1. Technical Field
The present disclosure relates to cannulated surgical instruments. More particularly, the present disclosure relates to surgical instruments or implants used in conjunction with guidewires having enlarged heads, and to methods for using the same.
2. Brief Description of the Related Art
Rods or nails are used in a variety of surgical procedures, such as to treat fractures of long bones in the body. For example, an intramedullary (or “IM”) rod or nail is a metal rod that can be inserted into the medullary cavity of a bone to bridge a fracture and aid in the healing process.
In one surgical technique used for intramedullary nail implantation, a guidewire with a spherical or ball tip is surgically introduced to the medullary cavity of a bone to bridge a fracture. A guidewire tube is then passed over the inserted ball tip guide wire. With the guidewire tube now bridging the fracture gap, the ball tip guidewire is removed from the tube and medullary cavity. A smooth guidewire is then inserted into the hollow guidewire tube, and the tube is removed to leave only the smooth guidewire in the medullary cavity of the bone. The smooth guidewire can then be used to guide an intramedullary nail into the medullary cavity by passing the cannula of the nail over the smooth wire as the nail is inserted. Once the nail is properly placed and secured, the smooth guidewire is removed through the nail cannula. This technique may be referred to as a “wire exchange” technique because the ball tip guidewire is exchanged for the smooth guidewire before insertion of the IM nail.
This wire exchange technique is typically performed because the size of the cannula in a traditional intramedullary nail is insufficient to allow passage of the enlarged head of a ball tip guidewire through the cannula. In a recent generation of intramedullary nails, however, improved designs and materials may allow for a larger nail cannulation which is sufficient to allow an enlarged head or ball tip of a guidewire to pass therethrough. Because the nail cannula is smaller than a typical guidewire tube, these recent designs may result in the ball tip becoming stuck or “hung up” when the shoulder between the ball tip and the wire shaft of the guidewire engages a lip or sharp edge of the distal terminus of the cannula.
To prevent the possibility of the ball tip guidewire becoming stuck as it is pulled proximally into the cannula, a surgeon may choose to perform a “wire exchange,” thereby foregoing a savings in time that would result from using the ball tip guidewire as the guidewire for the intramedullary nail. Conversely, a surgeon attempting to save time in this manner may find that the ball tip of the guidewire becomes stuck at the distal end of the cannula.
What is needed is an intramedullary nail design in which a ball tip guidewire can be reliably used during the implantation of a surgical instrument, throughout the implantation procedure and without the need for a wire exchange.
The present disclosure provides a distal tip wire relief section which may be applied to any cannulated instrument or implant requiring the use of a guidewire with an enlarged head, such as a ball tip guidewire used in conjunction with an intramedullary nail. The implant incorporates an enlarged opening at the leading or distal portion of the cannula. The enlarged opening is selectively placed about the periphery of the distal portion to allow opening relief in areas where guidewire removal will be facilitated. Thus, a surgeon can reliably and repeatedly remove the guidewire after implantation of the implant by pulling the enlarged head of the guidewire proximally into and through the cannula.
In one embodiment, a surgical device is used with a guide wire having an enlarged tip. The device includes an elongated body with an internal wall, a proximal end and a distal end, the elongated body defining a longitudinal cannula spanning the proximal end and the distal end. The internal wall defines an enlarged distal opening providing a distal access to the cannula, the enlarged distal opening having a maximum radial extent that is larger than the maximum radial extent of a corresponding proximate portion of the cannula. The internal wall also defines a continuous transition between the enlarged distal opening and the cannula, so that the opening is adapted to slidingly receive the enlarged tip of the guide wire.
In one aspect, the guide wire may have a ball tip with a maximum radial extent that is smaller than a maximum radial extent of the cannula. The guide wire may further include a wire shaft having a radial extent, so that a difference between the radial extents of the wire shaft and the ball tip is less than a difference between the radial extents of the ball tip and the cannula.
In another aspect, the surgical device may be a surgical implant, such as an intramedullary nail, for example. Alternatively, the surgical device may be a reamer.
In another aspect, the enlarged distal opening may be concave. The enlarged distal opening may also extend around less than the entirety of the periphery of the internal wall.
In yet another aspect, the elongated body may include a lead-in portion at the distal end, the lead-in portion defining an oblique angle with respect to a centerline of the elongated body.
In another embodiment, a method of placing a surgical instrument in a bone is provided and includes: guiding a guide wire with an enlarged distal tip along a path leading into a medullary cavity of a bone; providing a surgical instrument with a cannula and an enlarged relief portion at a distal end of the cannula, the distal relief portion having a radial extent that is larger than both of i) a maximum radial extent of the cannula proximate the distal relief portion and ii) a maximum radial extent of the enlarged tip of the guide wire; inserting the surgical instrument into the medullary cavity of the bone by guiding the cannula over the guide wire and moving the surgical instrument along the path of the guide wire; and, after the step of inserting the surgical instrument, removing the guide wire from the surgical instrument while the surgical instrument remains in the medullary cavity of the bone.
In one aspect, the step of providing the surgical device with a cannula and a relief portion includes providing a surgical device with a cannula and a concave relief portion.
In another aspect, a difference between the radial extents of the enlarged tip and the wire shaft of the guidewire is less than a difference between the radial extents of the enlarged tip and the cannula.
In another aspect, the step of providing a surgical device may include providing a surgical implant, such an intramedullary nail, for example. Alternatively, the step of providing a surgical device may include providing a reamer.
In yet another aspect, the enlarged distal opening extends around less than the entirety of the periphery of the internal wall of the surgical instrument at the distal end.
In another embodiment, an intramedullary nail for implantation within a bone is provided and includes a nail having a distal end, a proximal end, and a longitudinal centerline extending between the distal and the proximal end. An internal wall of the nail bounds a bore extending through the nail along the centerline, with the bore having a maximum transverse extent. A lead-in portion is disposed at the distal end of the nail, with the lead-in portion defining a distal face at an oblique angle with respect to the centerline, the distal face having an enlarged opening therein leading to the bore. The enlarged opening has a maximum transverse extent that is greater than the maximum transverse extent of the bore, so that the distal face defines a ramped guide surface and the enlarged opening provides a continuous transition between the internal wall and the distal face.
In one aspect, the opening in the distal face may be an ellipsoidal opening. The enlarged distal opening may also be concave. Further, the enlarged distal opening may extend around less than the entirety of the periphery of the internal wall.
The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following descriptions of embodiments of the invention taken in conjunction with the accompanying drawings, wherein:
Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate preferred embodiments of the invention and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
Referring to
Referring generally to
Guidewire 12 has enlarged ball tip 14 at its distal end. Referring to
In the exemplary embodiment of
As best seen in
In an exemplary embodiment, as best seen in
Although relief 18 is shown extending only partially around the periphery of opening 28 in IM nail 10, it is within the scope of the present disclosure that relief 18 can vary according to the needs of a particular embodiment or surrounding geometrical configuration.
Referring again to
When guidewire 12 is disposed within cannula 22 and ball tip 14 is extended beyond opening 28 (
Referring now to
Advantageously, an intramedullary nail or other surgical instrument or implant may be used throughout a surgical procedure without the need for a “wire exchange.” A surgeon can pass a guidewire with an enlarged head, such as guidewire 12 with ball tip 14, into a medullary canal to span a fracture gap. Rather than passing a temporary tube over the enlarged-head guidewire, removing the enlarged-head guidewire, and then inserting a smooth guidewire in its place, the enlarged-head guidewire may be left in place and the surgical implant installed directly over the guidewire without concern that the enlarged head of the guidewire will become stuck outside the distal end of the cannula.
Also advantageously, a surgical instrument with an enlarged distal opening in accordance with the present embodiment may be used without a wire exchange, even where the instrument has a relatively small cannulation size. Using IM nail 10 as an example and referring to
While this invention has been described as having a preferred design, the present invention can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains and which fall within the limits of the appended claims.
Number | Name | Date | Kind |
---|---|---|---|
3892233 | Vestby | Jul 1975 | A |
4552554 | Gould et al. | Nov 1985 | A |
4628920 | Mathys, Jr. et al. | Dec 1986 | A |
4913137 | Azer et al. | Apr 1990 | A |
5034013 | Kyle et al. | Jul 1991 | A |
5100404 | Hayes | Mar 1992 | A |
5364393 | Auth et al. | Nov 1994 | A |
5624446 | Harryman, II | Apr 1997 | A |
5855579 | James et al. | Jan 1999 | A |
5968048 | Harder | Oct 1999 | A |
6123708 | Kilpela et al. | Sep 2000 | A |
6296645 | Hover et al. | Oct 2001 | B1 |
6592531 | Bonutti | Jul 2003 | B2 |
6702823 | Iaia | Mar 2004 | B2 |
6709436 | Hover et al. | Mar 2004 | B1 |
6808527 | Lower et al. | Oct 2004 | B2 |
7232442 | Sohngen et al. | Jun 2007 | B2 |
7527627 | Ferrante et al. | May 2009 | B2 |
D611225 | Khalil et al. | Mar 2010 | S |
7670340 | Brivio et al. | Mar 2010 | B2 |
7771428 | Siravo et al. | Aug 2010 | B2 |
20020103488 | Lower et al. | Aug 2002 | A1 |
20060015110 | Pepper | Jan 2006 | A1 |
20060084999 | Aschmann | Apr 2006 | A1 |
20060095039 | Mutchler | May 2006 | A1 |
20070049940 | Wallace et al. | Mar 2007 | A1 |
20070265628 | Kraus et al. | Nov 2007 | A1 |
20070276385 | Schlienger et al. | Nov 2007 | A1 |
20080009869 | Schlienger et al. | Jan 2008 | A1 |
20080287949 | Keith et al. | Nov 2008 | A1 |
20090088752 | Metzinger et al. | Apr 2009 | A1 |
20090182278 | Eversull et al. | Jul 2009 | A1 |
20090306666 | Czartoski et al. | Dec 2009 | A1 |
20100094292 | Parrott | Apr 2010 | A1 |
20100174284 | Schwammberger et al. | Jul 2010 | A1 |
Number | Date | Country |
---|---|---|
WO2009143374 | Nov 2009 | WO |
Entry |
---|
Zimmer Sirus Intramedullary Tibia Nail System—Surgical Technique, Anatomic Nail for Reamed and Nonreamed Technique, 06.00712.062—Rev 1 5MM, 2005. |
Zimmer Sirus INtramedullary Nail System—Brochure, Titanium nails with optimized anatomical designs for femoral and tibial fractures, 97-2290-001-00 5ML, 2005. |
Number | Date | Country | |
---|---|---|---|
20110184417 A1 | Jul 2011 | US |