Patent Grant
12076066
The disclosure relates to bone plates and methods for installing bone plates. More particularly, the disclosure relates to the use of at least one bone hook that engages the interior of the bone to position and hold the bone while a bone plate is attached to the bone. Specifically, the disclosure provides an exemplary configuration wherein two bone hooks engage interior portions of the fractured bone to position the bone and then apply a counterforce during the installation of the bone screws. In this configuration, the bone hooks are positioned in a slot defined by the bone plate.
Chest traumas, in particular rib fractures, are common. These fractures comprise about twelve percent of all fractures in patients, particularly the elderly. The most common complication of rib fractures is pneumonia which may be fatal. This is largely due to pain and splinting effects, preventing effective coughs and breathing. Treatment includes operative and non-operative methods. Pain medications and sometimes mechanical ventilation used in non-operative treatment may have major side effects. Non-operative treatment is associated with a prolonged stay in the hospital and possibly prolonged use of narcotic medications. Operative treatment is attractive as it may reduce long-term pain by immobilizing the broken edges of the bone and thus reducing pain. It involves alignment and stabilization of the rib fractures by using internal fixation devices or bone plates. Bone plates are stiff devices (usually metal such as titanium) positioned on the surface of the bone crossing the location of the fracture. The plate is connected to the bone with fasteners such as screws. A significant reduction in pneumonia rates has been found in surgically treated patients, 90% vs 22% at 21 days after surgery.
Although the use of bone plates is associated with desirable outcomes, the anatomy of the chest wall presents limitations to the use of the bone plates for several reasons. First, the underlying fine lining of the pleura can be easily violated with instrumentation leading to pneumothorax, potentially a life threatening condition. Second, between the ribs there is an intercostal space where the intercostal artery and nerve are found. Injury to these structures can occur leading to bleeding and excessive pain. Third, ribs are very soft bone and can bow away from the tools under the pressure of the drilling and screwing during the installation of the bone plate. Also, the procedure commonly requires holding the rib and plate with clamps. When clamps are used that engage the sides of the ribs, the intercostal material is violated. In order to apply these clamps, the incision of the chest wall has to be extended. Exposure of the rib/rib fractures may lead to a large incision which is an additional source of pain due to the incision size. Therefore, a minimally invasive incision that allows reliable reduction of the rib fracture and subsequent firm immobilization of the edges of the rib preventing even minimal movement may be ideal treatment of these injuries.
The disclosure provides a method, a device, and a kit used to practice the method. The method includes the steps of using at least one bone hook that engages the interior of the bone to apply a counterforce to the bone plate installation forces. The bone plate is configured to be positioned while the bone hook is in place. In an exemplary configuration, two bone hooks are used to position and then hold the ends of the fractured bone. The bone plate is positioned about the bone hooks and positioned over the bone ends. The bone hooks are used to apply a counterforce that is in opposition to the forces required to install the fasteners that secure the bone plate to the bone. The bone hooks are removed after the bone plate is installed. In the case of a rib fracture, with the hook or hooks engaging the interior of the bone, there is minimal damage to the intercostal material around the fracture and no engagement between the tools and the pleura behind the bone. With the bone hooks passing through the center of the bone plate, the size of the incision is minimized.
In one configuration, the disclosure provides a bone plate that has a body that can be flat or curved to match the curvature of the bone on which it is to be used. The body has a central portion located between a first end portion and a second end portion. Each of the end portions defines at least one fastener hole. The central portion defines an elongated slot. The slot has a width and a length. In combination with the bone plate, first and second bone hooks are provided to define a bone plate installation kit. Each bone hook has a shank and a hook. In use, the shanks of the bone hooks are located in the slot of the bone plate. Each shank has a maximum cross sectional dimension (such as a diameter or a width) that is smaller than the width of the slot which allows the user to manipulate the bone hooks when they are through the plate.
In another configuration, the disclosure provides a bone plate that has a body that can be flat or curved to match the curvature of the bone on which it is to be used. The body has a central portion located between a first end portion and a second end portion. Each of the end portions defines at least one fastener hole. The central portion defines an elongated slot that is open to an edge of the body at a neck. The slot has a width and a length. The neck has a minimum width. In combination with the bone plate, first and second bone hooks are provided to define a bone plate installation kit. Each bone hook has a shank and a hook. In use, the shanks of the bone hooks are located in the slot of the bone plate. Each shank has a maximum cross sectional dimension (such as a diameter or a width) that is smaller than the width of the slot and smaller than the minimum width of the neck. This allows the bone plate to be moved onto the bone hooks by passing the bone hook shanks through the neck.
The individual features may be combined in different combinations than specifically described below to form different configurations of the device of the disclosure. The preceding non-limiting aspects of the disclosure, as well as others, are more particularly described below. A more complete understanding of the devices, assemblies, and methods can be obtained by reference to the accompanying drawings, which are not intended to indicate relative size and dimensions of the assemblies. In those drawings and the description below, like numeric designations refer to components of like function. Specific terms used in that description are intended to refer only to the particular structure of the embodiments selected for illustration in the drawings, and are not intended to define or limit the scope of the disclosure.
The disclosure provides a method, a device in the form of a bone plate 2, and a kit 4 used to practice the method. Kit 4 includes the combination of bone plate 2 and first and second bone hooks 6 that cooperate with bone plate 2. The method includes the steps of using at least one bone hook 6 to engage the interior of a fractured bone 10 to apply a counterforce to the bone plate installation forces. The bone hook 6 passes through the bone plate 2. In general, the method minimizes the size the incision required to operate on a bone fracture and the disruption to the material around the fracture is minimized. In the case of a rib fracture, with hooks 6 engaging the interior of bone 10, there is minimal damage to the intercostal material 12 around the fracture and no engagement between the tools and the pleura 14 behind bone 10.
A first exemplary configuration of bone plate 2 is depicted in
Each bone hook 6 includes a handle 40, a shank 42, and a hook end 44. Handle 40 is optional. Shank 42 is a thin compared with the width of slot 28 and has a length sufficient to allow the user to place hook end 44 into fractured bone 10. Hook end 44 is tapered to a sharp point. Handle 40 and shank 42 are sized to fit through slot 28. The maximum lateral cross sectional dimension (such as a width or diameter) of handle 40 and shank 42 is smaller than the width of slot 28. Shank 42 is sized such that two shanks 42 can be located in slot 28 at the same time and moved around within slot 28. Bone plate 2 can thus be moved down over handle 40 and shank 42 or bone plate 2 can be moved onto shank 42 by passing shank 42 through neck 34. In the exemplary configuration, the maximum cross section shank dimension is about a third of the width of slot 28. In other configurations, the shank dimension is a tenth to two-thirds of the width of slot 28.
After surgical access and limited bone 10 exposure, hook ends 44 are placed in the bone marrow of both ends of the broken bone 10. The surgeon reduces the fracture by moving both ends of the broken bone 10 in opposing and aligned positions. As an option, temporary holding screws are drilled closely to the broken ends of the bone 10. As an option, hooks 6 and screws can be placed prior to the application of the hooks through the plate slot 28 first. With the ends of the bone 10 aligned, bone plate 2 is placed over bone hooks 6 with bone hooks 6 located in slot 28. In the second configuration, bone plate 2 is moved onto shanks 42 by passing shanks 42 through neck 34. Bone plate 2 is lowered over the bone 10. Bone plate 2 can be held in position with shanks 42. Using the bone hooks 6 (and optionally temporary screws) for holding the bone 10 in the aligned position, fasteners 50 such as fixating screws are placed through openings 26 into bone 10. The force 52 necessary for installing fasteners 50 down or inwardly is countered by the opposing force 54 holding bone hooks 6 (or optionally holding temporary screws) as they are pulled up. After fasteners 50 are installed, bone hooks 6 are removed.
The following are advantages of this method and use of this plate for rib fracture reduction and fixation:
In the foregoing description, certain terms have been used for brevity, clearness, and understanding. No unnecessary limitations are to be implied therefrom beyond the requirement of the prior art because such terms are used for descriptive purposes and are intended to be broadly construed. Moreover, the above description and attached illustrations are an example and the invention is not limited to the exact details shown or described. Throughout the description and claims of this specification the words “comprise” and “include” as well as variations of those words, such as “comprises,” “includes,” “comprising,” and “including” are not intended to exclude additives, components, integers, or steps.
This application claims the benefit of U.S. Provisional Patent Application No. 63/151,791 filed Feb. 21, 2021; the disclosures of which are incorporated herein by reference.
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| Number | Date | Country | |
|---|---|---|---|
| 63151791 | Feb 2021 | US |
