US 2523837 A
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Description (OCR text may contain errors)
Sept. 26, 1950 J. A. LUGER 2,523,837
MAKING AND REMOVING SURGICAL CASTS f Filed Feb. 15, 1946 2 Sheets-=Sheet 1 J7? We)? Z02 Jase a5 .1 Z ayei" jizarizey Filed Feb. 15, 1946 2 Sheets-Sheet 2 Spt. 26, 1950 J. A. LUGER 2,522,537
MAKING AND REMOVING SURGICAL CASTS I72 06;? for Jr arzeey Patented Sept. 26, 1950 UNITED STATES PATENT OFFICE 4 Claims.
The present invention relates generally to surgical casts, and in particular to making cuts or openings in casts. It has particular reference to removing surgical casts.
The conventional way of forming casts is to wind gauze carrying cast-forming substance, usually but not always plaster of Paris in a wet form ready to set, around and around a limb or body until the required thickness of cast has been built. Then the multiple layers are allowed to set and dry to ultimate rigidity.
When it is time to remove the cast, various cutting tools are employed to cut through the thickness of the cast to permit its removal. Conventionally on a leg, for example, the cast is out where it is most convenient, and on one side followed by spreading open the cut cast. To make one cut, it takes usually from to 1 hour with labor and perspiration on the doctors part and with discomfort, nerve-racking and pain to the patient. The task does not arise to the dignity one usually expects in such matters.
The present invention is directed to improvements in forming casts to facilitate opening or cutting them, especially for removing such casts. In general, the invention contemplates embodying in the cast one or more ribbon-lik elements of strong tensile material, such as metal. The elements ma be specially made to permit the superimposition of several such elements within the cast. as it is being formed. Also the invention involves the provision and use of a suitable tool cooperative with the elements to cause the cast to be out along the line of an element or an area of superimposed elements.
It is the general object to form a cast with a contained opening-element useful to sever the cast material in a manner somewhat akin to the opening of certaincanned goods having a removable severing strip and a winding key therefor.
It is the general object of the invention to provide ribbon-like elements having strength to resist tension exerted on the strip to cut the cast.
It is another object of the invention to provide, on a ribbon-like element, teeth or projections which pass through layers of gauze laid over the element, thus to mark the line of the underlying element, and also to aid in anchoring the element into the cast.
A particular object of the invention is to provide frame-lik ribbon-form structures so that windows may be provided in the cast.
A particular object is to provide strip-form elements extending the length of a cast to eiiect a lengthwise severing of the cast.
Various other and ancillary objects and advantages of the invention will appear from the following description and explanation of the invention as exemplified in the accompanying drawings in which:
Fig. 1 illustrates a strip form of tensile material provided with teeth, to be placed under and to be imbedded within a surgical cast.
. Fig. 2 represents a cast containing two sets of superimposed strips such as those in Fig. 1, which are eventually to be used to cut the cast over the region of each set. Fig. 2 also shows an opening in the cast formed in the practice of the present invention.
Fig. 3 represents a detailed view of the cast structure of Fig. 2, showing the relationships of the removable Strips and of the gauze layers which form the cast.
Fig. 4 illustrates a winding tool which is einployed for the removal of the tensile elements in cutting a cast.
Figs. 5, 6 and 7 each represent modified forms for one or both of the purposes of the structure in Fig. 1.
Figs. 8 and 9 each represent modified forms of tensile elements in the form of frames to provide openings in a cast.
Fig. 10 illustrates the combined use of frames, such as in Figs. 8 and 9, and of cast-removing strips.
The invention is not to be considered as limited to and by the specific embodiments which are illustrated in the drawings merel for the purpose of explaining the nature of the invention.
In Fig. 1 there is illustrated a fragmentary length of strip material for use in the present invention. Its detail of structure and dimensions may be varied over a wide range according to particular requirements, and also in accordance with the nature of the strip material. Briefly the strip ll! provides a tensionmember with corners l l preferably sharp and capable of serving toa degree as cutting edges in the removal operation later described. Associated with the strip l0 are a plurality of projections, such as pins or teeth I2 projecting substantiall perpendicularly from strip H] in such a manner as to project outwardly into the gauze layers being wound to form a cast, when one strip It! lies flatwise beneath the first layer of gauze, and other strips Ill lie flatwise between layers of gauze already applied. The teeth [2, in projecting through gauze covering the strip Ill, provide landmarks or guides indicating the location of a strip 10 beneath the gauze. One function Of the teeth I2 is to permit a strip Ill to be superimposed over an already placed strip l0. Another function of the teeth I2 is to anchor the strip [0 in the cast. The teeth are preferably provided in pairs of opposite integral teeth as illustrated, projecting substantially perpendicularly in one direction from the edges of the strip l0. Each pair of teeth l2 preferably flares slightly away from strip In, so that when another strip I0 is superimp sed pon the area over a strip carrying the teeth, the flaring teeth I2 permit a compact arrangement of two adjacent superimposed strips with gauze and cast-forming material between them.
By way of exemplifying the particular dimensions of a suitable strip, the following specifications are given: When the strip is of stainless steel it may be 0.01 inch thick and inch wide. In length it may vary as required, and even be provided in a large spool for severing intodesired lengths. The teeth i2 at the base are a e inch wide and stand upwardly from the strip lllto a height of A3 inch. The distance between adjacent pairs of teeth may vary as desired, a spacing of 5 inches being suitable.
Fig. 2 illustrates a leg is having a plaster cast l4 with inlaid strips H] of which the ends project. There is a hole H5 in the cast. In forming .a cast, there is first applied a soft felt base 20, (Fig. 3) over which the cast-forming gauze is wound. Where stockings are used in a conventional manner under the cast, the felt may be omitted. However, before winding the gauze, opposite regions of the cast,'corresponding to front and rear seam-lines, are selected and covered with strips l0. These may be adequately held in selected position, if necessary, on the felt or stocking, by strips Of adhesive tapes or other means, not shown. The strips H} are sufficiently long so that the extremitie l5 extend'freely beyond the terminal end regions of the cast M to be formed. In the case of plaster casts, there is provided the conventional gauze into which plaster is incorporated. This material is dipped in water for a prescribed length of time, and so wet, is wound about the body portion to build up a cast. This is conventional practice. The only change in building the cast is that it i first wound over the said two underlying strips l0, letting the teeth project through the several'layers of gauze covering each strip ID. These projecting teeth, therefore, mark a channel along the layers of gauze, which. channel is for the receipt of other strips ID with similar teeth. Before the teeth of any strip butthe last are lost from View by a covering layer of gauze, a new strip Hl'is placed in each channel marked by teeth. The number of'strips Ill-employed in the resulting-superimposition of them depends upon the thickness to which the cast is to be built and also on the tooth' length. Ordinarily for the strips Ill specified, a cast varying in thickness from to /2 inch has three to four strips It The final layers of gauze preferably completely cover and hide the teeth of the last applied strip if). so that no danger results from projection of the teeth through the cast.
Fig; 4 shows a tool 363 also herein called a winding mandrel. The tool functions to engage one or more ends of the ribbon-like elements, preferabl one at a time, to roll them out. In the form shown it has a cylindrical portion 3! to be rolled'along the cast when a substantially linear travel is in order. Thus, by rolling the tool along the cast to remove the topmost tensile element, theintervening cast material is cut and raised and may be rolled tightly onto the tool with the element. The pressure thus exerted is sufiicient to cause the tensile elements to cut through the cast material and form a groove along the cast which has the same width and location as the element being removed. One element at a time can be removed to cut a deeper and deeper groove.
The cylindrical body portion 3i may be about inch in diameter and about 1 inch long axially.
One end of this cylinder has a shank 32 of less diameter carrying a suitable handle 33 to be grasped by the hand for the said rolling action. The other end of the rolling cylinder is tapered as shown at 34 preferably as a cone. The diametrical slot 35 is cut from the end of the tapered portion nearly to the shank end of the rolling cylinder 3 l. Slot 35 may be about inch wide.
The conical end is a frustum on one side of the slot, but the opposing half-base'of the small end is extended as a chiselin tool 31, with a rounded hump 38 on one face of the chisel, for use as a fulcrum in prying operations. The conical end may be used when openings are cut in a cast as later described.
In operation an extending free end of a tensile element which normally is bent over as shown in Fig. 2 to the surface of the cast, and covered with gauze, is inserted into the slot 35 of the tool 30, to engage it for extraction by rolling. The winding mandrel is then merely rolled along the surface of the cast on the line of the element, with little effort on the part of the operator. A groove is formed including the tensile element and the cast material above it. It is preferable to take each of superimposed tensile elements in turn, thus to deepen the groove, and in the end to open the groove as a out. With both sets of opposing strips thus treated, the cast is easily divided into two portions readily removed. There is no danger of injury to the patient, and no disturbing forces are applied to render the patient uneasy or uncomfortable. In removing a single strip from a plaster cast, a nine year old child can operate the tool easily.
Fig. 5 shows a modification of the tensile element, illustrated by the strip form. However, the form of Fig. 1 is preferred even though it may be more wasteful of material to provide it. In the modification, the teeth do not extend from the edges of the strip 40 as they do from strip 10, but they are merely a single string of integral teeth struck from the metal as shown at 4|. This form is not preferred, because the strip 49 is weakened against tension in the region of each tooth 4|.
Fig. 6 shows another modification which functions equally as well as that in Fig. 1, but is designed to economize in strip material. The strip 43 is a single band without integral teeth and secured to it by welding, adhesion or any other securing means, is a U-shaped member 44 with its terminals providing teeth 45 and 45a and its base providing for anchorage to the strip 43.
Fig. 7 shows another modification in which the guiding teeth are not strong enough to provide anchorage. It consists of tensile tape 45, wire staples 4i, and paper mounting 48, The staple 4'! has substantially parallel teeth 49 and 49a and a base in the form of an angle the bottom surface of which lies in a plane, thus to hold the teeth 49 and 49a upright. The paper strip 48 is adhesively secured to the tape 45.
It is to be understood that anchor teeth may be dispensed with, and guidin teeth also, when superimposition is not practiced, or is otherwise efiected.
It is frequently desired to provide openings or windows in a cast so that treatment or observation may be had through the opening. The present invention ma be employed to form windows, and also has modified forms so that the presence of a window in the line of the removable strips does not interfere with the functioning of the strips.
In Fig. 8 there is shown an oval-shaped tensile ribbon-like element designated 50, having two free ends 5! and 52, each of which is suitable for engagement by the winding mandrel. The element 5|] is in the form of a frame to provide an opening in the cast, to be made by removing the one or more of such frames placed in the location of a groove to be cut in the cast. The frame 5|] is herein termed a shim, and where a plurality of them are superimposed, they are identical. In Order to indicate the channel for superimposing one shim over another, suitable guides or teeth are provided, in any suitable form such as above described. As shown, integral teeth of cat-ear type 53 are disposed around the periphery. Where it may be desired to indicate the end of a covered shim, one end, such as end 5|, may be upturned to provide a tooth as a guide. It is also useful to locate a free end for engaging it for removal by the winding mandrel. The other end 52 is provided as a tapered extension which may be imbedded in the cast so that one might search for it by chiseling or scraping away to locate it,
in order that the winding mandrel may be used.
Also if desired, the tapered end 52 may be turned to an upstanding position by bending it on any line inwardly from the pointed end 54, thus to penetrate the gauze being wound. It may even project through the finished cast. When the finished cast is dried, either one of these ends can be readily engaged to remove the strip and cut away the desired window, preferably by removing one shim at a time.
Fig. 9 is a modified form of shim, showing a curved structure in frame form, suitable for placing over a le or arm to provide an opening. Its body portion 55 has integral teeth of cat-ear type 56, and two ends 5'! and 58 opposing each other. The end 51 is tapered in the form of a tooth so that it may be turned to upstanding position, if desired, to facilitate locating it or facilitate locating another shim above it in the cast.
Fig. 10 represents a cast 60 on leg 6|, with provision of shims for providing an opening over the shin. In the cast the dotted lines 62 and 63 represent tensile strips havin their respective ends 64 and 65 available for engagement by the mandrel. The inner ends of the strips 62 and 63 terminate at the periphery of the desired opening. The area of the shims is indicated by the numeral 61, which also designates a groove formed in the cast by the prior removal of one or more of a plurality of shims. Fig. 10 also illustrates the mandrel of Fig. 4 being used to wind out one of the shims 68, such as those in Fig. 8 or Fig. 9, on the conical portion 34 of the mandrel 30.
The invention is not limited to flat or ribbonlike tensile elements although such are preferred to give the desired width to a cut groove, and also to facilitate the provision of the landmarks. A wire of circular or other cross-section may be used, to give a narrow opening or cut in a cast, into which a spreading tool can be inserted. However, it is desirable to roughen or notch a wire, to prevent lengthwise slipping through the cast.
From the foregoing description and explanation of the invention it will be appreciated that numerous modifications and changes may be made without departing from the spirit and scope 6 of the invention as set forth in the appended claims.
1. A surgical cast including therein a plurality of flat narrow tensile ribbon-like elements all of the same width and each having a free end, including one such element at the innermost surface of the cast, said elements occupying the same area of the cast inedge-over-edge superimposition, each element having teeth projecting into the cast toward the outermost surface of the cast for guiding the location of the next superimposed element and for anchoring each element in the cast, whereby said elements may be Wound from their free ends on a mandrel running over the outermost surface of the cast to cut open the cast along the said area.
2. A severing device for a surgical cast comprising a ribbon-like element having a free end for engagement by a winding mandrel, said element having a. plurality of pairs of integral teeth arranged with the teeth of each pair on opposed regions on the opposed edges of the element, said teeth projecting substantially perpendicularly to the flat face of the ribbon-like element.
3. The method of making a surgical castwhich comprises forming the cast by initially winding cast-forming material over a tensile ribbon-like element having a free end for engagement by a winding mandrel, said element being in the general form of a frame outlining an opening which may be made in the cast, and by thereafter including in the cast being wound one or more similar elements of the same width each with a free end, said elements being superimposed edge over edge in the cast, whereby said elements may be wound from their free ends on a mandrel running over the surface of the cast thereby to cut the cast over said area and provide an opening in the cast.
4. A surgical cast including therein at least two flat narrow tensile ribbon-like elements superimposed in the same area, all below the outer layer of the cast, each element having a free end to be engaged for rolling the element to cut the cast, and also having teeth thereon projecting into the cast toward the outermost surface of the cast and terminating within the cast, whereby said teeth fix the element on winding the first layer of cast material over said element, guide the placement of the adjacent outward element, and anchor the element in the finished cast against slippage lengthwise.
JOSEPH A. LUGER.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Number