• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    osteotomy plate, conductive plate, and method for its use An orthopedic plate is specifically configured for use in osteotomies, whose portions of the plates extend into a portion of a first bone segment and the portion is external to the cortical surface of an adjacent bone segment for osteotomy. pin the segment to allow it to merge. the plate has a first end and a second end where the end that is inserted into the bone has a chamber and a through hole having a hole axis optionally at an oblique angle to the longitudinal axis of the plate, and which may receive a screw, peg or pin. The second end of the plate includes a locking screw hole and optionally includes a compression portion extending in one direction to the screw hole at the opposite end. A plate driver having a recess that holds the plate is used to insert the plate into the bone.
    公开号:BR112012000387B1
    申请号:R112012000387-9
    申请日:2010-07-09
    公开日:2019-11-19
    发明作者:B Kay David；R Heavener Jackson；Johnson Jeffrey
    申请人:Orthohelix Surgical Des Inc；
    IPC主号:
    专利说明:

    1/9 “OSTEOTOMY PLATE, DRIVING PLATE AND METHOD FOR ITS USE” CROSS REFERENCE
    This is a US patent application for North American Provisional Application No. 61 / 270,486 filed on July 9, 2009 for ’’ OSTEOTOMY PLATE 5 AND METHOD FOR ITS USE ”, which is fully incorporated by reference.
    FIELD OF THE INVENTION
    The present invention relates to an orthopedic plate, which is configured for the fixation of a bone or bones of the foot, hand or wrist in particular following a process of fusion of adjacent segments or reconstruction, such as various osteotomy procedures. The invention also relates to a surgical conductor that is used to implant the osteotomy plate and a method for using the orthopedic plate and associated conductor in surgical reconstruction.
    BACKGROUND OF THE INVENTION
    The feet and hands both include numerous bones and joints that cooperate together to define human movement par excellence. They are completely sophisticated, delicate and elegant in function and design. Together, the foot and ankle have more than 25k bones and 33 joints, along with more than 100 named muscles, tendons and ligaments and a network of blood vessels, nerves, all of which reside under a relatively thin covering of tissue soft and skin. Structurally, the foot has three main anatomical regions: the forefoot, the midfoot and the hindfoot. These parts work together with the ankle to provide the body with support, balance, and mobility. A structural failure or malfunction anywhere can result in the development of problems, which manifest themselves in other areas of the body. The hand makes a cognate to the foot with 27 bones inside the hand and wrist. There are eight small bones inside the wrist called carpus, which join 25 with the radius and ulna to form the wrist joint. The carpus connect with the five pasterns to form the palm of the hand, which end in the rays (that is, the thumb and fingers), formed by phalanges. The three phalanges on each finger are separated by two joints, called interphalangeal joints (IP joints). The closest to the MCP joint (joint) is called the proximal IP joint (PIP joint). Joint 30 near the end of the finger is called the distal IP joint (AID). The thumb has only one IP joint between the two phalanges of the thumb. The IP joints of the digits also function as hinges when you bend and stretch your fingers and thumb.
    Likewise, the forefoot includes the five toes (which are also known as the phalanges) and their connected long bones (or metatarsals). Several small bones together form a phalanx or toe. Four of the five toes have three phalanx bones, respectively, connected by two joints. The big toe (or hallux) has two bones of the distal and proximal phalanx with an articulation between the cha
    2/9 feed interphalangeal joint. The big toe articulates with the head of the first metatarsal at the joint of the first metatarsophalangeal joint (the MTP joint) and there are two small, round bones called sesamoid on the plantar side of the metatarsal head. The phalanges are connected to the metatarsals on the sole of the foot. The forefoot balances the pressure on the sole of the foot and supports a substantial amount of body weight.
    The bones of the midfoot of the medial to the lateral are from 1 to 3 cuneiform, the cuboid and navicular bone growing later form the wedge, which also form a linkage with the stalks which form the basis for the ankle joint in intersection with hinges of the tibia, fibula, and foot. The five tarsus bones of the me10 diopé act together form a lateral arch and a longitudinal arch, which help to absorb shock. The plantar fascia (arch ligament) wears the midfoot bones and, together with the muscles, forms a connection between the forefoot and the hindfoot. The toes and their associated midfoot bones form from the first to the fifth rays starting with the big toe as the first ray. The bones that make up the webbed portion of the hand are: the scaphoid, the semi-lunar, the pyramidal, the pisiform, the trapezoid, the trapezoid, the capitate, and the hamate, which act together to allow the opposition of the thumb with each one of the fingers and allows the uniquely human ability to manipulate objects.
    , The hindfoot consists of three joints (subtalar, calcaneal and talonavicular) and connects the midfoot to the ankle. The heel bone (or calcaneus) projects posteriorly to the talus and forms a lever arm to activate the articulated action of the foot in order to allow propulsion of the entire body from this joint. The calcaneus is attached to the talus at the subtalar joint. The midfoot is often the object of trauma, such as results of falls, vehicle collisions and discarded objects. These accidents usually result in serious fractures and / or dislocations. In addition, there are several conditions that result from congenital deformation or that arise as a result of repeated use injuries. Surgical intervention, which includes surgical cutting of the bone or an osteotomy is often used to restructure the bones as a treatment for such conditions. For example, the calcaneus translation osteotomy, with which the present invention can be used, is normally used to treat a condition that is the result of adults acquiring flatfoot deformity. The present invention is also useful for conditions of the hand that result from previous trauma, surgical intervention or birth defects or that develop with age (such as rheumatoid arthritis).
    Examples of some of the other procedures with which the present invention can be used include hallus valgus and rigidus hallus corrections and bunionectomies. Other 35 applications that can use the present invention include first and fifth strands of the metatarsal, translational osteotomies, wedge osteotomies, pediatric femoral osteotomies, rotational osteotomies of the metacarpal and calcaneus, intrarticular osteotomies 3/9 and hand and wrist realignment osteotomies .
    Typical surgical treatment of the foot or hand restores normal anatomy, while fractured bones repair. In some cases, fusion of a joint may be necessary, for example, where arthritis arises in a patient due to the use of injuries, poor bones, or rather, unsuccessful surgeries. Current surgical treatment in these conditions requires pins, wires and / or screws to be inserted to stabilize the bones and joints and keep them in place until healing is complete. For example, a pin or screw can be inserted medially into the internal cuneiform and through the base of the second metatarsal bone. While the use of k-wires, pins, and screws can provide acceptable results for younger and more malleable patients, these fixation methods are not always satisfactory.
    SUMMARY OF THE INVENTION
    In accordance with the present invention an orthopedic plate (as well as a conductor for the plate) is provided which can be used to good advantage in an osteotomy. In a first embodiment, the plate has a footprint that is a modified rectangle having a first end with rounded corners, and a longitudinally opposite end with a tip that can include a cone or a crescent shape. Two or three of the four sides of the plate, including both sides in length and, optionally, the proximal end have a protruding tip or rails, which act to stabilize the plate, and which is connected with a thinner flat web of material that includes one or more holes for screws or pins. At the cutting end, the rails can end at pointed insertion tips that are joined by the web, which also includes a tapered cutting surface, or the plate can simply include the tapered tip. In a second embodiment, the plate has a simple footprint-like bar with a first end flap and a second end flap extending along the longitudinal axis of the plate and with decreased waist sections between the flaps. In the first end flap, the plate includes a first portion that is inserted into the cancellous bone. This portion includes a rounded or tapered tapered tip that promotes insertion into the bone. In the second end flap, the opposite part includes a through hole so that the plate can be attached to an extramedullary portion of an adjacent bone segment. Optionally, the plate includes a compression or translation gap, which extends in one direction and causes compression towards a through hole in the opposite spongy flap. The width of the plate decreases between the holes to allow flexing if desired. In other embodiments, the footprint can be more organic in shape, with a rounded tapered insertion surface, an intermediate section that widens to accommodate an angled screw hole and a rounded rear section that includes a second perpendicular screw hole. In a further modification of this board, the board advantageously includes a
    4/9
    angled hole with a mantle that protects the soft tissue of the screw head and helps in the ideal compression of the posterior fragment for certain procedures.The invention can be used in a variety of indications, including for example, osteotomies of the Dwyer osteotomy, cotton osteotomy, TMT fusion isolated 5 , Navicular fracture, Evans osteotomy and rotational osteotomies of the metacarpal, or intrarticular osteotomies or hand and wrist realignment osteotomies. Other applications that can use the present invention include metatarsal first and fifth strands, translational osteotomies, and wedge osteotomies.BRIEF DESCRIPTION OF THE DRAWINGS 10 Figure 1a is a medial view of a foot with an orthopedic plate, according to a first embodiment of the invention positioned for use in a translational calcaneus osteotomy procedure;Figure 1b is a medial posterior view of a foot with another modality of the plate of the present invention, also for use in a calcaneus osteotomy procedure. 15 translation neo;Figure 2 is a top view of the orthopedic plate in Figure 1;Figure 3 is a side view of the plate shown in Figure 2; and Figure 4 is a view of the end of the plate shown in Figure 3; ] Figure 5 is a top view of the plate shown in Figure 2; 20 Figure 6 is a perspective view of the end of the plate shown in Figure 2;Figure 7 is a bottom view of the plate shown in Figure 2;Figure 8 is a side view of the plate shown in Figure 2;Figure 9 is a top view of a second embodiment of the orthopedic plate of the present invention; 25 Figure 10 is a side view of the plate shown in Figure 9;Figure 11 is a view of the end of the plate shown in Figure 10; [Figure 12 is a top view of the plate shown in Figure 9;Figure 13 is a perspective view of the end of the plate shown in Figure 9;Figure 14 is a bottom view of the plate shown in Figure 9; 30 Figure 15 is a side view of the plate shown in Figure 9;Figure 16 is a top view of a third embodiment of the orthopedic plate of the present invention;Figure 17 is a side view of the plate shown in Figure 16;Figure 18 is a view of the end of the plate shown in Figure 17; 35 Figure 19 is a top view of the plate shown in Figure 16;Figure 20 is a perspective view of the end of the plate shown in Figure 16;Figure 21 is a bottom view of the plate shown in Figure 16;
    5/9
    Figure 22 is a side view of the plate shown in Figure 16;
    Figure 23 is a side view of the fourth embodiment of the orthopedic plate of the present invention;
    Figure 24 is a side view of the fifth embodiment of the orthopedic plate of the present invention;
    Figure 25 is a side view of the conductor of the plate of the present invention;
    Figure 26 is a top view of the plate conductor shown in Figure 25
    Figure 27 is a side view of the plate conductor shown in Figure 25;
    Figure 28 is a bottom view of the plate conductor shown in Figure 26;
    Figure 29 is a view of the first conductor end of the plate shown in Figure 25;
    Figure 30 is a view of the second conductor end of the plate shown in Figure 25;
    Figure 31 is a bottom view of the plate loosely connected to the conductor of the plate according to the invention;
    Figure 32 is a side view of the plate and the conductor according to the invention during insertion; and
    Figure 33 is a side view of the plate and the conductor according to the invention during insertion.
    DETAILED DESCRIPTION OF THE INVENTION
    Figure 1 shows a version of the skeleton of a foot on the side with a particularly preferred embodiment of the plate 210 of the present invention in place between the junction of the talus and calcaneus with an angular screw inserted in the Tali Sustentaculum. Thus, Figure 1 illustrates the plaque used in a calcaneus translation osteotomy for the treatment of flatfoot syndrome. Likewise, it can be used to fix other bone segments following osteotomies as mentioned earlier.
    As seen from above in Figure 2, it can be seen that the first embodiment of the plate 10 has a rectangular shape with a first end 12 and an opposite cutting end 14 aligned along the longitudinal axis of the plate. The peripheral ends 16 of the plate are raised on three sides, including the two long sides 18, 19 and on the short square wall 20. These edges form rails that help provide stability to the plate and, in particular, to inhibit the plate torsion during insertion and during the recovery period in which the lesions combine. The rails are rounded at the corners of the short square wall 20. The opposite short wall includes a beveled cut surface 22, which is illustrated as a crescent between the two forward-facing insertion tips 24 that are co-extensive with the edges of the long wall. The plate body is formed by a thinner flat web 25 that extends between the raised edges and
    6/9 includes a number of openings. Preferably, the web 25 includes a first opening 26, or a hole in the portion of the plate that extends to the bone and that accepts a screw or pin, in order to help hold the plate in place and keep it rotating in. of the bone. Behind this, and somewhere beyond midway along the axis of the plate, the plate includes a compression gap 27 that accepts a screw to cause compression in the direction of the first opening. Typically, the compression gap includes a shoulder 28 along its inner edge 29 that slopes in the direction that compression occurs. In the rear portion, towards the square end, the plate includes a locking hole 30, which includes a mechanism for causing locking, such as internal threads that join with external threads on the head of a locking screw to lock this portion from the plate to the extramedullary portion of an adjacent bone fragment.
    In a second embodiment, the plate 110 has a simple profile bar that is composed of a first end with a flap and a second end with a longer flap. The longest flap 112 has a rounded end at its proximal end that tips slightly into the body of the first flap 112, and at the rounded end includes a deep chamfer 115, which is reduced from the side edge of an option card through hole 116 , which can receive a screw or pin that helps to protect the plate in the spongy bone part against rotation or movement. The longest flap also includes an oval or compression gap 120 at the distal end of the first flap. The width of the plate is slightly prone around the gap to preserve the metal that defines the gap (preferably to reinforce the gap to inhibit deformation of the gap during any option of flexing the procedures, or even during insertion. Again the plate capsizes slightly in the transition between the first flap and the second flap and the most distal 114 of the flap pair includes a screw hole 122 (which preferably includes locking means such as internal threads or a variable locking mechanism, to form a locking interface between the plate and the respective bone or bone fragment by means of the rigid fixation of the screw in the screw hole in the plate.) The locking hole optionally also includes grooves for a guide drill. The compression gap is configured so causing compression along the longitudinal axis of the plate towards the locking screw hole. The plate includes 123 incurvatures between the s openings to form abdominal sections that minimize the material used and maximize the fit of the plate, as well as allowing additional contour of the plate in these areas, if desired.
    In a third embodiment, plate 210 corresponds in form and function to the second embodiment. Specifically, it has a first end of the rounded flap having a deep chamfer that allows the plate to be inserted into the bone and a second rounded end having a threaded hole for locking screws. In this hand
    7/9 quality, the compression gap is replaced by a non-blocking screw hole 220 that includes orifice protection 222, forming an arc or a portion of a cylinder raised above the upper surface of the plate body in order to sufficiently support the screw that is received in this orifice and protection of the screw head to help minimize the possibility of irritation of the soft tissues that the screw head could otherwise provide. The protection also provides some support and compression within the bone it projects. The non-blocking hole is angled so that the axis of the screw forms an angle of about 10 ° to 45 °, and preferably about 15 ° to 40 °, and more preferably about 25 ° to about 35 ° from the longitudinal axis and the orifice allows at about 30 °, preferably about 20 °, and more preferably about 15 ° conical rotation of the screw within the screw hole of the plate that is provided to allow the surgeon to capture the sustaculum. This screw is intended to capture the anterior portion of the calcaneus in a calcaneus osteotomy.
    Figures 3 and 4 illustrate the tip in view of the first modality of the plate along a first length and along the second shortest length, which is perpendicular to the first length. As can be seen, the plate web has a thickness that is generally uniform between the inner surface 27 that opposes and optimally, but does not necessarily involve the bones, and the outer surface 29. Likewise, the second modality is illustrated at the tip in the views in Figures 10 and 11 in which it can be seen in this embodiment that the plate is flat and of uniform thickness between the bone surface facing the cortical portion of the plate. Optionally, the inner surface 127 of the plate 110 could include a radius of generally uniform curvature along the longitudinal axis so that the plate would have the shape of a segment of a cylinder that maximizes the ability to place the plate, as desired, without the need for additional pre-surgical contouring for certain applications, although the thickness of the plate allows flexion if necessary. Also, optionally, for this design, the distal end of the plate can be of a larger or thicker radius in width to provide a large shoulder 136 so that the proximal portion of the plate can be guided into the bone.
    Figures 23 and 24 illustrate other modalities 310, 410 of orthopedic plate of the present invention that illustrate how characteristics different from the previous modalities can be combined, including the straight tapered cutting edge, and with the compression gap or with the angled screw hole and protection.
    Figures 25 to 30 illustrate the conductor of plate 500 of the present invention. The conductor 500 includes a support portion of the plate 510, which at one end has a recess or pocket 515 that captures the end of the plate 600 (see Figure 31) having the locking hole. Specifically, the plate holder 510 includes a button 517 associated with an axis 518 that is journaled inside a weld hole 519 in the plate holder 510. The end
    8/9 of axis 518 includes threads that can engage internal threads from the locking hole in the plate to pierce the plate within the plate holder, as well as in relation to the plate conductor. The plate conductor also includes a handle 520 that allows the surgeon to hold the plate conductor. The plate support portion holds the plate with the long axis in line with the long axis of the loop, but offset from the plate that gives the surgeon the best view of the surgical site. In addition, the handle 520 includes fenestrations 522 that lighten the weight of the plate conductor, and at the end of the handle, there is a reinforced area 525, which has a larger flat surface that can be used to touch the plate to the bone. Figures 32 and 33 illustrate a plate 600 being inserted into the cortical section of a calcaneus using the plate conductor 500.
    The screws useful with the plate of the present invention are self-starting, self-tapping screws including the option of partial or total cannulation. The screws include a cutting end having multiple flutes, and preferably 2 or 3 flutes with a tapered recess. The screws also include a partial cone of the inner diameter at the proximal end on some first threads transforms, for example, more than 2-8, and preferably above 3-5 transforms in order to increase the fatigue life of the screw, as well as provide potential physiological advantages in use. The screws also include a torque-carrying recess. The screws have a threaded distal end and a head including a torque driving recess. The locking screw head includes locking means, such as a variable locking mechanism, which could be a chuck that fits with the screw head, in order to lock the screw in relation to the plate at a desired angle, or may include external screw threads that fit with internal threads in the locking screw hole at a pre-selected angle, in this case, the screw axis is perpendicular to the longitudinal axis of the plate. The screw used in the compression gap has a rounded rear edge (like a hemisphere, or a toroid), which fits with the rounded concave fit of the compression gap, in order to maximize the contact surface between the screw head and the inclination geometry of the compression gap. The lateral end of the compression gap also includes an inclined ridge that slopes downwards towards the contact surface of the plate bone and that is engaged by the screw head to make the version of the screw and bone fragment attached along the axis of the plate. gap and towards the locking hole.
    The plate is formed of a biocompatible material and preferably a metal such as surgical grade stainless steel, titanium or a titanium alloy or a chromium-cobalt alloy. Preferably, the web of the plate has a thickness of between about 1.0 and about 2.5 millimeters, more preferably between about 1.5 and about 2 millimeters, and more preferably between about 1.5 and about 1.8 millimeters. The plate includes an elevated continuous outer tip 16 which is defined between the top and the bottom surface and which has a total thickness of
    9/9 about 2 and 5 millimeters, or approximately twice the width of the web portion of the dish.
    In addition, the plate may include a small through hole sized to receive a K-wire or other similar guide.
    During surgery the joints are the first prepped that can include disarticulation between the bones to be fused and removed from any bone, as part of the osteotomy, and, if necessary, the plaque is folded to contour the bone surface. A pilot hole can be drilled into the bone into which the plate is to be inserted. The plate is inserted into the recess of the plate in the plate conductor and secured by clamping the plate upward on the plate holder using the plate holder having an end that has threads that fit with the locking threads of the plate locking hole. The plate is punched into the spongy portion of the bone fragment, optionally touching the conductor of the plate with a one pound hammer as is necessary to insert the plate. The plate must be guided until the recess or receptacle makes contact with the anterior portion of the calcaneus. Once the plate is sunk, a guide drill is attached to the plate unit, and a hole is drilled for the locking screw. The plate can be held in position using olive wires (through the unblocked hole and in the bone). The plate is located in such a way that all screws are intended for the target bones and away from the joint, fracture or bone interface. The olive wire is removed, if any, and a pilot hole is drilled at the end of the plate that includes the first hole and that hole is either fastened or screwed. A second pilot hole can be drilled for the screw without locking at the desired angle given an optional 15 ° tapered rotation inside the hole without locking and a screw without locking is inserted into that pilot hole and tightened. As the screw is tightened in the angled hole, it will conduct the compression towards the melting site and the first hole. The plate allows up to 1.5 mm of compression. Finally, a pilot hole is drilled in the cortical surface of the second bone fragment, for example, using a guide drill, as a guide, including guide keys (ie lobes) that interconnect with corresponding key openings in the lock screw hole. and a locking screw is secured in this hole. The plaque is viewed radiographically, and the soft tissues are closed in the usual manner.
    This invention has been described in detail with reference to specific modalities thereof, including the best respective modes for carrying out each modality. It should be understood that these illustrations are by way of example and not by way of limitation.
    权利要求:
    Claims (4)
    [1]
    1. Osteotomy plate system for use in associated bone, comprising a locking screw having distal threads and a head having external threads, a non-blocking screw having distal threads and a head having a rounded surface, and a plate having the first end and a second opposite end, the second end aligned along a longitudinal axis of the plate (210) and joined by an intermediate section, which has a width in the direction perpendicular to the longitudinal axis, the first end including a non-blocking hole for the screw without locking, and the second end including a locking hole for the locking screw, a third screw having a longitudinal axis and the plate still includes a third screw hole (220), wherein the third screw hole (220 ) does not include internal threads,
    CHARACTERIZED by the fact that the first end ends at a cutting edge and the third screw defines a screw hole axis that forms an angle that is oblique with respect to the longitudinal axis of the plate, in which the third screw hole (220) includes additionally a protection (222).
    [2]
    2. Plate system according to claim 1, CHARACTERIZED by the fact that even though the screw screw axis within the third screw hole (220) can be varied in relation to the screw hole axis by up to 20 ° tapered rotation.
    [3]
    3. Plate system according to claim 1, CHARACTERIZED by the fact that it also includes a plate driver (500) that includes a recess (515) which fixes the plate for insertion into the bone and a handle having a longitudinal axis which protrudes in a direction parallel to the plate when it is placed in the recess.
    [4]
    4. Plate system according to claim 3, CHARACTERIZED by the fact that the plate driver further includes a plate retention part (510) that includes the plate recess and a handle (520) having a longitudinal axis that it projects in a direction parallel to the plate when it is placed in the recess and which is attached to the handle so that when the plate is placed in the recess, the longitudinal axis of the plate is offset from the longitudinal axis of the handle.
    类似技术:
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    Tennant et al.2014|Calcaneus osteotomy
    Berlet et al.2001|Talar neck fractures
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    Lawrence et al.2007|Technical tip: percutaneous fixation of sustentacular fractures of the calcaneus
    Gould2013|Subtalar and Transverse Tarsal Arthritis
    Cornell2012|Advantages of Cannulated
    Keeler et al.2010|Chapter Distal Tibial Osteotomy
    Giannoudis et al.2011|Subtalar Joint Fusion
    同族专利:
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    CA2767643A1|2011-01-13|
    AU2010271102B2|2013-10-17|
    US20170128111A1|2017-05-11|
    CA2767643C|2015-01-20|
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    法律状态:
    2019-01-15| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|
    2019-06-25| B06T| Formal requirements before examination|
    2019-10-01| B09A| Decision: intention to grant|
    2019-11-19| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 09/07/2010, OBSERVADAS AS CONDICOES LEGAIS. (CO) 20 (VINTE) ANOS CONTADOS A PARTIR DE 09/07/2010, OBSERVADAS AS CONDICOES LEGAIS |
    优先权:
    申请号 | 申请日 | 专利标题
    US27048609P| true| 2009-07-09|2009-07-09|
    US12/803,852|US8986353B2|2009-07-09|2010-07-08|Osteotomy plate, plate driver and method for their use|
    PCT/US2010/001936|WO2011005327A1|2009-07-09|2010-07-09|Osteotomy plate, plate driver and method for their use|
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