US 2391537 A
Description (OCR text may contain errors)
Dec. 25, 1 945. R. ANDERSON AMBULATORY ROTATING REDUCTION AND FIXATION SPLINT Filed Sept 7, 1945 4 Sheets-Sheet 1 INVENTOR R0652 4-01J0n *QV'MM ATTORNEY Dec. 25, 1945..
R.ANDERSON AMBULATORY ROTATING REDUCTION AND FIXATION SPLINT Filed Sept. 27, l943 4 SheetsSheet 2 l Hlllilllll'lll INVENTOR R0651? fl/vozeao/v WM ATTORNEY Dec. 25, 1945. R. ANDERSON AMBULATORY ROTATING REDUCTION AND FIXATION SPLINT 4 Sheets-Sheet 5 Filed Sept. 27, 1945 INVENTOR R0652 fluoz/esan BY C211 ATTORNEY Dec. 25, 1945. R, ANDERSON 2,
AMBULATORY ROTATING REDUCTION AND FIXATIQN SPLINT Filed Sept. 27, 1943 4 Sheets-Sheet 4 INVENTOR 9065,? fi/vofzwon BY v 4 ATTORNEY Patented Dec. 25, 1945 AMBULATORY ROTATING REDUCTION AND FIXATION SPLINT Rog er Anderson, Seattle, Wash.
Application September 27, 1943, Serial No. 503,943
This invention relates to improvements in ambulatory fracture reduction and immobilization splints and it has reference more particularly to splints employing a rigid extension bar for bridging the fracture and with transfixion units at the ends of the bar for fixed securement to the fracture fragments for their manipulation and immobilization during the period of healing of the fracture; it being the principal object of this invention to provide an ambulatory splint of the above stated kind that provides for the manual setting of the fracture, by accepted clinical methods, through aid of mechanical means which permits relative rotation of the fracture fragments on their anatomical axis and enables the operator to retain physical contact with the fracture and a personal touch in the reducing action to substantially the same extent as in the setting of a fracture by hand.
It is also an object of this invention to provide a splint of the type above stated whereby mechanical traction, or extension, may be applied to the fracture by adjustment in the length of the bar; which splint serves also as a fixation device that is especially useful in the treatment of fractures of the femur and humerus in that it is possible to free certain joints embodied therein for relative rotation of the fracture fragments on the anatomical axis of the fractured bone.
Still another object of the invention is to provide a splint that is especially suited for the manual setting of a fracture under X-ray observation, with extension force maintained mechanically while the fracture fragments are manually brought into opposition and while actual contacting of the fragments is manually accomplished.
More specifically stated, the objects of this invention are to be found in the provision of a light, durable and relatively small splint, having the provisions and advantages as above stated, and comprising a pair of fixation units for securement to the fragments at opposite sides of a fracture, and an adjustable extension bar for joining the units; each fixation unit comprising two or more trans-fixions, adapted to have their inner ends applied to a fragment, and their outer end portions to be fixedly secured to a rigid mounting bar; the bars of the two units being joined through special joints, to the opposite end portions of the adjustable extension bar.
Other objects of the invention are to be found in the use of jointed mountings, for the fixation units, adapted. to be loosened to provide for relative adjustment of the units in a noval manner for rotation of the fracture fragments on their anatomical axis, and for correction of angulation and alinement thereof. Also, providing for the rigid fixation of the parts by the clampin of the joints, thus to immobilize a fracture.
Still further objects of the present invention reside in those details of construction of the vari- 0115 parts that permits the units to be adjusted relative to each other for reduction of the fracture, and then to be held in fixed relationship to retain the fracture immobilized after a reduction has beenmade.
Inaccomplishing these and other objects of the invention, I have provided the improved details of construction, the preferred forms of which are illustrated in the accompanying drawings, wherein Fig. 1 is a perspective View of a splint embodied by the present invention, illustrating it as applied to a fractured bone for the reduction of the fracture and the immobilization of the fra ments.
Fig. 1A is a perspective of one of the pivot clamp assemblies, withparts thereof separated for better illustration and understanding of their features.
Fig. 1B is a sectional detail of the preferred type of pin clamp.
Fig. 2 is a top View of the splint as applied in Fig. 1, with parts broken away and others in section for better illustration.
Fig. 3 is a cross section on line 3-3 in Fig. 2.
Fig. 4 is a cross section on line 4-4 in Fig. 2.
Fig. 5 is a cross section on line 5-5 in Fig. 2.
Fig. 6 is an end view of the splint illustrating the character of the jointed mounting for the fixation unit through which rotation of a fracture fragment on its anatomical axis is made possible.
Fig. 7 is a perspective viewof a splint of an alternative form of construction, also providing for rotation of a fragment on its anatomical axis.
Fig. 8. is an end view of the splint of Fig. '7, shown partly in section.
Fig. 9 is a horizontal section on line 9--9 in Fig. 8. r
Fig. 10 is a perspective view of a splint of a modified form.
Fig. 11 is an enlarged detail showing of one of the forms of rod clamps employed in the structures.
Referring more in detail to the drawings The splint, in one of its present preferred forms of construction, shown in Fig. 1, comprises the two fixation units which are designated in their entireties, respectively, by reference charhas a bore therethrough, as seen in Fig. 113,
to loosely receive the rod to which it may be applied when the clamp is loosened; the collar being split at one side of the bore to permit it to loosen its hold on the rod. Applied through the split end portion of each of the clamp collars, is a clamping bolt l2 formed at one end with a relatively large, flat head l2. On the other end of the bolt shank, a. nut I3 is threaded and'adapt ed to be tightened against the collar to clamp it on the rod. This bolt is of special construction and serves, as will presently be explained, for holding one of the transfixion pins.
It is a feature of the transfixion units that the bolts [2, when loosened in the collars, are freely rotatable therein, the reason for this presently being apparent. v
Mounted by each of the clamps H is a transfixion pin 5. Each pin is rigid and has a sharpened point at one end whereby to facilitate its being applied through the bone. The outer end of the pin, preferably, is blunt and this end portion is adjustably aflixed to one of the clamps II. To provide for the mounting of the pins and for their rigid fixation to the clamps, each of the bolts I2 is formed, diametrically therethrough and just beneath the head portion thereof, with a hole that is just slightly greater in diameter that the diameter of the pin so that the latter will fit loosely therein when initially applied.
Prior to the assembling of these parts of the transfixion units, two or'more pins 5 are applied to each of the fracture fragments, pref- The extension bar and associated parts forming the unit, which is designated in its entirety by reference character C, comprises two straight lengths of metal tubing 20 and 2|. These are of rectangular cross section, and the part 20 is telescopically adjustable within the part 2|, as will be understood best by reference to Fig. wherein it is shown that the inner end portion of the tube 20 is closed by an end wall 22, and at a distance spaced therefrom, it has a partition wall 23 fixed therein. It is also shown that the outer end of tube 2| is closed by an end wall 24.
The telescopic adjustment of the tubular sections 20 and 2| is effected by rotation of an adjusting shaft 25 that is contained within the telescoped portions of the tubes and which passes 1 tion of the shaft 25 is threaded and threaded erably in non-parallel relationship andv not necessarily in the same plane, with the point portions of the pins just through the opposite cortex as shown in Fig. 1. Then, for each unit, a corresponding number of clamps II are loosely applied to a rod l0, andthe outer ends of the pins are slipped through the holes IT in the clamp bolts l2; it beingunderstood that since the clamps l are freely rotatable on the rods I0 and are slidable therealong, and since the bolts l2 also are freely rotatable in the clamps when the nuts l3 are loosened, the parts may be assembled in the manner shown in Fig. 1, or corresponding thereto regardless of the location of the pins or regardless of their particular relationship to each other, and it is not required that the pins of the same unit shall be in the same' plane or applied to the bone from the same side.
After the parts have thus been loosely assembled, they are then adjusted to a practical relationship in view of their use in the splint, and the nuts l3 are drawn tight on the bolts l2, thus to secure the clamps fixedly to the bars l0 and at the same time to draw the bolt heads tightly against the pins l5 and hold them rigid. When the bolts are thus tightly clamped, all parts of the transfixion unit will form a perfectly rigid unit through which the position of the bone fragment may be controlled, its adjustment for reduction effected, and the fragment immobilized,
thereon is a nut 32 which is located within the tube 20 between the end wall 22 and the partition wall 23. At opposite sides of the nut 32 coiled springs 34--34 are applied about the shaft, and these bear against the nut 32 and against the walls 22 and 23 respectively. The nut is square and fits slidably in the tube, but is held against rotation therein. Therefore, when the 1 them effect the adjustment, but they permit of a certain desired yielding and eliminate any perfectly solid and hard contacts.
The fixation units A and B are functionally mounted, respectively, on the telescopically associated sections 2| and 22 of the extension bar by jointed means of special form which will not be described:
First, by reference to Figs. 1 to 4, it will be noted that a split bracket collar '36 is applied about the tube 2 I, and is adapted for adjustment lengthwise thereon, and to be held at a set position of adjustment by a clamp bolt 31 through the split end of the bracket. The bracket has a laterally extending post or stud 40 fixed rigidly therein, and
' applied to this stud is a split clamp collar 42.
Likewise, applied to an end portion of the rod In of the transfixion unit A, is a split clamp bar having a stud or post 46 fixed solidly therein at one end. A clamping bolt 41 is applied through the split end of bar 45 whereby to draw it tightly about and clamp it rigidly on the rod I0. Applied to the post 46 is a split clamp collar 48 and a clamp bolt 50 is extended through the split ends of clamp collars 42 and 48, which are disposed in face to face contact on the bolt. When the clamp bolt is tightened, it draws both clamp collars tight about their respective studs or posts 40 and 46.
Mounted rigidly on the outer end of the tubular section 20 of the extension rod, is a head formed with a flat end surface lying in a plane that is perpendicular to the tube axis, as will be observed in Fig. 5. Rotatably fitted against this surface is a shoe or block 6|; the parts 60 and 6| being held in assembled relationship by a bolt 62 that is applied in the axial line of the tube, as understoodby reference to Fig. 5. When the bolt is loosened, the shoe 6i may rotate freely on the bolt; this rotation being indicated in Fig. 6.
The block 6| has a base flange 65 formed with a horizontal cross slot or channel 66 in which two pairs of guide rollers 61 are mounted and between which paired rollers, a rod 68 is held for guided endwise movement. This rod extends in a plane that is perpendicular to the axial line of the extension rod, and its opposite end portions extend beyond the base flange of the block, one end being equipped With a collar 69 in which a pin 10 is fixed to serve as a sort of handle whereby to rotate the rod, and at its other end, the rod has a pivoted and jointed connection with the transfixion unit B, as will presently be described, which permits the fragment held by the unit B to be rotated on its axis without loss of extension or change in angulation.
As a means of holding the rod 68 against rotation or endwise movement in its guides when such is desired, I provide a split collar clamp 15 through which the rod extends, as noted in Fig. 5. This clamp is contained in a socket 16 formed through the base flange 65 of the block and the bolt 62 which secures the shoe or block to the head, passes through the split end of this clamp collar. Therefore, when the bolt 62 is loosened, the rod 68 may rotate and also may slide freely in an endwise direction within the clamp collar 15. At the same time, the shoe is free to rotate on the bolt. Likewise, when the bolt 62 is tightened, it holds the shoe against rotation on the head and also holds the rod against rotation or endwise movement.
The jointed and pivoted means used herein for aifixing the rod 68 to the transflxion unit B in a manner whereby to permit the rotation of the fragment mounted by that unit on its anatomical axis, comprises a clamp bar 11 that is applied to the end portion of the rod H) of unit B. This clamp, as shown in Fig. 1, comprises a bar that has a hole 18 to receive the rod l6, and is split at one side of the hole, as at 19. A pin clamp bolt 86 is extended through the solid end of the bar. This bolt, which is like the bolts l2 already described, serves to mount a transfixion pin l which is applied to the adjacent fragment.
Applied about the near end of the laterally adjustable rod 68 is a clamp collar 8| that, when loosened, is freely rotatable on the rod but is held from displacement from the rod by a collar or head 82 at its end. Associated with the clamp collar 8|, is a similar collar 83 and, as seen in Fig. 1, a bolt 84 extends horizontally through these collars on which they are freely rotatable when the bolt is loosened. Both clamp collars are rendered rigid with respect to each other and to the rod 68 when the bolt is tightened; the bolt having a nut 85 threaded thereonto for this tightening purpose.
A vertical bolt 96 extends rotatably through the base of split clamp collar 83 and through the end portion of a clamp bar 71. A spacing collar 92 is applied to bolt 96 between parts 83 and TI and on the lower end of this bolt, as seen in Fig. 6, is a nut 94 for tightening the parts to render them relatively rigid. As noted in Fig. 1A, the lower end portion of the bolt 96 is squared to fit within a squared opening as at 90a in the clamp collar. Thus, when the nut 94 is tightened, the bolt 96, collar 86, rod l0 and clamp collar 83 ofunit B will be relativelyrigid, and when bolt 84 is loosened, the unit B can ivot on bolt 84.
Assuming that the parts of the splint are assembled as in Fig. 1, and that the fixation units have been applied to the fracture fragments X and 6 as illustrated in Fig. l, the technique in the use of the splint for the reduction and immobilization of a fracture would be as follows:
First, assuming that the transfixion pins l5, as required, have been applied to the fracture fragments and the parts of the units A and B have been properly assembled with the pins as previously explained, and the clamp bolts l2" drawn tight, to render the parts of each unit relatively rigid, the clamp bars 45 and 11 are then applied to the end portions of the round rods In of the units A and B, and then with the clamp bolt 31 of the bracket 36 loosened, and the bracket slidable on the bar 2|, and with bolts 50 and 84 loosened, the clamp collar 48 is applied to the post 46 on the bar 45, and the squared lower end of the clamp bolt 90 is applied through and secured in the clamp bar 11; it being understood that when the parts are initially assembled in this manner, the various clamping bolts are loosened so that the parts of the splint may be located in the desired or most practical position, and for adapting it to the size of bone or character of the fracture.
When this adjustment has been accomplished then the clamp nuts 50' and are tightened, thus rendering all parts of the splint relatively rigid.
If the ends of the fragments should be overlapped and out of alinement, they may then be brought into proper apposition by extension and by rotation of a fragment if required. Extension may be easily accomplished by rotation of the adjusting shaft 25; this being done through the mediacy of a Wrench applied to the wrench head 36 at the end of shaft 25. After the desired extension has been accomplished, the fragment ends may be brought into apposition by manipulation, or rotation, or both, which may be accomplished by taking direct hold of the units A and B, or in some instances, it is preferred that a handle, as indicated at 99 in Fig. 1, be temporarily affixed to the bar in of the unit B to give more leverage. For this manipulation, one or both of the bolts 56 and 84 might be loosened. and this may be dome without loss of traction.
Assumingthe fragments have been brought into proper extension and that it should be desired to rotate the fragment Y about the anatomical axis of the bone to effect proper alinement and registration of the fractured parts, this may be accomplished in the manner which has been illustrated in Fig. 6. With the pivot bolt 62 loosened, it will be apparent that the head 6| can pivot on the bolt, and that rod 68 can move endwise. It will then be evident that since the unit B, supporting the fragment Y, can pivot about bolt 84, and the head 6| can pivot on bolt 62 and the rod 68 can move endwiseto a farther or less extended position, rotation of the fragment can be effected while holding extension and without displacing the rotated fragment out of axial alinement with fragment X. Rotation may be in either direction and to any extent desired.
In Fig. 6, I have illustrated the longitudinal shifting of the rod 68 incident to rotation of the fragment Y in the direction of the arrow adjacent thereto; this shifting being necessary to permit rotation without displacing the rotated fragment Y from alinement with the fragment X. It will be understood upon inspection of Fig. '6, that any degree of rotation will be permitted, due to the rotation of the block 6| on pivot bolt 62, and that the rod 68 will slide in or outof its guideway in accordance with requirements, yet will retain the extension or traction. After parts have been rotated to proper relationship, the bolts 62 and 84 are tightened tohold the fracture immobilized.
In Figs. 7, 8 and 9, I have illustrated an alternative form of splint for accomplishing the same results as are possible by the device of Fig. 1. In this form of device, units A and C are like those previously described except as hereinafter noted, and have been given the same reference numerals where they apply. However, at the end of bar 20, in lieu of those parts previously described as required to take care of rotation, a bracket I has been fixed, and this-has an arm IOI outwardly offset from alinement with bar 20;
as shown best in Fig. 8, and this arm has a flat inner face I02 lying in a plane that is parallel with the axis of bar 26, and disposed flatly against this face is a head- I95 held pivotally thereagainst by a pivot bolt I06.
The head I65 mounts an arcuate segment bar I08 therein for guided endwise adjustment about its center of curvature. The segment, as seen in Fig. 9, is arcuately curved about a center that would be in the approximate axial center of the bone being treated, and it is toothed along its outer edge as at H0, and a small gear III is mounted on a shaft II2 rotatably mounted in the head. On the shaft is a hand wheel H3 for rotating the gear to move the segment endwise. Fixed to the segment is a bracket II5 formed with a rod guide H6 in which a rod H1 is longitudinally slidable and held at set positions by a clamp screw I20. The rod II! is equipped at its outer end with a clamp block H8 for mounting the bar III of the fixation unit B. The rod II! is adjustable endwise toward or from the axial line of the bone to which unit B is applied, and it may be rotated and held in fixed adjustmentby tightening the bolt I I6.
In the use of the type of splint shown in Fig. '7, the fixation units A and B are applied to the fragments as before explained. Then the bar unit C is assembled therewith, and endwise adjustment of rod II! is made to accommodate the splint to the size of the patient or character of fracture. Extension may then be effected by turning nut 30, and rotation may be effected by endwise adjustment of the arcuate segment by means of hand wheel H3. After adjustment, the parts may be locked against relative movement by tightening the bolts I66, I20 and 50. i
In Fig. 10, I have shown a device of a modified form which embodies all p the functions of the splint of Figs. 1 and 7 except that of rotation. In this splint, units A and B are like those already described, and unit C is the same with the exception that the bracket 36 is fixed solidly-to one end of tube section 20. The extension of tube 20 is effected by means like that already described through the turning of a wrench head.-
With this splint, as seen in Fig. 10, extension is possible and reduction is facilitated, and after reduction, the parts may be rigidly clamped to insure fixation during the healing period.
In Figs. 1 and 11 I have shown a special type of clamp bar that is of special utility in this splint, and while it has not been shown as applied to all parts where it could be used, it is desirable on such parts-as the handle 99 or on the bar This clamp comprises a base jaw I50 formed at its end with a semi-cylindrical transverse seat 'I5l. A movable jaw I52 has a supporting end portion I53 fulcrumed in a cylindrically curved transverse seat I54. in the base jaw. At its other end, the piece I52 has a cylindrically curved seat I55. The seats I5I and I54 have a radius of curvature slightly less than the diameter of the round rod II) that is to be gripped and the relationship of seat I55 to I 5| is such that the seated rod ID will have three lines-of engagement, as understood by reference to Fig. 11. A clamp bolt I58 is extended through the top jaw and is threaded into the base Jaw.
It is understood that in use of this splint, which is more particularly an ambulatory splint, the extension bar of unit C will lie close to the limb and generally within the end limits of the fractured bone. It can be used, however, to span a joint, such as from above to below the knee, and its use is facilitated due to the fact that it can be accommodated to transfixion pins applied in any way or from any side of the bone.
Both ends of the extension bar might be equipped with the rotation unit if such should be desired,
Splints of this character provide for the mechanical reduction of a fracture by devices tl'uough which personal touch can be retained in the operation. Fractures may be easily. reduced and immobilized during a healing period.
The particular advantage of the splints disclosed are that they are small, compact, light in weight, easy to manipulate and serve ,both for reduction and immobilization. Furthermore, it is ossible to rotate the fragments in their anatomical axes. The splints of Figs. 1 and 7 provide for the rotation of the fracture fragment held by the unit 13 about its anatomical axis and without loss of extension or position. This, to my knowledge, is not possible by use of any other splint of this particular type.
Having thus described my invention, what I claim as new therein and desire to secure by Letters Patent is:
1; An ambulatory splint comprising a rigid extension bar of adjustable length, for bridging a bone fracture, closely along the outside of the limb, transfixion units equipped for rigid securement, respectively, to the fracture fragments, mountings on the bar for the functional fixation of the units thereto, and means for effecting and retaining an adjustment in length of the bar whereby to establish and retain a definite extension of the fracture; said mountings including joints adapted to be loosened for alining or for changing angulation of the fragments, and one of the mountings being laterally extendable or retractable and having a hinge joint therein with an axis parallel to the said rigid bar'to provide for rotation of the corresponding fragment on the anatomical axis without change in the extension of the bone.
2. An ambulatory splint comprising a rigid extension bar for bridging a bone fracture closely along the outside of a limb parallel with the anatomical axis, transfixion units equipped for rigid securement, respectively to the fracture fragments, mounting for affixing the units to the bar; one of the said mountings including a rod extended laterally from the bar, a hinge joint with hinge axis parallel with the anatomical axis connecting the outer end of the rod and the corresponding transfixion unit, and clamp means securing the rod, to the bar for radial adjustment about the bar axis and change in its length of extension therefrom, and means for locking the joint and for locking the clam-p means to hold the rod rigidly at a set position.
3. An ambulatory splint comprising a rigid extension bar of telescopically associated sections, for bridging a bone fracture close to a limb, fixation units includin means for their rigid securement, respectively, to the fracture fragments; mountings for the fixation units rigidly joining them tothe bar sections; and means for relatively adjusting the bar sections in an end- Wise direction to determine and retain the extension of the fracture; said mountings being individually adjustable for the alining of fragments or change in their angulation; the mounting on one unit including a rod extending laterally from the bar, and a guide clamp therefor permitting its radial adjustment about the bar axis, and adjustment in its extended length, and joints connecting the rod at its outer end with a fixation unit permitting rotation of the corresponding fragment on the anatomical axis and change in angulation of fragments without loss of extension, and means for locking the adjustable parts against relative movement after an adjustment has been made.
4. A splint as recited in claim 3 wherein each fixation unit comprises a rod a pair of transfixion pins for transfixing a bone fragment and releasable, pin clamps adjustable along and rotatable on the rod and functionally applicable to the pins in any angular relationship at which they may be applied to the fragment.
5. A splint as recited in claim 3 wherein each fixation unit comprises a round rod, a plurality of independent pin clamps adjustable along and around the rod, a transfixion pin mounted by each clamp, and means in each pin,clamp for tightening it on its rod and. for securing the pin therein.
6. An ambulatory splint including a rigid, telescopic extension bar of adjustable length, for
bridging a bone fracture parallel with the anatomical axis, transfixion units designed for rigid securement, respectively, to the fracture fragments, mountings on the bar ends for the rigid securement of the transfixion units thereto; said mountings including jointed parts permitting adjustment in alinement or angulation of fragments for reduction of the fracture, and one of said mountings including a rod extending laterally of the bar, a guide clamp mounting the said rod on the bar for its axial rotation and for radial movement about the bar axis and for adjustment in its extended length, and jointed parts connecting the said rod and one of the transfixion units permitting rotation of the corresponding fragment on the anatomical axis while retaining it in alinement with the other fragment, means for locking the guide clamp and the adjustable mountings for the units and the jointed parts to fix all parts of the splint in rigid relationship for immobilization of the fracture.
'I. An ambulatory splint comprising an extension bar of telescopic sections for bridging a fracture, an adjusting screw connecting the sections and operable to change the effective length of the bar and for retaining an adjustment, transfixion units equipped for rigid securement to the fracture fragments for the reduction and immobilization of the fracture, mountings for said units on the bar sections including jointed parts releasable for the alining of the fragments and' correction of their angulation in the reduction of a fracture, a rod guide member mounted on one end of the bar for turning about a pivot axis parallel with the bar axis; a rod mounted in said guide member and extending laterally of the bar and adapted for endwise adjustment therein, and a hinge joint at the outer end of the rod mounting the corresponding transfixion unit for rotation of the fragment on the anatomical axis without loss of extension of the bone.