US 2393694 A
Description (OCR text may contain errors)
Jan. 29, 1946.`
o. s. v KlRscHNER SURGICAL APPARATUS .Filed Apil 10, 1.945
Patented Jan. Z9, 1946 UNITED STATES PATENT FFICE l SURGICAL APPARATUS Otto S. Kirschner, Vashon, 'Wash. Appl'ieationnprii 1o, 1945, serial N. 587,545
My invention relates to fracture reduction and fixation apparatus ofthe general type known as pin xation splints and relates more specilically to certain new and useful improvements, among which are: an extension bar assembly, a superior pin bar assembly, a distal pin bar assembly, an angulation bracket, a rotational arc assembly, and self-drilling .and anchoring pins to provide maximum rigidity and stiffness bebe inserted at right angles to the shaft of the bone, providing the shortest possible pin length from the bone to the attached pin bar, thereby reducing the spring in the pins to the minimum (firm fixation promotes rapid union) 4. Permits extension or impaction of the fragments without placing the patient on a fracture f table or employing other means of traction and without disturbing the alignment of the fragments; and
5. Permits reducing the fracture, in most cases, without the use of auxiliary means of traction.
A further object is to prov-ide an improved splint having the` followingI characteristics:
1. ,Each pin, because of its unique design, is self retaining, permitting the insertion of the pins in any desired plane or angle.
2 Each adjusting movement of either bone fragment is under control of a separate bolt kor nut, Movement of the fragment through one plane does not disturb the alignment in the other plane. f
3. Rotation of the fragments through their axialV center is provided by the rotating arc.
4. Adjustment in extension or inspection is effected at any time. without disturbing the alignment ofthe fragments.v y i 5.., Adjustment of. the fragments is manual instead of mechanical, permitting the surgen to feel the crepitus of the ends of the fragments as he brings them into alignment.
Other objects will inpart be obvious and in part be pointed out hereinafter.
To, the attainment of, theaforesaid objects and ends the invention still further resides in, the novel details of construction. combination and arrangement of. parte. all of which will be first fully described in the following detailed description, and then be particularly pointed out in the appended claims, reference being had to the ac companying drawing, in which:
Fig. 1 is a side elevationvand part longitudinal section of my invention in use. Y y
Fig. 2 isa top plan View of the apparatus, the bone being indicated in dotted lines. Fig '3 is an enlarged detail section on the line 3--3 of Fig. 2. v
Fig. 4 is an enlarged detail section on'the line 4-4 of Fig. 2. v
Fig. 5 is an enlarged detail section on thetline 5-5-of Fig. 1. f
in the drawing, `in which like numerals and letters of reference indicate likeparts in all the figures, it will be seen that I- and 2 indicate the two parts of an extension bar which is lapjointed as shown in Fig. 1. rfhe section I ofthe extension bar has a longitudinal slot 3 -through which a clamping screw 4 passes and is threaded at 9 into the bar section 2. A threaded traction rod 5 is anchored at 6 to the extension bar section I and passes freely through an ear I and` freely into a bore I0 in the extension bar sec-l tion 2, a nut 8 being provided for moving the section 2 toward and from the section I.. v
The extension bar section I has its free en slotted as at II to receive one, leg of an angle bracket I3. It also has holes I2 for the passage of a clamping bolt I5 that passes through the holes I2 and a hole I4 in bracket I3 and carries a washer 52 and nut 53 for clamping the bracket to. the extension bar for angular adjustment about the axis of the ybolt I2. The bracket I3 also has a bolt hole I 8 for the passage of a clamping bolt I9 that passes through the furcations of a superior pin-bar holder I6 and carries a washer 54 and nut 55. i
The superior pin-barholder I6 is provided with a bore 20 to receive the superior pin bar 2 I and is slotted, as at 5S, the furcations thus provided having bolt holes 51 through which pass the clamping bolt 58. The bolt 58 carries a washer 59 and nut 60 as best shown in Fig. 5.
Pin carriers 22 having holes 24'for the pin-,bars are split, as at 23, to form clam-ps, there being bolt holes 25 provided through which pin-clamping bolts 26 pass. The bolts 26 havev transverse holes 21 through which the pins pass. The bolt 26 carries a washer 6I and nutlll as best shown in Fig. 4.' When nut 64 is tightened pin 28 ('Fig. 4) will be tightly clamped against pincarrierf 2.2 and pin carrier ,22 will be tightly clamped toits pin bar,
Each traction pin comprisesV a rigid body 28, a chuck, wrench or handle receiving end 29, a
Ythreaded portion 3|), a reduced portion 3| and a Y drill point 32. 'I'he thread 30 is such as will cut itS own thread in the bone into which it is to be Y inserted.
' end of the section Z'has a bolt hole 63 to receive the clamping bolt 62 which also passes through a hole 3B in the ear 35 of the rotational arc 34.
The rotational arc 34 is longitudinally slotted,V
as at 31, and grooved, as at 38, Figs.v l, 2 ,and` 3. One threaded end 43 of a stud 42 passes through a hole 4| in arotational slide 39 and through the slot 31. The end 43 carries a vwasher 44 and a nut 45. Y f
The slide v39 has a tongue 40 to ride in the groove 38 and s lot 31 (see Fig. 3).l 'I'he stud 42 passes through a hole 5| in a distal pin bar base 50 and Vhas a threaded end 46 that carries a washer 41 and a clamping nut 48.
The distal pin bar is made in two co-axial secvtions 49, the adjacent ends of which are rigidly carried in recesses in the base 50. The rods 49 and the base 50 may be made integral if desired. Each section 49 of the pin bar has a pin carrier 22 mounted on it to hold the distal pins.
The rotational arc and the parts carried thereby may be adjusted Yabout the axis of bo1t762; the rotational slide 39 and its carried parts may be adjusted about the axis of the rotational arc; the pin-,bar base 50 may be adjusted about the axis of the stud 50; the. pin carriers on the bar 49 may be independentlyadjusted about the axis of the pin bar; and the pins carried by the pin carriers may be adjusted about the axis oftheir respective pin-clamping bolts. This gives a wide range of adjustments which will enable efficient manipulation and securing the parts of the bone in position.
The superior pin bar 2| and the parts which 'ity carries may be adjusted asa unit about the axis of the pin bar or the pins carried by that pin bar may be severally adjusted independently about said axis.y The superior pin-barholder I6 and the'parts carried thereby may be adjusted about the axis of bolt I9 and the bracket I3 and parts carried by it may be adjusted about the axis of the bolt I5. This too gives a wide rangel of adjustments. Y
From the foregoing it will be seen that the apparatus permits adjustments in every possible direction with each adjustment independently controlled by a separate bolt. 1
In use, the bone fragments having been transfixed by the pairs of pins arranged, preferably, in
a perpendicular position to the long axis of the bone, (they may be applied angularly if desired), the pins are secured to the respective pin bars. The parts are then manipulated to reduce the fracture and angulate the fragments in proper position for mending. By adjusting the nut 8 extension may be applied while retaining alignment of the fragments due to theextensibility of the extension bar and the engagement of the con,-y necting bolt in the slot 3 and the passage'of'the Y rod 5 through the ear 1 into the `|bore I0.
Crossed or locked shaft fractures Oblique shaft fractures Spiral shaft fractures Subtrochanteric fractures Super condillar fractures T fractures into joints Crush fractures Multiple fractures Compound fractures Fractures of surgical neck of humerus. y
. The success of this splint is due largely to'several unusual features.
' 1. Firm iixation pins. Pins require no previous drilling of holes, no tapping of threads; Each pin is self suiiicient: will stay firmly fixed where placed: no slippingor sliding in the bone. Thin section and drilling point make only small hole Vin bone; threaded section assures iirm fixation in Also, insertion of pin perpendicularto the cortexV of the bone greatly facilitates the labor of insertion of the pin. Y
2.Y Three plane manipulation of each fragment, Each movement is controlled .by separate bolt. Adjustment in one plane does not displace alignment in other planes.
3. Longitudinal rotation through central axis of bone provided by special arc and sliding asrsembly. Rotation provided Without disturbing other alignments.
4. Extension or impaction provided by sliding sections and threaded rod and nut Without dis- .turbing alignment while making' adjustments.
,Theprovision of the slot Il and bo1t hoies l2 enable the apparatus to be used on patients of different sizes. Y
The Kirschner splint is specially helpful in the treatment of such diiiicult fractures as:
bracket on said'extension bar; a pin bar carried Adjustments in extension are made anytime without returning the patient to the operating table. 5. Manipulating handles, engaging the pin bars, facilitate adjustment of fragments. y
With fully relaxed muscles, under proper anesthesia, most fractures may be satisfactorily reduced with no traction other than that provided by the extension bar and nut. In cases of much overriding or displacement some auxiliary means of traction is recommended before inserting pins. This assures proper relative position of pins in the skin, muscles and bone, avoiding undue skin and muscle stretch around the pin.
From the foregoing description* taken with the accompanying drawing, it is thought the complete construction, operationand advantages of my in; vention will be clear to those skilled in the art to which it appertains. Y
What I claim is:
l. An ambulatory splint including; anY exten,- sion bar having means for applying traction, said bar being longitudinally slotted at each end, the slot at one end of the bar lying in a planeatright anglesto the slot in the'other end of the bar;
an angle bracket pivotally-adjustable4 mounted in the slot at one end of said bar; a rotational are disposed transversely of said bar at its other end and pivotally-adjustably mountedin the slot at said other end; a pin-bar holder'pivotally-adjustable mounted onsaid angle.' bracket on an axis normal. to the pivotalV axis of said Yangle by said pin-bar holder and lying at right angles to the pivotal axis of said pinsb'ar holder on said angle bracket; pin carriers mounted on said pin bar; a rotational slide adjustably mounted on said rotational arc; a pin-bar base carried by said rotational slide; a pin bar carried by said pin-bar base; and pin carriers on the last named pin bars.
2. In an ambulatory splint whereinis provided an extension bar carrying at its ends superior and distal pins; the improvement which comprises: a bifurcated end of the extension bar; an angle bracket one leg of which lies between the furcations of said end; a clamp bolt with nut passing through said furcations and said leg for pivotally-adjustably securing said angle bracket to said extension bar; a pin-bar holder having one end bifurcated to receive, between the furcations of the same, the other leg of said angle bracket; a clamp bolt with nut passing through the last named furcations and said other leg; said pin-bar holder having a pin-bar-receiving hole and being split from said hole to the free end of the pin-bar holder; a clamp bolt with nut passing through the split part of said pinbar holder for clamping the pin bar in place, the pin bar being adjustable longitudinally and rotationally in said holder; and pin carriers slidably and rotatably adjustably mounted on said pin bar.
3. In an ambulatory splint wherein is provided an extension bar carrying at its ends superior and distal pins; thev improvement which comprises: a bifurcated end of the extension bar; an angle bracket one leg of which lies between the furcations of said end; a clamp bolt with nut passing through said furcations and said leg for l pivotally-adjustably securing said angle bracket to said extension bar; a pin-bar holder having one end bifurcated to receive, between the furcations of the same, the other leg of said angle bracket; a clamp bolt with nut passing through the last named furcations and said other leg;` said pinbar holder having a pin-bar-receiving holeA and being split from said hole to the free end of the pin-bar holder; a clamp bolt with nutV passing through the split part of said pin-bar holder for clamping the pin bar in place, the pin bar being adjustable longitudinally and rotationally in said holder; and pin carriers slidably and rotatably adjustably mounted on said pin bar, said pin` carriers each comprising a split clamp and a clamping bolt with nut, said clamping bolt having a pin-receiving hole by virtue of which when said clamping bolt nutv is tightened a pin held in said pin-receiving hole will be rigidly held to said pin carrier and said pin carrier willbe securely clamped to said pin bar.
4. In an ambulatory splint wherein is provided an extension bar carrying at its ends superior and