Patent Grant
9216047
This invention pertains generally to surgical methods and apparatus for tensioning cables or wires. More specifically, the invention relates to methods and apparatus for securing cable and/or orthopedic implants to bone or skeletal tissue in orthopedic surgery through the use of cables or wires.
Surgical cables and wires are used extensively in orthopedic surgery for securing bones and bone fragments in place and for fastening surgical implants to bones. In the most common type of orthopedic surgery where severe breaks of bones have taken place, or in reconstructive procedures on bones, for example in reconstructive hip procedures or the like, a permanent cable implant is provided to hold bone portions together. For example, during a total hip replacement, press-fit femoral components are inserted into the canal of the femur, resulting in an extremely tight fit in some cases. Seating of these press-fit components has been shown to induce large hoop stresses in the proximal femur, which can result in longitudinal cracks in the femur. Thus, a surgical cable system is applied for providing a counteracting compressive hoop stress, which prevents crack formation and/or propagation.
Typically, surgical cables are implanted using tensioning devices, which apply tension to a cable looped around the bone and the cable implant. The cables are typically formed into a loop, simple or complex, and tightened about the bone structure and implant with a tensioning tool.
These tensioning tools are often cumbersome due to the strength required to support the device while creating high tensile forces in the surgical cables. Cable tensioning tools are also extremely slow to operate because of threaded drives used to create the large tensile forces in the surgical cable. The slow operation of cable tensioners can cause significant delays in the surgery itself. Any delays in surgery prolong the time required for the patient to be under general anesthetic increasing the risk of complications and recovery time of the patient.
Finally, many cable tensioning tools are long and narrow in which cable is thread blindly through the device. These cable tensioning tools are extremely complicated and difficult to operate under the stress and time constraint of surgery especially during trauma cases. Furthermore, complicated mechanisms have an increased likelihood of mechanical malfunctioning, i.e. jamming, and the restoration of function is extremely difficult due to the blind threading of cable in the devices.
One example is shown in U.S. U.S. Pat. No. 5,312,410 filed Dec. 7, 1992 to Miller et al. In the Miller example, a rudimentary ratchet mechanism is used to create cable tension thread blindly through the device. The ratchet mechanism causes force to be transmitted from a lever directly to the ratchet teeth of the device causing shock waves from the intermittent motion and imprecise positioning of tensioned cable due to mechanical backlash. The imprecise positioning of the device can cause imprecise tensioning in the attached cable and could further damage the patient's fragile bones.
Another example is shown in U.S. Patent Application Pub. No. US 2006/0229623 A1 filed Feb. 21, 2006 to Bonutti et al. In the Bonutti example, the pistol grip is used only to crimp the cable and the proximal lever is used to actually tension the cable. The Bonutti example requires wrapping the cable around a cylinder by hand and awkwardly rotating the lever to achieve a small amount of cable being drawn through the instrument. Such awkward operation of medical instruments is not intuitive to medical personnel unfamiliar with complicated mechanical systems.
In accordance with the present invention, the pistol grip tensioning device provides a significantly improved apparatus for tensioning cable used to secure skeletal tissue or bones in orthopedic surgery developed from insights gained by surgeons' experience in the operating room. The pistol grip tensioning device apparatus provides a surgeon all the components to tension surgical cable, but in a more ergonomic and easier to use assembly than conventional cable tensioners.
The rear or proximal cable clamp assemblies lock surgical cable without damaging or deforming the cable as other conventional clamps. The cable attached to the cable clamp assembly is driven away from the patient by a simple drive rod to create tension on the cable around the bone. The drive rod is in turn driven by a surgeon squeezing a handle and lever together to operate the pistol grip tensioner. The surgeon can easily read the amount of tension created by the cable on the bone by reading a gauge or tension indicator integral to the tensioner to prevent over-tightening the cable and potential damage to the patient's bone. An additional cable clamp assembly is located on the tip or distal end of the cable tensioner to allow any amount of cable to be drawn under tension by the device. The distal cable clamp assembly can be used with the proximal cable clamp assembly to draw any length of cable with great force created by the mechanical advantage created by the drive mechanism and mechanical leverage.
In one form, the drive mechanism operates by a canting member fitting around the drive rod that mechanically engages or locks on to the rod, i.e. a friction drive. The drive rod is driven by the force of the surgeon squeezing the grips which is multiplied and transmitted by the drive mechanism on to the rod. A release mechanism allows the surgeon to repeat squeezing of the grips for the rod to travel farther without the rod slipping on the canting member under tension. The release mechanism, in the form of a simple lever or trigger, allows the drive rod to be reset to the initial position simply by pressing the lever of the trigger to draw more length of cable.
In one embodiment, the cable passes through cable clamp assemblies that are offset to the body of the cable tensioning apparatus to allow tactile and visual feedback as to the position of the cable in the tensioning apparatus. The offset cable clamp assemblies also allow manual adjustment and improved visualization of the cable tensioning process. In another embodiment, the cable passes through a central passage or bore to allow smoother mechanical operation and higher loading.
The cable tensioning apparatus may have ducts or flow ports located within the housing to allow cleaning. The ducts or flow ports allow cleaning solutions to flush out and clean all of the internal mechanisms of the cable tensioning apparatus. The cable tensioning apparatus is also modularly designed to allow the apparatus to easily be assembled and disassembled to further aid the cleaning of the apparatus.
One advantage of the cable tensioning apparatus is the cleanability of the cable tensioning apparatus. Cleanability reduces the risk of infection to patients due to cross contamination of biologic materials from patient to patient after repeated uses of the tensioning apparatus. The risk of infection is minimized because of the ease of disassembly and ease of access of internal component through ducts or flow ports throughout the device to allow high pressure flushing of the cable tensioning apparatus. The offset cable clamp assemblies further assist in cleanability because most of the cable passes externally with open access for cleaning.
Another advantage of the cable tensioning apparatus is the rapidity in which surgical cable can be drawn and tensioned. The ability to quickly tension multiple surgical cables used in the typical surgical procedure multiplies the speed in which the surgery itself is performed. In addition, surgical cable can be rapidly “pre-tensioned” to eliminate any slack in the cable to greatly increase the pace of the surgery itself. Any reduction of the time of the surgery is a great benefit because the reduction of the time that the patient is under anesthetic also reduces the risk of infection, the risk of complications from the anesthetic itself, and the recovery time of the patient.
One other advantage of the pistol grip cable tensioning apparatus is the simplicity of operation of the arrangement of basic parts that gives surgeons and medical technicians an intuitive understanding of the operation of the device. The device is intuitive because the operator can see and feel how the device is operating, i.e. tactile and visual feedback. Almost no training is required by medical personnel unlike complex cable tensioning systems. The elegant simplicity of the intuitive components created an unpredicted synergy that led to the rapid learning and adoption by surgeons and technicians of the apparatus without the usual lengthy learning period.
Another advantage of the elegant simplicity from the limited number of mechanical elements is the improved reliability because there are not numerous complex mechanisms, any of which can malfunction under slight deviation from ideal conditions. In addition, the limited number of mechanical elements also reduces the weight and the bulk of the device. The superior overall operation of the cable tensioning apparatus by surgeons in the operating room was unpredicted given the simplicity of the design because of the tactile nature of most surgeons.
Another advantage of the cable tensioning apparatus is the accuracy of the cable tensioning apparatus created by the friction drive. The accuracy is an advantage because a precise amount of tension needs to be applied on the cable. Tension needs to be applied to the surgical cable with surgical precision to prevent the cable, which is typically wrapped around fractured bone, from cutting into the fragile bone of the patient or further fracturing the bone. The extremely smooth and precise motion of the friction drive allows a precise amount of tension to be applied by the friction drive and monitored by the tension indicator. The precision is improved because of the virtual elimination of backlash, i.e. the amount of clearance between mated gear teeth such as on a ratchet. The precision of which tension can be applied to cable is a significant improvement over other cable tensioning mechanisms.
Additional advantages and features of the invention will become apparent from the following description and attached claims taken in combination with the accompanying drawings.
The following location and direction convention will be used throughout all the described drawings and their written descriptions. In describing the pistol grip cable tensioning device or apparatus of the present invention, the term “proximal” refers to a direction of the device away from the patient and rearwardly towards the user while the term “distal” refers to a direction of the instrument forwardly towards the patient and away from the user. As shown in
Cable Tensioning Apparatus Embodiments
The cable tensioning apparatus has four embodiments shown in
The second cable tensioning apparatus embodiment 2001 is shown in
The third cable tensioning apparatus 3001 is shown in
The fourth cable tensioning apparatus embodiment 4001 is shown in
The cable tensioning apparatuses 1001, 2001, 3001 and 4001 have ergonomically designed levers 1501, 2501, 3501 and 4501 and handles 1401, 2401, 3401 and 4401 to assist the typically gloved hand of the surgeon. The handle/lever combination allows for application of significant tensile force to the surgical cable 12 with direct visual and tactile feedback to the operator as to the progress of the tensioning. For example, the handle/lever combination in the first embodiment provides easy to grip surfaces 1403 and 1503, shown in
The pistol grip tensioning apparatus 1001, 2001, 3001 and 4001 also has ergonomic operation as well. The operation for the first embodiment of the cable tensioning apparatus 1001 is shown in
Only the portions of the cable 12 within the passages of the distal and proximal cable clamp assemblies 1801 and 1101 are hidden from view when offset cable clamp assemblies are used. The cable 12 is visible from the distal clamp cable exit 1827 to the proximal clamp cable entrance 1175. The housing member 1301, containing the drive rod 1201 located within, hides the view of the rod 1201.
As shown in
As shown in
The operation of the second embodiment of the pistol grip tensioning apparatus 2001 is nearly identical to the operation of the first embodiment 1001 and is shown in
Most of the cable 12 is within the pistol grip tensioning apparatus 2001 and hidden from view. The cable 12 is only visible from the distal clamp assembly 2801 cable entrance 2825 to the incision and any excess cable 12 exiting the proximal clamp cable exit 2173. As shown in
As shown in
The operation of the third embodiment of the pistol grip tensioning apparatus 3001 is nearly identical to the operation of the first embodiment 1001 with two exceptions and is shown in
The operation of the fourth embodiment of the pistol grip tensioning apparatus 4001 is nearly identical to the operation of the first embodiment 1001 with two relevant exceptions as shown in
The cable tensioning apparatus 1001, 2001, 3001 and 4001 can also have a variety distal cable clamp assemblies 1801, 2801, 3801, and 4801 which correspond to various styles or types of surgical connectors 10 or crimps. The various distal cable clamp assemblies 1801, 2801, 3801, and 4801 have a modular configuration tube so that they can connect and disconnect from the cable tensioning apparatus 1001, 2001, 3001 and 4001 to allow a variety of distal cable clamp assemblies 1801, 2801, 3801, and 4801 to be used.
Typically in most surgeries, the cable 12 is passed around the bone to be cerclaged, i.e. the patient's bone is wrapped with supporting cable. The cable tensioning apparatus 1001, 2001, 3001 and 4001 will be provided to the surgeon and the unattached end of the surgical cable will be passed through the clamp assemblies as previously described. Typically, the surgical connector 10 is pulled or positioned on the distal cable clamp assemblies 1801, 2801, 3801, and 4801 which is in turn in contact with an implant or the patient's bone. However, the distal cable clamp assembly 1801, 2801, 3801, and 4801 can be used with or without a surgical connector 10 to bring the clamp assembly 1801, 2801, 3801, and 4801 directly in contact with the bone.
In most surgeries, a single cycle of the drive rod 1201, 2201, 3201, and 4201 displacement to the fully rearwardly extended will provide enough travel or displacement to fully draw the cable 12 to the desired tension. Once the cable 12 is positioned, then the cable 12 will be locked in place by turning a set screw, a cam lock, or crimped on either the surgical connector 10 or on the implant itself. The release lever 1673, 2673, 3673, and 4673 will then be depressed to reduce tension on the cable 12 to allow the cable tensioning apparatus 1001, 2001, 3001 and 4001 to be removed. The cable 12 will be trimmed or cut in place and the patient will be closed.
However, multiple surgical cables can be tightened with even a single cable tensioning apparatus 1001, 2001, 3001 and 4001 in an iterative fashion because often when the first cable is tightened another adjacent cable will then loosen as the tensile load is taken up by the adjacent cable. The pistol grip tensioning apparatus 1001, 2001, 3001 and 4001 can work iteratively by securing or locking a distal cable clamp assembly 1801, 2801, 3801, and 4801 by rotating the clamp lever (1803, 2803, 3803, 4803) and then disconnecting to the tensioning apparatus 1001, 2001, 3001 and 4001 from the distal cable clamp assembly 1801, 2801, 3801, and 4801. Typically, the release lever 1673, 2673, 3673, and 4673 must be first depressed as well as the proximal cable clamp assemblies' levers 1160, 2160, 3160 and 4160.
Another distal cable clamp assembly 1801, 2801, 3801, and 4801 will then be attached or connected to the tensioning apparatus 1001, 2001, 3001 and 4001 with another cable 12 to be tensioned as previously described. If a cable 12 and distal cable clamp assembly 1801, 2801, 3801, and 4801 needs to be retightened then the tensioning apparatus 1001, 2001, 3001 and 4001 is reattached and more tension is applied as previously described. Each individual cable 12 is then secured with a set screw, cam or crimp and trimmed as previously described.
The operation of the cable tensioning embodiments are surprisingly intuitive because the operator can see and feel how the device is operating since the surgeon can see or feel where the cable 12 is located during the cable tensioning process. For example, in apparatus 1001, housing ducts 1303, shown in
The intuitive nature of the operation of the fourth cable tensioning apparatus 4001 is further improved by the particular design configuration and arrangement of the cable clamp assemblies 4101, 4801. As shown in
The cable tensioning apparatus 1001, 2001, 3001 and 4001 uses a pistol grip type interface by the user of the apparatus. The depression of the large pistol grip type lever/handle combination allows a large amount of cable 12 to be drawn through the apparatus and still provide sufficient tensile force. The cable tensioning process can easily be repeated through simple operation of the distal and proximal cable clamp assemblies. Other devices do not use a pistol style grip mechanism to tension cable, but rather use pistol grips to crimp sleeves onto cables or wires on cables.
The cleanability of the cable tensioning apparatus 1001, 2001, 3001 or 4001 reduces the risk of infection to patients due to cross contamination of biologic materials from patient to patient after repeated uses of the cable tensioning apparatus 1001, 2001, 3001, and 4001. The risk of infection is minimized because of the ease of partial disassembly or ease of access of internal components, for example through ducts 1303 and 1307 or flow ports throughout the device to allow high pressure flushing of the cable tensioning apparatus. The cleanability was unpredicted in the design of the cable tensioning apparatus 1001, 2001, and 3001 because the combination of ducts 1303 and 1307, the simple construction, and ease of disassembly provided unexpected hygienic results. The pistol grip tensioning apparatus 1001, and 2001 are unique because the apparatus 1001, and 2001 allows partial disassembly for cleaning. Note that most medical instruments are designed not to be disassembled because untrained medical personnel, i.e. OR techs, are not able to effectively reassemble complex medical instruments. The ability to partially disassemble the apparatus 1001 and 2001 provides the optimum balance of the need for hygiene against the need to simplify sterilization procedures for untrained medical personnel.
Ease of disassembly can be best seen in
The cable tensioning apparatus 1001 (or 2001) is disassembled as shown in
The bayonet connection is formed from the bayonet lugs 1309 (or 2309) on the housing structure 1305 (or 2305) and the bayonet recess on the indicator structure 1703 (or 2703) as shown in
To disassemble the cable tensioning apparatus 1001 (or 2001), the operator compresses the housing structure 1305 (or 2305) against the indicator structure 1703 (or 2703) shown as direction L in
To assemble or to reassemble the bayonet connection, the operator inserts the indicator structure 1703 (or 2703) into the housing structure 1305 (or 2305) in direction L as shown in
The bayonet connection of the cable tensioning apparatus 1001 and 2001 allows access for cleaning which increases the effectiveness of the autoclave sterilization process by preventing insulation to the steam heat. The bayonet connection and ability to partially disassemble the apparatus 1001 (or 2001) also improves hygiene and maintenance of the device.
All of the cables tensioning apparatuses 1001, 2001, 3001, and 4001 have the modular distal cable clamp assemblies 1801, 2801, 3801, and 4801 and that are able to be easily disassembled due to the modular construction shown in
The cable tensioning apparatuses 1001, 2001, 3001 and 4001 have ducts 1303, 1307, 2303, 2307, 4303, 4307, 4717 or flow ports so that interior components easily are flushed with cleaning solution to remove tissue or biologic materials best shown in
The ducts 3303 and 3307 or flow ports feature of the third embodiment 3001 of the cable tensioning apparatus 3001 are more limited. As shown in
The ducts 4303, 4307, 4717 or flow ports feature of the fourth apparatus 4001 of the cable tensioning apparatus 4001 are more expansive. As shown in
Hygiene is improved by all of the aforementioned cleanability design features because tissue or biologic materials should be removed because prions or slow viruses within tissue or biologic materials cannot be sterilized by most conventional sterilization techniques or processes. Certain infectious agents, such as prions or other slow viruses, are difficult to neutralize with standard sterilization techniques such as autoclaves and can carry the fatal Creutzfeldt-Jakob disease (CJD). The risk of infection from tissue or bio-mater creates many attendant costs in mitigating the risk of infection, i.e. the tracking of patients and subsequent risk of liability from an infection.
A key feature of the pistol grip tensioning apparatus 1001, 2001, 3001, and 4001 is its near universal applicability with any type of surgical cable. The surgical cable 12 shown in
Similarly, the pistol grip tensioning apparatus 1001, 2001, 3001, and 4001 has its near universal operability with any type of crimp or surgical connector 10. The surgical connector 10 shown in
However, almost any kind of crimps or surgical connector 10 can be used with the pistol grip tensioning apparatus 1001, 2001, 3001, and 4001. Surgical connector 10 is hereinafter defined to be any type of surgical connector or crimp that is operable with pistol grip tensioning apparatus 1001, 2001, 3001, and 4001. For example, the crimp or surgical connector (not shown) described in U.S. Pat. No. 6,605,091 B1 with application Ser. No. 09/608,536 filed Jun. 30, 2000 and entitled “Surgical Cable Assembly And Method,” can be used and is incorporated herein by reference in its entirety. In addition, the crimp or surgical connector described in U.S. Pat. No. 5,649,927 (not shown) with application No. 534,783 filed Sep. 27, 1995 and entitled “Cable Crimp System” can be used and is also incorporated herein by reference in its entirety. Also, the crimp described in U.S. Pat. No. 5,741,260 with application No. 803,503 filed Feb. 20, 1997 and entitled “Cable System For Bone Securance” can be used and is incorporated herein by reference in its entirety. Alternatively, almost any type of crimp or surgical connector for cable or wire can be used with the pistol grip tensioning apparatus 1001, 2001, 3001, and 4001 because of the cable pensioner's near universal applicability.
Offset Cable Passage
The offset cable race 1003, 3003, and 4003 is another feature which improves cleanability but also the rapidity of operation for the first, third and fourth embodiments of the cable tensioning apparatus 1001, 3001 and 4001. The offset cable race 1003, 3003, and 4003 for the apparatus 1001, 3001 and 4001 is generally more cleanable because most of the surgical cable 12 passes externally with open access for cleaning. Operation of the apparatus 1001, 3001 and 4001 is generally more rapid because surgical cable 12 can be rapidly “pre-tensioned” to eliminate any slack in the cable 12 to greatly increase the pace of the surgery itself.
Similarly, as shown in
An example of utilizing cable 12 with a trochanter connector 300 with an implant is illustrated in
The surgical procedure which utilizes the trochanter connector 300 to secure and support the femur 150 is described in further detail in U.S. Pat. No. 7,207,993 B1 with Ser. No. 09/775,891 filed Feb. 2, 2001 and entitled “Apparatus and Method for Repairing the Femur” which is incorporated by reference in its entirety herein. It should be noted that surgical cable 12 is used in many surgical procedures to repair bones such as the radius or tibia of the arm in conjunction with plates. The aforementioned U.S. Pat. No. 7,207,993 B1 should not be construed to limit the number of surgical applications of the cable tensioning apparatus 1001, 2001, 3001 and 4001. The “Apparatus and Method for Repairing the Femur” is merely used to illustrate as an example a procedure using the cable tensioning apparatus 1001, 2001, 3001 and 4001.
However, the advantages of the offset cable clamp assemblies 1101, 1801, 3101, 3801, 4101, and 4801 were only achieved with mechanical innovations to accommodate the improved approach of the offset clamp assembly design. The superior operational results were not predictable because it was not expected that the drive mechanism 1601, 2601, and 4601 would function under the high bending moment created by offset distance K of the offset cable clamp assemblies 1101, 1801, 4101, and 4801 and the tensile force of the surgical cable 12. The offset distance K shown in
The pistol grip cable tensioning apparatus 1001, 3001 and 4001 takes advantage of metallurgical innovations by utilizing gall-resistant stainless steels for proper functioning which were not widely commercially available previously. Commercially available gall-resistant metals such as the super alloy Nitronic 60 or Gall-Tough are utilized in the fabrication of the indicator structure 1703, 3703, and 4703. Gall-resistant stainless steels, such as Nitronic 60 or Gall-Tough, prevents the potential of galling or cold welding created by the high loading conditions caused by the bending moment created by the offset cable passage 1112, 3112, 4112 on the components of the cable tensioning apparatus 1001, 3001, 4001. In the one embodiment, gall-resistant stainless steels, such as Nitronic 60 or Gall-Tough, are used because gall-resistant steels outperform most other stainless steels in corrosion and pitting resistance. Sufficient reliability of mechanical operation is maintained by the usage of gall-resistant stainless steels, such as Nitronic 60 or Gall-Tough, with the offset race 1003, 3003, 4003 design. Alternatively, Nitronic 60 or Gall-Tough can also be utilized in the rear insert 1315, 2315, 3315, 4315 of the housing member 1301, 2301, 3301, 4301 to further reduce galling or binding as shown in
Another mode or means to limit galling or binding is through the utilization of polyaryletheretherketone (hereinafter PEEK) as a bearing material. As shown in
PEEK is an appropriate material to use as a bearing 4313 because PEEK has a low coefficient of friction with excellent resistance to mechanical wear. PEEK is also a biocompatible thermoplastic to mitigate any risk of wear debris potentially entering the patient. Finally, PEEK has high chemical resistance necessitated by sterilization of the instrument 1001, 2001, 3001, and 4001. Alternatively, the bearing 4313 could utilize Gall-Tough or Nitronic 60 to reduce galling. Yet another mode to limit binding is to extend the length of components and increase bearing surfaces as was done in the fourth embodiment 4001.
The third and fourth embodiments of the cable tensioning apparatus 3001, 4001 have the same advantages of cleanability and rapidity through “pre-tensioning” as discussed above for the first embodiment 1001. The offset cable race 3003, 4003 is shown as the phantom line in
Enhanced rapidity can be achieved by “pre-tensioning” cable 12 both between the clamp assemblies 3101, 3801 and 4101, 4801 and between the bones and connectors. The surgeon can still visually see and tactilely feel the cable 12 position during the resetting process to detect errors or slack as a result of inadvertent mechanical interference.
The only significant difference in operation between the first apparatus 1001 and the third apparatus 3001 is the requirement that both the handle 3401 and lever 3501 must be simultaneously squeezed while the cable clamp assemblies 3101 and 3801 are adjusted. The third embodiment 3001 does not have the ability of the first embodiment 1001 of being able to depress the lever 1501 and having the release mechanism preventing travel in the distal direction.
The improvements in the design approach of the offset cable race 1003, 3003, and 4003 provided the functional improvements of rapidity of operation and cleanability. The increased rapidity of operation is multiplied by each cable 12 that is to be tensioned by the cable tensioning apparatus 1003, 3003, and 4003. The dramatic decrease in time in cable tensioning and corresponding decrease in time under anesthetic ultimately reduces complications and saves lives. The increased cleanability also saves lives because the risk of the fatal Creutzfeldt-Jakob disease (CJD) can be also dramatically reduced. The offset cable race 1003, 3003, and 4003 provides one means of clamping surgical cable and centrally locating the cable race 2003 provides an alternative means.
Centrally Located Cable Passage
The centrally located cable race 2005 is a feature that improves the reliability of mechanical operation, and allows for greater tension loading of surgical cable 12. The apparatus 2001 is generally more reliable in mechanical operation because the centrally mounted clamp assemblies 2101 and 2801 reduce the bending moment created by the tension in the cable 12 and thus reduces the risk of galling or mechanical interference. The apparatus 2001 can generally provide greater cable tension again because of the reduction of the large bending moment that allows the structural components to support a greater tension load.
The bending moment can best be seen by comparing the bending moment created by offset distance K in
The substantial elimination of a bending moment also substantially eliminates additional friction forces primarily between the housing 2301 and indicator structure 2703 that may interfere with the mechanical operative reliability of the apparatus 1001, 3001, and 4001. The substantial elimination of a bending stress eliminates additional elastic deformation of the apparatus 2001 which can cause undesired mechanical interference when parts are shifted out of position from one another due to the bending stress. Because the bending stress is eliminated when the clamp assemblies are mounted centrally, the apparatus 2001 has the ability to absorb more stress and thus the ability to apply a greater force to the surgical cable 12. The ability to apply greater force by the apparatus 2001 translates into the ability to apply greater tension to the surgical cable 12. The need for applying high cable tension would occur, for example, during arthrodesis where two plates are connected together with wire or cables.
The central cable race 2005 still allows some “pre-tensioning” of the surgical cable 12 because slack in the cable 12 can be removed manually from the race 2005 out of the unlocked proximal clamp assembly 2101 shown as the phantom line in
The internal structural components of the central cable race 2005 and internal passages allow for the passing of a cable 12 into and out of the cable tensioning apparatus 2001. The cable 12 enters the cable entrance 2825 at the distal end and passes through the distal clamp passage 2805 as shown in
When the cable 12 is manually passed through the cable tensioning apparatus 2001 in the initial condition, the drive rod passage 2209 of the distal portion 2211 of the drive rod 2201 abuts and is in line with the indicator passage 2711 as shown in
As shown in
The cable 12 will pass through the drive rod passage 2209 and continue to be fed through the proximal clamp passage 2112 as shown in
The proximal cable clamp assembly 1101 does not damage surgical cable 12 by compression or shear forces on the surgical cable 12 due to the design herein. Any damage to the cable 12 could cause the potential of failure of the cable 12 and injury to the patient. The proximal cable clamp assembly 1101 avoids damage to the cable 12 by applying normal forces distributed over a large surface and thereby reducing the amount of force applied to any one local section of the surgical cable 12.
The proximal cable clamp assembly 1101 is shown in an unlocked configuration in
The saddle 1140 is provided with a generally rectangular-shaped saddle jaw 1146 that defines an undulating saddle jaw surface 1148. As illustrated and in order to simplify manufacture, the saddle jaw engaging surface 1167 is formed from a series of curved recesses 1149 separated by flat portions. The invention contemplates other jaw surface shapes, however, including serpentine jaw surfaces.
The saddle jaw 1146 extends into the bore or passage 1112 of the housing for engaging a periphery of the cable (not shown). The saddle jaw 1146 cooperates with a complementarily-shaped housing jaw housing 1124 in order to form a generally undulating clamping space. The undulating surface of jaw housing 1124 shown in
As will be appreciated by those of ordinary skill, the movement of the cam lever 1160 from a released position in the direction C to a clamping position shown in
The cam lever 1160 is provided with a multifaceted cam surface. The cam surface 1164 includes two facets: facet 1164A and facet 11648, which each define a clamping position for clamping cables. Each facet 1164A and 11648 of the cam lever 1160 is preferably provided as a substantially flat surface for engaging the cam support surface 1122 on the housing 1124. Each facet has associated with it a radial dimension measured from the cam lever pivot axis. The radial dimensions are selected to provide optimum clamping force for cable 12 used with the cable clamp assembly.
Preferably, cam surfaces 1164A and 11648 are provided with respective flat portions that extend on both sides of respective radial lines to facilitate the positive locking aspects of the invention. That is, cam surface 1164 includes a first flat portion of the cam surface 1164A that engages the cam support surface 1122 and positively locks the proximal clamp assembly 1101. Cam surface 1164 also includes a second, flat portion of the cam surface 11648 that engages the cam support surface 1122 and positively unlocks the clamp assembly 1101. Cam surface 1164A and 11648 provide for stable locking positions of the cam lever 1160 and positive tactile indication that the desired locking position has been reached.
As will be recognized by those of ordinary skill, the clamp assembly 1101 applies a clamping force to the cable 12 without direct contact between the cam lever 1160 and the cable 12, thereby minimizing damage from abrasion and shear forces. Clamping force is applied through the saddle, which applies a lateral force against the cable surface and redirects the cable 12 into an undulating or non-linear path defined between the housing jaw and saddle jaw. Thus, the potential for damage to the cable surface is reduced compared to prior art cable clamps. Moreover, less clamping force occurs with cable tension, since the cable attempts to straighten and consequently applies normal forces to the obstructing internal surfaces of the clamp. These cable tension induced normal forces reduce the normal forces generated by the clamp body through action of the lever. It will also be recognized that clamping devices herein may be used to clamp different sized cables, without refitting parts or clamping jaws with new dimensions. Moreover, the clamping devices herein provide for positive tactile determination as to when the cam lever 1160 has been moved to one of a plurality of clamping positions.
As shown in
The engaging surface 1167 is formed from the housing member 1301 to engage the cable 12. The engaging surface 1167 is formed in any variety of shapes so as to engage a portion of the periphery of the elongate member. In particular, The engaging surface 1167 can be non-linear along at least a portion of its lengthwise cross-section, and/or concave along at least a portion of its widthwise cross-section. In these two exemplary forms, the engaging surface 1167 respectively serves to redirect the cable 12 into a non-linear path and to cup a length of the cable 12 at the point of clamping. The engaging surface 1167 also serves to increase the normal force for clamping the cable 12, without damaging the cable 12. The proximal cable clamp assembly 1101 is described in further detail in U.S. Pat. No. 7,452,360, filed Nov. 14, 2001 titled “Method and Apparatus for Clamping Surgical Wires or Cables” which is incorporated by reference in its entirety herein.
The second locking clamp assembly 2101 is shown in
In contrast, the first, third and fourth apparatuses 1001, 3001, 4001 include bridging material 1169, 3169, 4169 to connect the proximal clamp assembly 1101 to the drive rod 1201 in a radially offset arrangement as shown in
The fourth apparatus 4001 utilizes the indirect proximal locking cable clamp assembly, i.e. the U-shaped saddle, also for the distal cable clamp assembly 4801. Finally, the fourth apparatus 4001 also illustrates the use of a funneled surface 4177 at the proximal cable entrance 4175 to assist the feeding of surgical cable 12 into the proximal cable clamp assembly 4101 as shown in
The distal cable clamp assembly 1801, 2801, 3801 locks surgical cable 12 by compression through cam action of the clamp assembly 1801 directly on the cable 12 for the first three embodiments 1001, 2001, 3001. The distal cable clamp assembly 1801, 2801, 3801 has the ability to lock the cable 12 in the more restricted space around the incision because the reduced length of the distal clamp lever 1803, 2803, 3803. In addition, the distal cable clamp assemblies 1801, 2801, and 3801 are also detachable and interchangeable through the use of a hexagonal bit. Finally, the distal cable clamp assembly 1801, 2801, and 3801 also engages the surgical connector 10 which is described in more detail below.
For the first apparatus 1001, the distal cable clamp assembly 1801 is shown in an unsecured or unlocked configuration in
As shown in
The distal cable clamp assembly 1801 has a central portion 1813 which is filleted or radiused inwardly as shown in
Finally, the entire distal cable clamp assembly 1801 is modular and detachable to adapt the cable tensioning apparatus 1001, 2001, and 3001 to other types of surgical connectors 10. The indicator structure 1703 defines a hexagonal socket 1705 and split ring retention spring 1707 for receiving a tubular extension 1821 of the distal cable clamp assembly 1801, with the retention spring 1707 fitting into an annular groove of the extension 1821 in a conventional manner. The round modular connection of the tubular extension 1821 is self centering to assure proper position of the distal cable clamp assembly 1801. The distal cable clamp assembly 1801 is non-rotatable because its tubular extension 1821 is hexagonal (or alternatively of other non-circular cross section) fitting into a hexagonal socket 1705 at the distal end of the hexagonal socket 1705 (or alternatively other non-circular cross section).
As shown in
The distal cable clamp assembly 1801 also engages or interfaces with the unique surgical connector 10 shown in
The distal cable clamp assembly 1801 engages the surgical connector 10 as shown in
The structure and engagement of the distal cable clamp assembly 1801 for the first embodiment has been described as an exemplar for the other distal cable clamp assemblies 2801, 3801 for the second and third embodiments of the pistol grip tensioning apparatuses 2001, 3001. The structure of the distal cable clamp assembly 1801 with the surgical connector 10 is substantially the same as the distal cable clamp assemblies 2801 and 3801 of the second and third apparatuses 2001 and 3001 and not repeated for brevity. The surgical connector 10 meshes or engages in the same manner with the distal cable clamp assemblies 2801 and 3801 of the second and third embodiments 2001 and 3001. Alternatively, many different conventional designs of surgical connectors or crimps may be configured to be used with the cable tensioning apparatus 1001, 2001, 3001, and 4001 via the hexagonal socket, retention spring, and tubular extension described previously.
For example, the cable 12 passes through the surgical connector 10 during tensioning into the passage 1805 of the distal cable clamp assembly 1801, which is carried on to the proximal clamp assembly 1101. The cable 12 is tensioned and the cable 12 is locked with the distal cable clamp assembly 1801. As shown in
The distal locking clamp assembly 2801 of the second apparatus 2001 shown in
The distal locking clamp assembly 3801 of the third apparatus 3001 shown in
The distal cable clamp assembly 4101 for the fourth apparatus 4001, as shown in
The first, second, and fourth embodiments of the cable tensioning apparatuses 1001, 2001 and 4001 rely on a friction drive mechanism 1601 (2601, or 4601) that mechanically engages or locks on to the drive rod 1201 (2201, or 4201) with a canting member 1651 (2651, or 4651), otherwise known as a rocker, and is shown in
The illustrated friction drive mechanism 1601 (2601 or 4601) includes the mechanical linkage 1631 (2631 or 4631), and the canting member 1651 (2651 or 4651). A release mechanism 1671 (2671 or 4671) is also provided. The friction drive mechanism 1601 for the first apparatus 1001, shown in
For example, in the first embodiment 1001, a mechanical linkage 1631 is mounted to the lever 1501 as shown in
As shown in
The friction engagement creates a mechanical feedback loop whereby the proximal force is balanced by friction forces at the canting annular top portion 1653 and canting bottom leg portion 1655. As more tensile force is applied by the drive rod 1201 in the distal direction B then a corresponding increase in friction and normal forces will be created in the canting annular top and bottom leg portions 1653 and 1655. In other words, the greater the tension on the drive rod 1201 and cable 12 then the greater the traction for the friction drive mechanism 1601.
A release mechanism 1671 is mounted to the housing member 1301 (or 2301). The release mechanism 1671 is made up of a release lever 1673 which is connected to the housing 1301 with the release pin 1675 as shown in
As shown in
The release mechanism 1671 primarily functions to allow for rapid resetting of the cable tensioning apparatus 1001 by depressing the release lever 1673 in direction H which acts as a trigger. The release mechanism 1671 allows the tensioning process to repeat once the drive rod 1201 reaches the end of its travel to allow more cable 12 to be drawn. The release mechanism 1671 allows the repeated translation of the drive rod 1201, i.e. the repetition of rod 1201 moving in the opposite proximal and distal directions A and B. The repeated translation of the rod 1201 used in combination with the proximal clamp 1101 and distal clamp 1801 assemblies allow for the tightening of a potentially infinite length of cable 12.
The release mechanism 1671 also prevents the drive rod 1201 from moving in the distal direction B once the lever 1501 reaches the end of its stroke in direction E and returns to its original position. The lever 1501 automatically returns to its original position because the canting member return spring 1607 which was compressed during tensioning then decompresses to return the lever 1501 to the initial position as shown in
The release mechanism 1671 allows the repeated depression of the lever 1501 without distal linear translation of the drive rod 1201, i.e. slipping of the drive rod 1201 in the distal direction when the lever 1501 is released. There is very little friction created by the canting member 1651 moving in the distal direction B because the canting member 1651 rocks back or tilts back to a vertical position to allow the canting member 1651 to easily slide or shift on the drive rod 1201.
The canting member return spring 1607 shifts the canting member 1651 back in the distal direction B to reset the canting member 1651 for another stroke or depression of the lever 1501. However, the friction drive mechanism 1601 never acts on the ratchet teeth to drive the cable 12 in the proximal direction A to create tension, but only to prevent back sliding of the drive rod 1201 during the lever 1501 return stroke.
The overall travel, rapidity and amount of cable 12 which can feed into the cable tensioning apparatus 1001 is improved because of the friction drive mechanism 1601 since the linkage causes the drive rod 1201 to travel farther with each depression of the lever 1501 than other devices. The cable tensioning apparatus 1001 is also more precise because the leverage created by the lever 1501 whose force is multiplied by the mechanical linkage 1631 allows infinite variability during the setting of the tension in the surgical cable 12. The infinite variability in setting the cable tension 1001 with the friction drive mechanism 1601 is immediately before the final locking of the distal clamp assembly 1801 and is a significant improvement over intermittent mechanical engagement such as on ratchet teeth during tensioning.
The improvement is significant because engagement on ratchet teeth has finite variability due to the necessity of meshing with the teeth and incumbent backlash present in the teeth. The engagement on ratchet teeth with a lever is also imprecise in controlling tension due to the variable shape of the ratchet teeth rather than the linear translation of leverage by the canting member 1651 to the linear drive rod 1201.
In one embodiment, the canting member 1651 has a generally diamond shaped aperture that connects to the cylindrical portion 1203 of the drive rod 1201. Alternatively, the canting member 1651 can have a circular, arcuate or elliptical aperture to frictionally engage the circular drive rod 1201. However, almost any set of geometries for drive rods can be conceived such as square, hexagonal, or triangular with matching apertures for canting members could be used as alternative means with the friction drive mechanism 1601.
Furthermore, the friction drive mechanism 1601 can alternatively utilize drive wheels, roller bearings, or clutch mechanisms to provide for the friction drive mechanism 1601 as alternative means in addition to the drive disclosed in the third embodiment 3001. For example, the linear motion from the lever 1501 can be converted into rotation via a rack and pinion to rotate a wheel or roller bearing that comes into contact with the drive rod 1201 for an alternative friction drive.
Again, the friction drive mechanism 1601 for the first apparatus 1001 is substantially the same as the friction drive mechanism 2601, 4601 for the second and fourth apparatuses 2001, 4001. The detailed description previously recited applies equally to those apparatuses 2001, 4001 and is not repeated.
However, the third embodiment drive mechanism 3601 is distinct. The third apparatus 3001 is composed of a handle 3401 and a lever 3501 which again operates a friction drive 3601 as shown in
As the handle 3401 shifts in the distal direction B, the handle pin 3405, which connects the lever 3501 and handle 3401, shifts the lever 3501 in the distal direction B. The handle 3401 is connected to the pivot pin 3637 which multiplies the force on the pivot pin 3637 through leverage on the handle pin 3405 in the proximal direction A. As shown in
The fourth apparatus 4001 is again composed of a handle 4401 and a lever 4501 which again operates a friction drive as shown in
When the cable 12 is tensioned in conjunction with a trochanter connector 300 as shown in
The tension indicator mechanism 1701 for the first apparatus 1001 is substantially the same as the tension indicator mechanism 2701, 4701 for the second and fourth apparatuses 2001, 4001 and will not be repeated for brevity. The tension indicator 1701 has two extreme conditions; the initial uncompressed condition shown in
The change in position of the indicator structure 1703 indicates the tension in the surgical cable 12. The indicator structure 1703 is able to change position in relation to the tension on the cable 12 because of the bayonet connection. The bayonet lugs 1309 of the housing structure 1305 allows the indicator structure 1703 to adjust position based on the amount of compression created on the calibrated compression spring 1709 because the housing structure 1305 shifts as a sleeve over the indicator structure 1703.
As indicated in
Again, the tension indicator mechanism 1701 for the first apparatus 1001 is substantially the same as the tension indicator mechanism 2701, 4701 for the second and fourth apparatuses 2001, 4001. The detailed description previously recited applies equally to those apparatuses 2001, 4001 and is not repeated.
However, the tension indicator 3701 for the third embodiments 3001 operates slightly differently. When the lever 3501 shifts because of the handle pin 3405, the calibrated compression spring 3709 then shifts in the distal direction to create mechanical compression of a calibrated compression spring 3709. The indicator mechanism 3701 is mechanically connected to the lever 3501 and is within the housing member 3301. When the lever 3501 is fully engaged the amount of tension can be read from markings on the indicator mechanism 3701 and the housing 3301. The tension indicator 3701 and housing 3301 for the third embodiments 3001 is an alternative means for measuring cable tension compared to the tension indicator and housing of the other embodiments.
The cable tensioning apparatus 1001, 2001, 3001 and 4001 can be made from any suitable, structurally strong material. The structural portions and other components are constructed of suitable materials which are compatible with the uses and environments into which the apparatus will be utilized. Preferably, the cable tensioning apparatus 1001, 2001, 3001 and 4001, is principally constructed of metallic materials such as 17-4 stainless steel, or 465 stainless steel.
As mentioned previously, the indicator structure and possibly some of the housing members are made of gall-resistant stainless steels such as Nitronic 60 or Gall-Tough. In addition, the calibrated compression spring 1709, 2709, 3709 and 4709 is made of stainless steel.
Alternatively, the exterior components can be made of other metal alloys such as titanium. In addition, the structural materials can also be chrome coated or plated to reduce galling, improved sterilization, for the reduction of friction and for cosmetic reasons. In yet other embodiments, medical lubricant or instrument milk can be added for improved lubrication and reduced friction.
The majority of the cable tensioning apparatus 1001, 2001, 3001 and 4001 is made using standard lathes and milling machines. Alternatively, other standard manufacturing processes such as metal casting can be use to make a majority of the components of the cable tensioning apparatus 1001, 2001, 3001 and 4001 as well. Wire Electrical Discharge Machining (or EDM) or spark machining is used to cut intricately shaped parts of the cable tensioning apparatus 1001, 2001, 3001 and 4001. EDM or spark machining is also used to cut the exotic metals of the cable tensioning apparatus 1001, 2001, 3001 and 4001 such as gall-resistant stainless steels such as Nitronic 60 or Gall-Tough. Welded components are preferably welded using laser welding and/or gas tungsten arc welding (GTAW), also known as tungsten inert gas (TIG) welding. Alternatively, other standard welding processes or epoxy can be used to connect some of the components of the cable tensioning apparatus 1001, 2001, 3001 and 4001.
The embodiments of this invention shown in the drawing and described above are exemplary of numerous embodiments that may be made within the scope of the appended claims. It is contemplated that numerous other configurations or conditions may be used, and the material of each component may be selected from numerous materials other than those specifically disclosed. In short, it is the applicant's intention that the scope of the patent issuing here from will be limited only by the scope of the appended claims.
This application is a continuation of U.S. application Ser. No. 12/540,303, filed Aug. 12, 2009, which claims priority to U.S. Provisional Application No. 61/088,078, filed Aug. 12, 2008, the contents of which are hereby incorporated by reference herein in their entirety.
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| Number | Date | Country | |
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| 20130085504 A1 | Apr 2013 | US |
| Number | Date | Country | |
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| Number | Date | Country | |
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| Parent | 12540303 | Aug 2009 | US |
| Child | 13598283 | US |
