CA2408250C - Method and apparatus for ratcheting adjustment of bone segments - Google Patents
Method and apparatus for ratcheting adjustment of bone segments Download PDFInfo
- Publication number
- CA2408250C CA2408250C CA002408250A CA2408250A CA2408250C CA 2408250 C CA2408250 C CA 2408250C CA 002408250 A CA002408250 A CA 002408250A CA 2408250 A CA2408250 A CA 2408250A CA 2408250 C CA2408250 C CA 2408250C
- Authority
- CA
- Canada
- Prior art keywords
- ratchet
- assembly
- adjustment assembly
- bone
- adjustment
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
- A61B17/66—Alignment, compression or distraction mechanisms
- A61B17/663—Alignment, compression or distraction mechanisms for jaw bones, e.g. subcutaneous distractors with external access
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
- A61B17/8071—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for the jaw
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8009—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the plate having a ratchet
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Neurology (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
- Apparatus For Radiation Diagnosis (AREA)
Abstract
A method and system for incremental adjustment of bone segments (20, 25) is provided. The apparatus includes a low-profile ratchet assembly (5) which may be subcutaneously implanted, and an adjustment assembly which may be inserted percutaneously for releasable engagement with the adjustment assembly. The ratchet assembly (5) includes a first piece having a tongue (33) which ratcheting serrations (35), and a second piece having a cavity to receive the tongue (33) and also including ratcheting pawls (70) to engage the serrations (35). The adjustment assembly may be threaded to engage a bore on the ratchet assembly (5). Alternatively, the adjustment assembly may have a sleeve (72, 91) which hooks onto the ratchet assembly and a plunger. Bio-absorbable materials may be used.
Description
Method and apparatus for ratcheting adjustment of bone segments The present invention relates to an orthopedic system and, more particularly, to an improved orthopedic system for controlled ratcheting adjustment of the separation of bone segments on either side of a bone repair site.
A variety of orthopedic devices for controlled relative adjustment of the separation and orientation of bone segments are known in the art. For example, distraction devices (commonly referred to as distractors) are known. Typically, distractors are used to perform distraction osteogenesis. This procedure was perfected by the Russian orthopedic doctor, Gavriel Ilizarov. A typical procedure of this type involves at most an osteotomy completely separating the bone into two segments, or at least an incision of the cortical portion of the bone. Then, the bone segments on either side of the bone repair site may be incrementally separated. As used herein "bone repair site"
refers to any bone region which is desired to be treated using the orthopedic system and which is bounded on opposing sides by relatively healthy bone regions to which orthopedic devices can be secured. The bone repair site will often be an osteotomy or a fracture.
The incremental separation of the bone segments allows new bone to form in the osteotomy void; this is variously referred to as osteosynthesis or osteogenesis, among other terms. This incremental "distraction phase" is followed by a "consolidation phase," during which the distractor is held fixed, and the new bone growth gains strength. Following the consolidation phase, the distractor is removed from the patient.
In addition to distractors, it is also known to provide reduction devices, or "reducers," for controllably and gradually bringing separated bone segments together.
The design of the early reducers and distractors, which used bone pins and screws to attach the externally-mounted devices to the bone, are known to have certain problems.
For example, numerous pins are needed to attach a single device; at a minimum, two pins are required (one for the part of the device associated with each bone segment), but typically, many more are used. Each pin necessitates a transcutaneous incision, thus multiplying the risk of infection to the patient. Furthermore, a pin clamp or coupling is required to join the fixation/distraction mechanism to the pins, and the design and operation of these couplings are complicated by the difficulty encountered in aligning the pins accurately when they are inserted into the bone. Additionally, because the pins
A variety of orthopedic devices for controlled relative adjustment of the separation and orientation of bone segments are known in the art. For example, distraction devices (commonly referred to as distractors) are known. Typically, distractors are used to perform distraction osteogenesis. This procedure was perfected by the Russian orthopedic doctor, Gavriel Ilizarov. A typical procedure of this type involves at most an osteotomy completely separating the bone into two segments, or at least an incision of the cortical portion of the bone. Then, the bone segments on either side of the bone repair site may be incrementally separated. As used herein "bone repair site"
refers to any bone region which is desired to be treated using the orthopedic system and which is bounded on opposing sides by relatively healthy bone regions to which orthopedic devices can be secured. The bone repair site will often be an osteotomy or a fracture.
The incremental separation of the bone segments allows new bone to form in the osteotomy void; this is variously referred to as osteosynthesis or osteogenesis, among other terms. This incremental "distraction phase" is followed by a "consolidation phase," during which the distractor is held fixed, and the new bone growth gains strength. Following the consolidation phase, the distractor is removed from the patient.
In addition to distractors, it is also known to provide reduction devices, or "reducers," for controllably and gradually bringing separated bone segments together.
The design of the early reducers and distractors, which used bone pins and screws to attach the externally-mounted devices to the bone, are known to have certain problems.
For example, numerous pins are needed to attach a single device; at a minimum, two pins are required (one for the part of the device associated with each bone segment), but typically, many more are used. Each pin necessitates a transcutaneous incision, thus multiplying the risk of infection to the patient. Furthermore, a pin clamp or coupling is required to join the fixation/distraction mechanism to the pins, and the design and operation of these couplings are complicated by the difficulty encountered in aligning the pins accurately when they are inserted into the bone. Additionally, because the pins
2 extend in a generally perpendicular direction from the insertion site, the resultant overall device sticks out quite far from the patient's body (i.e., the device has a high profile), and the device is unsightly. A high-profile device also is more subject to bumps and snags than one maintained tight to the patient's body. Further, aesthetic considerations are important because a high-profile device may be rejected by prospective patients, especially children.
Accordingly, more recent devices have been designed not to use transcutaneous pins for attachment to the bone, but rather to use more low-profile bone anchors, such as plates with screw holes, as part of a low-profile overall device. This improved prior art is exemplified by U.S. Patent 5,364,396 to Robinson et al., which discloses an implantable bone distraction device which includes low profile blocks for attachment to osteotomically separated bone sections. As disclosed, the entire device can be implanted subcutaneously, except for a transcutaneous actuator assembly which is linked to the implanted distraction assembly, and allows adjustment of the distraction increment from outside the patient's body. The difficulty with this device is that it requires the subcutaneous implantation of a rather large ri-iechanism, with the result that it is difficult to hide the presence of the implant.
U.S. Patent 3,604,414 to Borges also discloses an implantable bone reduction device designed to be adjusted using an external apparatus. The reduction plate is of two-piece construction, with the plates incorporating opposing toothed sections.
The toothed sections prevent relative movement of the plates in the direction of fracture separation, but allow movement in the direction of fracture reduction. A tool for moving the plates toward each other is provided to facilitate engagement of the plates after they have been attached to the opposing segments of bone. The difficulty with this device is that it requires the osteotomy site to be fully uncovered each time an adjustment is made, since the adjustment tool resembles a caliper, and engages the opposing plates from above, and in a perpendicular orientation, which requires full access to the face of each plate. Such an invasive surgery increases the likelihood for infection and scarring.
U.S. Patent 5,672,167 to Seldin and U.S. Patent 5,827,286 to Incavo et. al.
disclose implantable bone distraction devices designed to be adjusted without first reopening the osteotomy site. Both disclose devices comprising two plates, each of which is attached
Accordingly, more recent devices have been designed not to use transcutaneous pins for attachment to the bone, but rather to use more low-profile bone anchors, such as plates with screw holes, as part of a low-profile overall device. This improved prior art is exemplified by U.S. Patent 5,364,396 to Robinson et al., which discloses an implantable bone distraction device which includes low profile blocks for attachment to osteotomically separated bone sections. As disclosed, the entire device can be implanted subcutaneously, except for a transcutaneous actuator assembly which is linked to the implanted distraction assembly, and allows adjustment of the distraction increment from outside the patient's body. The difficulty with this device is that it requires the subcutaneous implantation of a rather large ri-iechanism, with the result that it is difficult to hide the presence of the implant.
U.S. Patent 3,604,414 to Borges also discloses an implantable bone reduction device designed to be adjusted using an external apparatus. The reduction plate is of two-piece construction, with the plates incorporating opposing toothed sections.
The toothed sections prevent relative movement of the plates in the direction of fracture separation, but allow movement in the direction of fracture reduction. A tool for moving the plates toward each other is provided to facilitate engagement of the plates after they have been attached to the opposing segments of bone. The difficulty with this device is that it requires the osteotomy site to be fully uncovered each time an adjustment is made, since the adjustment tool resembles a caliper, and engages the opposing plates from above, and in a perpendicular orientation, which requires full access to the face of each plate. Such an invasive surgery increases the likelihood for infection and scarring.
U.S. Patent 5,672,167 to Seldin and U.S. Patent 5,827,286 to Incavo et. al.
disclose implantable bone distraction devices designed to be adjusted without first reopening the osteotomy site. Both disclose devices comprising two plates, each of which is attached
3 to a bone segment, and which plates engage one another. The devices are designed to operate in a ratcheting manner in response to the extracorporeal application of force.
These ratchets allow relative movement of the plates in one direction along the system axis, but not the reverse. The Seldin device is actuated by the application of force to a pre-tensioned ratchet arm incorporated into the first plate. This ratchet arm contacts a corresponding ratchet pawl on the second plate and forces the two plates apart, thereby achieving distraction of the attached bone segments. The ratchets then prevent the plates from assuming their previous position. The difficulty with the Seldin device is that it provides an imprecise and inaccurate means of measuring bone distraction.
The Seldin device has a further disadvantage of requiring that the external actuating force be applied perpendicular to the bone axis. This perpendicular force may tend to cause increased patient discomfort. Additionally, the Seldin device requires the actuating force be applied at or near the suture location, which also may result in increased discomfort, suture healing problems, or scarring. With the Incavo device, bone lengthening is achieved through the use of an external extension brace which is manipulated to apply force directly to the patient's limb. The Incavo device extends in response to this manual distraction, and its ratchet arrangement prevents it and the respective bone segments from returning to their prior position. The difficulty with the Incavo device is that it requires the use of large external alignment apparatus, and may not be adaptable to small bone distractions such as in maxillofacial applications.
Accordingly, there is a need in the art to provide a low profile, aesthetically pleasing, subcutaneous distractor that minimizes the total volume of implant installed, while providing maximum flexibility, precision, and accuracy in adjusting incrementally the distance between separated bone halves.
The present invention addresses the need in the art by providing an orthopedic adjustment system consisting of a small implantable ratchet assembly, the halves of which are attachable to opposing segments of bone, and which are incrementally adjustable in one direction along the system axis but not the other. The manipulation of the ratchet assembly, and thus its incremental distraction or reduction, is achieved through the temporary attachment of an elongated percutaneous actuation assembly inserted through a small opening in the patient's skin, the size of which hole is substantially smaller than the ratchet pieces. The adjustment assembly may be either
These ratchets allow relative movement of the plates in one direction along the system axis, but not the reverse. The Seldin device is actuated by the application of force to a pre-tensioned ratchet arm incorporated into the first plate. This ratchet arm contacts a corresponding ratchet pawl on the second plate and forces the two plates apart, thereby achieving distraction of the attached bone segments. The ratchets then prevent the plates from assuming their previous position. The difficulty with the Seldin device is that it provides an imprecise and inaccurate means of measuring bone distraction.
The Seldin device has a further disadvantage of requiring that the external actuating force be applied perpendicular to the bone axis. This perpendicular force may tend to cause increased patient discomfort. Additionally, the Seldin device requires the actuating force be applied at or near the suture location, which also may result in increased discomfort, suture healing problems, or scarring. With the Incavo device, bone lengthening is achieved through the use of an external extension brace which is manipulated to apply force directly to the patient's limb. The Incavo device extends in response to this manual distraction, and its ratchet arrangement prevents it and the respective bone segments from returning to their prior position. The difficulty with the Incavo device is that it requires the use of large external alignment apparatus, and may not be adaptable to small bone distractions such as in maxillofacial applications.
Accordingly, there is a need in the art to provide a low profile, aesthetically pleasing, subcutaneous distractor that minimizes the total volume of implant installed, while providing maximum flexibility, precision, and accuracy in adjusting incrementally the distance between separated bone halves.
The present invention addresses the need in the art by providing an orthopedic adjustment system consisting of a small implantable ratchet assembly, the halves of which are attachable to opposing segments of bone, and which are incrementally adjustable in one direction along the system axis but not the other. The manipulation of the ratchet assembly, and thus its incremental distraction or reduction, is achieved through the temporary attachment of an elongated percutaneous actuation assembly inserted through a small opening in the patient's skin, the size of which hole is substantially smaller than the ratchet pieces. The adjustment assembly may be either
4 of flexible or rigid construction, and may comprise either a sleeve and plunger or a solid advancing screw configuration. The ratchet assembly is attached to the associated bone segments with bone screws, and the assembly as well as the bone screws may be made of a bio-absorbable material to eliminate the need for post-procedure removal.
This adjustment system can operate as either a reducer or a distractor, allowing precise and accurate control of bone position, while providing a low profile implanted device that aesthetically is more acceptable to a patient, and which reduces overall chance for infection at the incision site.
Specifically, the present invention provides a ratcheting orthopedic adjustment system comprising a ratcheting assembly, having a system axis, which may be aligned in the direction of the orthopedic adjustment. The assembly permits incremental relative movement in a first direction along the system axis but not in the opposite direction.
The ratcheting assembly comprises a first ratchet piece for attachment to a first bone segment, and a second ratchet piece for attachment to a second bone segment, and an elongated percutaneous adjustment assembly. The ratcheting assembly may comprise, for example, a reducer (in which case the first direction represents a decrease in the separation between the ratchet pieces, so as to facilitate consolidation of the bone segments) or a distractor (in which case the first direction represents an increase in the separation between the ratchet pieces, so as to permit osteosynthesis in the bone repair region between the bone segments).
The adjustment assembly is releasably engageable with the ratcheting assembly.
The adjustment assembly has a portion which is insertable through an opening in the patient's skin substantially smaller than the dimension of the ratcheting assembly, and a portion which remains outside the patient's body and is for manipulation.
After the ratcheting assembly is subcutaneously implanted, the adjustment assembly may be inserted through the opening, releasably engaged with the ratcheting assembly, manipulated to achieve an incremental relative movement of the first and second ratchet pieces in the first direction, disengaged from the ratcheting assembly, and finally may be removed from the opening.
The first ratchet piece comprises a tongue, a first bone-anchoring portion, and a first interaction portion. The first ratchet piece is substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations. The second ratchet piece comprises a housing, a second bone-anchoring portion, and a second interaction portion. The housing has a cavity shaped to accept the insertion of the tongue, and also has one or more ratchet pawls for engagement with the ratchet serrations. The bone-anchoring portions of the ratchet pieces may be screw holes which accept bone screws to attach the ratchet pieces to the associated bone segments.
The present invention also provides that the ratcheting assembly may be made in full or part from a bio-absorbable material. In this embodiment, if screws are used for insertion through the screw holes to attach the ratchet pieces to the associated bone segments, these bone screws may be made of a bio-absorbable material which takes at least as long to be absorbed by the patient as does the part of the ratcheting assembly which is made of bio-absorbable material.
The present invention also provides an adjustment assembly comprising an elongated sleeve for engaging one of the ratchet pieces, an elongated plunger for engaging the other ratchet piece (the plunger being slidingly accepted by the sleeve), and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly.
When the sleeve and plunger of the adjustment assembly are releasably engaged with their respective ratchet pieces, manipulation of the adjustment assembly (by adjusting the relative positions along the adjustment assembly axis of the sleeve and plunger) achieves a modification of the relative position of the first and second ratchet pieces in a first direction along the system axis. The mechanical interaction of the ratchet serrations of the first ratchet piece with the ratchet pawls of the second ratchet piece permit the incremental relative movement in the first direction, while mechanically preventing relative movement in a second direction opposed to the first direction.
The present invention also provides that the sleeve may be provided with a hole transverse to the longitudinal bore, and the plunger may be provided with a distal pushing end, an intermediate section having a longitudinal slot, and a proximal pushing end. With the plunger positioned in the bore of the sleeve, a pin may be placed through the transverse hole in the sleeve and also through the slot in the plunger.
The pin will then mechanically limit the relative displacement of the sleeve and the plunger along the longitudinal adjustment axis. The adjustment assembly may further be provided with a biasing spring located so as to mechanically bias the relative displacement of the sleeve and the plunger along the longitudinal axis.
The present invention also provides that one of the interaction portions may comprise an indentation or hole in the respective ratchet piece. In this case, the corresponding engagement portion of the adjustment assembly may comprise a hook-shaped portion shaped to releasably mechanically engage with that indentation or hole.
The adjustment assembly may comprise a ratchet engagement end for engaging one of the ratchet pieces, a ratchet engagement portion for engaging the other ratchet piece, and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly. The ratchet engagement portion is threadably accepted by the respective ratchet piece. The interaction portion of the respective ratchet piece comprises an internally threaded bore which threadably accepts the external threading on the engagement portion of the activation assembly. When the threads of the ratchet engagement portion are engaged with the respective ratchet piece, manipulation of the adjustment assembly achieves a modification of the relative position of the first and second ratchet pieces in the first direction. The interaction portion which is not the internally threaded bore may comprise a raised portion shaped to mechanically engage the ratchet engagement end of the adjustment assembly.
The adjustment assembly may also comprise an elongated sleeve having a longitudinal through bore, the sleeve being capable of engaging one of the ratchet pieces, and an elongated plunger, slidingly accepted by the sleeve, for engaging the other ratchet piece. When the sleeve and plunger are engaged with their respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions, along the adjustment assembly axis, of the sleeve and plunger, modifies the relative position of the first and second ratchet pieces along the system axis.
The adjustment assembly may comprise an activation screw and an activation tool. The activation screw includes: a substantially cylindrical exterior surface, a tool engagement end, a ratchet engagement end for engaging one of the ratchet pieces, a ratchet engagement portion for engaging the other ratchet piece (the ratchet engagement portion comprising an external threading along a portion of the activation screw), and a longitudinal screw axis generally defined by the longitudinal centerline of the activation screw. One of the ratchet pieces is provided with an internally threaded bore which threadably accepts the external threading on the engagement portion of the activation screw. In this embodiment, the activation screw may be rotated about the longitudinal screw axis by engaging the activation tool with the tool engagement end of the activation screw, such that the interaction of the external threading of the ratchet engagement portion and the internally threaded bore of the associated ratchet piece results in a modification of the relative position of the activation screw and the associated ratchet piece along the longitudinal screw axis. The end result is that the ratchet engagement end of the activation screw transmits a force to the other ratchet piece, resulting in a modification of the relative positions of the first and second ratchet pieces along the system axis.
The present invention also provides that the adjustment assembly may be substantially rigid, in which case the adjustment assembly axis follows a fixed line.
Alternatively, the adjustment assembly may be flexible, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis can be varied.
The present invention also provides a method for treating a bone repair site in a patient, using an adjustment assembly comprising a longitudinal axis, a first adjustment portion, and a second adjustment portion, wherein the first and second adjustment portions are slidingly engaged to permit controlled relative displacement along the longitudinal axis.
The method begins with the steps of subcutaneously implanting a first ratchet piece on the patient's bone on one side of the bone repair site and subcutaneously implanting a second ratchet piece on the patient's bone on the other side of the bone repair site.
Then method next involves percutaneously inserting the adjustment assembly through an incision in the patient's skin (the incision being substantially smaller than the ratchet pieces); releasably engaging the adjustment assembly with the first and second ratchet pieces; displacing the first and second adjustment portions relative to each other, so as to result in an incremental modification of the distance separating the first and second ratchet pieces; disengaging the adjustment assembly from the ratchet pieces;
and removing the adjustment assembly from the patient. The steps involving the adjustment assembly may be repeated as desired or necessary to treat the bone repair site. This method may also include fabricating part or all of the ratchet assembly, and the bone screws used to attach the assembly to the opposing bone segments, of a bio-absorbable material.
The features and advantages of the present invention will become more readily apparent from the following detailed description of the invention in which like elements are labeled similarly and in which:
FIG. 1 is a perspective view of a first embodiment of the ratcheting orthopedic device of the present invention, illustrating the orthopedic device attached to bone segments on either side of a bone repair site;
FIGS. 2A and 2B are side and end views, respectively, of the ratchet tongue half of a system as illustrated in FIG. 1;
FIGS. 3A and 3B are side and end views, respectively, of the ratchet housing half of a system as illustrated in FIG. 1;
FIGS. 4A, 4B, and 4C are a side, cutaway, and perspective end view, respectively, of the first embodiment of the actuation assembly of a system as illustrated in FIG. 1;
FIG. 5 is a perspective view of a second embodiment of the ratchet assembly of the present invention;
FIGS. 6A and 6B are perspective views of a second and a third embodiment of the actuator assembly of the present invention;
FIGS. 7A and 7B are perspective views of a fourth and a fifth embodiment of the actuator assembly of the present invention; and FIG. 8 is a perspective view of a third embodiment of the ratchet assembly of the present invention.
The orthopedic device of the present invention is discussed herein with reference to a preferred embodiment adapted to be used in a linear distraction of an osteotomically separated bone. It is to be understood that the invention is not limited to distraction, but rather finds general application for use with either orthopedic distraction or reduction devices. Furthermore, it will be clear that the invention finds applicability for use in any circumstance in which it is desired to adjust or control the separation of bone segments on either side of a bone repair site.
Referring more particularly to the drawings, FIG. 1 shows an osteotomic distraction system. As shown in FIG. 1, the distraction systerii comprises a low profile ratchet assembly 5 and actuation assembly 10 which allow incremental adjustment of the ratchet halves 30, 60 (shown in FIGS. 2A, 2B, 3A, 3B, 5, and 8) which are attached to opposing segments 20, 25 of an osteotomically separated bone 15.
At installation the ratchet assembly 5, comprising the first 30 and second 60 ratchet halves, is assembled such that the ratchet serrations or teeth 35 provided on the side surfaces of tongue 33 of the first ratchet half 30 fit within the cavity of the housing 65 and engage the ratchet pawls 70 (shown in FIGS. 3A and 3B) of the second ratchet half 60. The ratchet assembly 5 is installed subcutaneously, the first and second ratchet halves being anchored to the bone by way of bone-anchoring portions. For example, bone screws 27 may be accepted by screw holes 28 in each of the ratchet halves, to anchor the assembly to pre-drilled bone surfaces on opposing bone segments 20, 25.
After the ratchet assembly 5 is installed, the actuation assembly 10 is inserted percutaneously through an incision in the patient's skin. Based on the small cross-sectional area of the actuation assembly relative to the ratchet halves, the incision may be substantially smaller than the size of the ratcheting distraction assembly
This adjustment system can operate as either a reducer or a distractor, allowing precise and accurate control of bone position, while providing a low profile implanted device that aesthetically is more acceptable to a patient, and which reduces overall chance for infection at the incision site.
Specifically, the present invention provides a ratcheting orthopedic adjustment system comprising a ratcheting assembly, having a system axis, which may be aligned in the direction of the orthopedic adjustment. The assembly permits incremental relative movement in a first direction along the system axis but not in the opposite direction.
The ratcheting assembly comprises a first ratchet piece for attachment to a first bone segment, and a second ratchet piece for attachment to a second bone segment, and an elongated percutaneous adjustment assembly. The ratcheting assembly may comprise, for example, a reducer (in which case the first direction represents a decrease in the separation between the ratchet pieces, so as to facilitate consolidation of the bone segments) or a distractor (in which case the first direction represents an increase in the separation between the ratchet pieces, so as to permit osteosynthesis in the bone repair region between the bone segments).
The adjustment assembly is releasably engageable with the ratcheting assembly.
The adjustment assembly has a portion which is insertable through an opening in the patient's skin substantially smaller than the dimension of the ratcheting assembly, and a portion which remains outside the patient's body and is for manipulation.
After the ratcheting assembly is subcutaneously implanted, the adjustment assembly may be inserted through the opening, releasably engaged with the ratcheting assembly, manipulated to achieve an incremental relative movement of the first and second ratchet pieces in the first direction, disengaged from the ratcheting assembly, and finally may be removed from the opening.
The first ratchet piece comprises a tongue, a first bone-anchoring portion, and a first interaction portion. The first ratchet piece is substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations. The second ratchet piece comprises a housing, a second bone-anchoring portion, and a second interaction portion. The housing has a cavity shaped to accept the insertion of the tongue, and also has one or more ratchet pawls for engagement with the ratchet serrations. The bone-anchoring portions of the ratchet pieces may be screw holes which accept bone screws to attach the ratchet pieces to the associated bone segments.
The present invention also provides that the ratcheting assembly may be made in full or part from a bio-absorbable material. In this embodiment, if screws are used for insertion through the screw holes to attach the ratchet pieces to the associated bone segments, these bone screws may be made of a bio-absorbable material which takes at least as long to be absorbed by the patient as does the part of the ratcheting assembly which is made of bio-absorbable material.
The present invention also provides an adjustment assembly comprising an elongated sleeve for engaging one of the ratchet pieces, an elongated plunger for engaging the other ratchet piece (the plunger being slidingly accepted by the sleeve), and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly.
When the sleeve and plunger of the adjustment assembly are releasably engaged with their respective ratchet pieces, manipulation of the adjustment assembly (by adjusting the relative positions along the adjustment assembly axis of the sleeve and plunger) achieves a modification of the relative position of the first and second ratchet pieces in a first direction along the system axis. The mechanical interaction of the ratchet serrations of the first ratchet piece with the ratchet pawls of the second ratchet piece permit the incremental relative movement in the first direction, while mechanically preventing relative movement in a second direction opposed to the first direction.
The present invention also provides that the sleeve may be provided with a hole transverse to the longitudinal bore, and the plunger may be provided with a distal pushing end, an intermediate section having a longitudinal slot, and a proximal pushing end. With the plunger positioned in the bore of the sleeve, a pin may be placed through the transverse hole in the sleeve and also through the slot in the plunger.
The pin will then mechanically limit the relative displacement of the sleeve and the plunger along the longitudinal adjustment axis. The adjustment assembly may further be provided with a biasing spring located so as to mechanically bias the relative displacement of the sleeve and the plunger along the longitudinal axis.
The present invention also provides that one of the interaction portions may comprise an indentation or hole in the respective ratchet piece. In this case, the corresponding engagement portion of the adjustment assembly may comprise a hook-shaped portion shaped to releasably mechanically engage with that indentation or hole.
The adjustment assembly may comprise a ratchet engagement end for engaging one of the ratchet pieces, a ratchet engagement portion for engaging the other ratchet piece, and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly. The ratchet engagement portion is threadably accepted by the respective ratchet piece. The interaction portion of the respective ratchet piece comprises an internally threaded bore which threadably accepts the external threading on the engagement portion of the activation assembly. When the threads of the ratchet engagement portion are engaged with the respective ratchet piece, manipulation of the adjustment assembly achieves a modification of the relative position of the first and second ratchet pieces in the first direction. The interaction portion which is not the internally threaded bore may comprise a raised portion shaped to mechanically engage the ratchet engagement end of the adjustment assembly.
The adjustment assembly may also comprise an elongated sleeve having a longitudinal through bore, the sleeve being capable of engaging one of the ratchet pieces, and an elongated plunger, slidingly accepted by the sleeve, for engaging the other ratchet piece. When the sleeve and plunger are engaged with their respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions, along the adjustment assembly axis, of the sleeve and plunger, modifies the relative position of the first and second ratchet pieces along the system axis.
The adjustment assembly may comprise an activation screw and an activation tool. The activation screw includes: a substantially cylindrical exterior surface, a tool engagement end, a ratchet engagement end for engaging one of the ratchet pieces, a ratchet engagement portion for engaging the other ratchet piece (the ratchet engagement portion comprising an external threading along a portion of the activation screw), and a longitudinal screw axis generally defined by the longitudinal centerline of the activation screw. One of the ratchet pieces is provided with an internally threaded bore which threadably accepts the external threading on the engagement portion of the activation screw. In this embodiment, the activation screw may be rotated about the longitudinal screw axis by engaging the activation tool with the tool engagement end of the activation screw, such that the interaction of the external threading of the ratchet engagement portion and the internally threaded bore of the associated ratchet piece results in a modification of the relative position of the activation screw and the associated ratchet piece along the longitudinal screw axis. The end result is that the ratchet engagement end of the activation screw transmits a force to the other ratchet piece, resulting in a modification of the relative positions of the first and second ratchet pieces along the system axis.
The present invention also provides that the adjustment assembly may be substantially rigid, in which case the adjustment assembly axis follows a fixed line.
Alternatively, the adjustment assembly may be flexible, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis can be varied.
The present invention also provides a method for treating a bone repair site in a patient, using an adjustment assembly comprising a longitudinal axis, a first adjustment portion, and a second adjustment portion, wherein the first and second adjustment portions are slidingly engaged to permit controlled relative displacement along the longitudinal axis.
The method begins with the steps of subcutaneously implanting a first ratchet piece on the patient's bone on one side of the bone repair site and subcutaneously implanting a second ratchet piece on the patient's bone on the other side of the bone repair site.
Then method next involves percutaneously inserting the adjustment assembly through an incision in the patient's skin (the incision being substantially smaller than the ratchet pieces); releasably engaging the adjustment assembly with the first and second ratchet pieces; displacing the first and second adjustment portions relative to each other, so as to result in an incremental modification of the distance separating the first and second ratchet pieces; disengaging the adjustment assembly from the ratchet pieces;
and removing the adjustment assembly from the patient. The steps involving the adjustment assembly may be repeated as desired or necessary to treat the bone repair site. This method may also include fabricating part or all of the ratchet assembly, and the bone screws used to attach the assembly to the opposing bone segments, of a bio-absorbable material.
The features and advantages of the present invention will become more readily apparent from the following detailed description of the invention in which like elements are labeled similarly and in which:
FIG. 1 is a perspective view of a first embodiment of the ratcheting orthopedic device of the present invention, illustrating the orthopedic device attached to bone segments on either side of a bone repair site;
FIGS. 2A and 2B are side and end views, respectively, of the ratchet tongue half of a system as illustrated in FIG. 1;
FIGS. 3A and 3B are side and end views, respectively, of the ratchet housing half of a system as illustrated in FIG. 1;
FIGS. 4A, 4B, and 4C are a side, cutaway, and perspective end view, respectively, of the first embodiment of the actuation assembly of a system as illustrated in FIG. 1;
FIG. 5 is a perspective view of a second embodiment of the ratchet assembly of the present invention;
FIGS. 6A and 6B are perspective views of a second and a third embodiment of the actuator assembly of the present invention;
FIGS. 7A and 7B are perspective views of a fourth and a fifth embodiment of the actuator assembly of the present invention; and FIG. 8 is a perspective view of a third embodiment of the ratchet assembly of the present invention.
The orthopedic device of the present invention is discussed herein with reference to a preferred embodiment adapted to be used in a linear distraction of an osteotomically separated bone. It is to be understood that the invention is not limited to distraction, but rather finds general application for use with either orthopedic distraction or reduction devices. Furthermore, it will be clear that the invention finds applicability for use in any circumstance in which it is desired to adjust or control the separation of bone segments on either side of a bone repair site.
Referring more particularly to the drawings, FIG. 1 shows an osteotomic distraction system. As shown in FIG. 1, the distraction systerii comprises a low profile ratchet assembly 5 and actuation assembly 10 which allow incremental adjustment of the ratchet halves 30, 60 (shown in FIGS. 2A, 2B, 3A, 3B, 5, and 8) which are attached to opposing segments 20, 25 of an osteotomically separated bone 15.
At installation the ratchet assembly 5, comprising the first 30 and second 60 ratchet halves, is assembled such that the ratchet serrations or teeth 35 provided on the side surfaces of tongue 33 of the first ratchet half 30 fit within the cavity of the housing 65 and engage the ratchet pawls 70 (shown in FIGS. 3A and 3B) of the second ratchet half 60. The ratchet assembly 5 is installed subcutaneously, the first and second ratchet halves being anchored to the bone by way of bone-anchoring portions. For example, bone screws 27 may be accepted by screw holes 28 in each of the ratchet halves, to anchor the assembly to pre-drilled bone surfaces on opposing bone segments 20, 25.
After the ratchet assembly 5 is installed, the actuation assembly 10 is inserted percutaneously through an incision in the patient's skin. Based on the small cross-sectional area of the actuation assembly relative to the ratchet halves, the incision may be substantially smaller than the size of the ratcheting distraction assembly
5. The actuation assembly 10 subcutaneously engages the ratchet assembly 5 and one or more incremental steps in the distraction procedure, corresponding to one or more ratchet increments, are performed with no need for additional or larger incisions. The actuation assembly is then removed. The actuation assembly can be repeatedly inserted and removed as desired to, perform the distraction. The combination of low-profile ratchet assembly 5 and removable actuation assembly 10 in this way minimizes the aesthetic impact of present distraction devices implanted beneath the skin. Patient distress at receiving the implant is correspondingly reduced.
The ratchet assembly 5 is a low-profile design, and as such the design of the ratchet arms 40 and the placement of the screw holes 28 which connect the interaction portions 30, 60 of the ratchet assembly 5 to the associated bone segments may be varied to ensure ease of installation and actuation for the specific implantation location. For example, FIG. 8 shows another possible embodiment, with the placement and number of screw holes 28 varied, as compared with FIGS. 2A, 2B, 3A, 3B, and 5, for a different bone site application, but many others are possible as will be obvious to one of ordinary skill in the art. ' The actuation assembly, as shown in FIGS. 4A, 4B, 4C, 6A, 6B, ?A and 7B, can be .
either of a plunger type or of a solid screw type, and can be either rigid or flexible.
The actuation assembly of the plunger type allows an operator to adjust the distance between ratchet halves, and so the distance between bone halves, by depressing knurled knob 88 (shown in FIGS. 4A and 4B) on the distal pushing end of the assembly, forcing a displacement of the plunger relative to the sleeve along the adjustment assembly axis A-A. This displacement results in a force being applied to the interaction portions of . the first and second ratchet halves, causing a corresponding relative displacement of the first and second ratchet halves. .
In a preferred embodiment, the actuation assembly of the plunger type incorporates an engagement portion, in the form of a hook 80 fixed on the end of hollow sleeve portion 72, which is received in an interaction portion, in the form of an indentation or hole 45, in the first ratchet half 30 (shown in FIGS. 2A and 2B). 1t further includes a slideable plunger portion 74, having at its front end, or proximal pushing end, an engagement portion in the form of prongs 85 which contact an interaction portion, in the form of the end face of 50 of the housing 65, of the second ratchet half 60 (as shown in FIGS. 3A
and 3B).
As shown in FIG. 4A, an intermediate section of the plunger portion 74 may have a longitudinal slot 75, interacting with a pin 76 which is affixed in a radial or transverse hole in the sleeve portion. The interaction of this pin with the slot 75 in the plunger portion provides a mechanical stop for the relative motion of the plunger and sleeve portions. Also, the activation assembly may be provided with a coil spring 78 which provides a biasing force which provides some resistance to activation of the device.
FIGS. 6A and 6B illustrate an alternate embodiment of the plunger type actuation assembly 90 that incorporates a hollow outer-sleeve portion 91 terminating in a ratchet engagement portion in the form of an externally threaded portion 92. This threaded portion 92 is threadably received in an interacting portion in the form of an internally threaded bore 110 in the first ratchet half 30 (shovrn in FIG. 5). The assembly also includes a slideable plunger portion 94 slideably accepted in the sleeve portion, the plunger having a ratchet engagement end 95 which contacts an interaction portion in the form of a raised block portion 115 on the second ratchet half 60 (shown in FIG. 5).
By squeezing handgrip portions 86 and 87 together, in the manner of the well-known cable shutter release for photographic cameras, the slideable segment 94 is displaced axially with respect to the outer sleeve portion 91.
FIGS. 7A and 78 illustrate another alternative embodiment of the actuation assembly, having a solid screw 130 incorporating an external threading 135. The threading can be along an intermediate portion of the length of the screw (as shown), or along its full length. The threading is threadably receivable in an internally threaded bore 110 in the first ratchet half 30 (shown in FIG. 5), and the blunt distal end 140 of the screw directly contacts a raised block portion 115 on the second ratchet half 60 (shown in F1G. 5).
The actuation assembly of the solid screw type 130 allows an operator to adjust the distance between ratchet halves 30, 60, and so the distance between bone segments 20 and 25, by twisting the screw proximal end 145, resulting in an axial motion of the screw as it rotates in the bore 110 of the first ratchet piece 30, and causing a contact of the blunt distal end 140 (the engagement end) of the screw with the raised block portion 115 (the interaction portion) of the second ratchet half 60, which in turn causes a relative displacement of the first and second ratchet halves. The proximal end may be configured to engage with a tool, such as a screwdriver or wrench, which may be used to rotate the screw.
As shown in figures 6A, 6B, 7A and 7B, the actuation assembly of either the plunger 90 or solid screw 130 type can be either flexible or rigid or a combination of flexible and rigid. If rigid, the shape of the actuation assembly is fixed, and the adjustment assembly axis follows a fixed line. If flexible, the~shape of the actuation assembly is variable, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis is variable. It is envisioned that a fully or partially flexible assembly (see FIGS. 6B and 7B) will provide ease and comfort of distraction which might not be possible with a completely rigid assembly. This is a matter of personal preference for the patient or physician and does not eliminate the advantage of utilizing a completely rigid actuation assembly.
In an alternate embodiment of the ratchet assembly 5, and as a way of reducing patient trauma associated with post-procedural removal of the ratchet assembly, some or all of the ratchet assembly can be fabricated of a bio-absorbable material such as a resorbabie polyester. The selection of a particular bio-absorbable material is dictated by the need to maintain ratchet assembly integrity throughout the full term of the distraction, reduction, or healing procedure.
Similarly the bone screws utilized to secure the ratchet assembly to the opposing bone segments 20, 25 can be fabricated of bio-absorbable material. Where bio-absorbable bone screws are utilized with a bio-absorbable ratchet assembly, selection of a particular bone screw material should be such that it lasts at least as long as that selected for the bio-absorbable ratchet assembly.
In an embodiment of the present invention suitable for maxillofacial applications, such as illustrated in FIGS. 1 and 5, the ratchet assembly 5 is designed with elongated ratchet arms 40, such that the interaction portions of the device are offset from the bone-anchoring portions. This allows the device to be installed in an intra-oral position, such that it sits between the patient's cheek and gum. Such an application has the benefit of reducing the number and size of the incisions required for installation of the ratchet assembly, as welt as further reducing aesthetic disruption since there is no need to maintain an incision for insertion of the adjustment assembly. In addition, an intra-oral installation would allow the operator to measure directly the total length of distraction since the ratchet assembly would be directly observable inside the patient's mouth. Usage in this manner can be further aided by the provision of a scale 38 (as shown in FIGS. 2A and 5) directly onto the outside visible portion of the ratchet half or halves. This permits precise distraction without the need for external measurement devices.
It should be emphasized that the above described embodiments of the present invention are merely exemplary, adapted for specific applications in the human skeletal system. The modifications appropriate for other applications may readily be realized by those who are skilled in the art and who have been equipped with the understanding of the structure and operation of the present invention as set forth in the above description.
For example, the particular distractor system shown in FIGS. 1 through 8 could be used, with modifications obvious to those of skill in the art, in orthopedic reduction procedures simply by changing the sense of the slopes of the ratchet teeth and pawls, without departing from the scope of the present invention. Accordingly, it should be understood that the embodiment herein is merely illustrative of the principles of the invention.
Various other modifications may be made by those skilled in the art which will embody the principles of the invention and fall within the scope thereof.
The ratchet assembly 5 is a low-profile design, and as such the design of the ratchet arms 40 and the placement of the screw holes 28 which connect the interaction portions 30, 60 of the ratchet assembly 5 to the associated bone segments may be varied to ensure ease of installation and actuation for the specific implantation location. For example, FIG. 8 shows another possible embodiment, with the placement and number of screw holes 28 varied, as compared with FIGS. 2A, 2B, 3A, 3B, and 5, for a different bone site application, but many others are possible as will be obvious to one of ordinary skill in the art. ' The actuation assembly, as shown in FIGS. 4A, 4B, 4C, 6A, 6B, ?A and 7B, can be .
either of a plunger type or of a solid screw type, and can be either rigid or flexible.
The actuation assembly of the plunger type allows an operator to adjust the distance between ratchet halves, and so the distance between bone halves, by depressing knurled knob 88 (shown in FIGS. 4A and 4B) on the distal pushing end of the assembly, forcing a displacement of the plunger relative to the sleeve along the adjustment assembly axis A-A. This displacement results in a force being applied to the interaction portions of . the first and second ratchet halves, causing a corresponding relative displacement of the first and second ratchet halves. .
In a preferred embodiment, the actuation assembly of the plunger type incorporates an engagement portion, in the form of a hook 80 fixed on the end of hollow sleeve portion 72, which is received in an interaction portion, in the form of an indentation or hole 45, in the first ratchet half 30 (shown in FIGS. 2A and 2B). 1t further includes a slideable plunger portion 74, having at its front end, or proximal pushing end, an engagement portion in the form of prongs 85 which contact an interaction portion, in the form of the end face of 50 of the housing 65, of the second ratchet half 60 (as shown in FIGS. 3A
and 3B).
As shown in FIG. 4A, an intermediate section of the plunger portion 74 may have a longitudinal slot 75, interacting with a pin 76 which is affixed in a radial or transverse hole in the sleeve portion. The interaction of this pin with the slot 75 in the plunger portion provides a mechanical stop for the relative motion of the plunger and sleeve portions. Also, the activation assembly may be provided with a coil spring 78 which provides a biasing force which provides some resistance to activation of the device.
FIGS. 6A and 6B illustrate an alternate embodiment of the plunger type actuation assembly 90 that incorporates a hollow outer-sleeve portion 91 terminating in a ratchet engagement portion in the form of an externally threaded portion 92. This threaded portion 92 is threadably received in an interacting portion in the form of an internally threaded bore 110 in the first ratchet half 30 (shovrn in FIG. 5). The assembly also includes a slideable plunger portion 94 slideably accepted in the sleeve portion, the plunger having a ratchet engagement end 95 which contacts an interaction portion in the form of a raised block portion 115 on the second ratchet half 60 (shown in FIG. 5).
By squeezing handgrip portions 86 and 87 together, in the manner of the well-known cable shutter release for photographic cameras, the slideable segment 94 is displaced axially with respect to the outer sleeve portion 91.
FIGS. 7A and 78 illustrate another alternative embodiment of the actuation assembly, having a solid screw 130 incorporating an external threading 135. The threading can be along an intermediate portion of the length of the screw (as shown), or along its full length. The threading is threadably receivable in an internally threaded bore 110 in the first ratchet half 30 (shown in FIG. 5), and the blunt distal end 140 of the screw directly contacts a raised block portion 115 on the second ratchet half 60 (shown in F1G. 5).
The actuation assembly of the solid screw type 130 allows an operator to adjust the distance between ratchet halves 30, 60, and so the distance between bone segments 20 and 25, by twisting the screw proximal end 145, resulting in an axial motion of the screw as it rotates in the bore 110 of the first ratchet piece 30, and causing a contact of the blunt distal end 140 (the engagement end) of the screw with the raised block portion 115 (the interaction portion) of the second ratchet half 60, which in turn causes a relative displacement of the first and second ratchet halves. The proximal end may be configured to engage with a tool, such as a screwdriver or wrench, which may be used to rotate the screw.
As shown in figures 6A, 6B, 7A and 7B, the actuation assembly of either the plunger 90 or solid screw 130 type can be either flexible or rigid or a combination of flexible and rigid. If rigid, the shape of the actuation assembly is fixed, and the adjustment assembly axis follows a fixed line. If flexible, the~shape of the actuation assembly is variable, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis is variable. It is envisioned that a fully or partially flexible assembly (see FIGS. 6B and 7B) will provide ease and comfort of distraction which might not be possible with a completely rigid assembly. This is a matter of personal preference for the patient or physician and does not eliminate the advantage of utilizing a completely rigid actuation assembly.
In an alternate embodiment of the ratchet assembly 5, and as a way of reducing patient trauma associated with post-procedural removal of the ratchet assembly, some or all of the ratchet assembly can be fabricated of a bio-absorbable material such as a resorbabie polyester. The selection of a particular bio-absorbable material is dictated by the need to maintain ratchet assembly integrity throughout the full term of the distraction, reduction, or healing procedure.
Similarly the bone screws utilized to secure the ratchet assembly to the opposing bone segments 20, 25 can be fabricated of bio-absorbable material. Where bio-absorbable bone screws are utilized with a bio-absorbable ratchet assembly, selection of a particular bone screw material should be such that it lasts at least as long as that selected for the bio-absorbable ratchet assembly.
In an embodiment of the present invention suitable for maxillofacial applications, such as illustrated in FIGS. 1 and 5, the ratchet assembly 5 is designed with elongated ratchet arms 40, such that the interaction portions of the device are offset from the bone-anchoring portions. This allows the device to be installed in an intra-oral position, such that it sits between the patient's cheek and gum. Such an application has the benefit of reducing the number and size of the incisions required for installation of the ratchet assembly, as welt as further reducing aesthetic disruption since there is no need to maintain an incision for insertion of the adjustment assembly. In addition, an intra-oral installation would allow the operator to measure directly the total length of distraction since the ratchet assembly would be directly observable inside the patient's mouth. Usage in this manner can be further aided by the provision of a scale 38 (as shown in FIGS. 2A and 5) directly onto the outside visible portion of the ratchet half or halves. This permits precise distraction without the need for external measurement devices.
It should be emphasized that the above described embodiments of the present invention are merely exemplary, adapted for specific applications in the human skeletal system. The modifications appropriate for other applications may readily be realized by those who are skilled in the art and who have been equipped with the understanding of the structure and operation of the present invention as set forth in the above description.
For example, the particular distractor system shown in FIGS. 1 through 8 could be used, with modifications obvious to those of skill in the art, in orthopedic reduction procedures simply by changing the sense of the slopes of the ratchet teeth and pawls, without departing from the scope of the present invention. Accordingly, it should be understood that the embodiment herein is merely illustrative of the principles of the invention.
Various other modifications may be made by those skilled in the art which will embody the principles of the invention and fall within the scope thereof.
Claims (25)
1. A ratcheting orthopedic adjustment system comprising:
a) a ratcheting assembly (5), having a system axis, for incremental relative movement in a first direction along the system axis, whereas incremental relative movement in a direction opposite the first direction is prohibited, the ratcheting assembly (5) comprising a first ratchet piece for attachment to a first bone segment, and a second ratchet piece for attachment to a second bone segment; and b) an elongated percutaneous adjustment assembly having a portion which is insertable through an opening in the patient's skin substantially smaller than the dimension of the ratcheting assembly (5) and is releasably engageable with the ratcheting assembly (5), and a portion which remains outside the patient's body and is for manipulation;
wherein after the ratcheting assembly (5) is subcutaneously implanted, the adjustment assembly may be inserted through the opening, releasably engaged with the ratcheting assembly (5), manipulated to achieve an incremental relative movement of the first and second ratchet pieces in the first direction, disengaged from the ratcheting assembly (5) and removed from the opening; whereby c) the first ratchet piece has at least one surface being provided with ratchet serrations (35);
and d) the second ratchet piece has one or more ratchet pawls (70) for engagement with the ratchet serrations (35).
a) a ratcheting assembly (5), having a system axis, for incremental relative movement in a first direction along the system axis, whereas incremental relative movement in a direction opposite the first direction is prohibited, the ratcheting assembly (5) comprising a first ratchet piece for attachment to a first bone segment, and a second ratchet piece for attachment to a second bone segment; and b) an elongated percutaneous adjustment assembly having a portion which is insertable through an opening in the patient's skin substantially smaller than the dimension of the ratcheting assembly (5) and is releasably engageable with the ratcheting assembly (5), and a portion which remains outside the patient's body and is for manipulation;
wherein after the ratcheting assembly (5) is subcutaneously implanted, the adjustment assembly may be inserted through the opening, releasably engaged with the ratcheting assembly (5), manipulated to achieve an incremental relative movement of the first and second ratchet pieces in the first direction, disengaged from the ratcheting assembly (5) and removed from the opening; whereby c) the first ratchet piece has at least one surface being provided with ratchet serrations (35);
and d) the second ratchet piece has one or more ratchet pawls (70) for engagement with the ratchet serrations (35).
2. The ratcheting orthopedic adjustment system of claim 1 wherein a) the system axis is aligned in the direction of the orthopedic adjustment;
b) the first ratchet piece comprises a tongue (33), a first bone-anchoring portion, and a first interaction portion (30), the first ratchet piece being substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations (35);
c) the second ratchet piece comprises a housing (65), a second bone-anchoring portion, and a second interaction portion (60), the housing (65) having a cavity shaped to accept the insertion of the tongue (33) and further having one or more ratchet pawls (70) for engagement with the ratchet serrations (35);
d) the adjustment assembly further comprises an elongated sleeve (72;91) for engaging one of the ratchet pieces;
an elongated plunger (74;94) for engaging the other ratchet piece, the plunger (74;94) being slidingly accepted by the sleeve (72;91); and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly:
whereby when the sleeve (72;91) and plunger (74;94) of the adjustment assembly are releasably engaged with the respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions along the adjustment assembly axis of the sleeve (72;91) and plunger (74;94) achieves a modification of the relative position of the first and second ratchet pieces in a first direction along the system axis, the interaction of the ratchet serrations (35) of the first ratchet piece with the ratchet pawls (70) of the second ratchet piece allowing the incremental relative movement of the first and second ratchet pieces in the first direction while mechanically preventing relative movement of the first and second ratchet pieces in a second direction opposed to the first direction.
b) the first ratchet piece comprises a tongue (33), a first bone-anchoring portion, and a first interaction portion (30), the first ratchet piece being substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations (35);
c) the second ratchet piece comprises a housing (65), a second bone-anchoring portion, and a second interaction portion (60), the housing (65) having a cavity shaped to accept the insertion of the tongue (33) and further having one or more ratchet pawls (70) for engagement with the ratchet serrations (35);
d) the adjustment assembly further comprises an elongated sleeve (72;91) for engaging one of the ratchet pieces;
an elongated plunger (74;94) for engaging the other ratchet piece, the plunger (74;94) being slidingly accepted by the sleeve (72;91); and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly:
whereby when the sleeve (72;91) and plunger (74;94) of the adjustment assembly are releasably engaged with the respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions along the adjustment assembly axis of the sleeve (72;91) and plunger (74;94) achieves a modification of the relative position of the first and second ratchet pieces in a first direction along the system axis, the interaction of the ratchet serrations (35) of the first ratchet piece with the ratchet pawls (70) of the second ratchet piece allowing the incremental relative movement of the first and second ratchet pieces in the first direction while mechanically preventing relative movement of the first and second ratchet pieces in a second direction opposed to the first direction.
3. The system of claim 2 wherein one of the interaction portions (30;60) comprises an indentation or hole (45) in the respective ratchet piece, and the corresponding engagement portion of the adjustment assembly comprises a hook-shaped portion shaped to releasably mechanically engage with the indentation or hole (45).
4. The system of claim 2 wherein a) the sleeve (72;91) further comprises a hole transverse to the longitudinal bore;
b) the plunger (74;94) further comprises a distal pushing end, an intermediate section having a longitudinal slot (75), and a proximal pushing end; and c) the adjustment assembly further comprises a biasing spring and a pin (76);
such that when the plunger (74;94) is positioned in the bore of the sleeve (72;91), the pin (76) may be placed through the transverse hole in the sleeve (72;91) and also through the slot (75) in the plunger (74;94), the pin (76) thereby mechanically limiting the relative displacement of the sleeve (72;91) and the plunger (74;94) along the longitudinal adjustment axis, and the spring is located so as to mechanically bias the relative displacement of the sleeve (72;91) and the plunger (74;94) along the longitudinal axis.
b) the plunger (74;94) further comprises a distal pushing end, an intermediate section having a longitudinal slot (75), and a proximal pushing end; and c) the adjustment assembly further comprises a biasing spring and a pin (76);
such that when the plunger (74;94) is positioned in the bore of the sleeve (72;91), the pin (76) may be placed through the transverse hole in the sleeve (72;91) and also through the slot (75) in the plunger (74;94), the pin (76) thereby mechanically limiting the relative displacement of the sleeve (72;91) and the plunger (74;94) along the longitudinal adjustment axis, and the spring is located so as to mechanically bias the relative displacement of the sleeve (72;91) and the plunger (74;94) along the longitudinal axis.
5. The system of claim 2 wherein the adjustment assembly is substantially rigid, and the adjustment assembly axis follows a fixed line.
6. The system of claim 2 wherein the adjustment assembly is flexible, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis is variable.
7. The system of claim 2 wherein the bone-anchoring portions comprise screw holes, and which system further comprises bone screws (27) for insertion through the screw holes (28) to attach the ratchet pieces to the associated bone segments (20;25).
8. The system of claim 2 wherein at least part of the ratcheting assembly (5) is made of a bio-absorbable material.
9. The system of claim 8 wherein the bone-anchoring portions comprise screw holes (28), and which system further comprises bone screws (27) for insertion through the screw holes (28) to attach the ratchet pieces to the associated bone segments (20;25), the bone screws (27) made of a bio-absorbable material which takes at least as long to be absorbed by the patient as does the part of the ratcheting assembly (5) which is made of bio-absorbable material.
10. The system of claim 2 wherein the ratcheting assembly (5) is a reducer, and the first direction represents a decrease in the separation between the ratchet pieces.
11. The system of claim 2 wherein the ratcheting assembly (5) is a distractor, and the first direction represents an increase in the separation between the ratchet pieces.
12. The ratcheting orthopedic adjustment system of claim 1 wherein a) the system axis is aligned in the direction of the orthopedic adjustment;
b) the first ratchet piece comprises a tongue (33), a first bone-anchoring portion, and a first interaction portion (30), the first ratchet piece being substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations (35);
c) the second ratchet piece comprises a housing (65), a second bone-anchoring portion, and a second interaction portion (60), the housing (65) having a cavity shaped to accept the insertion of the tongue. (33) and further having one or more ratchet pawls (70) for engagement with the ratchet serrations (35);
d) the adjustment assembly further comprises a ratchet engagement end for engaging one of the ratchet pieces;
a ratchet engagement portion for engaging the other ratchet piece, the ratchet engagement portion being threadably accepted by the respective ratchet piece;
and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly;
wherein the interaction portion (30) of the respective ratchet piece comprises an internally threaded bore (110) which threadably accepts the external threading on the engagement portion of the activation assembly, and wherein further when the tongue (33) is positioned within the cavity, the ratchet serrations (35) of the first ratchet piece engage with the one or more ratchet pawls (70) of the second ratchet piece to allow incremental relative movement of the first and second ratchet pieces in a first direction along the system axis, while mechanically preventing relative movement of the first and second ratchet pieces in a second direction opposed to the first direction, and whereby when the threads of the ratchet engagement portion are engaged with the respective ratchet piece, manipulation of the adjustment assembly achieves a modification of the relative position of the first and second ratchet pieces in the first direction.
b) the first ratchet piece comprises a tongue (33), a first bone-anchoring portion, and a first interaction portion (30), the first ratchet piece being substantially planar, having a top surface, a bottom surface, and two side surfaces, the side surfaces being provided with ratchet serrations (35);
c) the second ratchet piece comprises a housing (65), a second bone-anchoring portion, and a second interaction portion (60), the housing (65) having a cavity shaped to accept the insertion of the tongue. (33) and further having one or more ratchet pawls (70) for engagement with the ratchet serrations (35);
d) the adjustment assembly further comprises a ratchet engagement end for engaging one of the ratchet pieces;
a ratchet engagement portion for engaging the other ratchet piece, the ratchet engagement portion being threadably accepted by the respective ratchet piece;
and an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly;
wherein the interaction portion (30) of the respective ratchet piece comprises an internally threaded bore (110) which threadably accepts the external threading on the engagement portion of the activation assembly, and wherein further when the tongue (33) is positioned within the cavity, the ratchet serrations (35) of the first ratchet piece engage with the one or more ratchet pawls (70) of the second ratchet piece to allow incremental relative movement of the first and second ratchet pieces in a first direction along the system axis, while mechanically preventing relative movement of the first and second ratchet pieces in a second direction opposed to the first direction, and whereby when the threads of the ratchet engagement portion are engaged with the respective ratchet piece, manipulation of the adjustment assembly achieves a modification of the relative position of the first and second ratchet pieces in the first direction.
13. The system of claim 12 wherein the interaction portion (60) which is not the internally threaded bore comprises a raised portion (115) shaped to mechanically engage the ratchet engagement end (95) of the adjustment assembly.
14. The system of claim 12 wherein the adjustment assembly comprises:
a) an elongated sleeve (72;91) having a longitudinal through bore, and capable of engaging one of the ratchet pieces;
b) an elongated plunger (74;94) for engaging the other ratchet piece, the plunger (74;94) being slidingly accepted by the sleeve (72;91); and c) an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly;
whereby when the sleeve (72;91) and plunger (74;94) of the adjustment assembly are engaged with the respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions, along the adjustment assembly axis, of the sleeve (72;91) and plunger (74;94), modifies the relative position of the first and second ratchet pieces along the system axis.
a) an elongated sleeve (72;91) having a longitudinal through bore, and capable of engaging one of the ratchet pieces;
b) an elongated plunger (74;94) for engaging the other ratchet piece, the plunger (74;94) being slidingly accepted by the sleeve (72;91); and c) an adjustment assembly axis generally defined by the longitudinal centerline of the adjustment assembly;
whereby when the sleeve (72;91) and plunger (74;94) of the adjustment assembly are engaged with the respective ratchet pieces, manipulation of the adjustment assembly by adjusting the relative positions, along the adjustment assembly axis, of the sleeve (72;91) and plunger (74;94), modifies the relative position of the first and second ratchet pieces along the system axis.
15. The system of claim 14 wherein the adjustment assembly is substantially rigid, and the adjustment assembly axis follows a fixed line.
16. The system of claim 14 wherein the adjustment assembly is flexible, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis is variable.
17. The system of claim 12 wherein the adjustment assembly comprises an activation screw and an activation tool, the activation screw comprising:
a) a substantially cylindrical exterior surface;
b) a tool engagement end;
c) a ratchet engagement end for engaging one of the ratchet pieces;
d) a ratchet engagement portion for engaging the other ratchet piece, the ratchet engagement portion comprising an external threading along a portion of the activation screw; and e) a longitudinal screw axis generally defined by the longitudinal centerline of the activation screw;
and wherein one of the ratchet pieces further comprises an internally threaded bore (110) which threadably accepts the external threading on the engagement portion of the activation screw, wherein the activation screw may be rotated about the longitudinal screw axis by engaging the activation tool with the tool engagement end of the activation screw; such that the interaction of the external threading of the ratchet engagement portion and the internally threaded bore (110) of the associated ratchet piece results in a modification of the relative position of the activation screw and the associated ratchet piece along the longitudinal screw axis, such that the ratchet engagement end of the activation screw transmits a force to the other ratchet piece, resulting in a modification of the relative positions of the first and second ratchet pieces along the system axis.
a) a substantially cylindrical exterior surface;
b) a tool engagement end;
c) a ratchet engagement end for engaging one of the ratchet pieces;
d) a ratchet engagement portion for engaging the other ratchet piece, the ratchet engagement portion comprising an external threading along a portion of the activation screw; and e) a longitudinal screw axis generally defined by the longitudinal centerline of the activation screw;
and wherein one of the ratchet pieces further comprises an internally threaded bore (110) which threadably accepts the external threading on the engagement portion of the activation screw, wherein the activation screw may be rotated about the longitudinal screw axis by engaging the activation tool with the tool engagement end of the activation screw; such that the interaction of the external threading of the ratchet engagement portion and the internally threaded bore (110) of the associated ratchet piece results in a modification of the relative position of the activation screw and the associated ratchet piece along the longitudinal screw axis, such that the ratchet engagement end of the activation screw transmits a force to the other ratchet piece, resulting in a modification of the relative positions of the first and second ratchet pieces along the system axis.
18. The system of claim 17 wherein the activation screw is substantially rigid, and the adjustment assembly axis follows a fixed line.
19. The system of claim 17 wherein the activation screw is flexible, permitting shaping of the adjustment assembly such that the line followed by the adjustment assembly axis is variable.
20. The system of claim 17 wherein the bone-anchoring portions comprise screw holes (28), and which system further comprises bone screws (27) for insertion through the screw holes (28) to attach the ratchet pieces to the associated bone segments (20;25).
21. The system of claim 12 wherein at least part of the ratcheting assembly (5) is made of a bio-absorbable material.
22. The system of claim 21 wherein the bone-anchoring portions comprise screw holes (28), and which system further comprises bone screws (27) for insertion through the screw holes (28) to attach the ratchet pieces to the associated bone segments (20;25), the bone screws (27) made of a bio-absorbable material which takes at least as long to be absorbed by the patient as does the part of the ratcheting assembly (5) which is made of bio-absorbable material.
23. The system of claim 12 wherein the ratcheting assembly (5) is a reducer, and the first direction represents a decrease in the separation between the ratchet pieces, so as to facilitate consolidation of the bone segments (20;25).
24. The system of claim 12 wherein the ratcheting assembly (5) is a distractor, and the first direction represents an increase in the separation between the ratchet pieces, so as to permit osteosynthesis in the bone repair region between the bone segments (20;25).
25. Use of the ratcheting orthopedic adjustment system according to any of claims 1 to 24 for treating a bone repair site in a patient.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US09/428,330 | 1999-10-27 | ||
| US09/428,330 US6277124B1 (en) | 1999-10-27 | 1999-10-27 | Method and apparatus for ratcheting adjustment of bone segments |
| PCT/CH2000/000538 WO2001030249A1 (en) | 1999-10-27 | 2000-10-03 | Method and apparatus for ratcheting adjustment of bone segments |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2408250A1 CA2408250A1 (en) | 2001-05-03 |
| CA2408250C true CA2408250C (en) | 2006-12-19 |
Family
ID=23698430
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002408250A Expired - Fee Related CA2408250C (en) | 1999-10-27 | 2000-10-03 | Method and apparatus for ratcheting adjustment of bone segments |
Country Status (9)
| Country | Link |
|---|---|
| US (1) | US6277124B1 (en) |
| EP (1) | EP1223873B1 (en) |
| JP (1) | JP4230697B2 (en) |
| AT (1) | ATE301968T1 (en) |
| AU (1) | AU754512B2 (en) |
| CA (1) | CA2408250C (en) |
| DE (1) | DE60022068T2 (en) |
| ES (1) | ES2244468T3 (en) |
| WO (1) | WO2001030249A1 (en) |
Families Citing this family (85)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6423069B1 (en) * | 1999-03-23 | 2002-07-23 | Synthes (Usa) | Orthopedic system having detachable bone anchors |
| JP2002263128A (en) * | 2001-03-12 | 2002-09-17 | Koseki Ika Kk | Maxilla extending device |
| GB0107708D0 (en) | 2001-03-28 | 2001-05-16 | Imp College Innovations Ltd | Bone fixated,articulated joint load control device |
| US6972020B1 (en) * | 2001-06-01 | 2005-12-06 | New York University | Multi-directional internal distraction osteogenesis device |
| WO2002098277A2 (en) * | 2001-06-04 | 2002-12-12 | Michelson Gary K | Anterior cervical plate system having vertebral body engaging anchors, connecting plate, and method for installation thereof |
| US7097645B2 (en) | 2001-06-04 | 2006-08-29 | Sdgi Holdings, Inc. | Dynamic single-lock anterior cervical plate system having non-detachably fastened and moveable segments |
| JP4283665B2 (en) * | 2001-06-04 | 2009-06-24 | ウォーソー・オーソペディック・インコーポレーテッド | Dynamic plate for anterior cervical spine with movable segments |
| US20060235408A1 (en) * | 2001-11-09 | 2006-10-19 | Wang Robert C | Apparatus and methods for bone fracture fixation |
| US7235077B1 (en) * | 2001-11-09 | 2007-06-26 | Board Of Regents Of The University And Community College System Of Nevada On Behalf Of The University Of Nevada, Reno | Bone fixation device and method |
| DE10156316A1 (en) * | 2001-11-19 | 2003-06-05 | Wittenstein Ag | distraction |
| DE20215334U1 (en) * | 2002-10-04 | 2004-02-19 | Synthes Ag Chur, Chur | Longitudinal bone fixation element used in the fixation of splintered bone fragments comprises a rear section provided with a grid for cooperating with a stopper placed on the bone fixation element coaxially to the longitudinal axis |
| US6918910B2 (en) * | 2002-12-16 | 2005-07-19 | John T. Smith | Implantable distraction device |
| US7776047B2 (en) | 2003-04-09 | 2010-08-17 | Depuy Spine, Inc. | Guide for spinal tools, implants, and devices |
| US20040204712A1 (en) * | 2003-04-09 | 2004-10-14 | Eric Kolb | Bone fixation plates |
| US7935123B2 (en) * | 2003-04-09 | 2011-05-03 | Depuy Acromed, Inc. | Drill guide with alignment feature |
| US7909829B2 (en) | 2003-06-27 | 2011-03-22 | Depuy Spine, Inc. | Tissue retractor and drill guide |
| JP4448092B2 (en) * | 2003-05-07 | 2010-04-07 | 日本ストライカー株式会社 | Callus extension reproduction device |
| US7909848B2 (en) | 2003-06-27 | 2011-03-22 | Depuy Spine, Inc. | Tissue retractor and guide device |
| US20050049595A1 (en) | 2003-09-03 | 2005-03-03 | Suh Sean S. | Track-plate carriage system |
| US7909860B2 (en) | 2003-09-03 | 2011-03-22 | Synthes Usa, Llc | Bone plate with captive clips |
| US7182785B2 (en) * | 2004-03-11 | 2007-02-27 | Craniotech Acr Devices, Llc | Mandibular bone transport reconstruction plate |
| US20050234448A1 (en) * | 2004-03-19 | 2005-10-20 | Mccarthy James | Implantable bone-lengthening device |
| US7632277B2 (en) * | 2004-03-29 | 2009-12-15 | Woll Bioorthopedics Llc | Orthopedic intramedullary fixation system |
| US7485121B2 (en) * | 2004-05-04 | 2009-02-03 | Synthes (Usa) | Midface distractor |
| US7481841B2 (en) * | 2004-06-30 | 2009-01-27 | Depuy Products, Inc. | Adjustable orthopaedic prosthesis and associated method |
| US7875033B2 (en) * | 2004-07-19 | 2011-01-25 | Synthes Usa, Llc | Bone distraction apparatus |
| WO2006024491A1 (en) | 2004-08-30 | 2006-03-09 | Interstitial Therapeutics | Methods and compositions for the treatment of cell proliferation |
| US7559951B2 (en) * | 2004-09-30 | 2009-07-14 | Depuy Products, Inc. | Adjustable, remote-controllable orthopaedic prosthesis and associated method |
| US7635364B2 (en) * | 2004-12-01 | 2009-12-22 | Synthes Usa, Llc | Unidirectional translation system for bone fixation |
| US20070055250A1 (en) * | 2005-07-11 | 2007-03-08 | Kamran Aflatoon | Cervical plates with spacer mechanism |
| US7704257B2 (en) | 2005-11-23 | 2010-04-27 | Stryker Trauma S.A. | Compression instrument |
| US20070173855A1 (en) * | 2006-01-17 | 2007-07-26 | Sdgi Holdings, Inc. | Devices and methods for spacing of vertebral members over multiple levels |
| US20070214619A1 (en) * | 2006-03-16 | 2007-09-20 | Sons Davis L | Cadaver mouth closure device |
| US8894714B2 (en) | 2007-05-01 | 2014-11-25 | Moximed, Inc. | Unlinked implantable knee unloading device |
| US7655041B2 (en) * | 2007-05-01 | 2010-02-02 | Moximed, Inc. | Extra-articular implantable mechanical energy absorbing systems and implantation method |
| US20080275567A1 (en) * | 2007-05-01 | 2008-11-06 | Exploramed Nc4, Inc. | Extra-Articular Implantable Mechanical Energy Absorbing Systems |
| US9907645B2 (en) * | 2007-05-01 | 2018-03-06 | Moximed, Inc. | Adjustable absorber designs for implantable device |
| US20110245928A1 (en) | 2010-04-06 | 2011-10-06 | Moximed, Inc. | Femoral and Tibial Bases |
| US20100137996A1 (en) * | 2007-05-01 | 2010-06-03 | Moximed, Inc. | Femoral and tibial base components |
| US20080275557A1 (en) * | 2007-05-01 | 2008-11-06 | Exploramed Nc4, Inc. | Adjustable absorber designs for implantable device |
| US10022154B2 (en) * | 2007-05-01 | 2018-07-17 | Moximed, Inc. | Femoral and tibial base components |
| US8123805B2 (en) | 2007-05-01 | 2012-02-28 | Moximed, Inc. | Adjustable absorber designs for implantable device |
| US8709090B2 (en) | 2007-05-01 | 2014-04-29 | Moximed, Inc. | Adjustable absorber designs for implantable device |
| WO2009046024A1 (en) * | 2007-10-01 | 2009-04-09 | Physical Sciences, Inc. | Distraction osteogenesis methods and devices |
| US8211149B2 (en) * | 2008-05-12 | 2012-07-03 | Warsaw Orthopedic | Elongated members with expansion chambers for treating bony members |
| US20100076444A1 (en) * | 2008-09-24 | 2010-03-25 | Hienz Staehler | Bone distraction device having a quick release disengagement mechanism |
| US20100104999A1 (en) | 2008-10-23 | 2010-04-29 | Bulloch Scott E | Apparatus, System, and Method for Intra-Oral Distraction |
| US8287573B2 (en) * | 2008-12-16 | 2012-10-16 | Craniotech Acr Devices, Llc | System and method for mandibular bone transport reconstruction |
| US10349980B2 (en) | 2009-08-27 | 2019-07-16 | The Foundry, Llc | Method and apparatus for altering biomechanics of the shoulder |
| US9278004B2 (en) | 2009-08-27 | 2016-03-08 | Cotera, Inc. | Method and apparatus for altering biomechanics of the articular joints |
| US9861408B2 (en) | 2009-08-27 | 2018-01-09 | The Foundry, Llc | Method and apparatus for treating canine cruciate ligament disease |
| BR112012004337A2 (en) | 2009-08-27 | 2016-03-15 | Cotera Inc | Method and apparatus for force redistribution in joints |
| US9668868B2 (en) | 2009-08-27 | 2017-06-06 | Cotera, Inc. | Apparatus and methods for treatment of patellofemoral conditions |
| CA2775147C (en) * | 2009-09-24 | 2018-01-30 | Synthes Usa, Llc | Distractor with removable footplates |
| US8679178B2 (en) * | 2009-10-20 | 2014-03-25 | Moximed, Inc. | Extra-articular implantable mechanical energy absorbing assemblies having two deflecting members and compliance member |
| US8523948B2 (en) | 2009-10-20 | 2013-09-03 | Moximed, Inc. | Extra-articular implantable mechanical energy absorbing assemblies having a tension member, and methods |
| GB2474887B (en) * | 2009-10-30 | 2013-12-04 | Stats Uk Ltd | Device and method for pre-tensioning a coupling |
| US8568457B2 (en) * | 2009-12-01 | 2013-10-29 | DePuy Synthes Products, LLC | Non-fusion scoliosis expandable spinal rod |
| US8968367B2 (en) * | 2010-01-05 | 2015-03-03 | The Johns Hopkins University | Compression-distraction spinal fixation system and kit |
| US8961567B2 (en) | 2010-11-22 | 2015-02-24 | DePuy Synthes Products, LLC | Non-fusion scoliosis expandable spinal rod |
| DE102010055431B4 (en) * | 2010-12-10 | 2014-09-11 | Celgen Ag | Distraction device for bone regeneration in the jaw area |
| US9044270B2 (en) | 2011-03-29 | 2015-06-02 | Moximed, Inc. | Apparatus for controlling a load on a hip joint |
| US8562681B2 (en) | 2012-01-31 | 2013-10-22 | Styker Spine | Laminoplasty implant, method and instrumentation |
| US9468466B1 (en) | 2012-08-24 | 2016-10-18 | Cotera, Inc. | Method and apparatus for altering biomechanics of the spine |
| EP2735276B1 (en) | 2012-11-27 | 2018-09-05 | Stryker European Holdings I, LLC | Pediatric internal mandibular distractor |
| EP2742883B1 (en) * | 2012-12-12 | 2016-07-27 | Stryker European Holdings I, LLC | Surgical distance adjusting assembly for a bone distractor |
| US10478543B2 (en) | 2013-01-11 | 2019-11-19 | The Charles Stark Draper Laboratory, Inc. | Systems and methods for increasing convective clearance of undesired particles in a microfluidic device |
| US10342909B2 (en) | 2013-01-11 | 2019-07-09 | The Charles Stark Draper Laboratory Inc. | Systems and methods for increasing convective clearance of undesired particles in a microfluidic device |
| US10603419B2 (en) | 2013-01-11 | 2020-03-31 | The Charles Stark Draper Laboratories, Inc. | Systems and methods for increasing convective clearance of undesired particles in a microfluidic device |
| US9351771B2 (en) | 2013-02-08 | 2016-05-31 | Robert Gorsline | Systems, methods, and apparatuses for fusion, stabilization, or fixation of bones |
| CA2901009A1 (en) | 2013-02-28 | 2014-09-04 | Robert GORSLINE | Systems, methods, and apparatuses for reaming bone elements |
| US10695112B2 (en) * | 2014-03-28 | 2020-06-30 | DePuy Synthes Products, Inc. | Bone distraction system |
| WO2015187123A1 (en) * | 2014-06-02 | 2015-12-10 | Albany Medical College | Dynamic decompressive craniotomy fixation devices and related methods |
| JP6615890B2 (en) * | 2014-08-21 | 2019-12-04 | ザ チャールズ スターク ドレイパー ラボラトリー， インク． | System and method for increasing convective clearance of unwanted particles in microfluidic devices |
| MX2017005843A (en) * | 2014-11-05 | 2017-12-04 | S Johnston Thomas Jr | Detachable actuator arm for distraction devices. |
| US10166053B2 (en) | 2014-12-30 | 2019-01-01 | Stryker European Holdings I, Llc | Distractor with bidirectional rotation control |
| EP3040038B1 (en) | 2014-12-30 | 2017-03-22 | Stryker European Holdings I, LLC | Distractor with bidirectional rotation control |
| FR3056903B1 (en) * | 2016-10-03 | 2021-12-17 | Global D | MANDIBULAR PLATE, KIT AND IMPLEMENTATION PROCEDURE. |
| US10646213B2 (en) * | 2016-12-19 | 2020-05-12 | Warsaw Orthopedic, Inc. | Remote spinal manipulating assembly and method for remote spinal manipulation |
| CN109567883A (en) * | 2018-05-25 | 2019-04-05 | 宁波慈北医疗器械有限公司 | A kind of jaw bone tractor of self-locking function |
| US11399871B2 (en) | 2018-06-21 | 2022-08-02 | Wendy L. Johnston | Bone distraction device having a quick release disengagement mechanism |
| US20220015751A1 (en) * | 2018-11-16 | 2022-01-20 | Small Bone Lengthening Llc | Bone distraction devices and methods of using same |
| CN110623715A (en) * | 2019-10-23 | 2019-12-31 | 四川大学 | Digital guide plate for stretching and osteogenesis of mandible and manufacturing method thereof |
| US11871969B2 (en) | 2021-03-03 | 2024-01-16 | Acustitch, Llc | System and method for osseous reconstruction and repair and implant device |
| FR3136952A1 (en) * | 2022-06-23 | 2023-12-29 | Adapsia | Intraoral distractor |
Family Cites Families (17)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US268632A (en) | 1882-12-05 | Suture-clamp | ||
| US3385299A (en) | 1965-10-23 | 1968-05-28 | New Res And Dev Lab Inc | Wound clip |
| US3604414A (en) * | 1968-08-29 | 1971-09-14 | Nicomedes Borges | Bone setting device |
| US3659595A (en) | 1969-10-22 | 1972-05-02 | Edward J Haboush | Compensating plates for bone fractures |
| US5672167A (en) | 1990-05-21 | 1997-09-30 | Recordati Corporation | Controlled release osmotic pump |
| US5885283A (en) * | 1992-08-04 | 1999-03-23 | Gittleman; Neal B. | Osteogenic mandibular distention apparatus and method |
| US5364396A (en) | 1993-03-29 | 1994-11-15 | Robinson Randolph C | Distraction method and apparatus |
| DE19500202A1 (en) * | 1995-01-05 | 1996-07-18 | Oraltronics Marketing Und Vert | Distractor for cranio=facial use |
| ES2105964B1 (en) * | 1995-04-11 | 1998-06-01 | Plaza Fernandez Rafael De | LINEAR EXPANDER FOR PROGRESSIVE CORRECTION OF CRANIOFACIAL DEFORMATIONS. |
| FR2734147B1 (en) | 1995-05-19 | 1997-10-10 | Klein Jean Michel | IMPLANTABLE OSTEOSYNTHESIS DEVICE |
| EP0770359A1 (en) * | 1995-10-05 | 1997-05-02 | Medicon e.G. Chirurgiemechaniker-Genossenschaft | Distraction device for bone segments |
| DE19542064C1 (en) * | 1995-11-13 | 1997-06-05 | Eska Implants Gmbh & Co | Osteosynthesis plate for length adjustment of osteotomy |
| US5672177A (en) * | 1996-01-31 | 1997-09-30 | The General Hospital Corporation | Implantable bone distraction device |
| US5700263A (en) | 1996-06-17 | 1997-12-23 | Schendel; Stephen A. | Bone distraction apparatus |
| US5769850A (en) * | 1996-10-16 | 1998-06-23 | Chin; Martin | Apparatus and method for submergible, self-retaining distraction osteogenesis |
| US5827286A (en) | 1997-02-14 | 1998-10-27 | Incavo; Stephen J. | Incrementally adjustable tibial osteotomy fixation device and method |
| JP4248624B2 (en) * | 1998-07-03 | 2009-04-02 | 株式会社デンソー | Electronic control device for internal combustion engine. |
-
1999
- 1999-10-27 US US09/428,330 patent/US6277124B1/en not_active Expired - Lifetime
-
2000
- 2000-10-03 WO PCT/CH2000/000538 patent/WO2001030249A1/en active IP Right Grant
- 2000-10-03 CA CA002408250A patent/CA2408250C/en not_active Expired - Fee Related
- 2000-10-03 JP JP2001532672A patent/JP4230697B2/en not_active Expired - Fee Related
- 2000-10-03 DE DE60022068T patent/DE60022068T2/en not_active Expired - Lifetime
- 2000-10-03 AU AU74008/00A patent/AU754512B2/en not_active Ceased
- 2000-10-03 ES ES00962152T patent/ES2244468T3/en not_active Expired - Lifetime
- 2000-10-03 EP EP00962152A patent/EP1223873B1/en not_active Expired - Lifetime
- 2000-10-03 AT AT00962152T patent/ATE301968T1/en not_active IP Right Cessation
Also Published As
| Publication number | Publication date |
|---|---|
| DE60022068D1 (en) | 2005-09-22 |
| AU754512B2 (en) | 2002-11-21 |
| ATE301968T1 (en) | 2005-09-15 |
| US6277124B1 (en) | 2001-08-21 |
| DE60022068T2 (en) | 2006-04-20 |
| JP2003512124A (en) | 2003-04-02 |
| EP1223873B1 (en) | 2005-08-17 |
| WO2001030249A1 (en) | 2001-05-03 |
| JP4230697B2 (en) | 2009-02-25 |
| CA2408250A1 (en) | 2001-05-03 |
| EP1223873A1 (en) | 2002-07-24 |
| ES2244468T3 (en) | 2005-12-16 |
| AU7400800A (en) | 2001-05-08 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| CA2408250C (en) | Method and apparatus for ratcheting adjustment of bone segments | |
| US11723698B2 (en) | Minimally invasive spinal fixation system and related methods | |
| CA2483583C (en) | Compact maxillary distractor | |
| US9393063B2 (en) | Tether tensioning instrument | |
| US5672177A (en) | Implantable bone distraction device | |
| KR100604453B1 (en) | Orthopedic system having detachable bone anchors | |
| US7416553B2 (en) | Drill guide and plate inserter | |
| US7776047B2 (en) | Guide for spinal tools, implants, and devices | |
| US8623020B2 (en) | Vertebral staples and insertion tools | |
| CA2765164C (en) | Internal cable fixator | |
| EP3064160A1 (en) | Hinged fixation devices for combined upper jaw correction | |
| US20040210232A1 (en) | Guide device and plate inserter | |
| EP1322243B1 (en) | Maxillary distractor | |
| US20110166611A1 (en) | Combination distracter and inserter instrument |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKLA | Lapsed |
Effective date: 20171003 |
|
| MKLA | Lapsed |
Effective date: 20171003 |