to tightly wrap around the finger. Additionally, padding can be used in conjunction with tube  340  to immobilize the finger. It is also contemplated that tube  340  can comprise flexible material or could even, in fact, be the padding itself. Regardless of the material used to construct tube  340 , preferably tube  340  provides for sliding within trough  330  to a desired position to apply proper axial pressure. 
         [0034]    In some embodiments, tube  340  couples to trough  330  with a preferred orientation to provide for proper reduction. For example, tube  340  can include rails that slide within tracks placed within trough  340 , or vice versa. The rails and tracks can be configured to only support a single configuration of tube  340  and trough  330 . 
         [0035]    In a preferred embodiment, support tube  340  is adjustable to receive fingers of different dimensions. Providing a “one size fits all” tube  340  reduces manufacturing costs while also ensuring that tube  340  offers necessary support. For example, tube  340  could be produced with an overly small diameter, having flexible walls, and an open face. Such a tube expands to accommodate an inserted finger. Alternatively, tube  340  can made to have a larger diameter and can include one or more tightening elements (e.g., straps, clasps, snaps, etc . . . ) to adjust or to secure tube  340  to the finger. Furthermore, tube  340  can be made overly long where excess material can be removed from the end of tube  340  to shorten its length to accommodate comfortably shorter fingers or smaller hands. 
         [0036]    Embodiments employing tube  340  preferably include tube adjuster  350  coupled to tube  340  and trough  330 . Adjuster  350  is configured to position support tube  340  at a substantially fixed position within trough  330  to ensure that tube  340  maintains a proper axial compression or angle of flexion during healing. As shown in  FIG. 3 , adjuster  350  can include peg  353  and one or more pairs of slots  355 . Peg  353  can be inserted into slots  355  to prevent tube  340  from sliding out of position where the counter force of the finger causes tube  340  to rest against peg  353 . It is also contemplated that tube  340  could include slots through which peg  353  could penetrate to hold tube  340  in a fixed position relative to trough  330 . 
         [0037]    It should be noted that other forms of adjuster  350  can be used while still falling within the scope of the inventive subject matter. For example, tube  340  and trough  330  can couple to each other via a rack and pinion assembly. The rack can be placed on a surface of tube  340  or on a surface of trough  340  (see stops  220  of  FIGS. 2A and 2B ). As the pinion of the adjuster is rotated, tube  340  can travel along the rack to a desirable position that provides proper axial compression. Use of a rack and pinion assembly provides for fine grained adjustment of the axial pressure supplied by tube  340  to reduce the metacarpal fracture. 
         [0038]    Preferably adjuster  350 , regardless of its form, includes a lock that locks support tube  340  at a substantially fixed position. The lock can simply prevent slipping in a distal direction as shown by peg  353 . Alternatively the lock can prevent any relative movement of tube  340  within trough  330 . As shown, peg  353  is locked into positing by slots  355  and via a hook that latches into a slot to prevent peg  353  from sliding out or becoming lost. Additionally, peg  353  can pass through tube  340  to prevent any relative movement between tube  340  and trough  330 . Another example of a lock useful in embodiments having a rack and pinion adjuster includes using a pawl to lock the pinion and prevent tube  340  from sliding freely within trough  330 . 
       Reduction of Metacarpal Fracture 
       [0039]      FIG. 4  illustrates reduction of metacarpal fracture  400  on hand  405  through the use of a brace comprising palm plate  410 , trough  430 , and support tube  440 . The finger having fracture  400  is placed within support tube  440  which in turn is placed within trough  430 . Axial pressure is applied to the finger by adjusting the position of tube  440  using adjuster  450 . The rigid support provided by palm plate  410  and trough  430  ensures that the MP joint maintains proper flexion angle  470  relative to metacarpal  480 . Tube  440  also maintains proper axial compression while the brace is worn. 
         [0040]    Although  FIG. 4  illustrates the use of a support tube  440 , it should be noted that tube  440  could be omitted from the brace. For example, the finger could be disposed directly within trough  430  without additional support. In some embodiments lacking support tube  440 , the finger disposed within trough  430  is wrapped or at least partially covered by padding (e.g., foam). It is also contemplated the padding can be disposed on the inner surface of trough  430  as previously described. 
         [0041]    In  FIG. 5 , hand  505  is wearing a brace  500  that is configured according to the disclosed inventive subject matter. In the example shown, the little finger of hand  505  has experienced a boxer&#39;s fracture and is properly reduced by brace  500 . The little finger and ring finger of hand  505  are placed within troughs  530  to restrict or otherwise immobilize the fingers. Troughs  530  are coupled to palm plate  510  and together and form a proper flexion angle to promote healing. Brace  500  is secured to hand  505  via a fastening system that holds plate  510  and trough  530  in a stable position to maintain a proper standard reduction position for an extended period of time. The fastening system preferably also allows an individual to remove the brace when desirable for various activities including cleaning the hand, showering, or other circumstances. 
         [0042]    A brace fastening system preferably binds brace  500  to hand  505  without substantially restricting movement of the thumb, index finger, or middle finger. In some embodiments having a single trough for the little finger, the ring finger is also free to move. In a preferred embodiment, the fastening system includes a plurality of straps  560  that can wrap around the back of the hand, around the thumb, and attach to palm plate  510 . Suitable material for straps  560  comprise hook and loop fasteners including Velcro® brand fasteners 
         [0043]    One skilled the art will appreciate that brace  500  can include numerous variations while still falling within the scope of the inventive subject matter. For example, brace  500  can be made from various materials to provide advantageous characteristics, can comprise modular components, or can comprise adjustable parts. 
         [0044]    Brace  500  preferably comprises a rigid material that can support hand  505  during healing. Preferred rigid materials also offer the ability to customize brace  500  to the shape or contours of hand  505 . For example, brace  500  can be comprised of thermoplastic that can be heated and molded to a person&#39;s hand. In addition, preferred materials can include radiolucent materials that allow a practitioner to adjust brace  500  for proper reduction while viewing a fracture via a radiographic image or through live fluoroscopy. 
         [0045]    Although in a preferred embodiment plate  510  and one or more of troughs  530  are formed as a single work piece, it is also contemplated that Brace  500  can comprise modular components. For example plate  510 , a support tube, and trough  530  can be produced separately according to various sizes and shapes. The individual components can be combined or locked together in desirable positions or angles to form brace  500 . A module brace system allows for addressing a wide range of hand or finger dimensions as well as for addressing extreme scenarios where a “one size fits all” brace would not be practical. 
         [0046]    It is also contemplated that the components of brace  500  can be individually adjustable. In some embodiments, the various components (e.g., plate  510 , troughs  530 , a support tube, etc . . . ) are manufactured as being overly large including excess material. Excess material can be removed so that brace  500  properly fits a specific hand. In other embodiments, the components can include tightening elements to ensure snug fits as previously discussed. 
         [0047]    It should be apparent to those skilled in the art that many more modifications besides those already described are possible without departing from the inventive concepts herein. The inventive subject matter, therefore, is not to be restricted except in the spirit of the appended claims. Moreover, in interpreting both the specification and the claims, all terms should be interpreted in the broadest possible manner consistent with the context. In particular, the terms “comprises” and “comprising” should be interpreted as referring to elements, components, or steps in a non-exclusive manner, indicating that the referenced elements, components, or steps may be present, or utilized, or combined with other elements, components, or steps that are not expressly referenced. Where the specification claims refers to at least one of something selected from the group consisting of A, B, C . . . and N, the text should be interpreted as requiring only one element from the group, not A plus N, or B plus N, etc.