Patent Application
20070191848
The present invention relates to devices for treating bone fractures. More particularly, the present invention relates to bone plates.
Bone fracture is a common orthopaedic injury. Treatment of bone fractures varies from conservative treatments such as casting to more aggressive treatments including surgical intervention. One surgical intervention commonly used is bone plating. In this procedure, the fracture is exposed by way of an incision, the fracture is reduced to return the bone pieces to their normal anatomical alignment, and a rigid bone plate is placed to bridge the fracture. Screws are installed through the plate and into the bone to achieve rigid fixation of the bone pieces relative to one another.
Bone plate fixation is based on the concept of stress shielding the fracture site to reduce motion of the fracture to promote healing. However, overly stiff fixation may lead to atrophy of the plated bone.
Furthermore, in traditional plating, the screws press the plate against the bone which results in friction between the plate and bone when the fracture site is loaded. This friction can lead to disturbance of soft tissues at the fracture site including soft tissue and periosteal stripping and damage to the periosteal vascular structures. It has been proposed to use limited contact bone plates having a shaped bone contact surface that reduces the bone contact area between the plate and bone to reduce the disturbance of soft tissues by the plate.
Finally, one challenge in the treatment of fractures by plating is bending the plate to fit the underlying bone profile. Conventional plating systems often require extensive intraoperative bending to accommodate the patient's bone geometry.
The present invention provides a bone plate spacer for placement in a gap between a bone plate and an underlying bone to form a fracture fixation construct at a bone fracture site.
In one aspect of the invention, the spacer includes a body including a hydrogel responsive to fluid from the fracture site over time to change the rigidity of the fracture fixation construct.
In another aspect of the invention, the spacer is transformable upon exposure to fluids at the fracture site from an initial relatively more flexible postoperative condition to a subsequent relatively less flexible postoperative condition.
In another aspect of the invention the spacer is able to release fluid under load to hydrodynamically lubricate the spacer/bone interface.
In another aspect of the invention, the spacer is able to swell to conform to the shape of the plate and the shape of the bone to fill a gap between the plate and bone.
In another aspect of the invention, a combination includes a bone plate spacer and a bone plate.
In another aspect of the invention, a method includes: positioning a hydrogel spacer adjacent a bone fracture; placing a bone plate over the hydrogel spacer; and inserting fasteners through the bone plate and hydrogel spacer and into the bone to form a fracture fixation construct including the plate, spacer, fasteners and bone.
Various examples of the present invention will be discussed with reference to the appended drawings. These drawings depict only illustrative examples of the invention and are not to be considered limiting of its scope.
Embodiments of a hydrogel bone plate spacer include a body positionable between a bone plate and a bone to form a fracture fixation construct. The body may be initially rigid postoperatively to provide stress shielding of the fracture to promote fracture healing. The body may become less rigid over time to allow micromotion of the fracture to promote bone formation. For example, the body may include a hydrogel composition that absorbs fluid from the surgical site to transform from an initial relatively rigid postoperative condition to a subsequent relatively less rigid postoperative condition. For example, the body may include an at least partially dehydrated hydrogel in an initial relatively rigid state that softens and becomes flexible upon exposure to body fluids. In this example, the spacer may be installed tightly under the bone plate to initially stiffen the fracture fixation construct to provide stress shielding during initial healing. Softening of the hydrogel over time will result in increasing loads being transferred to the fracture site.
In another example, the spacer body may be initially flexible postoperatively to allow micromotion of the fracture to promote fracture healing. The body may stiffen over time to eventually provide more rigid fixation of the fracture. For example, the spacer may include a hydrogel composition that absorbs fluid from the surgical site to transform from an initial relatively flexible postoperative condition to a subsequent relatively less flexible postoperative condition. For example, the spacer may include an at least partially dehydrated hydrogel that swells upon contact with body fluids to tighten the fracture fixation construct.
For example, the spacer may be installed loosely under the bone plate to provide an initial relatively more flexible fracture fixation construct. As the spacer swells, it fills the gaps between the plate and bone and stiffens the construct. The spacer may include a container for the hydrogel such that the hydrogel swells against the container to stiffen the spacer. For example, the container may include a relatively inelastic, flexible covering that resists stretching but that is easily bent and able to conform to the shape of the bone and bone plate.
The container may include a film, membrane, woven construct, braided construct, and/or other suitable container. The container may be in the form of a bag, sleeve, bonded skin, and/or other suitable form. The container may include metals, polymers, and/or other suitable materials. Polymers may include polylactic acid, polyglycolic acid, polyester, polyolefin, polyimides, polyamides, polyacrylates, poly(ketones), fluropolymers, and/or other suitable polymers. For example, the container may include a relatively woven polyester sleeve sealed around the hydrogel. The container may allow fluid to diffuse into the hydrogel. The container may include a second hydrogel having a different chemical composition and/or a different level of hydration such that the spacer has an inner relatively more expandable hydrogel and an outer relatively less expandable hydrogel. As fluid penetrates to the inner hydrogel it may swell until the container is filled and resists further swelling. This swelling increases the turgidity of the spacer and thereby increases the stiffness of the fracture fixation construct.
The time for the spacer to transform may be a few hours, a few days, a few weeks, or a few months. The transformation time may be controlled by the choice of hydrogel polymers, degree of crosslinking, degree of dehydration, and the permeability of the outer surface of the spacer.
The hydrogel bone plate spacer may reduce soft tissue and bone disturbances by providing a lubricious cushion between the plate and bone. For example, the surface of the body may be soft and compliant to reduce mechanical abrasion of the tissues adjacent to the fracture site by the bone plate and/or screws. The body may provide hydrodynamic lubrication to reduce friction and thus reduce abrasion of the tissues adjacent to the fracture site. The body may include an abrasion resistant outer surface. For example, an outer container may include a flexible, relatively inelastic and abrasion resistant polymer construction.
The hydrogel bone plate spacer may be able to form itself to the shape of the plate and the underlying bone to fill differences in the shape of the plate and bone. For example, the body of the hydrogel bone plate spacer may include a hydrogel composition that swells to fill the space between the plate and bone. For example, the body may swell as it absorbs fluid from the surgical site. The act of swelling and filling the space between the plate and bone may stiffen the fracture fixation construct to provide more rigid fixation over time, cushion the bone/plate interface, and/or facilitate nutrient transport to tissues under the bone plate. For example, the spacer may be porous to facilitate the diffusion of body fluids containing nutrients through the spacer to reach the underlying bone and fracture site.
The spacer may have an elongated body corresponding generally to the shape of the bone plate. For example the spacer may be substantially the same length as the bone plate to provide a continuous spacer under the bone plate. The spacer may be smaller than the bone plate to be applied to a selected area under the bone plate. For example, the spacer may be positioned adjacent fasteners attaching the bone plate to the bone. For example, the spacer may be provided as a discrete pad that can be positioned under the plate at a screw location to form a washer under the plate. A plurality of spacers may be positioned under the bone plate to provide spacing a multiple selected location. The spacer may include one or more preformed holes for allowing fasteners to pass through the spacer. Alternatively, the spacer may be solid and a fastener may be driven through the spacer forming its own passageway as it is driven.
The hydrogel bone plate spacer body may include a hydrogel having a three dimensional network of polymer chains with water filling the void space between the macromolecules. The hydrogel may include a water soluble polymer that is crosslinked to prevent its dissolution in water. The water content of the hydrogel may range from 20-80%. The high water content of the hydrogel results in a low coefficient of friction for the bearing due to hydrodynamic lubrication. Advantageously, as loads increase on the bearing component, the friction coefficient decreases as water forced from the hydrogel forms a lubricating film. The hydrogel may include natural or synthetic polymers. Examples of natural polymers include polyhyaluronic acid, alginate, polypeptide, collagen, elastin, polylactic acid, polyglycolic acid, chitin, and/or other suitable natural polymers and combinations thereof. Examples of synthetic polymers include polyethylene oxide, polyethylene glycol, polyvinyl alcohol, polyacrylic acid, polyacrylamide, poly (N-vinyl-2-pyrrolidone), polyurethane, polyacrylonitrile, and/or other suitable synthetic polymers and combinations thereof.
In use, the fracture site is exposed by creating an incision through the overlying soft tissues. The fracture 15 is reduced by returning the bone pieces to their proper anatomic alignment and position. The spacer 10 is laid over the fracture and the plate 12 is laid over the spacer 10. Screws are inserted through the plate 12 and spacer 10 and threaded into the bone 14. The plate 12 may include elliptical holes 18 that force the screws 20 laterally as the screws 20 are tightened to apply compressive forces to the fracture 15. The plate 12 may be left loose initially to allow movement of the fracture initially. Over time, the spacer 10 absorbs fluids from the fracture site and swells to fill the space between the plate 12 and bone 14 (
Alternatively, the spacer 10 of
Although examples of a hydrogel bone plate spacer and its use have been described and illustrated in detail, it is to be understood that the same is intended by way of illustration and example only and is not to be taken by way of limitation. Accordingly, variations in and modifications to the hydrogel bone plate spacer and its use will be apparent to those of ordinary skill in the art, and the following claims are intended to cover all such modifications and equivalents.
