US 2372866 A
Description (OCR text may contain errors)
April 3, 1945- B. F. TOFFLEMIRE FRACTURE APPLIANCE Filed July 26, 1943 INVENTOR.
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Patented Apr. 3, 1945 UNITED FItACTURE APPLIANCE Benjamin F. Tofliemire, Brcmerton, Wash. Application July 26, 1943, Serial No. 496,241
My invention relates to improvements in fracture appliances especially designed for the reduction and fixation of mandibular fractures and it consists of the combinations, constructions and arrangements hereinafter described and claimed.
wrench. The adjusting nuts holding the movable parts together face outward where they are readily accessible without having to move the patient.
The appliance may be assembled as a unit and then folded into a minimum of space for storage or transportation. The device may be opened up like a book and a preliminary fitting made without the bone screws being in place and before the patient is taken into surgery. The entire unit may then be placed in a sterilizer along with the bone screw and the instruments used in the operation and rendered sterile before or during the induction of anesthesia. Since the entire unit is adjusted to the approximate size and conformation necessary in advance, it is merely necessary to place the bone pins in the previously determined and marked positions, reduce the fracture and securely fasten the parts together .by tightening the belts with the wrench. This eliminates much of the delay, effort and annoyance incident to the assembling of a-device using scattered parts.
A further object of my invention is to provide an appliance having a minimum number of horizontally placed rods and fixation equipment. By
' cumbersome aggregation of rods, clamps, bolts and nuts extending outward on either side and for- The' consequent inability to chological reaction in the patient. My device overcomes these disadvantages.
A further object of my invention is to provide shoulder or face, creates an undesirable psy a device that utilizes the anatomical configuration of the human chin in such a manner that the patient has complete vertical freedom of the head in a forward nodding position and alsoa horizontal rotation-freedom of the head. The structure of the device permits unlimited adjustment in both a horizontal and vertical plane. The device will fit varying size and shapes of human jaws and permit freedom of the chin in chewing. It is possible to insert the bone-pin at a higher level than i possible with other devices without danger of violating the structures within the mandibular canal The bone-pins can therefore be directed downward and inward through the bodyoi the mandible; anteriorly, downward and backward, utilizing the additional strength of bone at the mental protuberance, profit by the natural anatomical fshelf of bone in this area, and avoid the apice of the anterior teeth.
The device is compactfiexible and adaptable for all types of jaws and permits freedom of jaw movement and greater comfort to the patientapplied to a jaw;
Figure 2 is a front elevation of the central part of Figure 1, and illustrates the use of a curved chin-bow;
Figure 3 is a side elevation of the fracture ap- .pliance, looking in the direction of the arrow 3 in Figure 1; g
I Figure 4 is an enlarged vertical section through one of the clamps used in the device;
Figure 5 is an enlarged vertical section through a bone-pin retainer; and
Figure 6 is a plan .view of a simplified pliance for unilateral fracture.. 1
While I have shown the preferred forms of my Bip- -invention, it should be understood that various changes or modifications may be made Within the scope of the appended claims without departing from the spirit and scope of the invention.
In carrying out my invention, I provide a multi-v ple mandible unit shown in Figures 1, 2 and 3 for bilateral, comminuted fractures involving more or less extensive displacement, distortion and deformation of the bone fragments. In Figure 6, I
illustrate a simplified unit for unilateral fractures of the mandible. I will first describe the multimandibular unit and then the simplified unit.
The multiple-mandible unit comprises a face bow A consisting of two L-shaped parts I and 2 hinged together at 3 and having downwardly extending posts 4 and 5. Infra-mandibular suspension rods B and C have vice-grip clamps 6 and l disposed at one end that grip the posts 4 and and permit the rods B and C to be rotated on the posts and adjusted longitudinally therealong into the desired position before the nuts 8 ill and 9 are tightened to secure the rods rigidly to the posts. Figure 2 shows the rods B and C without the T-bar pin retaining unit for purpose of clarity.
Figures 1 and 3 illustrate the T-bar pin retaining units indicated generally'at D and E. Each unit is identical so a description of the unit E will suffice for both and corresponding parts will be given like reference numerals. A vertical rod ID is adjustably secured to the rod C by a clamp F. This clamp is shown in detail in Figure 4 and permits the T-bar to be adjusted longitudinally along the rod C and the vertical rod I0 to be adjusted vertically in the clamp. A single nut l I may be tightened and will cause the clamp F to grip both rods C and I0.
The clamp F comprises a bolt l2 with a head 13 that has a reduced cylindrical portion 14 for receiving a sleeve IS. The head i3 has a transverse bore l6 therein for receiving the rod C. The sleeve 15 is slightly longer than the length of the reduced portion l4. Abifurcated member I! has aligned openings l8 for receiving the bolt [2 and has a bore l9 extending at right angles to the axis of the openings 18 and designed to receive the vertical rod [0. The slot 20 forming the bifurcation communicates with the bore I9. rod l0 and force the sleeve IE to clamp the rod C, thus locking the parts together. The rod Ill may be rotated in the bore I! and adjusted longitudinally into the desired position.
The T-bar E has a top bar 2| carried by a depending member 22 which in turnis pivotally connected to the top of the rod ID by a bolt and nut 23. The bar 2| may be swung into angular positions with respectto the bar I0 and locked in adjusted position by the nut 23.
retainers G are adjustable along the bar 2l and may be clamped in the desired angular position. An enlarged detail section of the retainers Gis shown in Figure 5. i v
The bone-pin retainer G comprises a bolt 24 with a head 25 and the bolt has a transverse bore 26 extending therethrough with a part of the bore extending into the underside of the head. The bore 25 removably receives a bone-pin H and a plate 21 bears against the pin. The plate 21- has a groove 28 for receiving the bar- 2|. A second or lower plate 29 has a groove 30 in its upper surface for receiving the bar 2|. The plates 21 and 29 have aligned openings 3| and 32 therein for receiving the bolt 24 and a nut 33 tightened on the bolt 24 locks the retainer G on the bar and locks the bone-pin H in the desired angular position.
The T-bar, pin-retaining units D and Bare placed in the region of the angle'of the jaw on either side and the bone-pins H are inserted at the desired angle so that they will converge inward, see Figures 1 and 3. The. vertical-rods Ill should clear the cheeks andjaw and these rods are secured to the infra-mandibular suspension A tightening of the nut II will clamp the.
Bone-pin rods B and C by the clamps F. The clamps F permit unlimited movement in any desired direction and under the control of a single retaining bolt which instantly immobilizes all moving parts wherliI the one fixation bolt I2 is secured by the nut The infra-mandibular connecting rods B and C extend forward toward the chin, on either side, see Figure 1, to a point opposite the mental foramen, where the rods connect to the chin posts 4 and 5 of the face bow A. The clamps 6 and 1 secure the rods to the posts with a vice-grip while permitting adjustment or a rotating expansion or contraction to accommodate the differences found in individual faces and different types of injuries. The face bow A has an additional adjustment by means of the centrally placed hingejoint 3 at the mandibular symphasis.
Upon the horizontal portion of the face bow may be fitted as many pin retaining units J as are needed to take care of the comminuted segments of bone. Frequently a single bone pin H I on either side of the symphasis will take care of the anterior support where no comminuted segments are to be transfixed. This does away with the bilateral pairs of twin-pin attachments used in the mental foramen region by other contemporary fracture appliances. While very little disfiguration if any, is caused by the bone-pins, the saving of additional trauma is a distinct advantage in multiple-mandible cases.
The pin retaining unit J is illustrated in Figures 1 and 2 and comprises U-shaped members 34 adapted to straddle the face bow and having slots 35 for receiving the bone-pins. A set screw 36 is carried by the member 34 and bears against the face bow to clamp the bone-pin H thereagainst. The retainer J may be detached from the pin and face bow without disturbing any other part of the assembly.
In those cases where long posterior segments of edentulous jaws are adversely affected by strong muscular pull with resulting displacement, a chin bow K is used, see Figure 2. The chin how has short rods 31 and 38 pivoted at its ends as at 39 and 40 respectively and so designed that the hinged rods maintain a parallel relationship with the infra-mandibular rods B and C. Rod clamps necting rods B and C by the rod clamps L in approximately the position the chin bow is to occupy. One side, for example the side with the rods 38 and C, is securely fastened by tightening the hexagon nut 4| on the clamp L engaging with these rods. The infra-mandibular rods on the appliance are then either rotated outward or inward asthe fragments may require, and the other parallel rod clamp J is then tightened by the nut 4| as well as the vice grip clamps 6 and 1 are tightened.
The face bow fits into the horizontal depression normally existing in the area between the lower lip and chin. Utilizing this incisive fossa permits the patient to have complete vertical freedom of the head. The Vertical posts 4 and 5 provides a common rotation center for each rod B and C at the position of the mental foramen. Freedom to the chin for chewing is provided and this wouldnot be possible if the infra-mandibular suspension principle were continued anterior to the area of the mental foramen, instead of being diverted vertically at this point to become a part of the horizontal face bow extending across the incisive fossa.
The mandibular canal contains the inferior alveolar vessels and nerves and these structures emerge from the manibular canal by means of the mental foramen on either side of the jaw approximately below the lower first bicuspid tooth for anterior distribution and the mandibular canal ceases to exist as such in the anterior portion of the mandible, between the right and left mental foramens. This permits the use of the incisive fossa at the point of the chin for the horizontal portion of the face bow. This permits a form-fittin appliance to be used and reduces the external bulk of the device. The bow-pins may be inserted at a higher level without danger of violating the structures within the mandibular canal since this is non-existent anterior to the posts 4 and 5. The bone pins converge toward the tips and are directed away from the membranes on the floor of the mouth thereby avoiding the possibility of contamination of a surgically clean field of operation with saliva and blood from the mouth, an area that is impossible to maintain in an aseptic condition. The pins can extend at any desired angle and will be clamped in place.
In Figure 6, I show the simplified unit, and it comprises a hinged connecting rod M upon which the pin retaining units G are placed in such a manner that two pins H are inserted in the bone on either side of the fracture. The pin retaining units on one side of the hinge M are made secure to the pins and the rod by merely tightening the hexagon nuts 33 (not shown in Figure 6, but shown in Figure 5) after the pins have been screwed into the jaw. The two pins inserted in the jaw on the otherside of the fracture are secured to the rod M on the other side of the hinge by pin retaining units after the fracture is reduced. By using a hinged rod M it is possible to line up the two pins on one side of the hinge and the two pins on the other side with the two arms of the rod and then tighten the nut for locking the hinge M from movement.
Normal apposition of the bone ends may be readily checked by the occlusal relationship of the teeth in centric occlusion. The excess ends of the bone pins should be cut on". The connecting rod M will maintain vertical as well as horizontal alignment for the fracture with a minimum equipment and bulk. The patient may use his jaws with a reasonable degree of freedom. There is no contamination with the flora of the mouth. The patient will have no aggregation of arches, wires and elastics within the mouth to gather food debris and interfere with normal oral hygiene. The patient will not have to subsist on a liquid diet and he will not have loose teeth, spongy gums and the unsanitary disuse atrophy changes so often found in cases of intermaxillary fixation. All of. the parts are fastened together by hexagonal nuts permitting a single wrench to tighten all of ,the parts or loosen them. The device shown in Figure 6 with the hinged rod M may be used on anterior mandibular fractures instead of the more complicated face-bow attachment wherever there are not additional unilateral or bilateral involvements in the body of the mandible.
with parallel and downwardly extending posts, infra-mandibular rods, means for swingably and adjustably supporting the rods on the posts and adapted to be tightened in position so as to under lie the checks of the wearer, T-bars, means for slidably supporting the T-bars on the rods and securing them thereto, bone-pins, means for securing certain of the pins on the face bow, and means for securing the other pins to the T-bars with freedom of angular and longitudinal adjustment.
4 2. A fracture appliance comprising a hinged face bow with parallel and downwardly extending posts, infra-mandibular rods having clamps slidable along the posts for securing them in the desired angular positions on-the posts so that the rods underlie the cheeks of the wearer, T-bars, clamps securing the T-bars to the rods so that the T-bars extend above the rods, said T-bars having short rods, means pivoting the short rods to the T-bars and adapted to secure them in adjusted position, bone-pins, means for securing certain of the pins on the face bow on either side of the hinge, and bone-pin retaining units adjustable along the short rods and permitting the other pins carried thereby to be inclined at the desired angles, said retaining units locking the pins in place.
3. A fracture appliance comprising a hinged face bow with parallel and downwardly extending posts, infra-mandibular rods having clamps slidable along the posts for securing them in the desired angular positions on the posts so that the rods underlie the cheeks of the wearer, T-bars,
clamps securing the T-bars to the rods so that the T-bars extend above the rods, said T-bars having short rods, means pivoting the short rods to the T-bars and adapted to secure them in adjusted position, bone pins, means for securin certain of the pins on the face bow on either side of the hinge, bone-pin retaining units adjustable along the short rods and permitting the other pins carried thereby to be inclined at the desired angles, said retaining units locking the pins in place, and a chin bow secured to the infra-mandibular rods for aiding in looking the parts against movement.
4. A fracture appliance comprising a face bow with parallel and downwardly extending posts, infra-mandibular rods, means for swingably and adjustably supporting the rods on the posts so that the rods will extend along the under sides of the jaw and cheeks, said means tightening the rods in position, T-bars having vertically extending members with members normally extending at right angles thereto but which may be swung into angular positions with respect, to the vertical members, means for slidably supporting the vertical members on the rods so that the other members will be spaced the desired distance above the rods and permit the rods to underlie the cheeks, said last-named means permitting the vertical members to be rotated into the desired angular positions before tightening them in place, means for securing said other members to the vertical members at the desired angular positions for causing both members to lie close to the face, bone pins, and means for securing certain of the bone pins to the face bow and others to the said other members on the T-bars at the desired angles.
BENJAMIN F. TOFFLEMIRE.